The Posttraumatic Growth Inventory: A Revision Integrating Existential and Spiritual Change.

Spiritual Change (SC) is one of 5 domains of posttraumatic growth (PTG). The current Posttraumatic Growth Inventory (PTGI) assesses this area of growth with only 2 items, one focusing on religiosity and the other focusing on spiritual understanding. The addition of 4 newly developed spiritual-existential change (SEC) items, creating an expanded PTGI (Posttraumatic Growth Inventory-X), reflects a diversity of perspectives on spiritual-existential experiences that are represented in different cultures. Samples were obtained from 3 countries: the United States (n = 250), Turkey (n = 502), and Japan (n = 314). Analyses indicated that the newly added items capture additional experiences of growth outside traditional religious concepts, yet still are correlated with the original SC items, especially in the U.S. and Turkish samples. Relationships of the PTGI-X to established predictors of PTG, event-related rumination, and core beliefs, were as predicted in all 3 countries. The new 6-item SEC factor demonstrated high internal reliability, and the 5-factor structure of the expanded scale was supported by confirmatory factor analysis. The resulting 25-item PTGI-X can be used as a validated instrument in a wide range of samples in which traditional religious beliefs are less dominant.

Core beliefs shaken by an earthquake correlate with posttraumatic growth.

Posttraumatic growth (PTG), psychological growth as a result of personal struggle with trauma, is hypothesized to occur when a highly stressful life event, such as a natural disaster, forces people to reexamine their core beliefs. To the authors' knoweldge, the present study is the first investigation in Japanese people examining the role of core beliefs, intrusive rumination, and deliberate rumination in PTG. Hypotheses that the level of reexamination of core beliefs, intrusive rumination, and deliberate rumination correlate with the seismicity of an earthquake and that the challenge to core beliefs is the major determinant of PTG were tested. Japanese undergraduate students who experienced the Great East Japan Earthquake on March 11, 2011 (N = 314) participated in this study and completed the Japanese version of the Core Beliefs Inventory (CBI), the Event-Related Rumination Inventory (ERRI), and the Posttraumatic Growth Inventory (PTGI). Results indicated that core beliefs were less likely to be challenged and that ruminations were less likely to be activated in Japanese people who were in the southern area with an approximate Richter magnitude of 4 or lower. PTG was more likely to occur when core beliefs were reexamined following the earthquake. Also, younger participants and those who recalled having engaged in both deliberate and intrusive rumination reported more PTG. Future studies should investigate which aspects of trauma can trigger or suppress the reexamination of one's core beliefs, for they are likely to be the major determinants of PTG, and should look at change longitudinally.

"The Keepers of Stories": Personal Growth and Wisdom Among Oncology Nurses.

This study examined whether oncology nurses experience personal growth and wisdom as a result of caring for patients. Using a grounded theory approach, 30 nurses were interviewed regarding their experiences caring for cancer patients. Every nurse in this sample cited at least one example of growth and wisdom. Subthemes of personal growth were largely consistent with the documented domains of posttraumatic growth and included appreciation of life, new perspective on life, relating to others, spiritual/religious growth, and personal strength. Subthemes of wisdom were more varied, reflecting the diversity of this construct in the context of nursing. Benevolence arose as a unifying theme between personal growth and wisdom, with subthemes centering on altruistic attitudes and behavior toward patients and the greater community. Findings suggest that nurses develop personal growth, wisdom, and benevolence as a result of the emotional connections formed with patients and the subsequent struggle to cope with their loss. This process accords well with findings in other populations experiencing trauma and adversity directly.

A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for acute leukemia.

An acute leukemia diagnosis can be an extremely stressful experience for most patients. Posttraumatic growth (PTG) is positive psychological change experienced following a struggle with highly challenging life circumstances. The current study is the first longitudinal investigation of predictors of PTG and distress in adult acute leukemia patients undergoing induction chemotherapy. Findings suggest that these patients report PTG, and levels of PTG appear to increase over the weeks following leukemia diagnosis and induction chemotherapy. Variables associated with higher total PTG scores over time included greater number of days from baseline, younger age, and greater challenge to core beliefs. Variables associated with higher distress included greater number of days from baseline, greater perceived cancer threat, higher symptom severity, and lower spiritual well-being. Results underscore the critical role that examination of one's core beliefs may play in the development of PTG over time.

Assessing posttraumatic cognitive processes: the Event Related Rumination Inventory.

Cognitive processes in the aftermath of experiencing a major life stressor play an important role in the impact of the event on the person. Intrusive thoughts about the event are likely to be associated with continued distress, while deliberate rumination, aimed at understanding and problem-solving, should be predictive of posttraumatic growth (PTG). The Event Related Rumination Inventory (ERRI), designed to measure these two styles of rumination, is described and validation information is provided. Using a college student sample screened for having experienced highly stressful life events, data were obtained (N=323) to conduct an exploratory factor analysis that supported the two factors of the ERRI. Separate confirmatory factor analyses (CFA) on two additional samples (Ns=186 and 400) supported a two-factor model. The two ERRI factors were validated by comparison with related variables and by assessing their contributions to predicting distress and PTG in two samples (Ns=198 and 202) that had been combined to conduct the second CFA. Data indicate the ERRI has solid psychometric properties, captures variance not measured by stable differences in cognitive styles, and the separate factors are related to posttraumatic distress and growth as predicted by existing models of PTG.

A short form of the Posttraumatic Growth Inventory.

A short form of the Posttraumatic Growth Inventory (PTGI-SF) is described. A sample of 1351 adults who had completed the Posttraumatic Growth Inventory (PTGI) in previous studies provided the basis for item selection. The resulting 10-item form includes two items from each of the five subscales of the original PTGI, selected on the basis of loadings on the original factors and breadth of item content. A separate sample of 186 completed the short form of the scale (PTGI-SF). Confirmatory factor analyses on both data sets demonstrated a five-factor structure for the PTGI-short form (PTGI-SF) equivalent to that of the PTGI. Three studies of homogenous clinical samples (bereaved parents, intimate partner violence victims, and acute leukemia patients) demonstrated that the PTGI-SF yields relationships with other variables of interest that are equivalent to those found using the original form of the PTGI. A final study demonstrated that administering the 10 short-form items in a random order, rather than in the fixed context of the original scale, did not impact the performance of the PTGI-SF. Overall, these results indicate that the PTGI-SF could be substituted for the PTGI with little loss of information.

The Core Beliefs Inventory: a brief measure of disruption in the assumptive world.

Stressful events that disrupt the assumptive world can force people to make cognitive changes to accommodate these highly stressful experiences. As fundamental assumptions are reestablished, many people report changes and experiences that reflect posttraumatic growth (PTG). The present research describes the development of the Core Beliefs Inventory (CBI), a brief measure of disruption of the assumptive world developed for use in applied research and clinical settings. Three studies, two using college samples (Study 1, n=181 and Study 2, n=297 time 1; 85 time 2) and the third using leukemia patients (Study 3, n=70 time 1; 43 time 2), assessed the utility of the CBI to predict PTG in both cross-sectional and longitudinal designs. Relationships between the CBI and measures of self-reported PTG and well-being indicate that the CBI has construct validity, acceptable test-retest reliability, and very good internal consistency. The CBI may be a useful tool in investigating predictions about the effects of stressful experiences on an individual's assumptive world, PTG, and successful adaptation.

Use of the revised Posttraumatic Growth Inventory for Children.

Posttraumatic growth (PTG; positive change resulting from the struggle with trauma) was examined among children impacted by Hurricane Katrina. The revised Posttraumatic Growth Inventory for Children (PTGI-C-R) assessed PTG at two time points, 12 (T1) and 22 months (T2) posthurricane. The PTGI-C-R demonstrated good reliability. Analyses focused on trauma-related variables in predicting PTG. Child-reported subjective responses to the hurricane and posttraumatic stress symptoms (PTSS) correlated with PTG at T1; however, in the regression, only PTSS significantly explained variance in PTG. At follow-up, T1 PTG was the only significant predictor of PTG. Findings suggest that the PTGI-C-R may assist efforts to understand children's responses posttrauma.

Intrusive versus deliberate rumination in posttraumatic growth across US and Japanese samples.

To examine the role of rumination in the aftermath of traumatic/stressful events, posttraumatic growth (PTG) and the four types of rumination (i.e., intrusive rumination soon after the event, intrusive rumination recently, deliberate rumination soon after the event, and deliberate rumination recently) were assessed retrospectively for participants from the USA (N=224) and Japan (N=431). The results from a hierarchical regression analysis revealed that the hypothesized relationships among the four types of rumination and PTG were largely supported. Intrusive rumination soon after the event was positively related to PTG but recent deliberate rumination most strongly predicted the current levels of PTG for both samples. Some evidence for cultural differences in the role of rumination in PTG was also observed. In the US sample, deliberate rumination recently was more important than the deliberate rumination in the immediate aftermath of the traumatic/stressful event, whereas in the Japanese sample, deliberate rumination both soon after and recently were positively related to PTG. The results illustrate the importance of considering rumination as multidimensional and as varying across time in its impact on PTG. Future directions and clinical implications were discussed.

The role of rumination in the coexistence of distress and posttraumatic growth among bereaved Japanese university students.

This study examined the relationships between rumination, distress and posttraumatic growth (PTG). Seventy-one bereaved Japanese university students completed the PTG Inventory, the Impact of Event Scale-Revised, and a rumination scale. Three models, with variables including intrusive rumination, deliberate rumination, distress, and PTG, were tested using structural equation modeling. Results indicated that 1 model, which depicted recent intrusive rumination leading to distress and deliberate rumination soon after the event leading to PTG, with distress and PTG coexisting, was shown to best fit the data. Present findings offer implications for future research on PTG.

The factor structure of the posttraumatic growth inventory: a comparison of five models using confirmatory factor analysis.

There are different views about the dimensions of the positive changes resulting from the struggle with traumatic events. Using Posttraumatic Growth Inventory (PTGI) data reported by participants (N = 926) experiencing a variety of traumatic events, five models of the underlying structure of the PTGI were tested via confirmatory factor analyses to examine whether the PTGI comprises three domains (Changed Perception of Self, Changed Interpersonal Relationships, and Changed Philosophy of Life), five factors (Relating to Others, New Possibilities, Personal Strength, Spiritual Change, and Appreciation of Life), or a unitary dimension. Results indicated an oblique 5-factor model best fit the data, thus revealing the PTGI was multidimensional. Present findings offer implications for understanding the nature of posttraumatic growth.

Examining posttraumatic growth among Japanese university students.

To determine the underlying factor structure of the Japanese version of the Posttraumatic Growth Inventory (PTGI-J), a principal components analysis was performed on data from 312 Japanese undergraduate students who reported growth due to their most traumatic event within the last 5 years. Results showed the PTGI-J has high internal consistency and, of the original five factors reported by Tedeschi and Calhoun (1996), three were replicated: Relating to Others, New Possibilities, Personal Strength, and a fourth factor integrating Spiritual Change and Appreciation of Life emerged. There were neither gender differences nor relationships with time since trauma. PTGI-J scores were positively associated with posttraumatic symptoms and correlated with type of traumatic event experienced. These results and future directions are discussed from a cross-cultural viewpoint.

Correlates of posttraumatic growth in survivors of intimate partner violence.

The negative consequences of intimate partner violence are well documented. This study investigated the possibility that some survivors of intimate partner violence may also experience posttraumatic growth because of their struggle with this highly stressful circumstance. In addition, the relationships between posttraumatic growth and relationship status, type of abuse, depression, and availability of models of posttraumatic growth were examined. Most women reported posttraumatic growth. Overall abuse experienced and depression were unrelated to posttraumatic growth, but abuse was related to one domain of growth. Contact with a model of posttraumatic growth and having left an abusive relationship were both positively related to posttraumatic growth.

Rated importance of personal qualities across four relationships.

Are there stable personal qualities that people value in others across a range of personal and professional relationships? For 4 relationship types that varied across social and professional associations (those of "close friend," "romantic partner," "an employee of yours," and "your boss"), participants rated each of 34 personal qualities on the basis of how important it would be in selecting someone for the relationship. The author factor-analyzed the ratings of importance and created composite scores to represent the 4 factors identified (intimacy, dependability, achievement, and kindness). The author found no difference that was due to relationship type for the factor of kindness. The relationship of romantic partners received the highest ratings on the factor of intimacy. Participants rated the relationship of close friends lower than the other 3 relationships for both of the factors of dependability and achievement. The results indicated that people value some qualities the same regardless of the relationship involved, with other qualities varying in importance across these relationships. Of special interest was the tendency of participants to see stable qualities as generally less important for choosing close friends than for choosing the others in the other three relationships.