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.

Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain.

Chronic pain remains a daunting clinical challenge, affecting 30% of people in the United States and 20% of the global population. People meeting this challenge by achieving wellbeing while living with pain are a virtually untapped source of wisdom about this persistent problem. Employing a concurrent mixed-methods design, we studied 80 people living with chronic pain with "positive stories to tell" using semi-structured interviews and standardized questionnaires. In-depth interviews focused on what helped, what hindered, how they changed, and advice for others in similar circumstances. Major qualitative themes included acceptance, openness, self-efficacy, hope, perseverance, self-regulation, kinesthetic awareness, holistic approaches and integrative therapies, self-care, spirituality, social support, and therapeutic lifestyle behaviors such as music, writing, art, gardening, and spending time in nature. Themes of growth and wisdom included enhanced relationships, perspective, clarity, strength, gratitude, compassion, new directions, and spiritual change. Based on narrative analysis of the interviews and Ardelt's Three-Dimensional Wisdom Model, participants were divided into 2 groups: 59 wisdom exemplars and 21 nonexemplars. Non-exemplar themes were largely negative and in direct contrast to the exemplar themes. Quantitatively, wisdom exemplars scored significantly higher in Openness and Agreeableness and lower in Neuroticism compared to non-exemplars. Wisdom exemplars also scored higher in Wisdom, Gratitude, Forgiveness, and Posttraumatic Growth than nonexemplars, and more exemplars used integrative therapies compared to the non-exemplars. As a whole, the exemplar narratives illustrate a Positive Approach Model (PAM) for living well with pain, which allows for a more expansive pain narrative, provides positive role models for patients and clinicians, and contributes to a broader theoretical perspective on persistent pain.

El dolor crónico sigue siendo un desafío clínico abrumador, que afecta al 30 % de las personas de los Estados Unidos y al 20 % de la población mundial. Las personas que se enfrentan a este reto logrando bienestar mientras conviven con el dolor son una fuente prácticamente sin explotar de sabiduría sobre este persistente problema. Empleando un diseño concurrente de métodos mixtos, hemos estudiado a 80 personas que viven con dolor crónico con "historias positivas que contar" usando entrevistas semiestructuradas y cuestionarios estándar. Las entrevistas en profundidad se centraron en qué les ayudó, qué les ocasionó dificultades, cómo han cambiado y en consejo para otras personas en circunstancias similares. Los principales temas cualitativos incluían la aceptación, la apertura, la confianza en sus capacidades, la esperanza, la perseverancia, la autorregulación, la conciencia propioceptiva, los enfoques psicosomáticos y los tratamientos integrales, el cuidado propio, la espiritualidad, el apoyo social y los comportamientos del estilo de vida terapéutico como la música, la escritura, el arte, la jardinería y pasar tiempo en la naturaleza. Los temas de crecimiento y sabiduría incluían relaciones más estrechas, perspectiva, claridad, fuerza, gratitud, compasión, nuevos rumbos y cambio espiritual. Basándonos en el análisis de los informes de las entrevistas y en el paradigma de sabiduría de tres dimensiones de Ardelt, se dividieron a los participantes en 2 grupos: 59 modelos de sabiduría y 21 no modelos de sabiduría. Los temas no modelo eran mucho más negativos y estaban en directo contraste con los temas modelo. Cuantitativamente, los modelos de sabiduría obtuvieron una puntuación significativamente más alta en apertura y amabilidad y más baja en neuroticismo en comparación con los no modelo. Los modelos de sabiduría también puntuaron más alto en sabiduría, gratitud, perdón y crecimiento postraumático que los no modelos y más modelos usaron tratamientos integrales en comparación con los no modelos. En conjunto, los informes de los modelos ilustran un modelo de enfoque positivo para vivir bien con el dolor, que permite informes de dolor más comunicativos, proporciona modelos de rol positivos para los pacientes y médicos y contribuye a una perspectiva teorética más amplia acerca del dolor persistente.

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.

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.

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.

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.

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.

Beyond the concept of recovery: growth and the experience of loss.

Responding to D. E. Balk (2004) about use of the term recovery to describe bereavement outcome, the authors take the view that this term is inadequate. Among the points raised are (a) the term recovery may imply a response to psychological disorder, whereas bereavement responses are generally normative; (b) recovery does not easily allow for transformative outcomes in bereavement, e.g., posttraumatic growth; and (c) terminology guides the thinking of bereaved persons, clinicians, and researchers in this area, and the term recovery may produce bias toward viewing bereavement as a disordered state. More neutral terms such as change or resolution avoid some of these pitfalls.

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.

An exploratory study of posttraumatic growth in children following a natural disaster.

This study extends L. G. Calhoun and R. G. Tedeschi's (1998) model of posttraumatic growth (PTG), positive change resulting from the struggle with trauma, to children by exploring the construct among youngsters who experienced Hurricane Floyd and the subsequent flooding. Despite burgeoning interest in PTG, few studies have examined the phenomenon among non-adults. This first systematic study of PTG in children explores hypothesized linkages among PTG and social support, competency beliefs, and ruminative thinking. Results suggest that competency beliefs relate to PTG and that a supportive social environment and ruminative thinking are associated with positive competency beliefs. Contrary to expectations, social support did not relate to rumination. Findings testify to the merit of studying the PTG process in children. Clinical implications and future directions are considered.

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.

The unification of psychology: a noble quest.

Henriques' effort to develop a unified theory for psychology represents a noble quest (this issue). Even if the quest fails, the effort itself may produce benefits for psychology. This article focuses first on some general comments on the unified theory, with some suggestions about elements that seem desirable in the theory and some elements that may benefit from further elaboration. A specific application to the area of posttraumatic growth suggests the theory is capable of providing a framework for understanding specific areas of human psychology. Finally, the potential future of the unified theory is considered with a focus on its potential as a "useful mass movement" in psychology.

Posttraumatic growth after war: a study with former refugees and displaced people in Sarajevo.

Research carried out with survivors of a variety of different traumata indicates that a large proportion of them perceive positive changes in themselves after the trauma. This study investigated whether posttraumatic growth also could be found among people who had been exposed to particularly severe traumata over a period of several years (1991 to 1995) during the war in the area of the former Yugoslavia. Included in the study were two representative samples of adult former refugees and displaced people who lived anywhere in former Yugoslavia before the war and were currently living in Sarajevo, Bosnia and Herzegovina, three and a half years after the war. The main instrument was a new Bosnian translation of the Posttraumatic Growth Inventory. Results indicated some differences in the factor structure as compared with the original instrument. The overall means for the scale were considerably lower than reported in most studies on other kinds of trauma. Younger people reported considerably more growth than older people.