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The ‘building blocks’ of Positive Psychological Change

David BloreAccredited CBT, Consultant Accredited EMDR

Doctoral researcher University of Birmingham

Visiting Lecturer Teesside University

Chester & NE Wales BABCP: 8th April 2011

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EXERCISE 2

List all the personal or other attributes/ qualities that, in your personal opinion, would contribute – or detract from – PPC

e.g. (the following are not necessarily correct!!)• Being female• Being happy• Having more than £1000 in the bank

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The fractal nature of PPC

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A few of the components of PPC

Traumatic event Sociodemographic factors Personality factors Self efficacy Hardiness and toughness Self esteem Resilience Sense of coherence Coping Locus of control Religiosity Emotions generally

Blame Forgiveness Hope Optimism Attributional style Cognitive appraisal Wisdom Paradox Social comparison Supportive others Existential issues Flow

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Traumatic event

Research results were generally confusing and PPC:• “…may not be a function of event type per se. It is more likely that it is the

characteristics of the subjective experience of the event… that influences adversarial growth.” (Linley & Joseph 2004a, p.15)

Mothers of bereaved children showed greatest PPC, whilst husband’s of women with breast cancer showed the least (Linley & Joseph 2004b p.14; Weiss 2002; Polantinsky & Esprey 2000)

threat and harm was indicative of PPC (Linley & Joseph 2004b, pp15-6), BUT: – “…there does not appear to be a consistently positive linear relation between degree

of trauma and growth.” (Ibid, p.15)

“Curvilinear” relationship with traumatic event type, i.e. mid range trauma resulting in the most PPC and mild and severe trauma producing less PPC (Fontana & Rosenheck 1998; Schnurr et al 1993) but not clear what constitutes mild, mid and severe trauma

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Sociodemographic factors

Being female was more associated with PPC than being male, although evidence was ‘mixed’

There were confusing results in relation to age and that generally mature, younger people are more likely to report PPC, whilst older

people in “temporal proximity to one’s own death” (Linley & Joseph 2004b;

Davis et al 1998) reported less PPC

Higher levels of education and income were associated with PPC

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Personality factors

The ‘Big Five’ personality factors, (extraversion, openness to experience, agreeableness, conscientiousness and neuroticism) (Gross 2005, pp.742-3)

All were positively associated with PPC with the exception of neuroticism (Linley & Joseph 2004b p.16)

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Self efficacy

A strong sense of self-efficacy will lead individuals to exert effort to master coping challenges, the success of which, likelihood of further success (Tedeschi

& Calhoun 1995) thus a self-fulfilling prophecy

Knowing that one has control through coping, and can freely choose whether or not to use it, is very empowering. Bandura (1988) argues that this available choice produces a sense of being in command, and hence internalises the locus of control

“…survivors begin to have an impact on their environment, they perceive some small measure of self-efficacy and control in a world that is not wholly random.” (Janoff-Bulman 1992, p.143)

…therefore coping; locus of control; action; and self-efficacy, are all interlinked when it comes to the successful management of NPC and, potentially, subsequent PPC

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Hardiness and toughness

Hardiness > plant biology > ability to resist adverse growing conditions such as frost. Toughness > materials science > ability to resist fracturing when stressed.

– Considered psychologically interchangeable (Golby & Sheard 2004)

The H personality (Kobasa 1979; Kobasa et al 1985), consists of:– Commitment: characterised by curiosity and active involvement in task-

related behaviours – Control: individuals who believe that they can influence matters – Challenge: an expectation that life will set challenges which will stimulate

personal development

          

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Hardiness and toughness

H associated with PPC (Waysman et al 2001)

Hardy people are thought to develop optimistic appraisals and meaning as well as a willingness to learn from the traumatic event and to incorporate them into a life plan (Kobasa 1979)

Hardy men appraised tasks as threatening, responded with negative and positive affect and physiological arousal than those hardy (Wiebe 1991). The effect was marked amongst women

H > psychiatric symptomatology and self-esteem Younkin (1992)

H > acts as a buffer against stress Tedeschi & Calhoun (1995)

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Self esteem

Higher levels of self-esteem in combination with optimism is widely associated with higher levels of PPC (e.g. Joseph et al 1993; McMillen et al 1995; Tedeschi & Calhoun 1995; Abraído-Lanza et al 1998; Linley & Joseph (2004b)

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Resilience

3 forms of resilience > metaphor of a ‘tree in the wind’ (Lepore & Revenson 2006, p.25-7)

– Resistance resilience

– Recovery resilience

– Reconfiguration resilience

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Resilience

Resistance resilience: – ‘Tree’ stands still in the face of a howling gale (Lepore & Revenson 2006, p.25)

– Frequently seen as unhealthy (Bonanno 2004, and Wortman & Silver 1989)

– Has resulted in treatments that led to breaching resistant clients’ defences (Lepore & Revenson 2006)

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Resilience

Recovery resilience: – ‘Tree’ bends to accommodate the wind and once the wind stops blowing– ‘Tree’ retains its original shape > same concept as psychological

homeostasis (Selye 1956) but (Bonanno 2004) says not, whilst (Garmezy 1991); Lazarus

1993 and Masten & Reed 2002) that it is– How quickly the ‘Tree’ returns to its normal position is also unclear with

Bonanno (2004) arguing recovery needs to be immediate, or even that the Tree should not bend at all – suggestive more of resistance resilience

– Even a slow return to the normal position is better than no recovery Lepore &

Revenson (2006) > recovery resilience perceived as normal and resistance resilience as abnormal. Both may be normal (Wortman & Silver 1989)

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Resilience

Reconfiguration resilience– ‘Tree’ changes its shape to accommodate the prevailing gales – Seen as fundamentally different to the other forms of resilience Lepore &

Revenson (2006) – Logically however, a reconfigured tree growing with the prevailing gales

would result in highly adaptive growing provided the prevailing gales did not change direction! If it did, the reconfigured ‘tree’ would become a highly vulnerable, resistant, ‘tree’

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Sense of coherence (Antonovsky 1989)

Comprehensibility:– An ability to make sense of the incomprehensible

Manageability: – The ability to manage, cope with, or bear, life’s challenges

– The opposite has parallels to an external locus of control, e.g. traumatic events seek individual’s out and victimise them

Meaningfulness:– Considered by Antonovsky to be the most important component of

the triad because without it, comprehensibility is unstable.

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Sense of coherence

Use of SOC (Tedeschi & Calhoun 1995, p.59) extended to describe the categories of coping responses that followed a traumatic experience: “…to achieve a sense of coherence, there are four crucial spheres

that must be seen as meaningful: inner feelings; interpersonal relationships; one’s major activity; and existential issues such as death, failure, conflict, and isolation…” (Ibid, p.53)

Plausible too that a SOC interchangeable with PPC – Might explain why Linley & Joseph (2004b) concluded,

unequivocally > SOC not associated with PPC (?conjecture because they did not explain their reasoning)

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Coping

Emotion-focussed coping (Maercker & Langner 2001) including emotional social support associated with PPC

Positive and negative religious coping (e.g. Pargament, Smith et al 1998; and Pargament, Koenig et al 2000)

Problem-focussed coping (e.g. Armeli et al 2001; Evers et al 2001; Maercker & Langner 2001) as well as acceptance, positive reinterpretation and positive religious coping

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Locus of control

Internal LoC > taking decisive actions for social change (Gore & Rotter 1963)

After struggle to cope with trauma iLoC > catalysts for social change e.g. Simon Weston (Weston 2003)

Interactive nature of an internal LoC (Baylis 2004):“An internal locus of control has long been regarded as a key factor creating resilience in the face of extreme adversity” (Werner & Smith 1982 p.211)

Extreme degree of LoC (Tedeschi & Calhoun 1995, p.45) could > traumatic events being harder to cope with than when beliefs are more moderate (Perloff 1983;

Swindle et al 1988)

iLoC tend to resist influence from others (Crowne & Liverant 1963) whilst aversive events actually produce attempts to reassert control (Blore & Holmshaw 2009; Thompson 1981)

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Religiosity

‘Spiritual development’ (e.g. Pargament et al 1990)

Cynicism and becoming less religious (Schwartzberg & Janoff-Bulman 1991)

Strengthening religious beliefs (e.g. Calhoun, Tedeschi & Lincourt 1992)

A mixture of weakening and then strengthening (Tedeschi & Calhoun 1995, p.38)

Strengthening of religious beliefs may serve a variety of purposes including gaining a sense of control, comfort and meaning as well as feeding back into the perceived changes in relationships with others – in this case with God (Pargament et al 1990)

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Religiosity Associated with PPC (Linley & Joseph 2004b, p.16) :

– Religious activities

– Intrinsic (i.e. to the person) religiousness

– Positive religious coping Religious beliefs can fend off everything (Calhoun et al 1992) “Sacred canopy” (Berger 1967) protects against chaos which is:

“…only adaptive when it leads to positive affect and the confidence to engage in new behaviours to test one’s limits and to maximise the possibilities of one’s success.” (Tedeschi & Calhoun 1995, p.73 see also Janoff-Bulman 1989b, p.169)

Search for meaning (Viktor Frankl 1959/2004)

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Emotions generally

Positive affect “consistently positively associated…” with PPC (Linley & Joseph 2004b, p.16)

Negative affect > negatively associated:– Depression (Frazier et al 2001; Updegraff et al 2002)

– Anxiety (Best et al 2001) – Associated with pre-incident mental health problems (Linley & Joseph 2004b)

PTSD was negatively associated early after trauma, but not at one year post event (Ibid)

Time, in relation to affect, important because expression of emotion can be beneficial in the early aftermath, but can be counterproductive later Tedeschi & Calhoun (1995, p.66)

– Complicated by other factors including perceived controllability (Wasch & Kirsch

1992), and cultural and gender differences

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Blame and forgiveness

Blame negatively associated with PPC: – illustrates the Effect of “clumsy leading questions asked by police

officers” (Purves 2001, p105) at the scene of an RTA

Logically the antonym, of blame, forgiveness, should be associated with PPC, however: – F is notable omission from both Linley & Joseph (2004b) and

Tedeschi & Calhoun (1995), although it is covered at length by Fincham & Kashdan (2004) in relation to positive psychology generally - rather than specifically psychological trauma

– ‘Complete’ or ‘incomplete’ forgiveness (Zechmeister & Romero 2002; Levenson et al 2006 see also Campaign for Forgiveness Research: www.forgiving.org )

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Hope and optimism

“…the traditional view of health turns out to be flawed… optimism and pessimism affect health itself, almost as clearly as do physical factors”

(Seligman (1990/2006, p.14 – from the chapter ‘Two Ways of Looking at Life’).

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Hope and optimism

H > emotionally based, O >more cognitive Seligman (1990/2006) H depends on lack of permanence and specificity :

– “Finding temporary and specific causes for misfortune is the art of hope: temporary causes limit helplessness in time, and specific causes limit helplessness to the original (traumatic event).” (Ibid p.48)

H encompasses not only expectancy that desired goals can be achieved but to imagine how they can be achieved (e.g. Tennen & Affleck 1998).

O linked “superficially” with control factors such as LoC and self-efficacy Tedeschi &

Calhoun (1995) and stress optimism: – “…focuses directly on how events will turn out rather than who controls them or

how well one can perform acts that may affect them.” (Ibid, p.47, see also Scheier & Carver 1992)

Optimists:– Use coping strategies > active and problem focussed + willing to prioritise effective

problem solving (Linley & Joseph 2004b) – Are less anxious, hostile, depressed, self-conscious, and vulnerable than

pessimists (Tedeschi et al 1993)

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Hope and optimism

O is not necessary for PPC (Bellizzi & Blank 2006) – at least for women with breast cancer, which supports the other two studies on the same traumatic event (Boyers

2001 and Sears, et al 2003) as well as:– “…the relationship between optimism and perceptions of growth are

relatively low…” (Tedeschi & Calhoun 1995, p47)

– Conclusion being PPC “cannot therefore be simply optimism” (Ibid, p.48)

O is related to subjective well-being post trauma (Holmes 2005) O positively associated with PPC (Millam 2004; Feigel 2004 and Linley &

Joseph 2004b)

Conclusion seems to be that H and O is related to PPC:– “…we also rejoice in our sufferings, because we know that suffering

produces perseverance, perseverance, character; and character, hope. And hope does not disappoint us…” (Romans 5v3-5, New International Version)

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Attributional style AS (Heider 1958) are viewed as a retrospective factor rather than a

predictor of future direction.

AS was not identified in Linley & Joseph’s (2004b) meta-analysis as a factor in PPC, but speculation is that AS is likely to be a factor, as:

– “…it may be more useful to help survivors gain control over future events rather than focus on… attributions about why the (traumatic) event occurred… attributional style has been conceptualised as either being pessimistic… or optimistic… (the latter) might be important in determining how people respond to stress.” (Joseph (1999, p. 61)

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Cognitive appraisal

Positive associations between the various components of cognitive processing (e.g. ruminations, intrusions and avoidance), and PPC (Linley & Joseph 2004b, p.16)

Components lead to meaningfulness, or more specifically new meaningfulness (Janoff-Bulman 1992) and to Joseph & Linley’s concept of association or accommodation (Joseph & Linley 2005; Payne et al 2007).

When (not ‘if’) meaning is found it is nearly always positive (Tedeschi & Calhoun 1995, p.72)

The OVT concept of accommodation and assimilation suggests only accommodation leads to PPC (Joseph & Linley’s 2005) - if meaning is not found and the traumatic material is assimilated into existing models of the world, then PPC does not occur

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Wisdom and paradox

Linley & Joseph (2004b) do not list wisdom as a form of PPC

Tedeschi & Calhoun (1995, p.86) see wisdom as a process leading to PPC:– “Western culture tends to consider wisdom an individual difference variable,

and that wisdom is not considered an automatic concomitant of aging or experience. Rather, some individuals, through their experiences, become wise.” (Tedeschi, Park & Calhoun 1998, p.15)

– Thus wisdom as a PPC variable may be culturally bound

Wisdom can also permit a new philosophy of life to develop (e.g. Janoff-Bulman 1989a)

– “A common theme… is that after a period of spiritual or existential quest, individuals often report that their philosophies of life are more fully developed, satisfying, and meaningful to them… because existential or spiritual issues have become more salient and less abstract.” (Tedeschi & Calhoun 2004a, p.407)

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Wisdom and paradox

Wisdom and paradox are clearly linked, the latter being a phenomena that individuals are very likely to encounter at some stage with PPC (Tedeschi & Calhoun 2004a, pp406-7).

Due to inherent belief that ‘only bad results from bad’. Thus paradox is only paradox because of the perspective that one starts with.

Presumably if one started with the belief ‘good comes from bad’ then there would be no paradox.– Would no paradox be paradoxical?

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Paradox

Something unpleasant gives rise to something positive (Tedeschi & Calhoun 2004a)

“Losses have produced something of value” (Ibid, p.406)

‘Being stronger’ as a result of a traumatic experience that exposed one’s vulnerability, appears to be common (Thomas, et al 1991).

PTG paradoxically “does not necessarily yield less emotional distress” (Tedeschi & Calhoun 2004a, p.407). In other words once ‘good’ is recognised, then ‘good’ occurs, but the fact that ‘bad’ continues is thus paradoxical. However, it may also suggests that NPC and PPC are in some way inter-related – a concept central to OVT (Joseph & Linley 2005).

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Social comparison

2 types of comparison with others: upward and downward social comparison (Tedeschi & Calhoun 1995, p.65-6)

‘Upward social comparison’ describes the conclusion “that one is worse off than others” in similar circumstances (Ibid).

‘Downward social comparison’, describes “others who are coping less well” in similar circumstances (Ibid).

The suggestion is that downward social comparison is compared with better outcomes, but whether this relates to PPC or more effective reducing of NPC is not clear

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Supportive others

Satisfaction with social support was associated with PPC (Linley & Joseph

2004b) but confusingly, support generally wasn’t (Ibid p.16) … … probably because friends and family have an existing relationship

with the traumatised individual pre-traumatic event (Tedeschi & Calhoun 1995,

p.95) unlike ‘similar others’ and professionals

– Poorly functioning families generate additional stress because of a lack of both communication and understanding (Coyne et al 1988)

– Anxieties of families is a factor (Tedeschi & Calhoun 1995, p.96)

– If good relationships can be maintained or improved, PPC possible (Ibid, p.94)

– +ve effects on relationships, and thus PPC can result from shared understanding post-trauma (Patterson 1989)

– ‘Depth of caring’ is associated with PPC (Zenmore & Shepel 1989)

– Both parties in a relationship will feel better if supportive listening, empathy and encouragement are forthcoming (Notarius & Herrick 1988)

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Existential issues

An ‘increased appreciation in existence’ (Malinek, Hoyt & Patterson 1979)

Quality of life is negatively associated with PPC (Linley & Joseph 2004b)

An ‘improved perspective on life’ (Affleck, Tennen & Gershman 1985)

‘No longer taking life for granted’ and ‘living life to the fullest’ (Joseph, Williams & Yule 1993)

  ‘Renewed appreciation’ for simple moments in life and taken-for-

granted relationships (Miles & Crandall 1983)

Cruciality of the moment or ‘reckoning time’, ‘life at a crossroads’ (Tedeschi & Calhoun 1988)

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Flow

Flow: The psychology of optimal experience, Csíkszentmihályi (1990) also considers the role of flow in the “transformation of tragedies” (pp193-8)

Flow was evident because a traumatised individual develops “…very clear goals while reducing contradictory and inessential choices” (p.193)

The book describes numerous people who, having experienced a traumatic event have set out on a quest to ‘find themselves’…

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Flow

…particularly poignant is the story of Reyad, who, described his experiences of the 1967 war against the Israelis after which:

“…I decided to leave Egypt and start hitchhiking toward Europe. Ever since I have been living with my mind concentrated within myself. It has not been just a trip, it has been a search for identity. Every man has something to discover within himself… I believe destiny rules life, and it makes no sense to struggle too hard… if I do not earn anything today it does not matter. It means that this happens to be my fate. Next day I may earn 100 million – or get a terminal illness. Like Jesus Christ said, what does it benefit to man if he gains the entire world, but loses himself?” (Csíkszentmihályi 1975, pp196-7)

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Overview

So we can’t even agree what to call PPC

We know, yet we don’t know, what PPC is:

“The more we know about (PPC), the more we know that we do not know very much.” (Calhoun & Tedeschi, 1998 p.215)

We don’t have a complete consensus of what PPC consists of– Meta analysis (Linley & Joseph 2004b) of 39 studies on PPC contained

disagreement on core ingredients of PPC:

“…It is unlikely that (PPC) will be substantially explained by one or even several factors” (Ibid, p.19)