Loss and Trauma

General and Close Relationship Perspectives

John Harvey, Eric Miller, John Harvey, Eric Miller

• Verlag: Routledge
• Jahr: 2021
• ISBN:
  9781317711223
• Auflage: 1
• Thema: Psychology
• Thema: Emotions in Psychology

Given the relationship between trauma, loss, and interpersonal bonds, the editors have assembled a noteworthy list of contributions discussing trauma associated with close relationships (divorce, infertility, widowhood). Certainly, trauma is closely associated with loss.

This edited volume offers the perspective of over twenty leading scholars in the study of trauma and loss. Each chapter offers extensive coverage of contemporary issues (terror management, rational suicide, spirituality, stigmatization). Relationship issues within these topics are also explored.

PART

I

GENERAL PERSPECTIVES ON LOSS, TRAUMA, COPING, AND THE POSITIVE IMPACTS OF LOSS

1 CHAPTER

John A. Updegraff Shelley E. Taylor

From Vulnerability to Growth: Positive and Negative Effects of Stressful Life Events

Preparation of this manuscript was supported by a grant to the second author from the National Institute of Mental Health (MH 056880) and by funding from the MacArthur Foundation’s SES and Health Network. The first author was supported by a training grant from the National Institute of Mental Health (MH 15750).

Severely stressful life events can have a substantial impact on those who experience them. For some, experience with a traumatic life event can leave them confused, withdrawn, depressed, and increasingly vulnerable to the next stressful situation that arises. The clinical literature, for example, has found various stressful life events to be risk factors for the development of depression, anxiety, and in extreme cases, posttraumatic stress disorder (PTSD). For other individuals, a traumatic experience can serve as a catalyst for positive change, a chance to reexamine life priorities or develop strong ties with friends and family. Recent research has explored the immediate and long-term positive effects of similarly severe life events, such as cancer, bereavement, and HIV-infection, to identify the factors and processes that appear to contribute to resilience and growth. These two lines of research, however, have developed largely independent of each other and a number of questions remain to be explored in their integration. For example, do the roots of these apparently divergent patterns lie in the events themselves or in the people who experience them? Do some experiences typically lead to negative outcomes, whereas others contribute to the development of positive changes? What psychological factors appear to moderate these outcomes? How do positive outcomes, such as perceptions of stress-related growth and benefit, relate to measures of negative adjustment?

To address these questions, we begin with a review of positive outcomes that have been reported in response to stressful life events, such as the perceptions of stress-related growth and benefit, and theories that help to explain these changes. We then look at some of the negative outcomes associated with stressful life experiences, such as depression, anxiety, and posttraumatic stress disorder, and discuss theoretical perspectives on these outcomes. Psychological factors that may moderate the relationship between these stressors and the outcomes, such as coping style, optimism, and control, are then addressed. Finally, we address characteristics of stressful events that may contribute to the nature of their long-term impact, and conclude by noting limitations of existing research and directions for future work.

Positive Effects of Stressful Life Experiences

For decades, philosophers and psychologists have written about the paradoxical positive effects that may occur in the wake of severely traumatic events, such as the Holocaust, serious illness, natural disasters, and other traumatic events (e.g., Chodoff, Friedman, & Hamburg, 1964; Frankl, 1963; Mechanic, 1977; Visotsky, Hamburg, Goss, & Lebovits, 1961). Although relatively understudied scientifically in comparison to the negative effects, the positive effects of stressful life events have increasingly come under the scrutiny of theorists and researchers. Studies exploring a variety of stressful events have found that typically over half of individuals who experience a traumatic life event report some degree of positive outcomes as a result, including changes in self-perceptions, social relationships, and life perspective (Dhooper, 1983; Taylor, 1983; Wallerstein, 1986; Yarom, 1983). For example, in a study of bereavement, Calhoun and Tedeschi (1990) found that most participants reported positive changes resulting from the deaths of their spouses, with the most prevalent benefits being reported in the domain of self-perception. Two-thirds of the participants in Thompson’s (1985) study of residential fire victims and over half of the participants in Affleck, Tennen, and Gershman’s (1985) study of parents with children in neonatal intensive care units reported that they perceived benefits from their experiences. Similarly, in a study of cancer patients, Collins, Taylor, and Skokan (1990) found that the changes reported in the domains of social relationships, priorities, and activities were primarily positive, but that changes in the their views of themselves and the world were mixed; on balance, reported changes were positive. Two studies have explicitly compared the quality of life reported by cancer patients with a normal sample free of chronic disease, and found quality of life experienced by the cancer sample to be higher than that of the non-ill sample (Danoff, Kramer, Irwin, & Gottlieb, 1983; Tempelaar et al, 1989). Other studies have shown that, both during the immediate aftermath of traumas such as bereavement and disability and over the course of a long-term stressor such as AIDS caregiving, positive emotions are as prevalent as negative emotions (Folkman, 1997; Silver, 1982; Wortman & Silver, 1987), suggesting that adjustment to stressful events may be far less distressing and much more variable than commonly assumed (Wortman & Silver, 1989).

Across the studies that have examined the benefits that people perceive as resulting from severely stressful life events, three important and consistent domains of change have appeared (Taylor, 1983): (1) self-concept, (2) relationships with social networks, and (3) personal growth and life priorities. The positive changes in self-concept following severe life stressors typically include the belief that one is a stronger person for the experience and is better able to handle the blows that life will inevitably deal. For example, in Calhoun and Tedeschi’s (1990) bereavement study, over two-thirds of the participants described themselves as stronger and more competent people, and over 80% felt that they were wiser, stronger, more mature, and better able to cope with other crises (see also Thomas, DiGiulio, & Sheehan, 1991). Sledge and colleagues documented similar changes in self-concept in repatriated prisoners of the Vietnam War (Sledge, Boydstun, & Rabe, 1980). Taylor (1983) found that breast cancer survivors often reported a stronger sense of self as a result of their illness, and as did individuals infected with HIV (Taylor, Kemeny, Reed, & Aspinwall, 1991).

A second area in which individuals commonly perceive posttraumatic benefits is in their social relationships. Life crises can force people to take a dependent and receptive stance toward their external environment (Stewart, Sokol, Healy, & Chester, 1986) that may necessitate the solicitation of help from family and friends. Thus, if an individual is overwhelmed by an unanticipated threat and feels that the world is falling apart, having a supportive and stable social network to rely on can increase one’s appreciation of friends and family and lead to the perception that these social ties have been strengthened as a result. Indeed, research does bear out such a claim. In Calhoun and Tedeschi’s (1990) and Thompson’s (1985) studies, the most common benefit that victims cited was the realization that other people were available to help and rely upon. Similarly, in Mendola and colleagues’ (1990) study of women with impaired fertility and Schwartzberg’s (1993) study of men with AIDS, close to half of the respondents reported improved social relations and a stronger sense of belonging. Evidence is mounting that when stressful events occur in conjunction with high levels of social support, they can have positive influences on mood (Caspi, Bolger, & Eckenrode, 1987) and on psychological growth (Park, Cohen, & Murch, 1996).

A third general area in which people often perceive stress-related benefits is in their personal growth and life priorities. In a study of HIV-positive men, Schwartzberg (1993) reported that three-quarters of the participants viewed their HIV-infection as a catalyst for personal growth, including reprioritizing values and time commitments, becoming more understanding with friends and family, and accomplishing goals that would have otherwise been delayed (see also Reed, 1989). In a study of cancer patients (Collins et al., 1990), more than 90% of respondents reported at least some beneficial changes in their lives. Further, Baumeister (1994) reviewed evidence suggesting that a negative life change, even a relatively minor one, can serve to link together other existing problems, conflicts, and dissatisfactions in a person’s life, resulting eventually in a broad restructuring of attitudes and priorities that can have positive long-term effects.

Mounting evidence suggests that these reordered priorities may translate into changes in activities. For example, in studies of women with breast cancer, Taylor and colleagues (Taylor, 1983; Taylor, Lichtman, & Wood, 1984) reported that over 75% of the participants made health-related behavioral changes as a result of their condition. Affleck and colleagues’ (Affleck, Tennen, Croog, & Levine, 1987) research on heart attack patients found that perceptions of stress-related benefits were associated with better long-term physical health and lower levels of mortality, suggesting that perceptions of benefit might have been associated with the adoption of more healthy behaviors (see also Bar-On, 1987).

Finding benefits in traumatic events is not unexpectedly associated with better psychological adjustment to those events. Park and colleagues (1996) found that college students who reported high degrees of perceived growth in response to a stressful life event also showed pre-event to post-event increases in optimism and positive affectivity. Other studies of women with impaired fertility (Mendola et al., 1990) and disaster victims (McMillen, Smith, & Fisher, 1997; Thompson, 1985) have reported similar findings. Lehman and colleagues (Lehman et al., 1993), however, reported no relationship between perceived benefits and psychological adjustment, and suggested that a balanced recognition of the positive and negative aspects of a traumatic event contributes best to psychological functioning, a position supported by other studies (Taylor, Kemeny et al., 1991).

Indeed, the question of whether positive changes, or a mix of positive and negative changes, are associated with optimal adjustment following stressful events is an issue that remains unresolved. Some research (Taylor, Kemeny et al., 1991) has shown that a mix of changes proved to be more beneficial. However, more recent research on women with AIDS found exclusively positive changes to be associated with best adjustment (Updegraff, Taylor, Kemeny, & Wyatt, 2000). It may be that, for ongoing traumatic events that require a major life readjustment, positive changes better predict adjustment, because the sheer stress of the event may be otherwise overwhelming; in contrast, people reporting on events that are in the past and for which the full ramifications are known may be more likely to acknowledge a mix of changes which may be associated with adjustment (cf. Updegraff et al., 2000).

Taken together, these studies suggest that stressful life events can have long-term positive effects and can help people to understand more about themselves, their social network, their priorities, and their lives in general. It should be noted, however, that much of this research has been based on self-report data, so it is unclear how valid these changes may actually be. To date, only a few studies have linked these reported changes to behavioral outcomes (Taylor et al., 1984) or to corroborated perceptions by friends or relatives (Park et al., 1996). A few studies have begun to tie such positive changes to physiological, neuroendocrine, and immune functioning (Epel, McEwen, & Ickovics, 1998; Kamen-Siegel, Rodin, Seligman, & Dwyer, 1991) and to health (Affleck, Tennen, Croog et al., 1987). For example, a study by Bower, Kemeny, Taylor, and Fahey (1998) found that the ability to find meaning in an AIDS-related bereavement experience was associated with a slower course of AIDS among men infected with HIV. Given that these perceptions of stress-related growth may have such salutatory effects on behavior and health, it is important for future research to tie these reports of benefits to tangible outcomes.

Because stressful life events create the potential for positive change as well as negative change, it is important for theories to be able to explain both positive changes as well as the overall variability in response to stressful life events. A number of theories have been proposed to explain the positive effects that people report from stressful life events, such as Taylor’s (1983) theory of cognitive adaptation, Aldwin’s (Aldwin, Sutton, & Lachman, 1996) deviation amplification model of stress and coping, Hobfoll’s (1988) conservation of resources theory, and Meichenbaum’s (1985) stress inoculation approach. These theories will be presented in light of evidence noted.

Taylor’s Cognitive Adaptation Theory

Taylor’s (1983) theory of cognitive adaptation conceptualizes individuals as active agents in restoring psychological equilibrium in the aftermath of a traumatic life event. According to the theory, traumatic life events initially take their toll by challenging people’s sense of meaning, their sense of mastery, and their self-esteem. As a result, people are motivated to restore their self-esteem and sense of meaning and mastery by the production of self-enhancing cognitions (Taylor & Brown, 1988). For example, a sense of meaning can be regained by understanding why a traumatic event occurred and what its role in a person’s life will be, and a sense of meaning is typically produced by either a causal attributional search or a rethinking of attitudes and life priorities. Similarly, individuals can preserve their sense of mastery by believing that they can exercise control over the event. However, different events allow for different amounts of control, and if an individual’s attempts at control in one domain are thwarted, Taylor (1983) suggests that individuals will preserve their sense of control and mastery by focusi...