not sufficient on its own, as cognitive and motivational components are no less essential.
■ Meaningfulness refers to the motivational belief that it makes emotional sense to cope, that, though life may have its pains, one wishes to go on. People have areas of their life that they care about and that make sense to them. Thus, people with a weak SOC give little indication that anything in life seems to matter particularly to them.
So how does one accrue a SOC? Researchers would argue that a SOC usually develops by around age 30. The more one’s experiences are characterized by consistency, participation in shaping outcome, and balance of stimuli (rather than overload or underlay), the more one is likely to see the world as coherent. Antonovsky believed the SOC remains relatively stable as long as ‘radical and enduring changes in one’s life situation’ do not occur (Antonovsky and Sagy, 2001). Some studies appear to confirm this, although in one large study, SOC was significantly lower in the youngest age group and increased with age.
It is possible to conceive SOC as a personality characteristic or coping style (Antonovsky and Sagy, 2001). SOC is a rich concept and includes the elements of hardiness, self-efficacy and locus of control (Linley, 2003). It is, however, seen as more universally meaningful than the constructs mentioned above (Antonovsky, 1993). There exists substantial empirical and theoretical support for its nature as a unitary construct (Antanovsky, 1987, 1993).
Sense of coherence has been linked to high associations with wellbeing and life satisfaction, reduced fatigue and loneliness. Some research has found significant negative correlations with anxiety and depression; moreover a strong SOC protects against depression, predicts low suicidal thoughts in depressed patients and predicts lower (30 per cent) mortality from all causes (Antonovsky, 1993).
Furthermore, low SOC predicts musculoskeletal symptoms (neck, shoulder, and low-back) in later life and is a predictor of response to pain-management programmes for chronic pain sufferers. It is linked to pain levels in cancer patients. In arthritis patients, lower SOC is linked to pain levels, as well as greater difficulty in performing daily activities and general health (Antonovsky, 1993, adapted from Boniwell, 2008).
Coping styles
L
azarus and Folkman’s transactional model of stress appraisal is the most widely known and used model within coping research. Coping is defined as‘constantly changing cognitive and behavioural efforts to manage specific
external and/or internal demands that are appraised to be taxing or exceeding the resources of the person’, (Lazarus and Folkman, 1984, as cited in Cheavens and Dreer, 2009: 233).
Primary appraisal is the extent to which individuals perceive their situation to be threatening. Secondary appraisal is an individual’s perception of whether or not they have the resources available to them to deal with the stressor.
There are two main coping strategies that individuals use when faced with stressful or adverse situations. Problem-focused coping is when people identify the stressor and take active steps to engage with and tackle the issues at hand. Emotion-focused coping is when individuals tend to focus on dealing with the emotions surrounding the situation, rather than attempting to change or deal with the situation. Emotion-focused coping tends to consist of turning to others and seeking social support. This type of coping includes avoidance, which is when an individual ignores the situation at hand and avoids any interaction with solving the issue (Collins et al., 1990; Urcuyo et al., 2005; Thornton and Perez, 2006).
Earlier research posited that problem-focused coping was the better form of coping;
however, newer research shows that emotion-focused coping can indeed have positive consequences. For example, avoidance was once seen as a negative copping strategy although we now know that, in the short term, engaging in healthy distractions can be a good thing for people who have experienced significant trauma (Reynolds and Kee Hean, 2007).
The next section will move away from resilience or returning to ‘normal’ levels of functioning, and look at the phenomenon of post-traumatic growth, or thriving following adverse events.
A common theme throughout humanity is the notion of self-sacrifice and suffering for a greater good (Jimenez, 2009). Indeed, Judaeo-Christian religions are based on the sacrifice of one man’s life for all humankind. Thus, an implication of divinity through suffering is apparent with rewards of immaterial kinds in the afterlife awaiting those that suffer on Earth now. Suffering for self-actualization is present within the philosophical and psychological literature, with an emphasis on meaning and development of the self (authenticity) via adversity (Kierkegaard, Nietzsche, May, Yalom).
Although there are sections of academia that look into the ‘use of trauma’
as a way to better the self, there is a field of study within positive psychology that looks at how, through dealing with (and not the direct result of) trauma, a person can become better, stronger and operate at higher levels of functioning than which existed before the traumatic event occured. Previously studied under the terminologies of benefit finding, positive changes, growth from adversity, thriving, and psychological growth (Tennen and Affleck, 2004; Lechner, 2009), this phenomenon is now known as post-traumatic growth (PTG). Post-traumatic growth has been found to exist within samples of survivors from ‘war, bereavement, breast cancer, mastectomy, bone marrow disease, heart attack, rheumatoid
arthritis, spinal chord injury, MS, shipping disaster, tornado, plane crash, rape, childhood sexual assault, incest, shooting, HIV, infertility, chemical dependency, military combat and bombing’ (Joseph et al., 2005: 263–4;
Ai et al., 2007).
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Post-traumatic growth is currently divided into five domains (Calhoun and Tedeschi, 2004):2
■ The first domain is personal strength (or perceived changes in self). This is when trauma survivors report becoming stronger, deeper, more authentic, confident, open, empathetic, creative, more alive, mature, humanitarian, special, humble, and the list goes on. Many describe themselves as a ‘better person’ now that they have undergone this wake up call.
■ The second domain is relating to others, where people report becoming closer with their immediate and extended families. People report that friendships bind tighter and that people who were acquaintances/strangers/neighbours before the event, become prominent positive features in their daily life. Camaraderie and friendship among survivors of the same trauma is common. A downside of this is that many trauma survivors report that some friends go missing and are not supportive during their adversity. Although painful at the time, people report that this is a bonus as it allows them to identify their true friends and spend time (which is so much more precious) with those that count.
■ The third domain encompasses appreciation for life (or increased existential awareness). As one would expect, many people undergo a change in life philosophy. When trauma highlights our vulnerability and the fact that we are not invincible, we start to reflect on deeper issues such as mortality, spirituality, the meaning of and purpose in life, and so forth. Many survivors report that the trauma allowed them to ‘see clearly’, to understand what matters in life and allowed them to make changes to their priorities, from how and with whom they decide to spend their day with, to the importance of
time out
Viktor Frankl
For those of you who have read the wonderful and powerful book ‘Man’s Search for Meaning’, you will be well aware of the name Viktor Frankl (Frankl, 1963).
Frankl was an Austrian psychiatrist who was imprisoned in Theresienstadt,
Auschwitz and Turkheim during the years 1942–5. Throughout his incomprehensible ordeal in the Nazi concentration camps, Frankl lost his wife and family. During his incarceration, Frankl watched his fellow inmates to discover a theory of survival and human drive: the will to meaning. Frankl proposed that those who had a will to meaning, those that had something to live for, even in the direst circumstances, survived. Frankl’s theory was later translated into a form of psychotherapy, entitled logotherapy, with the main school still in operation in Vienna. His story and theories are a triumph to the human spirit and a testament to his belief that when everything is taken away from someone, they still have the ability to choose their reactions.
nature, health, life, importance (or unimportance) of physical appearance and monetary goods.
■ The fourth domain, new possibilities, covers the desire of individuals to change their life goals, re-enrol in schooling to learn a new subject, gain a degree or obtain new skills. Overall, they have a keen focus on the ‘here and now’ with a new appreciation of life and their time here on Earth.
■ The fifth domain is spiritual change where people may decide to return to their previous (or alternative) faith. They begin to actively participate (attend church, pray) and their belief in a higher being is strengthened via gratitude to that being.
time out
Examples of post-traumatic growth
In order to materialize the concept of growth, we’ve chosen some quotes that truly resonate with us as researchers in the area. One is from the well known cyclist, Lance Armstrong who, after battling three types of cancer and given a negative prognosis went on to win the Tour de France seven times and maintains the world record to this day. The other is from a former female cancer patient that Kate worked with who recounted her experience of cancer and growing from the experience:
Without the illness I would never have been forced to re-evaluate my life and my career. I know if I had not had cancer, I would not have won the Tour de France.
– (Lance Armstrong) And it’s . . . and I feel my life’s better! I know it sounds crazy (laughs), but I feel the quality of my life is better because (sniffles) I’ve prioritized (sniffles) and I know what matters.
– (Brenda, cancer survivor)