A gift wrapped in barbed wire - Scholarship at UWindsor (PDF)

University of Windsor University of Windsor Scholarship at UWindsor Scholarship at UWindsor Electronic Theses and Dissertations Theses, Dissertations, and Major Papers 2008 A gift wrapped in barbed wire: Personal growth among individuals A gift wrapped in barbed wire: Personal growth among individuals with arthritis or inflammatory bowel disease with arthritis or inflammatory bowel disease Rebecca J. Purc-Stephenson University of Windsor Follow this and additional works at: https://scholar.uwindsor.ca/etd Recommended Citation Recommended Citation Purc-Stephenson, Rebecca J., "A gift wrapped in barbed wire: Personal growth among individuals with arthritis or inflammatory bowel disease" (2008). Electronic Theses and Dissertations. 8003. https://scholar.uwindsor.ca/etd/8003 This online database contains the full-text of PhD dissertations and Masters’ theses of University of Windsor students from 1954 forward. These documents are made available for personal study and research purposes only, in accordance with the Canadian Copyright Act and the Creative Commons license—CC BY-NC-ND (Attribution, Non-Commercial, No Derivative Works). Under this license, works must always be attributed to the copyright holder (original author), cannot be used for any commercial purposes, and may not be altered. Any other use would require the permission of the copyright holder. Students may inquire about withdrawing their dissertation and/or thesis from this database. For additional inquiries, please contact the repository administrator via email ([email protected]) or by telephone at 519-253-3000ext. 3208.  A GIFT WRAPPED IN BARBED WIRE: PERSONAL GROWTH AMONG INDIVIDUALS WITH ARTHRITIS OR INFLAMMATORY BOWEL DISEASE by Rebecca J. Pure-Stephenson A Dissertation Submitted to the Faculty of Graduate Studies through the Department of Psychology in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy at the University of Windsor Windsor, Ontario, Canada 2008 © 2008 Rebecca J. Purc-Stephenson  1*1 Library and Archives Canada Published Heritage Branch 395 Wellington Street Ottawa ON K1A0N4 Canada Bibliotheque et Archives Canada Direction du Patrimoine de I'edition 395, rue Wellington Ottawa ON K1A0N4 Canada Your file Votre reference ISBN: 978-0-494-47097-8 Our file Notre reference ISBN: 978-0-494-47097-8 NOTICE: The author has granted a non- exclusive license allowing Library and Archives Canada to reproduce, publish, archive, preserve, conserve, communicate to the public by telecommunication or on the Internet, loan, distribute and sell theses worldwide, for commercial or non- commercial purposes, in microform, paper, electronic and/or any other formats. AVIS: L'auteur a accorde une licence non exclusive permettant a la Bibliotheque et Archives Canada de reproduire, publier, archiver, sauvegarder, conserver, transmettre au public par telecommunication ou par I'lnternet, prefer, distribuer et vendre des theses partout dans le monde, a des fins commerciales ou autres, sur support microforme, papier, electronique et/ou autres formats. The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. L'auteur conserve la propriete du droit d'auteur et des droits moraux qui protege cette these. Ni la these ni des extraits substantiels de celle-ci ne doivent etre imprimes ou autrement reproduits sans son autorisation. In compliance with the Canadian Privacy Act some supporting forms may have been removed from this thesis. While these forms may be included in the document page count, their removal does not represent any loss of content from the thesis. •*• Canada Conformement a la loi canadienne sur la protection de la vie privee, quelques formulaires secondaires ont ete enleves de cette these. Bien que ces formulaires aient inclus dans la pagination, il n'y aura aucun contenu manquant.  Personal growth and chronic illness iii Author's Declaration of Originality I hereby certify that I am the sole author of this thesis and that no part of this thesis has been published or submitted for publication. I certify that, to the best of my knowledge, my thesis does not infringe upon anyone's copyright nor violate any proprietary rights and that any ideas, techniques, quotations, or any other material from the work of other people included in my thesis, published or otherwise, are fully acknowledged in accordance with the standard referencing practices. Furthermore, to the extent that I have included copyrighted material that surpasses the bounds of fair dealing within the meaning of the Canada Copyright Act, I certify that I have obtained a written permission from the copyright owner(s) to include such material(s) in my thesis and have included copies of such copyright clearances to my appendix. I declare that this is a true copy of my thesis, including any final revisions, as approved by my thesis committee and the Graduate Studies office, and that this thesis has not been submitted for a higher degree to any other University or Institution.  Personal growth and chronic illness iv Abstract Despite the growing interest in the development of personal growth following a health- related adversity such as the diagnosis of a chronic illness, there has been little research investigating the factors that may give rise to personal growth. The objective of the present study was to explore the experience of posttraumatic growth and to identify the factors associated with posttraumatic growth among individuals with arthritis or inflammatory bowel disease (IBD) at two time points spaced six months apart. Using Schaefer and Moos' (1992) model as a theoretical framework, the association of positive outlook, spirituality, social support, stressors, cognitive appraisal variables, and coping strategies was examined among 214 individuals diagnosed with arthritis and 377 individuals diagnosed with IBD. Two structural equation models were estimated for each illness group. For the IBD group, the results showed that positive outlook, stressors, and social support each had an indirect effect on posttraumatic growth, mediated through symptom control beliefs, benefit-finding, and adaptive coping strategies. For the arthritis group, the results showed that positive outlook and stressors had an indirect effect on posttraumatic growth, mediated though benefit-finding and adaptive coping strategies, whereas social support had an indirect effect on posttraumatic growth, mediated through symptom control beliefs and adaptive coping. Importantly, this study highlights the relative roles of positive outlook, stressors, social support, cognitive appraisal variables and coping strategies that may facilitate the experience of posttraumatic growth among individuals facing a non-life threatening chronic illness.  Personal growth and chronic illness v Dedication To my beloved Tarik. As much as you think I helped you this year, I think you helped me more. You taught me to believe in myself and you gave me hope when I thought there was none. And... I'll never look at Macs or blue jays the same way again.  Personal growth and chronic illness vi Acknowledgements I would first like to thank my dissertation committee. In particular, I would like to thank my advisor, Dr. Fuschia Sirois, for taking me on as a student and helping me achieve this goal. I would also like to thank Dr. Dennis Jackson, Dr. Kathryn Lafreniere, and Dr. Anne Snowdon for their thoughtful, valuable, and always friendly feedback throughout the course of this study. A sincere thank you to Dr. Susan Cadell for agreeing to be my external reviewer and providing helpful guidance on this study. I would also like to thank Dr. Charlene Senn for the guidance, encouragement and support she provided throughout my graduate career whenever I needed it. I hope to become the esteemed academic and mentor you are. I would also like to thank Dr. Christine Thrasher for continuing to work and collaborate with me for all of these years. I have thoroughly enjoyed working with you and have learned so much from that experience. I would also like to acknowledge the participants who took the time to complete my study. The support and interest for this study was far beyond what I expected, and I have an incredible amount of respect for each of you. I am incredibly grateful for the time and thoughtful responses you provided. And finally, Darren... What would I have done without you this year!? Thanks for keeping me sane and motivated throughout the final stages of this project, and always being there during my emotional highs and lows. You are a true friend.  Personal growth and chronic illness vii TABLE OF CONTENTS APROVAL PAGE ii AUTHOR'S DECLARATION OF ORIGINALITY iii ABSTRACT iv DEDICATION v ACKNOWLEDGEMENTS vi LIST OF FIGURES AND TABLES xi CHAPTER I. INTRODUCTION 1 What is a Trauma? 3 Health-related Trauma and Adversity 5 Arthritis and Inflammatory Bowel Disease 6 The Experience of Personal Growth Following Trauma or Adversity 10 Background of Personal Growth Following Adversity 12 A Renewed Interest in Positive Outcomes 13 Definition of Personal Growth 14 Benefit-finding, Positive Reinterpretation, and Posttraumatic Growth 15 Posttraumatic Growth 16 Domains of Posttraumatic Growth 17 Posttraumatic Growth: Conceptual Issues 22 Posttraumatic Growth: Psychometric Issues 23 Theoretical Underpinnings of Posttraumatic Growth 27 Two-Process Model of Perceived Control (Rothbaum et al., 1982) 28 Cognitive Adaptation Theory (Taylor, 1983) 29 Theory of Restoration of Assumptive World (Janoff-Bulman, 1992) 30 Summary of Theories 32 Variables Related to Posttraumatic Growth 33 Explanatory Models of Posttraumatic Growth 41 Studies Applying Explanatory Models 43 Current Gaps in the Posttraumatic Growth Literature 45  Personal growth and chronic illness viii Rationale for the Present Study Hypotheses II. METHOD Sample Procedure Materials Sociodemographics Personal resources Social Resources Event and Health-Related Factors Cognitive Appraisals Coping Responses Positive Outcomes of Life Crises and Transitions Perceptions of Well-being Data Analysis 50 54 58 58 66 67 67 67 70 72 76 77 79 81 83 III. RESULTS 88 Confirmatory Factor Analysis of Posttraumatic Growth Inventory (PTGI) 89 Testing for Multigroup Invariance 91 The Experience of Positive and Negative Growth 96 Qualitative Analysis of Positive and Negative Effects 97 Change in Posttraumatic Growth Over Time 106 Differences in Posttraumatic Growth among Illness Groups 107 Descriptive Results 116 Personal Resources 123 Social Resources 125 Health-related Burden 126 Event and Health-related Factors 128 Cognitive Appraisals and Coping 130 Testing a Model of Posttraumatic Growth 13 5 Predictors of Posttraumatic Growth at Time 2 146  Personal growth and chronic illness ix Outcomes of Posttraumatic Growth 153 IV. DISCUSSION 157 The Positive Side of Health-Related Adversity 15 8 The Negative Side of Health-Related Adversity 160 Identity Shifts and Regaining Control Beliefs 160 Changes in the Types of Personal Growth Experienced 161 Factors Related to Posttraumatic Growth 163 Posttraumatic Growth and Later Well-Being 172 Limitations and Strengths 173 Implications 177 Directions for Future Research 177 Conclusion 180 REFERENCES 181 APPENDICES Appendix A : Consent Form for Time 1 Survey 209 Appendix B: Consent Form for Time 2 Survey 212 Appendix C: Explanation of the Study 215 Appendix D: Sociodemographics 216 Appendix E: Personal Resources 217 Appendix F: Social Resources 219 Appendix G: Event and Health-Related Characteristics 220 Appendix H: Cognitive Appraisals 226 Appendix I: Coping Responses 229 Appendix J: Outcomes of Life Crises and Transitions 230 Appendix K: Perceptions of Well-being 232 Appendix L: Qualitative Analysis of Positive Effects 233 Appendix M: Qualitative Analysis of Negative Effects 236 VITA AUCTORIS 241  Personal growth and chronic illness x List of Figures and Tables Figures Figure 1. Hypothesized Model for Predicting Posttraumatic Growth 54 Figure 2. Means for Subscales of the Posttraumatic Growth Inventory 111 (PTGI) across Individuals with Arthritis or Inflammatory Bowel Disease at Time 1 (N = 592) Figure 3. Means for Subscales of the Posttraumatic Growth Inventory 114 (PTGI) across Individuals with Arthritis or Inflammatory Bowel Disease at Time 2 (N = 279) Figure 4. Hypothesized Model for Predicting Posttraumatic Growth 138 among Respondents with Arthritis Figure 5. Hypothesized Model for Predicting Posttraumatic Growth 143 among Respondents with Inflammatory Bowel Disease Tables Table 1. Demographics for the Arthritis Participants at Time 1 60 and Time 2 Table 2. Demographics for the Inflammatory Bowel Disease 64 Participants at Time 1 and Time 2 Table 3. Fit Indices for the Five Flypothesized Models 90 Table 4. Standardized Parameter Estimates, Means, Standard 92 Deviations and Factor Correlations for Confirmatory Factor Analysis of the Posttraumatic Growth Inventory (N = 582) Table 5. Means, Standard Deviations and Internal Consistency 94 Values for the Posttraumatic Growth Inventory (PTGI) Table 6. The Posttraumatic Growth Inventory (PTGI) Overall Scaled 109 Scores and Subscales Scores across Time 1 and Time 2 Table 7. Changes in Posttraumatic Growth at Time 1 and Time 2 110 for each Illness Group  Personal growth and chronic illness xi Table 8. Means and Standard Deviations for Arthritis and IBD for 118 Time 1 and Time 2 Table 9. Correlations between all of the Study Variables and the 119 Five PGTI Subscale Values for the Arthritis Group at Time 1 and Time 2 Table 10. Correlations between all of the Study Variables and the 120 Five PGTI Subscale Values for the IBD Group at Time 1 and Time 2 Table 11. Correlations of all the Study Variables Collected at Time 1 121 with the Five PTGI Subscale Values Collected at Time 2 Table 12. The Models Tested, Scaled x2, Goodness-of-fit Indices, and 137 the Chi Square Difference (Ax2) Tests for the Arthritis Group Table 13. The Models Tested, Scaled x2, Goodness-of-fit Indices, 142 and the Chi Square Difference (Ax2) Tests for the IBD Group Table 14. Stepwise Hierarchical Multiple Regression Showing the 148 Relation of Personal Factors, Social Resources, Health-related Factors, Cognitive Appraisals and Coping with overall Posttraumatic Growth at Time 2 for the Arthritis Group Table 15. Stepwise Hierarchical Multiple Regression Showing the 151 Relation of Personal Factors, Social Resources, Health-related Factors, Cognitive Appraisals and Coping with overall Posttraumatic Growth at Time 2 for the IBD Group  Personal growth and chronic illness 1 CHAPTER I Introduction Research on stress and coping has largely followed the idea that stressful events, or adversity, lead to negative psychological, emotional, and physical outcomes (Updegraff, Taylor, Kemeny, & Wyatt, 2002). The negative impact of adversity is indisputable and can lead to such psychological distress as depression, anxiety, confusion, anger, disrupted personal relationships, and vocational difficulties (Bifulco & Brown, 1996; Finlay-Jones & Brown, 1981; Holland & Rollan, 1989; Nolen-Hoeksema & Morrow, 1991). However, the focus on the negative impact of adversity has resulted in the relative neglect of potentially positive outcomes. That is, the response to adversity is not universally devastating nor is severe psychological distress a normative response. There are reports that in the aftermath of a trauma or adversity, individuals often show persevering resilience and eventually experience enhanced personal growth. In this context, "personal growth" describes the experience of individuals whose development in some areas has exceeded what was present before the struggle with the trauma occurred. According to a growing body of literature, individuals exposed to even the most traumatic events report at least some personal growth emerging from their struggle (see Linley & Joseph, 2004 for a review). Research investigating reports of personal growth among individuals who have experienced a health-related adversity is growing. Whereas the majority of research on the relation between personal growth and health-related adversity has been conducted on individuals with life threatening diseases, such as cancer and HIV/AIDS, there is an increasing amount of research that suggests  Personal growth and chronic illness 2 individuals with other forms of chronic diseases, albeit not necessarily life threatening, also experience personal growth. Chronic illness involves an ongoing, persistent health issue that cannot be cured, and is akin to a chronic stressor or traumatic event. Like many other stressful events, chronic illness effects people differently depending on how the illness is perceived. When the illness is perceived as tragic and uncontrollable, it can undermine an individual's ability to cope, give rise to depression, and negatively impact psychological well-being (Taylor, 1983). However, when the illness is viewed as an opportunity for growth and positive experiences, it can strengthen an individual's ability to find benefits and can improve overall well-being. Although research in this area is growing, our understanding of the incidence and development of personal growth among individuals with a chronic illness is largely unknown. Therefore, the purpose of this study is to examine the experience of personal growth and the factors associated with the experience of personal growth between two chronic illness populations: individuals with arthritis or inflammatory bowel disease (IBD). Using these two illness populations, this study will: (a) explore the experience of personal growth, (b) identify the types of personal growth reported, and (c) test a model of personal growth to reveal the factors potentially relevant to the development of personal growth, and (d) explore how posttraumatic growth is related to later psychosocial well-being. The following sections describe the nature of a traumatic experience, provide a background of personal growth, discuss current conceptualizations of personal growth, and highlight the theories that try to make sense of the phenomenon.  Personal growth and chronic illness 3 What is a Trauma? We all use the word "trauma" in every day language to mean a highly stressful event. According to the Diagnostic and Statistical Manual IV (DSM), a trauma refers to experiencing, witnessing, or confronting an event that involves actual or threatened death or serious injury or threat to physical integrity to self or others. Accordingly, traumatic events may include but are not limited to, personal assault (sexual assault, physical attack, robbery, mugging), natural or manmade disasters, military combat, severe automobile accidents, or being diagnosed with a life-threatening illness. Witnessed events include observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster. Events experienced by others that are learned about include violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend, or learning that one's child has a life-threatening disease. This suggests that a trauma includes responses to powerful acute or one-time incidents (e.g., accidents, natural disasters, crimes, surgeries, deaths) as well as chronic or repetitive experiences (e.g., abuse, combat, illness, and enduring deprivation). The response associated with experiencing such can involve emotional (e.g., shock, panic/fear, denial), physiological (elevated blood pressure, fatigue, headache), cognitive (poor concentration, intrusive thoughts), and behavioral (pacing, exaggerated startle) effects. The key to understanding traumatic events is that it refers to extreme stress that may overwhelm a person's ability to cope. Although different experts define trauma in