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The experience of positive personal growth, termed posttraumatic growth (PTG), following significant illness events, has become increasingly prominent as a topic of interest. The evidence indicates that higher levels of PTG are associated with numerous positive health-related outcomes, including reduced physical complications and increased survival. Based on such findings there have been recent efforts to incorporate PTG into cognitive-behavioural clinical interventions. Such efforts appear theoretically justified, with the prominent model of PTG emphasising a central role of cognitive processing in the development of growth. The first paper presented here critically reviews recent evidence pertaining to the relationship between cognitive processing and PTG. Whilst the literature appears to support the role of cognitive avoidance, positive reappraisal, and threat appraisals in the development of PTG, there are mixed conclusions and significant limitations to existing research. The evidence base needs substantial development, a greater theoretical foundation, and improved conceptual clarity before it provides sufficient empirical grounding upon which to develop clinical interventions. The second paper presented here focuses specifically upon stroke survivors. Within the stroke literature there remains a heavy pathology-focus and little attention has been paid to positive outcomes, which may lead to a biased understanding of post-stroke adjustment. The empirical paper reports on a cross-sectional survey study investigating PTG and its correlates in 87 stroke survivors. The findings extend the highly limited evidence base indicating the possibility of PTG after stroke. Higher levels of post- stroke PTG were associated with social support and positive appraisal patterns. The findings also justify further research into the role that demographic and stroke-specific factors play in the development of post-stroke PTG. Clinically, the pattern of associations found indicates that stroke rehabilitation should incorporate a greater psychosocial focus in order to promote positive outcomes.

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Research on the interpersonal impact of Post Traumatic Stress Disorder (PTSD) is a developing area. The work presented here builds on this growing dimension of PTSD research. A narrative literature review examines the development of the concept of PTSD, the existing research on the interpersonal impact of trauma, and alternative approaches to treatment. It highlights a clear need to consider a more systemic way of working by broadening our perspective of PTSD wider than the just the individual. The research paper presented uses Interpretative Phenomenological Analysis (IPA) to explore couples' experiences of their relationship surrounding a trauma. The research identified themes of; losing the person you love; isolating versus needing support; PTSD affects roles, responsibilities and dynamics; and the dyadic nature of moving on from trauma. A critical review of the design and process of research is presented followed by the ethics documentation for the application and approval of the research.

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This thesis set out to investigate some of the variables associated with, and the processes and mechanisms of, positive change following trauma and adversity, or adversarial growth, in diverse populations. A systematic and comprehensive review of the literature (Chapter 2) identified the state of knowledge, and pointed to a number of salient directions for future research. Some of these directions were pursued in the subsequent empirical chapters. Five empirical chapters (Chapters 3 –7) examined a range of variables and processes in adversarial growth, using a variety of populations. Using two large student samples, it was found that emotion-focused coping mediated the association between subjective distress and adversarial growth, and that emotional intelligence was a potentially key variable in the role of emotions in adversarial growth (Chapter 3). A longitudinal study of people who had been severely traumatised and were suffering chronic psychological distress revealed that the experience of positive change predicted lower psychological distress and negative change six months later (Chapter 4). Vicarious processes in adversarial growth were investigated in therapists, and it was shown that the working alliance may be a core channel through which the process of vicarious growth operates (Chapter 5). Extending this focus on vicarious processes, in two samples of disaster workers, and funeral directors, it was shown that psychosocial variables were more salient in their associations with adversarial growth than professional experience variables. Specifically, the role of cognitive processing was emphasised, together with an exploration of the novel area of death attitudes (Chapter 6). A more explicitly existential focus, using three samples of churchgoers, members of the general population, and funeral directors, addressed the role of Yalom’s ultimate existential concerns and adversarial growth. Negative death attitudes were shown to be consistently associated with more negative changes and fewer positive changes, but the associations with negative changes were mediated, in some instances, by the presence of meaning in life and satisfying close relationships, consistent with theoretical predictions. Further, aspects of the organismic valuing theory of growth through adversity were tested, and broadly supported (Chapter 7). The concluding chapter (Chapter 8) reviewed the main findings from the thesis, identified ongoing questions from the literature, and indicated salient directions for research, including an emphasis on the clinical applications of adversarial growth.