Women with HIV are particularly at risk for poor mental health outcomes and for a number of traumatic experiences, including sexual abuse. Benefit-finding is the ability to generate positive outcomes resulting from trauma and is important for women with HIV, since it is motivated by distress and has demonstrated health benefits among individuals with trauma and/or medical conditions. Qualitative narrative measures, especially those that reflect life stories, are most likely to assess benefit-finding. Narrative coherence, which reflects how well a life story is told, may be associated with benefit-finding and with better mental health outcomes. The current study hypothesized that greater psychological distress (depressive symptoms [CESD] and quality of life [QOL]) HIV disease progression (HIV viral load [VL] and CD4 count), and sexual abuse, and lower levels of substance use, assessed with self-report measures at multiple visits over an average of 10 years (M = 10.05 years, SD = 3.47 years), would predict benefit-finding and coherence, coded from autobiographical narratives of 99 women with HIV (91% African American, mean age = 44.78 years, SD = 8.85 years) who were participants in the Women's Interagency HIV Study, Chicago site. Greater benefit-finding and coherence were also hypothesized to predict higher resilience coded in narratives cross-sectionally and higher CD4 count, QOL, and antiretroviral medication (HAART) adherence, and lower VL and CESD 6 months following narrative administration (M = 5.64 months, SD = 1.49 months). Partial correlations and multiple hierarchical linear and logistic regressions controlling for demographics and other relevant covariates indicated that hypotheses were partially supported. History of sexual abuse predicted greater benefit-finding only. There were no significant longitudinal predictors of narrative coherence. Benefit-finding was positively related to narrative coherence and resilience (cross-sectionally) and positively predictive of HAART adherence, greater likelihood of CD4 >= 350 and undetectable VL, and fewer depressive symptoms 6 months later. Coherence was not significantly related to post-narrative outcomes. Results suggest that benefit-finding has numerous health benefits among women with HIV and that interventions for this population should draw on and enhance benefit-finding, a potential strength in facing adverse circumstances.

Yes / There is a growing evidence base that identifying positive experiences in providing care can have a beneficial influence on carer wellbeing. However, there is a need to better understand what carers identify as the positive aspects of care-giving. The aim of this study is to explore the satisfying aspects of providing care to people with dementia. This study utilised Time 1 data from 1,277 carers of people in the mild-to-moderate stages of dementia taking part in the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort study. Responses from 900 carers who answered the open-ended question ‘What is your greatest satisfaction in caring for your relative/friend?’ were analysed using thematic analysis. From the responses, 839 carers detailed satisfactions. Eight themes were identified, pertaining to three groups of beneficiaries: carers, people with dementia and the dyad. Perceived benefits for carers included identifying aspects of personal growth, seeing glimpses of the person, feeling they were making a difference and doing their duty. For the person with dementia, these included retaining independence, receiving good quality care and being happy. Dyadic benefits concerned the continuation of the relationship between carer and person with dementia. The findings highlight the need to take a dyadic approach when conceptualising positive experiences in providing care. Further research is needed to understand the role these positive experiences play and to develop interventions. Professionals working with carers should identify and validate these experiences. / ‘Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) (grant number ES/L001853/2); ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by the Alzheimer's Society (grant number 348, AS-PR2-16-001)

This dissertation examined the relationship between attachment insecurity and complicated grief by testing a path model of variables that were hypothesized to mediate this relationship. Three meaning-making variables were tested as potential mediators: benefit-finding, sense-making, and positive reappraisal. First, a series of principal components analyses were performed to determine the factor structure of these meaning-making variables. After these constructs were identified, a series of hierarchical regression analyses were conducted to determine the unique contribution of each of the primary variables in predicting either complicated grief or one of the meaning-making variables. As hypothesized, some of the attachment and meaning-making variables were highly associated with complicated grief. Attachment insecurity variables were also associated with some of the meaning-making variables suggesting that attachment may have some influence on how individuals use meaning-making strategies in the midst of a loss. These variables were then entered into a path analysis that accounted for other relevant risk factors. It was found that, contrary to the main hypothesis, the meaning-making variables did not appear to mediate the relationship between attachment insecurity and complicated grief. Multiple regression was used to determine the relative impact of meaning-making and attachment variables on complicated grief because these variables have not been previously included in one statistical model. The results suggested that both meaning-making and attachment insecurity variables can play an important role as risk factors for complicated grief and that these relationships are still present after accounting for the closeness that an individual reported towards the deceased. It was concluded that both sets of variables, attachment and meaning-making, should be included in models of the development of complicated grief and that both may have clinical implications in terms of how to approach counseling for individuals struggling with complicated grief. More research on this topic is needed to look at similar research questions within specific populations. It was also suggested that in the future, researchers need to find better ways to measure meaning-making constructs because the current findings suggest that meaning-making may be even more multifaceted than has been suggested in previous literature. / text

The primary aim of this thesis was to conduct a longitudinal study, to investigate the quality of life (QOL) in a large sample of people diagnosed with colorectal cancer (CRC), immediately post-diagnosis and one-year later. Various measures were utilised to capture the multifaceted concept of QOL, including psychological distress, satisfaction with life, positive affect and cancer-related quality of life. The investigation was conducted within Lazarus and Folkman’s stress and coping framework. Specifically, this research aimed to test the utility of the stress and coping framework in the context of CRC, and to explore the role of benefit-finding within the context of the stress and coping model components. One thousand, eight hundred participants (1078 men and 722 women) with a CRC diagnosis duration of 1 to 12 months, completed a telephone interview and written questionnaire, assessing demographics, disease/treatment characteristics, threat appraisal, social support, optimism, coping, benefit-finding and quality of life domains, at approximately five- and 12-months post-diagnosis. To identify CRC-specific coping strategies, the Coping with Colorectal Cancer measure was developed in the initial study. The eight factor structure was confirmed, and the subscales (Positive Perceptual Change; Religion/Spirituality; Rumination; Acceptance; Humour; Palliative; Seeking Social Support; and Lifestyle Reorganisation) found to have reliability and preliminary criterion-related validity within the context of the stress and coping framework. As predicted, regression analyses showed that, after controlling for demographics, disease/treatment characteristics and stress/coping variables, the coping subscales uniquely predicted Time 1 QOL outcomes, with Seeking Social Support continuing to predict Time 2 Positive Affect. In the second study, the benefit-finding domains specific to those with CRC were identified, and relationships with quality of life outcomes assessed, to determine the inclusion of benefit-finding in the path model. Based on completed data from 1757 of the initial 1800 participants, confirmatory factor analyses revealed three domains of benefit-finding: Personal Growth; Interpersonal Growth and Acceptance. As hypothesised, regressions analyses found that benefit-finding domains at Time 1 was associated with Time 1 QOL outcomes, specifically, Positive Affect and Cancer-related Quality of Life (both the aggregate score and its Social/Family, Functional and Colorectal Cancer-specific Well-being subscales). Time 1 Personal Growth also predicted Time 1 Psychological Distress. After controlling for Time 1 Positive Affect, Personal Growth continued to predict Time 2 Positive Affect. The final study drew on the results of the first two studies, which informed the coping strategies and benefit-finding domains to be included in regression analyses initially, and then, structural equation modelling. The final study included 1276 complete data sets of the initial 1800 participants. Parameters of the initial hypothesised model of the stress and coping framework, including relationships with benefit-finding (based on empirical findings) failed to fit the model to the data. After several revisions, the analysis revealed that the final model fit the data, where stress, coping and benefit-finding accounted for 63% of the variance in Time 1 QOL. The model showed that threat appraisal, coping resources, avoidant coping and benefit-finding directly impacted on Time 1 QOL, while threat appraisal, social support and approach coping directly impacted on benefit-finding. In this study, the approach coping strategies included in the path model could also be conceptualised as meaning-based coping strategies, as they appeared to facilitate a meaning-making process. However, benefit-finding, which some researchers have suggested is also a meaning-based coping strategy, had differential relationships with stress, coping and outcome variables, compared with the approach coping strategies. These results indicate that benefit-finding is an empirically distinct construct in the context of CRC. Finally, in this study, the impact of stress, coping and benefit-finding on Time 2 QOL, was indirect, being mediated by Time 1 QOL outcomes. The accumulated findings of these three studies have extended the cancer coping and benefit-finding research by revealing new relations between stress, coping and benefit-finding and QOL in a mixed-gender, older population with CRC. There are implications for measurement of, and theory building around benefit-finding. Finally, these studies inform the development of clinical interventions to enhance the quality of life in the short- and longer-term for individuals diagnosed with CRC.

The primary aim of this thesis was to conduct a longitudinal study, to investigate the quality of life (QOL) in a large sample of people diagnosed with colorectal cancer (CRC), immediately post-diagnosis and one-year later. Various measures were utilised to capture the multifaceted concept of QOL, including psychological distress, satisfaction with life, positive affect and cancer-related quality of life. The investigation was conducted within Lazarus and Folkman’s stress and coping framework. Specifically, this research aimed to test the utility of the stress and coping framework in the context of CRC, and to explore the role of benefit-finding within the context of the stress and coping model components. One thousand, eight hundred participants (1078 men and 722 women) with a CRC diagnosis duration of 1 to 12 months, completed a telephone interview and written questionnaire, assessing demographics, disease/treatment characteristics, threat appraisal, social support, optimism, coping, benefit-finding and quality of life domains, at approximately five- and 12-months post-diagnosis. To identify CRC-specific coping strategies, the Coping with Colorectal Cancer measure was developed in the initial study. The eight factor structure was confirmed, and the subscales (Positive Perceptual Change; Religion/Spirituality; Rumination; Acceptance; Humour; Palliative; Seeking Social Support; and Lifestyle Reorganisation) found to have reliability and preliminary criterion-related validity within the context of the stress and coping framework. As predicted, regression analyses showed that, after controlling for demographics, disease/treatment characteristics and stress/coping variables, the coping subscales uniquely predicted Time 1 QOL outcomes, with Seeking Social Support continuing to predict Time 2 Positive Affect. In the second study, the benefit-finding domains specific to those with CRC were identified, and relationships with quality of life outcomes assessed, to determine the inclusion of benefit-finding in the path model. Based on completed data from 1757 of the initial 1800 participants, confirmatory factor analyses revealed three domains of benefit-finding: Personal Growth; Interpersonal Growth and Acceptance. As hypothesised, regressions analyses found that benefit-finding domains at Time 1 was associated with Time 1 QOL outcomes, specifically, Positive Affect and Cancer-related Quality of Life (both the aggregate score and its Social/Family, Functional and Colorectal Cancer-specific Well-being subscales). Time 1 Personal Growth also predicted Time 1 Psychological Distress. After controlling for Time 1 Positive Affect, Personal Growth continued to predict Time 2 Positive Affect. The final study drew on the results of the first two studies, which informed the coping strategies and benefit-finding domains to be included in regression analyses initially, and then, structural equation modelling. The final study included 1276 complete data sets of the initial 1800 participants. Parameters of the initial hypothesised model of the stress and coping framework, including relationships with benefit-finding (based on empirical findings) failed to fit the model to the data. After several revisions, the analysis revealed that the final model fit the data, where stress, coping and benefit-finding accounted for 63% of the variance in Time 1 QOL. The model showed that threat appraisal, coping resources, avoidant coping and benefit-finding directly impacted on Time 1 QOL, while threat appraisal, social support and approach coping directly impacted on benefit-finding. In this study, the approach coping strategies included in the path model could also be conceptualised as meaning-based coping strategies, as they appeared to facilitate a meaning-making process. However, benefit-finding, which some researchers have suggested is also a meaning-based coping strategy, had differential relationships with stress, coping and outcome variables, compared with the approach coping strategies. These results indicate that benefit-finding is an empirically distinct construct in the context of CRC. Finally, in this study, the impact of stress, coping and benefit-finding on Time 2 QOL, was indirect, being mediated by Time 1 QOL outcomes. The accumulated findings of these three studies have extended the cancer coping and benefit-finding research by revealing new relations between stress, coping and benefit-finding and QOL in a mixed-gender, older population with CRC. There are implications for measurement of, and theory building around benefit-finding. Finally, these studies inform the development of clinical interventions to enhance the quality of life in the short- and longer-term for individuals diagnosed with CRC.

Experiencing growth after the diagnosis of a life threatening illness is commonly reported among people living with HIV (PLWH). The links between benefit finding and better adjustment in PLWH have been identified, but it is less clear whether these links vary by ethnicity. Minority stress theory suggests that individuals from minority populations may have unique stress experiences, which can have negative health implications but may also provide opportunity for growth. We hypothesized that the association between benefit finding and psychological adjustment would be stronger for Black (n = 80) than White (n = 87) PLWH. Contrary to predictions, the relationship between benefit finding and better adjustment was significant for White but not Black PLWH. Post-hoc analyses suggested that sexual orientation played role in this relationship. The relationship between benefit finding and psychological adjustment may be complex for Black PLWH, or they may achieve adjustment using other resources.

The diagnosis of cancer in a child is one of the most significant stressors a parent can experience, and research in the area of stress-related effects of illness on parents has emerged in many areas. The majority of studies have focused on the potential or actual negative impact on parents during and after treatment of their child's illness. However, studies that initially set out to explore the difficulties associated with coping with childhood cancer found that parents often reported positive aspects about the experience. There is now increasing interest and support for the study of "positive-health" factors that contribute to protective variables influencing the health and well being of parents, such as benefit finding. The present study aimed to illuminate the process of benefit finding in parents of children with cancer and to develop a theoretical model of this process based on the findings.This grounded theory study resulted in a conceptual model that organized and depicted the constructs and structures related to the process of benefit finding. Through constant comparative analysis, the Basic Psychosocial Problem was identified as being overwhelmed with fear. The parents identified intervening conditions that helped move them from feeling overwhelmed to feeling that they could manage the fear. Many parents identified a specific event, an "epiphenomenon" that created a turning point for them. This event, along with the intervening conditions, moved the parent from being overwhelmed to managing/transforming the fear, which was the Basic Psychosocial Process. The strategies that the parents identified as helping to manage the fear are being in the present, being strong, having faith/maintaining hope, and making meaning out of the event, of which benefit finding was the major component. This entire process occurred within the context of being a parent, as this awareness colored the entire experience. Benefit finding emerged as both a strategy and an outcome within this process and encompassed a growth in character, strengthening of relationships, and a gain in perspective. The theoretical model and substantive theory that emerged during the course of this study provide a way to understand this process in parents of children with cancer.

Group delivered empirically supported therapies have been reported to have beneficial effects for cancer patients. However, little is known about the relationship between group cohesion and outcomes of these interventions. This study tested the hypothesis that group cohesion relates to the effects of a group intervention. Participants included 56 women with Stage I to II breast cancer who had completed a 10-week CBSM intervention 3 to 12 months after undergoing surgery and adjuvant therapy. Groups of 3 - 5 participants met weekly for sessions of approximately 1 hour and 45 minutes duration. All participants were assessed at baseline (2 weeks prior to beginning the intervention) and at follow-up (12 weeks after enrollment in the study). Cohesion was measured at the end of each intervention session by External Comfort (EC), a factor of the relatedness scale of the Stuttgarter Bogen instrument (1976). EC denotes an aspect of the sense of comfort of an individual within the group that is dependent on how the group participant relates to other members. EC score for session 9 (EC9), and change in EC from session 2 to session 9 (calculated as a change score, i.e., session 9 score minus session 2 score), were used for analyses as independent variables in simple linear regression models. Dependent variables were also calculated as a change score (i.e., follow-up minus baseline) and included benefit finding (Post Traumatic Growth Inventory PTGI, total score and its 5 factors), depression (CESD), urinary cortisol, and natural killer cell function (total percent, number and cytotoxicity). Results yielded a positive change in EC from session 2 to session 9 (M = 2.29, S.D. = 2.67). Regression analyses indicated a significant negative relationship between change in EC9 and change in total PTGI scores (beta= -.450, p= .011), and change in Factor 1 Relating to Others (beta=-.414, p=.021). A marginally significant negative relationship was observed between change in EC from session 2 to session 9 and the New Possibilities Factor of the PTGI (beta=-.323, p=.077). A median split, by change in EC, indicated that participants with high EC scores throughout the intervention showed an increase in total PTGI scores, and in two of the five PTGI factors at follow-up. In contrast, participants who initially scored lower values in EC showed no change in these variables. These results suggest that the longer it takes an individual to feel comfortable in the group, the less the individual would be able to find benefit from their cancer experience after the intervention.

The aim of the current study was to test the effectiveness of the written disclosure paradigm on psychological health, cognitive processing, dispositional and social factors and to improve the paradigm on the basis of the underlying mechanisms responsible for its benefits. Participants consisting of 73 Middle East Technical University students were randomly assigned to one of three groups to write during 30-min sessions on 3 consecutive days: (1) Guided Disclosure Group (GDG) / (2) Standard Disclosure Group (SDG) / (3) Control Group (CG). GDG wrote about their most upsetting life events according to exposure, cognitive reappraisal, and benefit-finding instructions, respectively. SDG wrote about their deepest thoughts and feelings related to their most upsetting life events. CG described familiar environments without including any emotion or opinion. All participants completed measures of psychological health (i.e., general psychological distress symptoms), cognitive processing (i.e., intrusive thoughts, avoidance, and appraisal of the event), dispositional (i.e., trait anxiety, alexithymia, coping styles) and social factors (i.e., perceived social support, and severity of negative life events) prior to the first writing session, following the third writing session, and a 1-month follow-up. It was expected that GDG would report more improvements in outcome measures, relative to SDG. In turn, SDG was expected to display greater improvements, relative to CG. All groups reported similar improvements in psychological distress symptoms, cognitive processing and alexithymia. The findings were discussed in terms of relevant literature.

No description available.