The purpose of this dissertation was to examine coping and outcomes of grief for atheist individuals during bereavement. The landscape of grief research has significantly changed since the days of Freud, and widely accepted stage theory models of grief have not held up to empirical review (Wortman & Silver, 1989). Emerging research examines factors that may lead to positive changes as a result of loss or trauma, known as posttraumatic growth. However, atheist individuals continue to be an understudied group in the psychological and bereavement literature, while people with religious beliefs continue to receive the most focus (Brewster, Robinson, Sandil, Esposito, & Geiger, 2014; D’Andrea & Sprenger, 2007). This study explored how cognitive (e.g., assumptions about the world), existential (e.g., meaning), and behavioral (active and emotional) coping methods are associated with posttraumatic growth, complicated grief, and psychological distress in a believer and atheist sample after the death of a close friend or family member. Specifically, posttraumatic growth, complicated grief, and psychological distress were regressed onto the three types of coping (cognitive, existential, and behavioral) using a hierarchical regression analysis. The first analysis controlled for demographic variables and the second analysis consisted of matched groups on demographic variables that were found to be associated with grief outcomes in prior research (e.g., Bonanno et al., 2008; Bonanno, Galea, Bucciarelli, & Vlahov, 2007). Exploratory bivariate correlations were conducted to assess interrelations between the variables of interest. Additionally, MANOVA was used to assess differences in demographic variables between the believer and atheist sample. Significant cognitive, existential, and behavioral coping methods were found to be associated with posttraumatic growth, complicated grief, and psychological distress. Furthermore, the endorsement of a belief in God(s) was significantly and positively associated with posttraumatic growth, but also significantly and positively associated with complicated grief and psychological distress. Results from this study can be used to identify appropriate clinical strategies for counselors working with grieving atheists, and will deepen the breadth of literature on bereavement and coping within diverse populations. Limitations and directions for future research are also discussed.

Research suggests that individuals experience Posttraumatic Growth (PTG) from chronic health conditions, such as the diagnosis and treatment of cancer. How PTG is perceived at early time points following stressful events and whether PTG reflects a coping process or actual outcome remains uncertain. Researchers have implemented research methodologies to validate reports of PTG (e.g., corroboration by partners/significant others), although most research designs are cross-sectional, which limit conclusions and subsequent implications. The current longitudinal study examined cancer patients` and significant others` perceptions of Anticipated Posttraumatic Growth (APTG), dispositional and situational coping, and PTG at three time points spanning pre-treatment to 9 months later. Participants consisted of 87 mixed-cancer patients and 55 collaterals (e.g., spouses, family members, friends, or other community members). At pre-treatment, patients and collaterals completed a modified Posttraumatic Growth Inventory (PTGI) to assess APTG. Collaterals also completed a modified PTGI for patients. Results revealed that patients and collaterals reported high levels of APTG for themselves compared to reports of PTG in the literature. Patients` APTG was significantly higher than collaterals` APTG, although patients and collaterals experienced similar levels of PTG. Overall, patients over-anticipated PTG for all growth scales, and with the exception of the PTG scale of new possibilities, collaterals under-anticipated the level of growth they reported. For corroboration of growth, collaterals were accurate in anticipating the amount of PTG patients would experience, with the exception of the PTG scale of new possibilities. For patients, dispositional planning coping moderated a relationship between PTG and APTG, and situational planning coping mediated a relationship between APTG and PTG. Results of the current study provide evidence for APTG as a possible illusory phenomena, a coping process, and animportant precursor for later PTG. Additionally, the results have important considerations for the impact of cancer on the family and for growth as an observable construct. The findings are discussed in terms of relevant theory and implications for clinicians.

The field of psychology has traditionally focused on the deleterious effects of adversity to the exclusion of positive effects. However, a literature on positive sequelae of traumatic events has burgeoned over the past decade. The issue of whether individual's reports of positive changes are merely illusory self-enhancing biases or are reflective of objective, quantifiable change is perhaps the most contentious in the posttraumatic growth research at this time. This dissertation begins with a broad overview of the extant research on posttraumatic growth, then presents the evidence supporting each side of the validity debate. As the population studied in this dissertation is adults with traumatic-onset spinal cord injuries, a presentation of research that ties disability to the posttraumatic growth literature follows. Finally, the introductory chapter concludes with an argument for the importance of including a disability perspective in psychological science. Three papers follow, each taking up aspects of this relatively new focus on positive aspects of disability. / Psychology

By using the theoretical framework developed by Schaefer and Moos (1998), this study examined the mechanisms through which personal beliefs in ultimate justice affect posttraumatic growth in female survivors of sexual assault. Problem solving, spiritual coping, and meaning making were examined as potential mediators between beliefs in ultimate justice and posttraumatic growth through a path analysis. In total, 144 female community survivors, psychology students, and other participants were recruited from a large mid-western university (mean age = 29.3). The online survey was composed of a demographic questionnaire, the Revised Sexual Experiences Survey (Koss et al., 2007), Emotion Thermometer (Mitchell, 2001), Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996), Belief in Immanent and Ultimate Justice Scale (Maes, 1998), Trauma Resilience Scale (Madsen & Abell, 2010), and the Meaning in Life Questionnaire (Steger, Frazier, Oishi, & Kaler, 2006). Results indicate that problem solving and spirituality significantly mediated the relationship between belief in ultimate justice and posttraumatic growth. Search for meaning significantly mediated the relationship between beliefs in ultimate justice and distress. Implications for practice and research are discussed. Keywords: sexual assault, posttraumatic growth, belief in a just world, meaning making, coping

This research portfolio examines the impact of trauma exposure in the emergency services. Emergency services represent a unique population in that they are frequently and repeatedly exposed to distressing and potentially traumatic situations. Firstly, a systematic review was conducted looking at factors that may potentially predict positive outcomes following trauma exposure in firefighters, namely the concept of posttraumatic growth (PTG). A review of the existing evidence was conducted across five databases. Studies were assessed against inclusion criteria and 12 studies were included. Results suggested that PTG was generally either not significantly or weakly related to other factors. Variables that were associated with PTG were aspects of the trauma exposure, post-traumatic stress severity and organisational and operational factors; however results were limited by methodological quality. Overall, the current evidence base has not identified strong predictors of PTG and associations appear multifactorial. Results indicate that PTG appears to have limited clinical utility in firefighters and that future research should improve upon the methodological limitations of the existing evidence base. The second part of the portfolio consists of an empirical study exploring the levels of post-traumatic stress symptom (PTSS) severity in ambulance clinicians and a cross-sectional analysis of factors relating to PTSS severity and psychological wellbeing in this population. A total of 508 ambulance clinicians (Paramedics and Ambulance Technicians) were recruited across Scotland. The relationships between PTSS severity, psychological wellbeing, self-compassion and psychological inflexibility were analysed using structural equation modelling. Results showed approximately 50% demonstrate clinically concerning levels of PTSS in the ambulance service and a strong positive relationship between psychological inflexibility and PTSS severity as well as with psychological wellbeing. Self-compassion had a small association with psychological wellbeing but was not significantly associated with PTSS severity. The potential impact of relying on post-traumatic stress disorder criteria of symptoms lasting for four weeks or more may mask the extent of PTSS experienced in this population. Findings indicate concerning levels of trauma symptomology within a representative ambulance service sample, and suggest the need for further investigation into potential causal relationships between psychological flexibility and PTSS in order to deliver effective interventions to reduce PTSS severity in this population.

This thesis portfolio consists of two key pieces of work, a systematic review and an empirical research project, both of which explore outcomes associated with traumatic experiences. Systematic Review – There is a growing body of literature which demonstrates that, alongside the difficulties people may experience following trauma, many individuals are also likely to report growth following the struggle to come to terms with the event. This review explores the evidence for a relationship between reported growth and distress following civilian, interpersonal trauma. The review includes 13 studies which met the inclusion criteria (9 cross-sectional and 4 prospective). Findings are inconsistent and suggest that prospective study designs are more likely than cross-sectional designs to report significant relationships. A number of methodological issues and the implications for future research are discussed. Empirical Research Project – Survivors of childhood sexual abuse (CSA) present with a wide range of difficulties and the current evidence base for the treatment of complex trauma is limited. It is proposed that self-compassion and forgiveness based approaches may have the potential to be of benefit to this population. This cross-sectional study explored the relationships between posttraumatic stress symptoms, dissociation, self-blame, self-compassion and forgiveness. A clinical sample of adult survivors of CSA (N = 19) completed all measures. In keeping with previous literature, significant relationships were found between posttraumatic stress and both dissociation and self-blame. Forgiveness was positively correlated with dissociation, but not the other variables and no significant relationships were found between self-compassion and the variables of interest. Findings, implications and study limitations are discussed.

Previous research on the symptoms of Moral Injury suggests that it commonly results in clinical impairment (Drescher et al., 2011). Recent models have suggested that Acceptance and Meaning-Making may moderate the relationship between Moral Injury and Posttraumatic Growth (Blackie et al., 2016). However, Meaning-Making and Acceptance have yet to be examined in a population with Moral Injury. Data were collected from 120 participants from Amazon Mechanical Turk (MTurk) online marketplace. Participation was restricted to U.S. military and veterans who have experienced a traumatic event. Participants completed a demographics questionnaire (Seidler, 2016), the Posttraumatic Checklist (PCL; Weathers et al., 2013), the Moral Injury Questionnaire-Military Version (MIQ-M; Currier, Holland, Drescher, & Foy, 2013), the Integration of Stressful Live Events Scale (ISLES; Holland, Currier, Coleman, & Neimeyer, 2010), the Acceptance Subscale of the Multidimensional Psychological Flexibility Inventory (MPFI; Rolffs, Rogge, & Wilson, 2016), and The Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1995). This study tested the following research hypotheses: 1) Scores for Meaning-Making and Acceptance will significantly and positively predict scores for Posttraumatic Growth in a sample population with PTSD; 2) Scores for Meaning-Making and Acceptance will moderate the relationship between measures of Moral Injury and Posttraumatic Growth, with higher scores of Meaning-Making and Acceptance resulting in higher scores of Posttraumatic Growth and lower scores of Meaning-Making and Acceptance resulting in lower scores of Posttraumatic Growth; 3) Three distinct groups of people can be high and low scores for Moral Injury and symptoms of PTSD. In contrast to the hypothesis, both Acceptance of negative emotions and Meaning-Making demonstrated direct effects but did not moderate the relation between Moral Injury and Posttraumatic Growth. Acceptance also appears to partially mediate the relationship between Moral Injury and PTG. The results of the cluster analysis identified three groups of participants based primarily on scores for Moral Injury, namely those with high, low and moderate scores. Participants with high Moral Injury scores had high scores for PTSD symptoms. The other two groups had moderate PTSD symptom scores. Implications of findings and suggestions for future research are discussed.

The COVID-19 pandemic has negatively affected everyone in the world, however the phenomenon of growth following intense suffering has been well-documented over the past few decades (e.g., Tedeschi et al., 2018). Less research has been able to explain why some experience growth from trauma while others do not. Drawing from Joseph and Linley’s (2005) Organismic Valuing Theory model of posttraumatic growth, we examined the role of the basic psychological needs of autonomy, competence, and relatedness (during the onset of the pandemic and currently) in fostering posttraumatic growth. Participants (N = 289) completed an online survey assessing the impact of the pandemic, basic psychological needs, and posttraumatic growth. We hypothesized that participants with greater satisfaction of basic psychological needs during the onset of the pandemic and currently would report greater posttraumatic growth. We found that current satisfaction of psychological needs significantly predicted posttraumatic growth (β = .42, p < .001) whereas satisfaction of psychological needs at onset did not. Secondary analyses of the impact of each need (current and at onset) on posttraumatic growth revealed that current autonomy support significantly predicted posttraumatic growth above and beyond the other needs across both time points (β = .29, p < .001). Interpretations of these results are discussed, and implications and limitations of the study are addressed. / Graduate / 2023-12-31

No description available.

INTRODUCTION: Since September 11, 2001, over 2.5 million military service members have been deployed to combat zones to support operations in the War on Terror and over 250,000 service members transition out of the military every year (United States Department of Veterans Affairs, 2022). Evidence-based research suggests that this cohort of post-9/11 combat veterans can struggle with community reintegration and associated functional difficulties in the areas of disruption of identity, challenged beliefs about self and others due to trauma and moral injury, occupational disengagement, and limitations with social and role participation. OBJECTIVES: Many combat veterans find themselves returning home by a different way, struggling to find their place in the civilian world while maintaining their identity as a warrior. Occupational therapy can bridge the functional divide between these two worlds by helping modern-day warriors rebuild and reclaim their roles, occupations, and purpose. Master of Two Worlds is an interactive multimedia workbook designed to facilitate posttraumatic growth and community reintegration for post-9/11 combat veterans in the VA system with or without a mental health diagnosis. METHOD/APPROACH: The workbook uses Campbell’s (2008) Hero’s Journey framework to help veterans form a cohesive life narrative, determine new goals, and acquire civilian occupational skills. Readers will be able to access interactive multimedia videos and activities with their cell phones through QR codes in the workbook. Practical hands-on workbook activities focus on self-care, habit and routine formation, spirituality, and social and leisure participation, as well as integrating roles and identity to empower mastery of the military and civilian worlds. A mixed-methods pilot study will be conducted at the VA Long Beach Healthcare System (VALBHS). Quantitative data will be collected pre- and post-intervention using the following standardized outcome measures: Military to Civilian Questionnaire (M2C-Q), the PTSD Checklist for DSM-5 (PCL-5), and the Posttraumatic Growth Inventory – Expanded version (PTGI-X). Qualitative data will be collected via one-on-one interviews. ANTICIPATED OUTCOMES: Successful community reintegration of post-9/11 combat veterans through forming a new civilian occupational identity that integrates the warrior experiences as expressed through establishing healthy habits and routines, developing new priorities, goals, and possibilities for the future, redefining personal moral code to heal from moral injury, establishing a close social support network, and finding a sense of personal strength. Results and or Practice Implications: It is hypothesized that results will demonstrate statistically significant score changes on the outcome measures. Dissemination of the workbook will take place through an interdisciplinary community of practice on the national VA level and through key VA staff at strategic clinics within the system. CONCLUSION: Combat is a form of trauma. Posttraumatic growth and community reintegration are the ultimate successful outcomes of war trauma. It is incumbent on practitioners in occupational therapy to facilitate these outcomes for the betterment of those who have served and for society.