Post‐traumatic growth in stroke carers: A comparison of theories

The aftermath of traumatic events differs from person to person. Although some people show negative results, many people report positive results such as Post-traumatic Growth(PTG). PTG refers to positive psychological changes resulted from individuals' struggle against their main threatening life adversity, and it contains changed perception of self, changed sense of interpersonal relationship, and changed philosophy of life. Recently, the overwhelming majority of research has put their emphasis on the influencing factors of PTG, particularly the exploration of the developmental mechanism of PTG. According to Calhoun and Tedeschi's model of PTG, traumatic event is assumed to challenge the important components of individuals' assumptive world or core beliefs. When a trauma event happens, individuals are led to reexamine their core beliefs, and what makes it possible for individuals to recognize the positive changes and experience PTG. Therefore, the challenge to individuals' assumptive world or core beliefs is an important element for understanding the developmental process of PTG.Although many theoretical and empirical studies agreed that core belief challenge had effects on PTG, the roles of other relevant factors in the relationship of core belief challenge to PTG have been ignored. Relevant theories indicate that rumination may play an important role in the process which core belief challenge affects PTG, and social support may moderate the path which rumination impacts on PTG. For this reason, rumination and social support were incorporated into the exploration of relationship between core beliefs and PTG in our study, and the internal mechanism how core belief challenge affects PTG was also taken into much account. In the current study, 354 adolescents(165 males, 189 females) from grade 8, 9 in junior schools and grade 11, 12 in senior high schools of the Wenchuan county were investigated by means of questionnaires four and a half years after the Wenchuan earthquake. The main results were as follows:(1) The overall level of PTG among adolescents was high, while the level of female students was higher than that of male students, and the grade 8 students' PTG level was lower than that of students from any other grades.(2) Both intrusive rumination and deliberate rumination mediated partly the relationship between core belief challenge and PTG. On the one hand, core belief challenge could affect the PTG directly. On the other hand, core belief challenge could affect PTG negatively through intrusive rumination while had a positive effect on PTG through deliberate rumination. In addition, core belief challenge could affect PTG positively via the indirect way which intrusive rumination influenced deliberate rumination.(3) Neither the relationship of intrusive rumination to nor deliberate rumination to PTG, the path which social support moderated was the relationship of intrusive rumination to deliberate rumination. To be specific, the effect of intrusive rumination on deliberate rumination decreased with the increase of social support. That is, social support moderated the indirect path from intrusive rumination to PTG via deliberate rumination. The results have indicated that school psychologists should take notice of the changes in adolescents' core beliefs before and after the disaster, and guide them to think the significance of life positively. Moreover, the encouragement of positive cognition should also be given while social support for students be provided.

Purpose: The development of post-traumatic growth was studied longitudinally within 14 months poststroke. The predictions of two models of post-traumatic growth were examined.Method: Forty-three stroke survivors were investigated at two time points (i.e., time 1 and time 2), six months apart. Each completed the Post-traumatic Growth Inventory, Rumination Scale, Impact of Events Scale, Multidimensional Scale of Social Support, the Barthel Index and the COPE scale.Results: Post-traumatic growth was evident four to five months after stroke, increasing significantly over the next six months at which point levels resembled those reported in cross-sectional stroke studies. Active and denial coping and rumination at time 1 were positively associated, and age was negatively associated, with post-traumatic growth at time 2, but acceptance coping was not associated. Neither active coping nor rumination mediated the effect of social support on post-traumatic growth as predicted. As predicted, rumination mediated the relationship between post-traumatic stress and post-traumatic growth. Exploratory stepwise regression demonstrated rumination and active coping at time 1 accounted for 45% of variance in post-traumatic growth at time 2.Conclusions: Post-traumatic growth can develop soon after stroke. Deliberate rumination is a key factor in post-traumatic growth. Both active coping and denial coping were associated with post-traumatic growth demonstrating the psychological complexity of poststroke adjustment.Implications for rehabilitationTherapists can expect stroke survivors to show post-traumatic growth in the first months after stroke.Therapists should look to promote post-traumatic growth and positive adjustment through working with survivors to increase active coping (attempts to deal effectively with the impact of stroke) and rumination (cognitive processing of the impact of the stroke).Since denial coping was also associated with posttraumatic growth, stroke survivors who maintain overly optimistic views about the severity and impact of their stroke are likely to benefit from therapists continually facilitating capacity for growth and well-being.

Theoretical models of post-traumatic growth (PTG) have been derived in the general trauma literature to describe the post-trauma experience that facilitates the perception of positive life changes. To develop a statistical model identifying factors that are associated with PTG, structural equation modelling (SEM) was used in the current study to assess the relationships between perception of diagnosis severity, rumination, social support, distress, and PTG. A statistical model of PTG was tested in a sample of participants diagnosed with a variety of cancers (N=313). An initial principal components analysis of the measure used to assess rumination revealed three components: intrusive rumination, deliberate rumination of benefits, and life purpose rumination. SEM results indicated that the model fit the data well and that 30% of the variance in PTG was explained by the variables. Trauma severity was directly related to distress, but not to PTG. Deliberately ruminating on benefits and social support were directly related to PTG. Life purpose rumination and intrusive rumination were associated with distress. The model showed that in addition to having unique correlating factors, distress was not related to PTG, thereby providing support for the notion that these are discrete constructs in the post-diagnosis experience. The statistical model provides support that post-diagnosis experience is simultaneously shaped by positive and negative life changes and that one or the other outcome may be prevalent or may occur concurrently. As such, an implication for practice is the need for supportive care that is holistic in nature.

To examine the dyadic effects of rumination and self-disclosure on posttraumatic growth among newly diagnosed gynecological cancer couples. This cross-sectional study recruited 400 newly diagnosed gynecological cancer couples from a tertiary general hospital from July to December 2020. Questionnaires were administered to collect information on demographic and cancer-related characteristics, rumination, self-disclosure, and posttraumatic growth. The actor-partner interdependence model was used to explore the dyadic effects of rumination and self-disclosure on posttraumatic growth. Gynecological cancer survivors reported more posttraumatic growth than their spouses. The patients' deliberate rumination and self-disclosure and spouses' self-disclosure had actor and partner effects on their own and their spouses' posttraumatic growth. Besides, the patients' intrusive rumination and spouses' deliberate rumination had actor effects on their own posttraumatic growth. Spouses' posttraumatic growth was influenced by their own and their wives' deliberate rumination and self-disclosure, while survivors' posttraumatic growth was affected by their own deliberate rumination, intrusive rumination, self-disclosure, and their spouses' self-disclosure. Promoting deliberate rumination and self-disclosure could facilitate the couples' posttraumatic growth. Besides, reducing intrusive rumination may be useful for the survivors and indirectly contribute to spouses' posttraumatic growth. This study indicates that couple-centered interventions may be crucial and more effective in facilitating posttraumatic growth among newly diagnosed gynecological cancer couples.

The post-traumatic growth (PTG) model proposes that cognitive processing is a key mechanism that leads to growth in the aftermath of traumatic events. Building upon the PTG model, the present study examined the paths from the disruption of core beliefs to post-traumatic stress symptoms (PTSS) and PTG via intrusive and deliberate rumination. The sample includes 370 Korean undergraduate students who reported at least one highly stressful experience in their lifetime. Structural equation modeling demonstrated that disruption of core beliefs predicted PTG both directly and indirectly through multiple pathways: via deliberate rumination, intrusive rumination, and the path from intrusive to deliberate rumination. The disruption of core beliefs positively predicted PTSS only through intrusive rumination. No bivariate relationship was found between PTSS and PTG. These findings support the different roles of intrusive rumination and deliberate rumination in mediating the paths from disruption of core beliefs to PTSS and PTG. Implications and limitations of this study were discussed.

Research has indicated that clinical serious disease may lead to posttraumatic growth (PTG). However, little is known about PTG among hemodialysis (HD) patients. The study examined the relationship among resilience, rumination and PTG among Chinese HD patients. 196 HD patients were recruited from a tertiary hospital in a Northern city of China between 1 June 2015 and 30 May 2016. Patients were surveyed using the Posttraumatic Growth Inventory-Chinese version, Connor-Davidson Resilience Scale, and Chinese Event Related Rumination Inventory. Correlation analyses showed that resilience was most highly positively correlated with PTG (r = .70, p < .001), deliberate rumination moderately correlated to PTG (r = .50, p < .001), and intrusive rumination was lower negatively related to PTG (r = –.26, p < .001). Regression analyses showed that age, gender, duration of dialysis, resilience and deliberate rumination had significant associations with PTG (β = −.31, p ＜ .0001; β = –.14, p = .002; β = .10, p = .032; β = .44, p < .001; β = .20, p < .001). They together explained 65% of the total variance in PTG (F [8,195] = 46.74, p < .001). However, intrusive rumination was not associated with PTG (p > .05). The results suggested that resilience and deliberate rumination may be instrumental for PTG improvement.

Posttraumatic growth (PTG) may exist in trauma survivors, especially adolescents, whereas rumination is a typical cognitive characteristic among traumatized individuals. However, there were mixed relationships between rumination (intrusive rumination, deliberate rumination) and PTG. The study aimed to increase understanding of the relationships between them by investigating the role of social support among adolescents after the Yancheng tornado. Four hundred forty-three middle school students in the core area of the tornado were administered a revised social support scale based on Furman and Buhrmester's Network of Relationships Inventory, Event-Related Rumination Inventory, and Posttraumatic Growth Inventory. Results showed a nonsignificant relationship between intrusive rumination and PTG, whereas a positive relationship was found between deliberate rumination and PTG. Moreover, social support did not moderate the relationship between intrusive rumination and PTG, but it significantly mediated the relationship between deliberate rumination and PTG. Clinical implications on trauma intervention and limitations as well as future research directions were discussed.

Association of Rumination and Metacognition with Posttraumatic Growth in Parents of Children with Cancer

Purpose: The purpose of this study is to construct and test a structural equation model of posttraumatic growth (PTG) of earthquake victims based on Tedeschi and Calhoun’s model (2004). Methods: Data were collected from 195 earthquake victims living in K. City. The exogenous variables include distress perception, resilience, and social support, and the endogenous variables include intrusive rumination, deliberate rumination, and posttraumatic growth. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed. Results: The modified model showed a good fitness to the data. Moreover, 6 of the 9 paths of the final model were statistically significant, which include PTG affected by deliberate rumination (β=.58, p<.001), resilience (γ=.18, p=.001), and distress perception (γ=.20, p=.002). These predictors explain 51.8% of variance in posttraumatic growth. Conclusion: Based on the results of this study, it is necessary to develop and disseminate preventive intervention programs to increase the resilience of earthquake-prone communities. In addition, after exposure to a community-scale traumatic event such as earthquake, we should provide social supports to alleviate distress perception and transition from intrusive rumination to deliberate rumination so that we can seek new meaning from the earthquake and facilitate posttraumatic growth.

Coping and rumination as predictors of posttraumatic growth and depreciation

This study aims to examine the mediating effect of deliberate rumination between intrusive rumination and post-traumatic growth based on the post-traumatic growth model and the moderated mediation effects of self-compassion and gratitude in this mediation process. Data from an online survey of 223 university students with experience of interpersonal trauma experience, measuring experience of interpersonal trauma, impact of event, event-related rumination, post-traumatic growth, self-compassion, and gratitude were analyzed using SPSS 29.0 and PROCESS Macro 4.3. The main results are as follows. First, deliberate rumination partially mediates the relationship between intrusive rumination and post-traumatic growth. Second, self-compassion was found to moderate the indirect effect in the relationship between intrusive rumination and post-traumatic growth through deliberate rumination. Third, gratitude was found to moderate the indirect effect in the relationship between intrusive rumination and post-traumatic growth through deliberate rumination. Based on the research results, suggestions and implications for follow-up research were discussed.

Introduction: The term “post-traumatic growth” describes positive outcomes that accrue from the struggle with highly challenging life circumstances. The purpose of this study is to describe post-traumatic growth accruing from experience with vision loss caused by age-related macular degeneration (AMD) and to identify the relationships between depression, cognitive processing, social support, and post-traumatic growth. Methods: Individuals with vision loss caused by AMD completed an interviewer-administered composite questionnaire to identify elements of Tedeschi and Calhoun’s theoretical model of the process of posttraumatic growth, including measures of distress (depression), intrusive and deliberate rumination (cognitive processing), and social support (quality and quantity of social ties). Relationships were examined using path analysis. Results: Eighty-nine participants completed the questionnaire (mean age = 85.3 years, range = 74–98 years). All paths, including from depression to social support (β = –.363, p &lt; .001), from social support to deliberate rumination (β = .233; p ≤ .01), and from intrusive rumination to deliberate rumination (β = .514, p &lt; .01), were significant and consistent with the posttraumatic growth theoretical model. Deliberate rumination had a significant direct path to post-traumatic growth (β = .38, p = .001). Discussion: The findings may illuminate elements of the process of post-traumatic growth among those with AMD. We found that as social support increased, depression decreased. Increased social support seemed to encourage positive deliberate rumination, which led directly to post-traumatic growth. Although intrusive rumination is often associated with negative outcomes, the model demonstrates that it also stimulates engagement in deliberate attempts to process one’s experience. Deliberate cognitive processing is a direct precursor to post-traumatic growth. Implications for Practitioners: A focus on the process of growth and thriving can offer a broader view of the experience of living with vision loss. Interventions that foster post-traumatic growth among those with AMD should focus on enhancing social support and facilitating deliberate cognitive processing.

Objectives The present study examined the existence of posttraumatic growth (PTG) and its association with cognitive processing, resilience, and family functioning in family caregivers of patients with Alzheimer’s disease (AD). Method Family caregivers (N = 114) were surveyed using measures of cognitive processing, resilience, family functioning, and PTG. Data were analyzed using descriptive statistics, Pearson correlations, and multiple regression analyses. Results The average PTG score in the sample was 48.6 (SD = 18.7; range 14–105). Race, education level, severity of the patient’s AD, cognitive processing, resilience, and family functioning explained 25.8% of the variance in PTG (F [9, 95] = 5.025, p < 0.001). Race was significantly correlated with PTG; specifically, non-White caregivers reported higher PTG than White caregivers (p < 0.05). When controlling for race and education level, mild AD, intrusive rumination, and family satisfaction were significant predictors of PTG (p < 0.05). However, deliberate rumination, resilience, and family communication were not significant predictors PTG (p > 0.05). Conclusion These findings provide insight into factors that may influence the development of PTG in family caregivers of patients with AD. Results may inform intervention strategies to mitigate the negative consequences of caregiving and promote PTG in this caregiver population.

Correlates of posttraumatic growth among spouses of newly diagnosed gynecological cancer survivors: A cross-sectional study.

Nurses working in intensive care units are repeatedly exposed to trauma (e.g., verbal or physical abuse by confused patients, and unexpected death). However, after experiencing traumatic events, not all intensive care unit nurses develop psychopathological issues, including posttraumatic stress disorder. Therefore, this study aims to examine the level of posttraumatic growth and psychosocial factors such as posttraumatic stress symptoms, deliberate rumination, wisdom, and self-compassion to predict posttraumatic growth in Korean intensive care unit nurses. A total of 156 intensive care unit nurses participated in this cross-sectional survey. Posttraumatic growth, posttraumatic stress symptoms, deliberate rumination, wisdom, and self-compassion were measured using validated self-report scales, and data were analyzed by descriptive statistics. Posttraumatic growth was found to be comparatively low in intensive care unit nurses, while multiple regression showed that positive self-compassion was the most significant predictor for posttraumatic growth, followed by wisdom, age, and deliberate rumination. All together four variables explained 30% of the variance in posttraumatic growth. Findings from this study suggest that intensive care unit nurses' posttraumatic growth may be enhanced by increasing positive self-compassion, wisdom, and deliberate rumination. Therefore, a paradigm shift focusing on possible positive pathways, such as development of mental health programs to improve posttraumatic growth for intensive care unit nurses is required rather than focusing on management of posttraumatic stress disorder. The results of this study could provide theoretical guidance to seek more effective and integrated intervention strategies for intensive care unit nurses.