Centre for Trauma Resilience Growth,School of Sociology and Social Policy,Nottingham University

John Durkin

Psychological Growth Following Adversity in Firefighters

Posttraumatic Growth: Posttraumatic Growth: The role of social supportThe role of social support

John DurkinFireFit Conference

7th July 2009

Two Models of Health/Well-beingTwo Models of Health/Well-being

MEDICAL MODEL• Underlying cause• Endogenous• Biological• Expert• Diagnose & Treat• Aim to “feel better”• Restoration

PSYCHOSOCIAL MODEL• Organismic process• Interaction of self and

environment• Supportive environment• Valued and cared for…• Resolve own discrepancy• Growth tendency is innate

HedonicHedonic EudaimonicEudaimonic(Waterman, 1993)(Waterman, 1993)

• Pleasure• Goal attainment• Satisfaction• Affect & Feeling

• Wisdom• Understanding• Authenticity• Integrity

Subjective Well-BeingSubjective Well-Being(Diener, 1984)(Diener, 1984)

Positive Affect: e.g. “Excited; Enthusiastic; Alert”+

Negative Affect: e.g. “Upset; Nervous; Irritable”+

Satisfaction with Life: “In most ways my life is close to ideal”“If I could live my life over, I would change

almost nothing”

Psychological Well-BeingPsychological Well-Being(Ryff & Keyes, 1995)(Ryff & Keyes, 1995)

Positive Relations with Others: “Most people see me as loving and affectionate”“I have not experienced many warm and loving

relationships”Autonomy:

“My decisions are not usually influenced by what everyone else is doing”

“I tend to worry about what other people think of me”Environmental Mastery:

“In general I feel I am in charge of the situation in which I live”

“The demands of everyday life often get me down”

Psychological Well-BeingPsychological Well-Being (Ryff & Keyes, 1995)(Ryff & Keyes, 1995)

Personal Growth:“I have the sense that I have developed a lot as a person

over time”“I am not interested in activities that will expand my

horizons”Purpose in Life:

“I enjoy making plans for the future and working to make them a reality”

“My daily activities often seem trivial and unimportant to me”

Self-acceptance:“In general I feel confident and positive about myself”“In many ways, I feel disappointed about my

achievements in life”

Posttraumatic Growth InventoryPosttraumatic Growth Inventory(Tedeschi & Calhoun, 1996)(Tedeschi & Calhoun, 1996)

Appreciation of life“Appreciating each day”; “A willingness to express my emotions”

New Possibilities“I developed new interests”; “I established a new path for my life”

Personal Strength“A feeling of self-reliance”; “Knowing I can handle difficulties”

Spiritual Change“I have a stronger religious faith”; “A better understanding of spiritual matters”

Relating to Others“I accept needing others”; “A sense of closeness with others”

Changes in Outlook Questionnaire Changes in Outlook Questionnaire (Joseph et al. 1993)(Joseph et al. 1993) Positive (CiOP)

“I live every day to the full now” “I no longer take people or things for granted anymore”

Negative (CiON)“My life has no meaning any more” “I feel harder towards people”

MethodMethod

• Students at University of Nottingham (N=246)• Measures of Well-Being (PWB & SWB),

Distress (IES) and Growth• Convenience sample: English as first language• 125 scored 35 (IES) or over.

Growth & SWB Growth & SWB (PWB controlled)(PWB controlled)

1 2 3 4 5

1 Positive Affect -.08 .07 .08 .08

2 Negative Affect -.21* .06 .20*

3 Satisfaction with Life -.05 -.04

4 Positive Changes .66***

5 Posttraumatic Growth

*p< .05; **p< .01; ***p< .001

Growth & PWB Growth & PWB (SWB controlled)(SWB controlled)

1 2 3

1 Psychological Well-being .21* .18*

2 Positive Changes .67***

3 Posttraumatic Growth

*p< .05; **p< .01; ***p< .001

Growth following adversityGrowth following adversity

• Growth is related to psychological well-being (PWB), not subjective well being (SWB)

• Growth is a eudaimonic process, rather than a hedonic one

• The medical model may be inadequate in accounting for growth following adversity

What we now know…What we now know…

• Positive reports emerge from catastrophic experiences.

• Growth is positively related to distress.• Growth is related to PWB, not SWB.• The role of social support remains to be

investigated.

The Factors...The Factors...

GROWTHReports of enhanced sense of self, others and life (inc. spiritual).

• Posttraumatic Growth• Positive Changes in

Outlook• Stress-related Growth

SOCIAL SUPPORT“The sense of being valued, loved and cared for” (Cobb, 1976)

• Emotional (House, 1988)

• Structural• Perceived• Received

Growth MeasuresGrowth Measures

Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996)

• Relating to Others• New Possibilities• Personal Strength• Spiritual Change• Appreciation for Life

Changes in Outlook Questionnaire (CiOQ; Joseph et al. 1993)

• Positive Changes in Outlook (CiOP)

• Negative Changes in Outlook (CiON)

Social Support MeasuresSocial Support MeasuresPerceived Social SupportSocial Support Questionnaire

(SSQ; Sarason et al., 1987)

• Network size• Satisfaction with supports

Provision of Social Relations (Turner et al.,1983)

• Friends• Family• Colleagues

Received Social SupportCrisis Support Scale (CSS;

Joseph et al., 1992)

• Received support• Satisfaction with support

Negative Social SupportUnsupportive Social

Interactions Inventory (USII; Ingram et al., 2001 )

• Bumbling• Distancing• Blaming• Minimising

Longitudinal StudyLongitudinal Study

Social Support

Social Support

Growth Growth

Time One t1 Time Two t2

Traumatic Event

Longitudinal StudyLongitudinal Study

Social Support

Social Support

Growth Growth

Time One t1 Time Two t2

Traumatic Event

Completed StudiesCompleted Studies

• Literature Review• 35 studies (cancer,

sexual assault, heart surgery, combat)

• SS related to growth• No evidence of

causality• Methodological flaws

• Growth as Well-Being• Growth related to

positive emotions• Eudaimonic vs Hedonic

traditions• PTG is related to PWB

not SWB• Journal of Loss &

Trauma (2009)

Completed StudiesCompleted Studies

• Firefighters’ studies• All exposed to trauma• Growth not related to

social support• Social support appears

protective toward psychopathology

• Longitudinal: Phase 1• 70 firefighters CCFB• 70 firefighters NF&RS• All measures of Social

Support• Two measures of

Growth• At Phase 2, suggest

causal links?

Posttraumatic Growth: Posttraumatic Growth: The role of social supportThe role of social support

John DurkinFireFit Conference

7th July 2009