Meaning and Posttraumatic Growth During Bereavement

Last semester, I took a course on Positive Psychology. We were told to write a 10-page research paper on any topic regarding Positive Psychology. I chose to write about positive outcomes of grief, in hopes of finding some beneficial information. Here is the paper I turned in for class. Perhaps it may help some of you who are also grieving. I also included the academic artciles that I used as references, if you are interested in the original research. I enjoyed learning about this topic, but I can see that, as of now, not much research has been focused on the topic of the positive outcomes of grief.

 

 

 

Meaning and Posttraumatic Growth During Bereavement:

A Focus on College Students

Following the death of a loved one, it is possible that the most positive outcome of bereavement would be to develop a sense of meaning about the loss and to foster posttraumatic growth.  This personal growth can manifest itself in several different ways, including heightened maturity and self-esteem; enhanced tolerance, compassion, spirituality, and emotional strength; and a greater appreciation of life.

Bereavement is the condition caused by the death of a loved one. Following the loss, individuals often feel sad, depressed, anxious, angry, and alone.  No matter how they may react to the death, the feelings they experience are considered grief. After losing someone close, people have no control over whether they experience bereavement, but they can control how they grieve.  For example, some people may choose to cope by either ignoring the reality of the loss, but others may directly confront the truth.

Dr. K­übler-Ross revolutionized the study of death and dying in her 1969 book appropriately titled On Death and Dying.  She developed five stages of grief that were first applied to terminally ill patients dealing with their own mortality, but were later expanded to include all types of loss.  In no particular sequential order, the five stages are denial, anger, bargaining, depression, and acceptance.  Though K­übler-Ross’ concept of the five stages of grief is commonly accepted and referred to in popular culture, its validity has been brought into question by others in the field, including philosopher Dr. Attig.

In his book, How We Grieve: Relearning the World (1996), Attig rejects the concept of stages of grief and that bereaved individuals can “recover” from a loss. Instead, he asserts that people develop ways to live with the loss, from loving the deceased in the present to loving the deceased in their absence.

Following in this vein, the Developmental Psychology textbook Human Development: A Life Span View by Kail and Cavanaugh (2010) states that during bereavement, “we must reorganize our lives, establish new patterns of behavior, and redefine relationships with family and friends” (p. 613).  Kail and Cavanaugh maintain that a bereaved person must complete the following during the grief process: “acknowledge the reality of the loss, work through the emotional turmoil, adjust to the environment where the deceased is absent, and loosen the ties to the deceased” (p. 613-614).

Balk (2008) built upon the frameworks of leading grief researchers, such as Attig, to develop a “holistic template” which identifies six areas of a bereaved person’s life which may be affected by grief (p.8). These particular areas are the physical, behavioral, interpersonal, cognitive, emotional, and spiritual aspects of an individual’s life.  Examples of the effects of grief on each aspect of a person’s life include difficulty sleeping (physical), difficulty staying organized and meeting deadlines (behavioral), difficulty maintaining friendships with non-bereaved people (interpersonal), difficulty concentrating and remembering (cognitive), difficulty controlling sudden bursts of sadness (emotional), and difficulty understanding the existential question “Why?” (spiritual) (Balk 2008).  

This period of grief could potentially last for many years, but most people eventually learn how to cope with the loss and move forward with their lives.  Research has shown that the emotions of losing a loved one never truly go away, but the intensity of grief usually peaks within the first six months of bereavement (Kail & Cavanaugh 2010, p. 616).

While most are able to cope with the grief, approximately 10 to 15 percent of individuals experience what is known as Prolonged Grief Disorder, also referred to as “complicated grief” (Bonanno, 2004). Prolonged Grief Disorder is a psychological condition that is being considered for inclusion in the next edition of the Diagnostic and Statistical Manual of Mental Disorders. Symptoms of this disorder include daily yearnings for the deceased for months, difficulty accepting the death, impaired functioning in daily life, and loss of purpose in life (Neimeyer, et. al. 2008). Prolonged Grief Disorder has been associated with psychological issues including generalized anxiety and depression, and physical issues including stress-related diseases of the immune and cardiovascular systems (Neiymeyer, et.al. 2008).  Gerrish, et. al. (2009) theorize that the bereaved people who experience Prolonged Grief Disorder, or possibly even Posttraumatic Stress Disorder, after the loss of a loved one are psychologically predisposed to treat the experience as traumatic.  For example, they may have this predisposition because of negative attachment experiences during childhood.

Although only 10 to 15 percent of bereaved people can be categorized as experiencing Prolong Grief Disorder, this pathologically dramatic reaction to bereavement has been the focal point of most research on the topics of loss and trauma (Bonanno 2005). The study of normal or even positive experiences of bereavement is rare in comparison to the body of work regarding Prolong Grief Disorder. This perspective on bereavement is explored by the Positive Psychology movement, which believes that the discipline of Psychology has focused too much on psychological pathology and not enough on how people flourish (Seligman & Csikszentmihalyi 2000).

Gerrish et. al. (2009) explain the positive outcome of bereavement in which the person is “left in a better psychological state as a result of the adversity” (p. 226).  They further explain this “positive change”:

Positive change has been defined as personal transformation, posttraumatic growth, thriving, resilience, benefit-finding, positive life change, stress-related growth, and meaning reconstruction. Persons who have experienced positive change may be more compassionate; live life more fully; be wiser and more accepting of life’s paradoxes; be more mature and have enhanced self-esteem; be more patient, tolerant, empathetic, and courageous; be more spiritual and religious; and have heightened existential  awareness. (p. 227)

 

There is research focusing on each of these definitions of “positive change” mentioned above, though not all of the factors correlate with each other.

Bonanno (2005) explores the positive outcomes of bereavement and found intriguing results.  His research has found that 10 to 30 percent of people were severely affected over a two year period following a loss.  These individuals could be categorized as experiencing Prolong Grief Disorder.  5 to 10 percent of people experienced a delayed grief response, usually beginning to react to the loss around 1½ years after the event. 15 to 35 percent of people experienced moderate to severe psychological symptoms initially after the event, but the symptoms gradually lessened over the course of two years, finally returning to pre-loss levels. This experience is known as “recovery”. Surprisingly, the largest group, 35 to 55 percent, experienced “resilience”, meaning they initially experienced a brief increase of distress directly following the loss, but returned quickly to relatively normal functioning. These resilient people would experience brief and sporadic moments of anguish, but overall maintained a psychological balance.

Resilience is one of the “positive changes” mentioned by Gerrish et. al. (2009).  However, Bonanno (2005) did not believe that a connection between resilience and personal growth after a loss existed. Though he did not study the connection between resilience and posttraumatic personal growth specifically, he felt that bereaved people who experienced recovery during bereavement were more likely to sense a personal growth than those who were resilient.

The connection between resilience and posttraumatic growth is not definitive. Some researchers including Bonanno (2005) argue that the bereaved person needs to experience substantial amounts of distress in order to grow from the experience. Others disagree, stating that resilient people are more likely to recognize the positive aspects of bereavement (Aldwin & Levenson 2004). This hypothesis forms connections between people who have high levels of resilience/hardiness and view the experience of a loss with high levels of optimism/hope, and therefore are more likely to experience posttraumatic growth. This connection has been studied by Mathews & Servanty-Seib (2006) and Michael & Snyder (2005), both of whom focused their studies on college students.

College students present a unique set of issues to those studying bereavement.  Most undergraduate college students are between the ages 18 and 23, transitioning from adolescence to young adulthood and beginning to develop a sense of self (Kail and Cavanaugh 2010).  

It has been estimated that between 22 to 30 percent of undergraduate college students are in the first 12 months of bereavement (Balk 2008 and Hardison, Neimeyer, & Lichstein 2005). Knox (2007) claims that 40 to 70 percent of undergraduate college students will experience the death of someone close while are in college. “Bereavement may be a silent epidemic on [college] campuses” (Neimeyer, et. al. 2008, p. 36), yet “institutions of higher education are not settings conductive to the exploration and expression of grief” (Mathews & Servanty-Seib 2006, p. 187).

Throughout the bereavement process, college students face many hindrances, including “constant academic pressure, an environment that emphasizes having fun, peers who are unable or unwilling to provide support, and distance from their families and home communities” (Mathews & Servanty-Seib 2006, p. 187). Balk (1997) states that many college students feel that their unaffected peers do not understand the intensity and duration of grief. The bereaved college students themselves rarely avoid thinking about the death, but their unaffected peers prefer to avoid talking about the grief. Bereaved college students stated that they felt that talking about the grief was helpful, but that their unaffected peers seemed uninterested or uncomfortable whenever the topic of grief or death was mentioned. Balk asserts that “bereaved college students find few, if any, persons in the university willing to discuss the death, to acknowledge the importance of this event in the student’s life, or to recognize the significance for the griever of the person who died” (Balk 1997, p. 218).  Balk (2008) encourages colleges and universities to offer more resources for the grieving. He argues that this would not only help the student emotionally and academically, but it would also help the university because it “may ultimately affect a school’s retention and graduation rates” (p. 12).

Having experienced a traumatic loss in my own life, the death of my mother in the past 12 months, I can attest to feeling that unaffected peers were avoiding or felt uncomfortable about the topic of grief. I have experienced a friend of mine say to me, “I try not to talk about my mom around you because you don’t have one.” This statement made it clear that my friend did not understand what it felt like to grieve. I certainly do not feel like I “don’t have” a mom.  To the contrary in certain regards, I have gained a greater connection with my mother as a result of this experience.

Some of my other friends seem to only want to “hang out” and don’t understand why I can’t “have fun” like I used to. I am under the impression that most of my friends feel as though avoiding the topic of my mother and her death is what’s best for me. However, I feel that talking about her death more often would be beneficial to my mental health, instead of reflecting on the grief internally.

Michael & Snyder (2005) investigated the role of reflection, hope and optimism, and finding meaning in bereaved college students. They and other researchers (Boyraz, et. al.2010) consider reflection to be divided into two subtypes: rumination and cognitive processing. Rumination is defined as repetitive thoughts on the negative emotions of grief without reaching a solution to lessen these emotions. Rumination is intrusive to daily life and is a maladaptive coping strategy (Michael & Snyder 2005). Defined this way, rumination can be categorized as a symptom of Prolonged Grief Disorder.

Cognitive processing also manifests itself in repetitive thought, but these thoughts are focused on productively finding a resolution to the “discrepancies between cognitive models of the world pre-death and new information from the experience of the death” (Michael & Snyder 2005, p. 437).  After a traumatic loss, one’s assumptive world — “where much that the individual has counted on as being reliable, predictable, and even controllable” — has been shattered (Caserta, et. al. 2009, p.463). In order to cope with the grief effectively, the bereaved must relearn the world, as explained by Attig’s (1996) theories, mentioned earlier.

A critical result of cognitive processing when related to bereavement is the ability to find meaning in the loss. The type of meaning found may also be divided into two categories: sense-making and benefit-finding (Michael & Snyder 2005, and Neimeyer et. al. 2008), which are listed in the Gerrish, et. al. (2009) description of “positive change” after a loss, mentioned earlier.

Similar to Michael & Snyder (2005), research done by Neimeyer, et. al. (2008) also focuses on bereaved college students, and both studies compare or contrast the role of sense-making and benefit-finding in finding meaning in the death.

Sense-making is more likely to occur in the first year after the death and is associated with less rumination during bereavement (Michael & Snyder 2005, and Neimeyer et. al. 2008). It is suggested that people who ruminate about the death do so because they have been unable to make sense of the loss (Michael & Snyder 2005). Sense-making is also associated with a positive well-being after the bereavement process.

Benefit-finding is more likely to occur after the first 12 months post-loss and includes finding any aspect of the loss to be beneficial for the bereaved person or others in their life. This includes experiencing posttraumatic growth (individual) or feeling grateful that the death ended their loved one’s suffering (others). As mentioned earlier, I have found some benefits to my own personal bereavement: I feel that my experience strengthened my relationship with my mother. As my bereavement process continues, I may find other benefits of the experience. Benefit-finding is a strong predictor of positive well-being during the early phases of bereavement. But benefit-finding after the first 12 months post-loss is linked to poor-wellbeing.

It is hypothesized that bereaved people attempt to make sense of the loss, and if they are successful, they experience positive well-being. If they are unsuccessful in making sense of the death, then they attempt to search for benefits of the loss. This usually begins around 12 months after the death. At this time, benefit-finding becomes “an inadequate strategy in an attempt to cope with ongoing intrusive rumination and the attending distress” (Michael & Snyder 2005, p. 453).

Research by Neimeyer, et. al. (2008) states that college students who displayed the most symptoms of Prolonged Grief Disorder were those who neither made sense nor found benefits of the loss. The students who adjusted best to the grief were those who reported high degrees of sense-making but low degrees of benefit-finding from the death, possibly because sense-making is a finite process, but benefit-finding is ongoing. Research from Michael & Snyder (2005) suggests that the ongoing process of benefit-finding “is not so beneficial. It appears that it is more adaptive to find benefits early and then move on with life” (p. 454).

Michael & Snyder (2005) studied how hope and optimism are related to finding meaning after a loss in bereaved college students. Optimists have shown to use “active and adaptive coping strategies” that guide the person to positive adjustment during an adverse situation such as a traumatic loss (Michael & Snyder 2005, p. 439). They define hope as a “goal-directed thought processes” (p. 439). Research has shown a strong correlation between finding meaning in life and being hopeful. Michael & Snyder (2005) found that because hopeful people are by definition more goal-oriented, they will focus on recovering from grief quickly and are less likely to be bogged down by ruminations. Hope was also found to predict positive well-being in bereaved individuals and help them redefine and restructure their lives so that they may live effectively. However, hope was not found to be helpful in finding meaning within the loss. Instead, hope is associated with a general sense of meaning in life, which may or may not help the individual to make sense or find benefits in the loss.

The topic of resilience and hardiness in bereaved college students was studied by Mathews and Servanty-Seib (2006). Their research found that hardiness was inversely correlated to bereavement-related distress, and was an excellent predictor of the intensity of grief to be felt by bereaved individuals. However, Mathews and Servanty-Seib (2006) found no relationship between hardiness/resilience and posttraumatic growth, suggesting that the hypothesis presented by Bonanno (2005) may be correct: posttraumatic growth would be found in people who experienced recovery from a loss, instead of resilience.

This hypothesis is supported by Caserta et. al. (2009), who state that people who struggle with grief but learn to rebuild their lives may develop posttraumatic growth. They define posttraumatic growth as a stress-related growth expressed by a personal transformation that is more than simply bereavement-related adaptation. The individual develops a “new-found sense of strength, a renewed appreciation for relationships with others, and a reassessment of priorities” (p. 463). Research by Caserta, et. al. (2009) suggests posttraumatic growth and bereavement-related distress are not correlated, and in fact can coexist without affecting each other.

Other research has shown that bereavement-related distress and positive affect can also coexist, however the correlation is unknown (Boyraz, et.al. 2009). Positive affectivity may also aid the bereaved in using cognitive processing as a way to cope as opposed to ruminating. The broaden and build theory proposed by Fredrickson (2001) proposes that positive affect expands a person’s cognitive and behavioral coping strategies during stressful life events, such as the death of a loved one, and fosters the development of mental resources. Positive affect also fosters creative and flexible thinking and self-reflection. The study by Boyraz, et.al. (2009) supported Fredrickson’s broaden and build theory, showing that bereaved people who were predisposed to positive affectivity were more likely to use self-reflection as a coping strategy, and were therefore more likely to find meaning in the loss.

Finding meaning in a loss is a positive outcome of the bereavement process. It may come easily for some, but could be quite difficult for others to achieve. But if the bereaved person is able to find meaning in the loss and they are able to incorporate the meaning into their personal life story, the death can promote posttraumatic growth (Neimeyer, et. al. 2008).  In this case, the individual would be “left in a better psychological state as a result of the adversity” (Gerrish et. al. 2009, p. 226). This could potentially mean discovering new emotional strength or developing greater compassion, maturity, or appreciation for life.

                                                                                                                            

References

Aldwin, C.M., & Levenson, M.R. (2004). Posttraumatic growth: A developmental perspective. Psychological Inquiry, 15, 9-22.

Attig, T. (1996). How We Grieve: Relearning the World. Oxford, United Kingdom: Oxford University Press, USA.

Balk, D.E. (1997). Death, bereavement and college students: a descriptive analysis. Mortality, 2, 207-220.

Balk, D.E. (2008). Grieving: 22 to 30 Percent of All College Students. New Directions for Student Services, 121. Wiley Periodicals. doi: 10.1002/ss.262

Bonanno, G.A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events. American Psychologist, 59, 20-28.

Bonanno, G.A. (2005). Resilience in the Face of Potential Trauma. Current Directions in Psychological Science, 14, 135-138.

Boyraz, G., Horne, S.G., & Sayger, T.V. (2010). Finding positive meaning after loss: The mediating role of reflection for bereaved individuals. Journal of Loss and Trauma, 15, 242-258.

Caserta, M., Lund, D., Utz, R., & deVries, B. (2009). Stress-related growth among the recently bereaved. Aging & Mental Health, 13, 463-476.

Fredrickson, B.L. (2001). The role of positive emotions in positive psychology: The broaden and build theory of positive emotions. American Psychologist, 56, 218-226.

Gerrish, N., Dyck, M.J., & Marsh, A. (2009). Post-traumatic growth and bereavement.  Mortality, 14, 226-244.

Hardison, H.G., Neimeyer, R.A., & Lichstein, K.L. (2005). Insomnia and Complicated Grief Symptoms in Bereaved College Students. Behavioral Sleep Medicine, 3, 99-111.

Kail, R.V. & Cavanaugh, J.C. (2010). Human Development: A Life Span View. Belmont, CA: Wadsworth, Cengage Learning.

Knox, D. (2007). Counseling students who are grieving: Finding meaning in loss. In J.A. Lippincott & R.B. Lippincott (Eds.), Special populations in college counseling: A handbook for mental health professionals (pp.187-199). Alexandria, VA: American Counseling Association.

K­übler-Ross, E. (1969). On Death and Dying. New York, NY: Macmillan.

Mathews, L.T., & Servanty-Seib, H.L. (2007). Hardiness and grief in a sample of bereaved college students. Death Studies, 31, 183-204.

Michael, S.T. & Snyder, C.R. (2005). Getting Unstuck: the roles of hope, finding meaning, and rumination in the adjustment to bereaved among college students. Death Studies, 29,435-458.

Neimeyer, R.A., Laurie, A., Mehta, T., Hardison, H., & Currier, J.M. (2008). Lessons of Loss: Meaning-Making in Bereaved College Students. New Directions for Student Services, 121. Wiley Periodicals. doi: 10.1002/ss.264

Seligman, M.E.P. & Csikszentmihalyi, M. (2000). Positive Psychology: An Introduction. American Psychologist,55, 5-14.