The Search for Meaning in Life following Traumatic Brain Injury: Conceptual, Measurement, and Applic

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The Search for Meaning in Life following
Traumatic Brain Injury Conceptual, Measurement,
and Application Issues
Gary T. Reker, Ph.D.
Department of Psychology, Trent University
State of the Science Conference for the RRTC on
Community Integration of Persons with
Traumatic Brain Injury
April 12-13, 2007
Arlington, Virginia
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Dr. Viktor Frankl Logotherapist
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Broad Conceptualization of Personal Meaning
The Meaning of Experience (Assigning or
structuring meaning)
The Experience of Meaning (Creating and/or
discovering meaning)

• Implicit or definitional meaning
• Attachment of personal significance to specific
  experiences in life
• Individuals undergoing an
• experience must try to make sense
• of that experience
• Situational Meaning (Park
• Folkman Reker)
• For traumatic life events Two Construals of
  Situational Meaning (Davis et al.)

• The existential belief that life has purpose and
  coherence
• Attempts to understand how events fit into a
  larger context
• Global/Existential Meaning
• provides an overarching perspective or
  worldview that makes sense of the experienced
  sources of meaning

Discovering
Creating
Sources of Meaning (Meaning Orientations) -
Self-Transcendence - Collectivism -
Individualism - Self-Preoccupation
Benefit-Finding
Sense-Making
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Personal (Global) Meaning
Elemental View (Bottom-up)
Holistic View (Top-down)
Life as a whole has no meaning. Life only
contains meanings. Individuals seek to understand
the value and purpose of specific encounters.
Specific encounters need to be integrated into
a larger and higher purpose (What is the purpose
in life? What is worth living for?)
Sources of Meaning
Purpose and Coherence
Proper understanding of Personal Meaning requires
both a bottom-up and a top-down view of life.
Personal Meaning is defined as the cognizance
of order, coherence, and purpose in ones
existence, the pursuit and attainment of
worthwhile goals, and an accompanying sense of
fulfillment.
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Personal (Global) Meaning Purpose Coherence
Purpose

• having a mission in life, having life goals,
  having a sense of direction

• implicit in purpose is the notion of
  worthwhileness and what is of central importance
  in one's life

Coherence

• having a logically integrated and consistent
  analytical and intuitive understanding of self,
  others, and life in general

• implicit in coherence is a sense of order and
  reason for existence, a clear sense of personal
  identity, and greater social consciousness

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The Life Attitude Profile-Revised (Reker, 1992)
Purpose (7-point Likert scale)
2. In my life I have very clear goals and aims.
26. I know where my life is going in the future.
31. In achieving lifes goals, I have felt
completely fulfilled.
37. I have a mission in life that gives me a
sense of direction.
Coherence (7-point Likert scale)
16. I have a philosophy of life that gives my
existence significance.
27. In thinking of my life, I see a reason for
being here.
29. I have a framework that allows me to
understand or make sense of my life.
46. My personal existence is orderly and coherent.
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Levels (Depth) of Personal Meaning
Level 1 Self-Preoccupation (sources that focus
on self- interests or that are
self-serving)

• Meeting basic needs
• Financial security
• Hedonistic activities
• Material possessions

Level 2 Individualism (sources that focus on
self-growth, self-improvement,
self-development, and the
realization of ones potential)

• Leisure activities
• Creative activities
• Personal achievements
• Personal growth

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Levels (Depth) of Personal Meaning
Level 3 Collectivism (sources that focus on
the betterment of the group,
service to others, dedication to
larger social and/or political causes)

• Societal/Political causes
• Traditions and culture
• Leaving a legacy
• Humanistic concerns

Level 4 Self-Transcendence (sources that extend
beyond the self, beyond the here
and now, encompassing cosmic
meaning and ultimate purpose)

• Personal relationships
• Religious beliefs/activities
• Service to others
• Enduring values and ideals
• Relationship with nature

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The Search for Meaning in TBI
Experienced
Global Meaning Beliefs, values,
purpose, goals, sense of coherence
Situational Meaning Meaning attached to
the experience of a TBI
Incongruence
Shattered Global Meaning
Disrupted life plan, existential distress (Is
life worth living?), adaptational difficulties
Prompts a
Search for Meaning
To achieve re-integration
Change Global Meaning
Change the Meaning of the TBI
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Percentage of Coded Responses to the Open-Ended
Question Have You Found any Meaning in Your
Experience With a Stroke
Category
Patients Caregivers
(N40) (N40)
Appreciate life more
16 14
Learned to slow down
14 0
Appreciate caregiver (patient) more
3 17
Appreciate family and friends
6 8
Grown personally
5 8
Become more compassionate
8 5
Closer to God
3 3
No response
7 1
Found no meaning
43 54
Source Thompson (1991) 25 men/15 women, age
range 24-80 yrs. Interviewed
average 9 months post-stroke.
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Measuring Situational Meaning in TBI

• I appreciate life more following my TBI.
• I have learned to slow down more since my TBI.
• I have a deeper appreciation for family, friends,
  and community
• since my experience with TBI.
• I have become more compassionate following my
  TBI.
• I have not found any meaning in my experience
  with a TBI.
• I have grown personally through my experience
  with TBI.
• I feel that I have become more spiritual since my
  TBI.
• Since my TBI, I often ask myself Why me?

(Rated on a 7-point Strongly Agree..Strongly
Disagree Scale)
Scores can range from 8-56 with high score
indicating greater Situational Meaning in TBI
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Assessing Incongruence between Global and
Situational Meaning in TBI
Global Meaning Score (total 56)
Meaning Congruence Index (MCI)
Situational Meaning Score (total 56)
Patient A Global 56 Situational 56 MCI
1.00 (congruence)
Patient B Global 56 Situational 40 MCI
1.40 (congruence?)
Patient C Global 56 Situational 28 MCI
2.00 (incongruence?)
Patient D Global 56 Situational 12 MCI
4.67 (incongruence)
Patient E Global 56 Situational 8 MCI
7.00 (incongruence)
MCI can range from 1.00 to 7.00. The cut-off MCI
for congruence/ incongruence would need to be
established empirically. Determine baseline
chart progress (or lack of) in rehabilitation
across time.
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Change the Meaning of the TBI
Meaning-based
Coping Strategies

• Find Purpose in TBI
• TBI revealed inner
• strength
• TBI heightened an
• appreciation of life
• TBI improved
• relationship with
• significant others

• Positive Reappraisal of TBI
• feel lucky that experience
• was not worse
• judged better off compared
• to others
• simply put negative aspects
• aside

Existential Reattribution

• Why did the TBI happen
• to me?
• What caused the TBI?
• Who is responsible for
• the TBI?
• What impact will TBI
• have on me?

Post-Traumatic Growth (PTG)

• acknowledgement of the devastation of TBI
• promotion of a positive post-TBI life that is
  subjectively valued

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Change Global Meaning
Meaning-making
Processes

• Revise Belief System
• reevaluate spiritual/
• religious beliefs
• reconnect with spiritual
• roots
• associate with members
• holding similar beliefs

• Rethink Values
• spend more time with
• family, friends
• revalue ordinary events
• shift from instrumental
• to terminal values

• Reset New Goals
• set realistic goals that
• are more attainable
• reorder priorities
• strive for higher level
• goals

Transformation
Transcendence
Renewed Coherence
Renewed Purpose

• God puts obstacles in
• your path but also gives
• you the strength to
• overcome them

• misfortunes are not unexpected
• goals are attainable despite negative life
  experiences
• I will survive

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Link between Changed Meaning, Recovery,
and Adjustment

• Stroke Patients
• Finding meaning in stroke
• experience was associated
• with positive psychological
• adjustment (low depression
• and high meaningfulness)
• in patients and caregivers
• (Quantitative and Qualitative
• study)
• (Thompson, 1991)

• Cancer Patients
• Meaning gained from cancer
• experience brought
• new attitude toward life
• renewed self-confidence
• gains in self-knowledge
• regained sense of control
• over ones body over
• ones life generally
• (Qualitative study)
• (Taylor, 1983)

• CAD Patient (Age 40)
• After 2nd MI, patient re-evaluated priorities
  spent more time with family set realistic goals
  that led to
• greater appreciation for
• family, friends, and
• community
• personal growth
• realistic goal setting in the
• future
• (Qualitative study)
• Skaggs Barron, 2006)

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Possible Interventions

• Meaning is a very personal, subjective, private
  issue. When it comes to intervention One size
  does not fit all. We need
• Individually-Tailored Interventions
• A. Cognitive Reframing with a Facilitator.
• Causal attribution (Why did
  this happen to me?)
• Existential attribution (Why
  me?)
• B. Assessment of Sources of Meaning
  important to the TBI person (e.g., personal
  relationships, creative activities,
• traditions and culture, etc.) as a
  vehicle for promoting
• greater involvement in meaningful
  activities.

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• Individually-Tailored Interventions (contd)
• C. Photovoice (Poster Laura Lorenz,
  2007). Sharing of
• photovoice stories in a group
  environment to facilitate
• personal understanding of TBI as
  well as validation by
• others in a similar situation.
• D. Encourage Temporal Reflections to
  stimulate self-
• awareness
• Present Whats it like living with TBI?
• Past What was life like
  before TBI?
• Future What will life be like
  after TBI?

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• Potential Outcome Measures to Assess effects of
  Changed Meaning
• Post-Traumatic Growth Inventory (PTGI
  Tedeschi et al. 1996)
• Life Satisfaction (Poster Allison Clark,
  2007)
• Personal Meaning Index (PMI Reker, 1992)
• Multidimensional Resilience Inventory (MRI
  Peglar Reker,
• 2007)

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References
Park, C.L., Folkman, S. (1997). Meaning in the
context of stress and coping. Review of
General Psychology, 1, 115-144.
Reker, G.T. (1992). Manual of the Life Attitude
Profile-Revised (LAP-R. Peterborough, ON
Student Psychologists Press.
Skaggs, B.G., Barron, C.R. (2006). Searching
for meaning in negative events Concept
analysis. Journal of Advanced Nursing, 53,
559-570.
Thompson, S.C. (1991). The search for meaning
following a stroke. Basic and Applied Social
Psychology, 12, 81-96.
Taylor, S.E. (1983). Adjustment to threatening
events A theory of cognitive adaptation.
American Psychologist, 38, 1161-1173.