Posttraumatic%20Spiritual%20Growth:%20A%20Phenomenological%20Investigation%20of%20Caner%20Survivors

1
Posttraumatic Spiritual Growth A
Phenomenological Investigation of Caner Survivors

• Ryan M. Denney, M.A.
• The University of Southern Mississippi
• October 26, 2007

2
Overview

• Religion/Spirituality have been shown to be a
  coping mechanism and to promote resiliency in
  some trauma survivors.
• Many people report increased levels of
  spirituality following a traumatic experience
  (911, Hurricane Katrina).
• Many people report psychological growth following
  a trauma (increased coping/resiliency, meaning in
  life).
• Spiritual growth following a traumatic experience
  has not been thoroughly researched (PTG
  inventory).

3
The Trauma Continuum

• There is a continuum of stressor severity and
  there are no crisp boundaries demarcating
  ordinary stressors from traumatic stressors.
  Further, perception of an event as stressful
  depends on subjective appraisal, making it
  difficult to define stressors objectively, and
  independent of personal meaning making (Weathers
  Keane, 2007).
• Trauma-related disorders have very high
  comorbidity with major depression, anxiety
  disorders, substance use disorders, and eating
  disorders.
• Overlapping symptoms of Borderline PD and PTSD
  suicidality, dissociation, affect dysregulation,
  identity disturbance, self-harm, relational
  difficulties (International Society for the Study
  of Trauma and Dissociation, 2007).

4
DSM-IV-TR (2000)

• Traumatic Stressor an event that involves actual
  or threatened death or serious injury, or other
  threat to ones personal integrity.
• PTSD
• Acute Stress Disorder

5
PTG Definition(Calhoun Tedeschi, 2006)

• Traumatic experience
• set of circumstances that significantly challenge
  the persons preexisting assumptive world,
• disrupts a persons personal narrative,
• a watershed experience that divides a life into
  before and after the event,
• an experience or threat of loss, grief, suffering
  or other negative circumstance that causes a
  transformation in the view of self, others and
  philosophy of life.

6
PTG Definition Rationale

• Many people have been profoundly affected by
  their traumatic experience, but may not fit DSM
  criteria for a trauma-induced disorder.
• Due to the subjective, highly variable nature of
  responses to traumatic experiences, a more broad
  definition of trauma is needed.

7
Cancer as a Trauma

• Trauma injury to the body, or an event that
  causes long-lasting mental or emotional damage,
  as that potentially caused by cancer (The
  National Cancer Institute, 2007).
• While not all cancer survivors may have
  experienced cancer as a trauma, having cancer
  clearly has the potential of being a traumatic
  experience.
• Participants will self-identify their cancer
  experience as traumatic to them (will be asked on
  the demographic questionnaire).

8
Posttraumatic Growth

• Positive psychological change experienced as a
  result of the struggle with highly challenging
  life circumstances
• (Tedeschi Calhoun, 2004, p. 1).

9
Purpose

• To investigate how having cancer has affected the
  spiritual growth of cancer survivors.
• The goal will be to investigate the
  phenomenological, or lived experiences of
  participants with an emphasis on their spiritual
  growth.

10
Research Question

• How has having cancer affected the spiritual
  growth of cancer survivors across 12 domains of
  spirituality postulated by Tsang and McCullough
  (2003) and Hill (2005)
• (see domains list)

11
Why Qualitative?

• Most compatible with research question.
• Addresses the lack of specificity and depth into
  PTG and PTSG processes.
• Able to address the understudied phenomenon of
  PTSG.
• Gives a voice to persons sometimes marginalized.

12
Recruitment of Participants

• Key Informants
• Contact at the Hattiesburg Chapter of the
  American Cancer Society will identify
  participants.
• Snowball Sampling

13
Interview Protocol

• Non-leading questions (no implied direction)
• E.g., How might your cancer experience have
  affected your motivation or desire to be
  spiritual?
• Researcher will code for growth
• Participants will be given a copy of the
  interview protocol prior to interview to enhance
  response quality

14
Potential Implications

• Add to our understanding of how spirituality may
  be used, in a more targeted way, as a coping
  mechanism in clinical and medical settings.
• Inform PTG theory
• Add to our understanding of the process of PTGS
  (Currently no PTSG theory)
• Inform instrument construction (what are the most
  salient domains of PTSG?).
• Further refine the domains of spirituality adding
  to our understanding of the construct of
  spirituality.

15
Posttraumatic Spiritual Growth A
Phenomenological Investigation of Caner Survivors

• Ryan M. Denney, Doctoral Candidate
• The University of Southern Mississippi
• Dissertation Defense
• June 11, 2009

16
Overview and Rationale

• Spirituality is a multidimensional construct
  (Hill, 2003 Tsang McCullough, 2003).
• Spirituality has been shown to be a coping
  mechanism and to promote resiliency in some
  trauma survivors (Pargament, 2002 Pargament
  Ano, 2006).
• Many people report psychological growth following
  a trauma, for example increased
  coping/resiliency, meaning in life (Calhoun
  Tedeschi, 2006).
• Some people report increased levels of
  spirituality following a traumatic experience
  (Shaw, Joseph, Linley, 2005).

17
Importance

• Spirituality has not been traditionally
  researched as a multidimensional construct (Hill,
  2005).
• PTSG has not been an area of investigation in its
  own rightto date spirituality has been folded
  into broader PTG categories (PTG inventory
  Tedeschi Calhoun, 1996)
• Spirituality is a diversity variable

18
Purpose and Research Question

• Purpose To investigate the phenomenological
  experience of posttraumatic spiritual growth of
  cancer survivors
• Research Question How does surviving cancer
  impact the multidimensional spiritual growth of
  survivors?
• I.E., What is survivors lived experience of
  multidimensional spiritual growth following
  cancer?

19
Sampling Procedure

• Upon IRB approval, an informant at the local
  chapter of the American Cancer Society gave the
  researchers contact info to potential
  participants.
• Snowball sampling

20
Participants

• 3 Focus Groups (medical professionals, survivors,
  clergy)
• 13 cancer survivors
• 10 women, 3 men
• 12 Caucasian, 1 African American
• Age Range 44-73, mean age 61
• 7 married, 3 divorced, 2 single, 1 widowed
• 5 Baptist, 5 Methodist, 2 Catholic, 1 LDS
• 8 breast cancer, 2 Leukemia, 1 colon cancer, 1
  lung cancer, 1 ovarian cancer
• Length of time they had cancer 6 months to 22
  years, mean 5 years

21
Interview Protocol

• Asked questions tapping multiple dimensions of
  spirituality
• Modified questions based on focus group feedback
  (e.g., deleted the phrase cancer free
• Participants were given a copy of the interview
  protocol prior to interview
• Questions were neutrally worded so as not to bias
  responses toward growth

22
Data Analysis

• Phenomenological data analysis (Colaizzi, 1978)
• Interviews were transcribed verbatim and read in
  their entirety
• Significant statements identified (meaning units)
• Codes summary statement of the identified
  meaning units
• Domains cross-case clustered analysis of codes

23
(No Transcript)
24
Rigor Enhancing Techniques Credibility

• Credibility results accurately represent
  participants reality.
• Referential adequacydirect link to participant
  words
• Audio recording
• Verbatim transcriptions
• Triangulationseveral sources of information
• Several participants
• Outside auditor
• Integrating findings into existing theory
• Disconfirming Evidence
• Reporting of No Growth domains
• Member Checking
• Participants confirmed interview accuracy

25
Rigor Enhancing Techniques Transferability

• Transferability transferring (generalizing)
  findings to similar people,
• settings, and times of original study
• Thick Descriptions
• Presenting details about participant demographics
  and context
• Using participant words to augment and support
  findings

26
Rigor Enhancing Techniques Dependability

• Dependability accurate, impartial report of
  findings
• Dependability Audit
• Outside Auditora dispassionate peer reviewed
  methods and analyzed transcripts
• Committee members scrutiny
• Reflexivity

27
Rigor Enhancing Techniques Confirmability

• Confirmability results objectively corroborated
  by the obtained data
• Confirmability Audit
• Concurrent with dependability audit
• Field Notes
• Confirmability enhanced by triangulation, member
  checking, and referential adequacy techniques

28
Participants Definition of Spirituality

• Spirituality is my relationship with God.
• His Gods presence in your lifeat all times
  being aware of his love and that he knows every
  little thing that is going on.
• The inner peace that comes from knowing that God
  is present in your life.

29
Reports of Spiritual Growth

• I think it having cancer made me stronger, my
  religious values, my faith.
• I feel like my spirituality has grown
  tremendously because of this.
• I am more spiritual.
• From that time on, it was much easier to stay in
  touch with my spirituality.
• The level of my commitment was raised and
  deepened and I dont know how to express it.

30
Domain 1Increased God Locus of Control (11)

• Increased acceptance of God being in control
• Ultimately I have no control over this. I can
  turn it
• over to God and let him carry it.
• Increased surrendering of fate to God/Acceptance
• Acceptance is the key to cancer. It is the key
  to religion, to spirituality.
• Putting him God in charge of what I did
  instead of myself was probably how I grew the
  most.

31
Domain 1Increased God Locus of Control

• I walked out in my front yard, looked up, my
  hands and arms to the sky and I said, Lord this
  is too big for me to handle by myself, so here I
  am. If youll get me through it Ill do what you
  tell me to do. I put my faith in the divine
  healing power. Prayer and faith is the strongest
  part of coping with cancer.

32
Domain 2Increase in Divine Peace (8)

• Fear of death/the future followed by peacefulness
• If Gods plan for my life is that Im gonna die
  from breast
• cancer, then I accept that. Its like a calmness
  and a strength
• that I cant explain.
• Peace attributed to Spirituality
• I had such a peace that came from my
• faith and my belief.
• Where is this peace and this evenness in my
  life coming from? Well, it is coming from God.

33
Domain 2Increase in Divine Peace

• I have made the choice not to live in fear of
  it cancer coming back. I believe in my heart
  that it may eventually be what I die of, but we
  are all going to die of something. People that
  know me will just say that it seems there is such
  a calmness now. I dont have the fear. I leave it
  in Gods hands and I do not have any of that fear
  and anxiety when I do.

34
Domain 3Enhanced Prayer Experience (9)

• Increased quality (but not frequency or duration)
  of prayers
• It increased the concentration and intensity
  and
• energy that I put into them prayers.
• Deeper emotional connection or psychological bond
  with God
• It brought me closer to God. It seemed like
  having that
• cancer put me sure enough in his arms. Its just
  like its a
• closer bond now.
• Increased spontaneity
• They prayers are just more conversational now.
  Instead of
• having a separate prayer time, it is just more a
  part of
• everything I do throughout the day. Just that
  awareness of
• God in every situation.

35
Domain 3Enhanced Prayer Experience

• I probably became more teachable during that
  time. And because I was so needy I was more
  willing to listen. I would just picture myself
  literally sitting in his Gods lap with my head
  against him, and it wasnt like that before. It
  just made me seek Him in a different way because
  of how he literally met every one of those needs.
  It has really made me look at him like a daddy.

36
Domain 4Increased Spiritual Support (6)

• Spiritual support from family/friends
• When I was diagnosed with cancer, I was just
• overwhelmed with the support I got. I had people
• writing me and telling me that I was in their
  prayers
• and I received letters and phone calls from
  people I
• didnt really know.
• Novel spiritual experiences with others
• People would just come up behind me at church
• and touch me and pray for me.

37
Domain 4Increased Spiritual Support

• I feel like they family/friends really did
  rally and were very supportive. I had people that
  were just lifting me up in every possible way. I
  had a steady stream of people coming through my
  hospital room and I had all kinds of people
  pray with me in my room. It was just an
  experience that I wouldnt take anything for.

38
Domain 5Heightened Sense of Divine Purpose (8)

• Divine purpose for the cancer experience. Ranged
  from vague to specific
• I know he God has a plan for my life and that
  I have work to
• do.
• Maybe it the reason for having cancer was to
  be able to be
• there for other people, to listen to them, to
  tell them that I am a
• cancer survivor, to make them feel a little more
  at ease about
• what they are going through.

39
Domain 5Heightened Sense of Divine Purpose

• Theres no doubt that everything Ive been
  through,
• God has brought it to this incredible plan for
  me. And I
• will gladly have gone through this and whatever
  else I
• need to go through to bring about his purpose for
  me.

40
Domain 6 (novel)Increased Evangelism (4)

• More motivation to talk about spiritual beliefs
• Before I had cancer, I didnt share God with
  others like I
• should. I give my testimony a lot more often than
  I used to.
• Increased boldness, less fear
• I was always afraid to talk to anybody about my
  faith.
• But Ive found most people dont mind hearing
  it. I was
• supposed to have died but I didnt and I feel
  God had
• a part in that. Most people take that kind of
  seriously.

41
Domain 6 (novel)Increased Evangelism

• I never would have been one that would have
  gone up front and prayed on the alter or talked
  to anybody about my feelings. That Sunday
  whenever I got to go home from the hospital, I
  went to church and stood in front of the church
  and told everybody what had happened and about
  the miracle and their prayers and what it had
  done for me. I would have never done that before.
  I have completely changed. I just feel like
  anybody that will listen Ill tell about my story
  and Ive probably told it a million times.

42
Domain 7 (novel)Enhanced Spirituality of Family
and Friends (7)

• Positive impact on familys spirituality
• I think there has been a renewed sense of the
• importance of faith in my family.
• To some extent every member of my family
  experienced a
• deepened spirituality and a heightened commitment
  to the
• Lord.
• Not only did cancer re-affirm my faith, it
  helped my children
• have faith.

43
Domain 7 (novel)Enhanced Spirituality of Family
and Friends

• Increased public prayers of significant others
• One of my sons went to youth and they had a
  prayer vigil for
• me the night they found out.
• Increased spiritual activity in faith community
• When she found out I had cancer, immediately she
  put that
• ministry in place.

44
No Growth Domains

• Spiritual history
• No effect on spiritual beliefs
• No effect on conflict resolution
• I just didnt have any difficulties in
  relationships that I
• remember.

45
Miscellaneous Quotes

• Being cured would be nice, but I dont think I
  would say I wouldve not liked to have ever had
  this experience because it has really improved my
  life.
• Cancer is not a death sentence. It takes courage
  and determination.
• All prayers are not answered. That is another
  thing it cancer taught me.
• There are worse things than dying. Living and
  not being able to love or just being after money
  or whatever, that is worse than dying.

46
Implications and Contribution

• Inform PTG Theory
• Increased understanding of the construct of
  spirituality and its difference from religion
• Increased understanding of the process of PTSG
• Spiritual growth was reported across several
  domains of spirituality setting the stage for
  future domain-specific research
• Beginning point for understanding how spiritual
  growth may aid copingcorollaries and predictors
• Introduced the idea of vicarious posttraumatic
  spiritual growth
• Beginning point for a measure of posttraumatic
  spiritual growthfurther illuminated salient
  domains

47
Limitations

• Inability to generalize results, transferability
  only
• Results are only explanatory, not predictive
• Participants were demographically homogeneous
  all Christian, mostly female, breast cancer
  survivors, Caucasian
• Self-selection/Informants potential bias when
  selecting participants
• All participants reported being quite spiritual
  prior to cancer experiencemore likely to engage
  their spirituality to cope

48
Clinical Implications

• Spirituality can be a facet of resilience.
• Spirituality can be a source of coping.
• Important to understand how spirituality can be
  used to aid coping.
• Difficult life experiences can have a positive
  impact on lived experience (spirituality
  included).

49
Questions, Comments, and Discussion