2. Centre for Trauma Resilience Growth, School of Sociology and Social Policy, Nottingham University John Durkin Psychological Growth Following Adversity in Firefighters

3. Posttraumatic Growth: The role of social support John Durkin FireFit Conference 7th July 2009

4. Two 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

5. HedonicEudaimonic (Waterman, 1993) Pleasure Goal attainment Satisfaction Affect & Feeling Wisdom Understanding Authenticity Integrity

6. Subjective Well-Being (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”

7. Psychological Well-Being (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”

8. Psychological Well-Being (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”

9. Posttraumatic Growth Inventory (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”

10. Changes in Outlook Questionnaire (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”

11. Method 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.

12. Growth & SWB (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

13. Growth & PWB (SWB controlled) 1 2 3 1 Psychological Well-being.21*.18* 2 Positive Changes.67*** 3 Posttraumatic Growth *p<.05; **p<.01; ***p<.001

14. Growth 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

16. 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.

17. The Factors... GROWTH Reports 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

18. Growth 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)

19. Social Support Measures Perceived Social Support Social 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 Support Crisis Support Scale (CSS; Joseph et al., 1992) Received support Satisfaction with support Negative Social Support Unsupportive Social Interactions Inventory (USII; Ingram et al., 2001 ) Bumbling Distancing Blaming Minimising

20. Longitudinal Study Social Support Growth Time One t1Time Two t2 Traumatic Event

21. Longitudinal Study Social Support Growth Time One t1Time Two t2 Traumatic Event

22. Completed 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)

23. Completed 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?

24. Posttraumatic Growth: The role of social support John Durkin FireFit Conference 7th July 2009