(p. 279) Finding Benefits in Adversity
The discovery of benefits among individuals experiencing adversity is well documented (1) and plays a prominent role in theories of cognitive adaptation to threatening circumstances (2, 3), and in an emerging literature on post-traumatic growth (4) and psychological thriving (5). Yet the conceptual status of benefit-finding is equivocal and its potential relationship to personality remains speculative. In this chapter we summarize the prevalence of benefit-finding, primarily among people facing medical problems, and describe the emotional and health advantages associated with finding benefits in adversity. We then turn to evidence and informed speculation relating benefit-finding to the personality characteristics that are discussed at length in other chapters of this volume. These include optimism (see chapters 8 and 9), extraversion, neuroticism (see chapter 6 in this volume), and hope (see chapter 10 in this volume). We offer five alternative conceptualizations of benefit-finding and present previously unpublished findings that distinguish benefit-related cognitions as adaptive beliefs—benefit-finding—from active efforts to recall benefits as coping strategies during difficult times—benefit-reminding. Finally, we propose a direction for future research and consider the implications of this area of inquiry for clinical practice.
The Prevalence of Benefit-Finding in Major Medical Problems
Many studies of the psychological aspects of major medical problems have included queries about any gains, benefits or advantages that participants might have found after weeks or years of contending with these problems. (p. 280) In each of these studies a majority of informants cited benefits or gains from their adversity. This evidence comes from studies of heart attack survivors (6); women with breast cancer (7); survivors of spinal cord injuries (8); individuals who have lost their sense of taste and smell (9); women with impaired fertility (10); patients with chronic rheumatic diseases (11); stroke victims and their caregivers (12); parents of infants hospitalized in newborn intensive care units (13); and mothers of children with insulin-dependent diabetes (14). Aldwin (15), Calhoun and Tedeschi (16), and Park and Folkman (17) describe still other studies of benefit-finding in the face of adversity.
We find it remarkable that most people are able to describe benefits or gains across this range of threatening medical situations. Equally remarkable is that those who had more time to consider possible benefits were no more likely to report benefits than those who were only recently confronted with the threatening circumstance. Thus, if finding benefits reflects a temporally unfolding process, it is one that unfolds rather quickly. And there is no support in these studies that benefit-finding is a transient cognitive adaptation that gives way to other adaptive preferences. If it were transient, we would have found less benefit-finding among individuals who had more chronic medical conditions. Finally, these findings emerge across assessment methods. Although the evidence of benefit-finding derives in large part from answers to direct interview questions about what, if any, positive consequences ensued from the persons’ experiences, in several studies participants answered multi-item questionnaires in which they endorsed benefits that could have accrued from their medical conditions (9, 18).
Several categories of perceived benefits cut across these problems and echo what has been found in studies of other types of threatening events (3, 4). For example, one common theme is the strengthening of relationships with family and friends. Another is the perception of positive personality change, including greater patience, tolerance, empathy, and courage. Yet another commonly reported benefit is a valued change in life’s priorities and personal goals. Other benefits appear relatively specific to health-related adversity. As a case in point, many men believe that their heart attacks taught them the importance of health behavior practices for living a long life (6). And mothers often reported that their infants’ hospitalizations in intensive care units opened their eyes to the dedication and caring attitudes of health care professionals (13). Later in this chapter, we attempt to tie the kinds of benefits people experience to aspects of personality.
The Benefits of Benefit-Finding
Most of the evidence linking benefit-finding to positive adaptation and well-being comes from cross-sectional studies. Benefit-finding relates to less negative affect in cancer patients (19); less depression and greater meaningfulness in life in stroke victims (12); less psychological distress in (p. 281) infertile women (10) and victims of taste and smell loss (9); superior psychological adjustment in women with breast cancer (7); and less mood disturbance and intrusive thoughts in mothers of acutely ill newborns (13). Because it is difficult to disentangle temporal precedence in these cross-sectional studies, their findings also can mean that those who are better adjusted to these problems find it easier to construe positive aspects of their experience. Or, perhaps positive adjustment and the ability to find benefits are both influenced by differences in the severity of the problem.
We are aware of only two longitudinal studies of the predictive significance of benefit-finding. Prior to their child’s discharge from a newborn intensive care unit, Affleck, Tennen, and Rowe (13) asked mothers whether they had found any benefits from their child’s hazardous delivery and prolonged hospitalization. Seventy-five percent of these mothers cited at least one benefit, including improved relationships with family and friends, the importance of keeping life’s problems in perspective, increased empathy, positive changes in their personality, and the conviction that their child was now even more precious to them. Mothers who had cited no benefits from their child’s newborn intensive care, however, reported more mood disturbance and psychological distress six and 18 months later, even when their mood at the time they were asked to describe any benefits was partialed from these relations. The ability of benefit-finding to predict later emotional well-being also was independent of an objective severity index of the child’s medical problems, echoing what Thompson (12) found in a study of stroke survivors and what Tennen, Affleck, and Mendola (9) documented among individuals with taste and smell loss. Thus, it appears that benefit-finding predicts emotional well-being and is not confounded by objective measures of the severity of the problem.
These mothers’ ability to find benefits not only predicted their own well-being, but also their child’s actual developmental test scores 18 months later. This relation remained significant, even when we controlled for mothers’ predischarge mood, age, education, parity, and the severity of infants’ perinatal medical problems. This discovery is critical because it extends the positive outcomes of benefit-finding beyond the realm of self-report.
Another demonstration of the predictability of objective outcomes from earlier benefit-finding comes from a cohort of heart attack survivors who participated in an unusually long prospective study (6). After seven weeks of recovery from their initial heart attack, 58% of these men cited benefits, including anticipated changes in lifestyle, increased enjoyment, valued lessons about the importance of health behavior, and positive changes in their values and life philosophies. Eight years later, those men who had construed benefits were in significantly better cardiac health and also were less likely to have suffered a subsequent attack. These predictive relations remained significant, even after controlling for age, socioeconomic status, and severity of initial attack. It may be tempting to argue that benefit-finding predicted morbidity “simply” because those who referred to anticipated lifestyle and health behavior changes actually made such changes, which (p. 282) in turn produced superior cardiac health. But as anyone who has worked in a cardiac rehabilitation program (or, for that matter, anyone who has tried to stop smoking or maintain a weight loss diet) will attest, the road from appreciating the benefits of health behavior to cardiac health eight years later is filled with motivational, interpersonal, social, and medical obstacles. The possible mechanisms through which benefit-finding predicted subsequent cardiac health in this study and predicted infant development in the Affleck et al. (13) study deserve subsequent attention and replication.
In summary, research on the adaptational correlates of benefit-finding among individuals facing serious medical problems has documented its unique ability to predict emotional well-being. This, along with initial evidence that benefit-finding also may confer long-term health benefits, is a good reason to investigate why this positive appraisal of threatening events is related to positive adaptational outcomes. Our starting point is how benefit-finding relates to personality.
Personality and Benefit-Finding: The Usual Suspects Generate Little Light
Personality’s relation to perceived benefits and gains has been considered in the literature on “thriving” (5) and “crisis-induced personal transformation” (4), in recent formulations of “stress-related growth” (19), and it has been implied in many studies of cognitive adaptation to threatening events. The strategy of investigators examining personality in relation to perceived benefits or gains reminds us of the classic scene from Casablanca in which Captain Louis Renault initiates a police investigation by demanding that the “usual suspects” be “rounded up” (20). Psychological investigators similarly have rounded up the usual moderational and mediational suspects without a fully developed theory of benefit-finding. As a result of this strategy, the proposed personality correlates of benefit-finding are identical to proposed correlates in totally unrelated areas of investigation (21); moreover, these are personal characteristics already suspected of being dimensions of one another (22). Although there may be some benefits to sticking to the usual suspects, we have argued previously that this approach runs the distinct risk of uncovering only what one already suspected (20). We now review the usually suspected candidates for finding benefits in adversity.
Personality has great appeal as a way of explaining psychological adaptation during a crisis and in its aftermath. Although the proportion of individuals reporting benefits or gains suggests that such perceptions are common, many survivors of adversity do not experience positive consequences from their plight, and these individuals could well differ from their benefit-finding counterparts in general or specific personality characteristics.
(p. 283) Over the years, authors have linked adversity-related benefit-finding to an internal locus of control (23); a belief in a just world (24); dispositional optimism (18, 19); and, extroversion and openness to experience (25). Because the empirical literature is limited, we follow the review strategy we employed in our previous discussions of this literature (1, 20) as we focus on those personality dimensions that have received the greatest theoretical attention. Specifically, we consider how dispositional optimism/pessimism, cognitive and self-complexity, and dispositional hope, each of which emphasizes the pursuit of personal goals in the face of obstacles, relate to benefit-finding. We then address the potential role played by the “Big Five” personality constellation (26).
Moos and Schaefer (27), O’Leary and Ickovics (5), Tennen et al. (9), and Tedeschi and Calhoun (4) have hypothesized that dispositional optimism, or the generalized expectancy for positive outcomes (28), may anticipate the perception of benefits or gains following threatening events. Optimists show superior adaptation to medical stressors, including coronary artery bypass surgery (29), childbirth (30), failed in-vitro fertilization (31), and HIV-positive status (32); moreover, on conceptual grounds, optimistic as compared to pessimistic individuals might be more inclined to extract a sense of benefit from adversity because of their positive interpretation of ongoing events.
Several studies using the Life Orientation Test (LOT) of dispositional optimism and pessimism (28) already have shown that perceptions closely related to benefit-finding are aligned with optimistic expectations. For example, Fontaine, Manstead, and Wagner (33) found that dispositional optimism was associated with “positive reinterpretation” as a strategy of coping with life stressors. Curbow, Somerfield, Baker, Wingard, and Legro (34) reported that among individuals undergoing bone marrow transplantation, greater optimism was associated with reports of positive life changes and personal growth. And Carver, Pozo, Harris, Noriega, Scheier, Robinson, et al. (35) found that optimists were more likely to use “positive refraining” as a coping strategy before and after breast cancer surgery. In a study that measured situation-specific optimism, Affleck, Tennen, and Rowe (13) showed that mothers who maintained more optimistic expectancies for their premature infant’s development were more likely to find benefits in the neonatal intensive care crisis.
Tennen, Affleck, Urrows, Higgins, and Mendola (18) examined how dispositional optimism and benefit-finding relate to one another and operate in the day-to-day symptoms, mood, and functioning of individuals with rheumatoid arthritis, a chronic, painful, and disabling illness. After completing the LOT and a measure of perceived benefits from their chronic pain drawn from the Inventory of Perceived Control Beliefs (IPCB; 36), research participants reported for 75 consecutive days about their pain intensity, (p. 284) mood, and pain-related activity limitations (e.g., missing work and cutting back on planned social activities). As predicted, those scoring higher on the LOT were significantly more likely to endorse benefits from their illness.
Perceiving benefits from living with chronic pain also correlated with diary keepers’ positive daily mood. In this regard, we wondered whether the relation between perceived benefits and daily mood might be explained by the tendency of dispositional optimists both to construe these benefits from their suffering and to experience more positive mood states. As expected, controlling for dispositional optimism attenuated the relation between benefit-finding and mood. But enthusiasm for the idea that optimism “explains” the association between perceiving benefits and well-being is dampened when we consider recent refinements in the measurement of optimism. First, it appears that the LOT measures two relatively orthogonal constructs: optimism and pessimism (22). Accordingly, our analysis relating optimism, perceived benefits, and mood may be flawed because it failed to distinguish between optimism and pessimism.
A second refinement of the LOT recommended by Scheier, Carver, and Bridges (37) is even more critical to the specificity of the relation between optimism and perceived benefits in adversity. Two of the four items originally claimed to measure optimism appear instead to measure the ability to extract positive value from negative circumstances: “I always look on the bright side of things” and “I’m a believer in the idea that ’every cloud has a silver lining.’ “ Thus, any apparent relation between optimism and benefit-finding may simply be due to overlapping measures of the capacity to extract something positive from an otherwise grim experience, one dispositional (as measured by these two items on the LOT) and the other more specific to the threatening circumstance (as assessed by questions regarding perceived benefits).
When we reanalyzed the data reported by Tennen et al. (18) to separate optimism from pessimism and the expectancy from the benefit-finding components of optimism, we found that although benefit-finding remained significantly correlated with the original four-item optimism scale, even when pessimism was partialed from the association, the two-item optimism scale without its dispositional benefit-finding items did not correlate significantly with the benefits participants derived from their illness, nor did it confound the association between benefit-finding and well-being. These findings suggest that the shared variation between optimism as measured by the original LOT and benefit-finding may be attributable to predictor-criterion item overlap. Both published findings and our reanalysis of previously published data render equivocal the role of dispositional optimism in benefit-finding, at least among those facing major medical problems. The recent and welcome refinements in the LOT offer investigators an opportunity to revisit the findings linking optimism and pessimism to benefit-finding among individuals facing adversity.
(p. 285) Although the relation between optimism and benefit-finding remains uncertain because of the aforementioned concerns, investigators and theorists have not been reticent to propose mechanisms mediating their association. These purported mediators converge on the idea that optimists experience benefits in the face of threat because they try harder: optimists are active, problem-oriented copers (4) who, because of their active efforts, have an edge in dealing with acute challenges (27). Several theorists have suggested that the efforts optimists exert to reframe negative experiences in a positive light similarly propels them toward actual positive transformations (4, 5). That the experience of benefits is related to effortful strategies is an untested assumption to which we will return later in this chapter.
Cognitive and Self-Complexity
Cognitive complexity shares with dispositional optimism/pessimism the ability to achieve personal goals despite barriers. Harvey (38) theorized that the more complex one’s conceptual system, the greater should be one’s ability to achieve “adequate means of fate control… and a greater mastery over what would otherwise be a capricious, unpredictable, and overwhelming environment” (38, p. 249). In the face of adversity, cognitively complex individuals should be better able to pursue alternative goals and find more flexible ways of achieving them, allowing them to see threat as an opportunity to change their life goals, values, or priorities in desirable ways.
Linville’s (39) elaboration of the concept of self-complexity refines this argument. Linville documented that individuals who display high self-complexity—reflecting a greater number of discrete roles or identities used to organize self-schemas—adapt better to adversity, presumably because they are less likely to suffer global effects on self-representation. Bringing additional specificity to this hypothesis, Morgan and Janoff-Bulman (40) suggested that the complexity of positively valenced self-representations should best predict adaptation to events that threaten personal identities and roles. They indeed found that psychological adjustment to lifetime traumas (e.g., death of a parent, physical abuse, sexual assault) was superior among those who continued to hold many more independent positive self-representations (e.g., “hard-working,” “focused,” “imaginative,” “motivated”) than among trauma survivors with fewer independent positive self-representations (cf. 41). Although we believe that self-complexity may hold considerable promise as a personality moderator of the capacity to find benefits in adversity, the promise of cognitive complexity in relation to benefit-finding will only be realized through fully prospective inquiries.
Dispositional hope is yet another personality construct that rests on the perceived accessibility of desired goals. Hope differs from optimism/pessimism (p. 286) in that it encompasses not only one’s expectancy that desired goals can be achieved, but one’s ability to imagine avenues for goal attainment (42).
We are uncovering evidence of the key role that dispositional hope plays in experiencing benefits from living with fibromyalgia, a syndrome of unknown origin that often combines widespread pain, unusual tenderness in multiple tender point sites, and sleep disturbance. Our study affords a test of the relative importance of dispositional optimism/pessimism and dispositional hope as measured by the LOT and Hope (43) scales respectively, in experiencing benefits in the context of fibromyalgia pain.
The results from the 89 participants in this study show that neither the LOT pessimism scale (r = −.12), nor the revised LOT optimism scale (r = .15) correlates significantly with perceived benefits from living with fibromyalgia. Instead, it is individuals with greater dispositional hope who cited more benefits from living with their chronic pain (r = .34, p < .001). In particular, those scoring higher on the Hope scale endorsed greater agreement with the IPCB items “I have learned a great deal about myself from living with my pain,” and “dealing with my pain has made me a stronger person.” The ability of dispositional hope to predict these facets of perceived growth, controlling for differences in the related constructs of optimism and pessimism, is strong evidence of its unique role in shaping positive appraisals of adversity. Later in this chapter we will describe how fibromyalgia patients actually use their conviction of personal growth as a daily cognitive coping strategy for contending with their pain.
The “Big Five” Dimensions of Personality
McCrae and Costa (44) found that individuals low in neuroticism, high in extroversion, and high in openness to experience tend to rely on “drawing strength from adversity” as a style of coping with threat. It is not clear why these broad dimensions of personality are associated with perceived benefits following crisis or adversity. Perhaps they provide a template for predicting the types of benefits people will construe from adversity.
Specific benefits attributed to misfortune could match the characteristic approaches to the self, the world, and others associated with these major dimensions of personality. For example, the typical negative self-perceptions associated with neuroticism/negative affectivity would lead to the hypothesis that individuals high on this trait would be less able to find benefits or gains in adversity. Those scoring higher on measures of extra-version, who are more gregarious, cheerful, and seekers of social contact, might be especially likely to cite positive consequences of adversity for social relationships. The individual who is more open to experience— imaginative, emotionally responsive, and intellectually curious—might be particularly likely to meet the challenge of adversity through a philosophical reorientation and a new direction in life plans.
(p. 287) In the only study to examine how the Big Five factors relate to specific benefits found in adversity, Tedeschi and Calhoun (25) asked more than 600 college students who reported recent major life stressors, such as the death of a parent, criminal victimization, or accidental injuries, to complete the NEO Personality Inventory (NEO; 45) and the Posttraumatic Growth Inventory (PTGI; 25), which measures characteristic forms of positive change claimed from adversity, such as the emergence of new possibilities, spiritual growth, and better relationships. NEO scores for extraversion, openness, agreeableness, and conscientiousness each correlated significantly with the total post-traumatic growth score. Although a multivariate analysis of personality predictors was not reported, it appears that extra-version is the most likely candidate to maintain an independent prediction of overall benefit-finding. It correlated highest with benefit-finding and was the only dimension to be associated significantly with each of the subscales of the PTGI. Extraversion, as might be predicted, correlated most strongly with the report of improved relationships. Openness to experience also was an expectedly strong correlate of the PTGI subscale labeled “new possibilities,” which concerns the emergence of new interests and new life paths.
Other Personality Factors that Might Relate to Benefit-Finding
Tedeschi and Calhoun (4) propose several other personality factors that might set the stage for personal growth amid crisis and which would most likely be construed as a benefit of the crisis. One such factor is an internal locus of control. Individuals with an internal locus of control find rewards for their behavior in internal rather than external sources. This orientation might give them a sense of control in threatening circumstances that might infuse these circumstances with the sense of meaning and coherence associated with growth in adversity. Along with Moos and Schaefer (27), Bandura also proposes that self-efficacy or confidence in one’s coping capacities (46), a sense of coherence, which includes a recognition that even catastrophic events are comprehensible and that life experiences are manageable and meaningful (47), and hardiness (48) position individuals to extract growth from personal crisis. In a fashion akin to locus of control, the posited “salutogenic” (47) effects of self-efficacy, sense of coherence, and hardiness derive from cognitive or behavioral effort. Self-efficacy leads individuals to try to master challenges. A sense of coherence promotes active search for meaning during threatening events, which in turn orients one to view these events as comprehensible and to muster the resources needed to master them. And hardiness involves active involvement, a sense of personal influence, and an inclination to actively derive meaning from stressful events. Notice that these are all strategic and effortful processes rather than unintended consequences of threatening life events.
(p. 288) Limitations of Current Conceptions of Personality and Benefit-Finding
Although each of the personality traits described to this point may play a role in benefit-finding, investigators are aware that fully prospective designs are the best way to rule out the possibility that the personality characteristics associated with benefit-finding are not themselves a response to adversity. In support of retrospective designs in which both personality and an aversive event are measured some time after the event, investigators have suggested that because personality demonstrates temporal stability during adulthood, we can assume that preevent personality can be accurately inferred from postevent assessments. This simply is not so. Moderately high test-retest correlations and no mean difference for a cohort on a personality factor does not rule out even dramatic change for certain individuals within the cohort (49). As Pervin (50) reminds us: “overall stability, as reflected in correlation coefficients, may mask significant gains in functioning. … By the same token, stable means may mask significant individual differences” (p. 321).
The concerns we have raised regarding the “usual suspects” have been primarily methodological: indicators of some of these personality predictors overlap with one another; they have not been put to the rigorous requirements of fully prospective studies; and they are assumed to remain stable. Yet what may be most limiting about rolling out these same personality characteristics to explain individual differences in benefit-finding is the implication that those who are already well functioning are most likely to benefit further—or at least experience such benefit—from a crisis. Individuals who already experience a sense of personal control, who are optimistic about the future, who are outgoing and open to new experience, who are confident in their coping capacities, and who view the world as meaningful and its slings and arrows as manageable are, according to current theory, most likely to emerge from a crisis or traumatic experience believing that they are in some way better off than they were prior to the experience.
Implicit in this work is that paragons of mental health and personal development are the sole beneficiaries of perceived benefits following adversity, a perspective that fails to explain the most interesting and dramatic instances of positive change documented in accounts of such change, such as the heroin addicts described by Biernacki (51), who decided to give up their identity as an addict and successfully did so without treatment. These were by all accounts pessimistic, hopeless, fatalistic individuals who nonetheless managed to experience profound personal growth in the process of intentionally changing a central component of their identities. Current visions of personality characteristics associated with finding benefits in adversity also are contradicted by descriptions of perceived positive change offered by the many research participants who lacked the postulated personality characteristics prior to their traumatic experience. Miller and C’deBaca (52) and Lifton (53) described individuals who were certainly not (p. 289) optimistic, hardy, or extraverted. They were not particularly open to experience, and lacked a sense of coherence and meaning in life. And from all evidence, they maintained an external control orientation. Yet they reported dramatic change in the face of personal crisis. A more complete understanding of the role of personality in benefit-finding thus requires that we consider other conceptions of personality. It is to such conceptions that we now turn.
Levels of Personality, Personal Narratives, and Benefit-Finding
McAdams and his colleagues have recently offered a different personality context from which to interpret finding benefits in the face of adversity. McAdams (54) distinguishes three levels of personality: dispositional traits, personal concerns, and life narratives. Investigators interested in personality correlates of benefit-finding have relied exclusively on personality construed from the trait perspective, which is why all of the personality characteristics related to benefit-finding we have described to this point are all at McAdams’s first level.
Yet this approach may be the most limited and limiting for the study of benefit-finding. Among the many critiques of trait conceptions of personality, those most relevant to our discussion have been offered by Thome (55) and Mischel and Shoda (56), who argue convincingly that personality defined as traits leaves no room for “conditional patterns” (55) or “if… then … situation-behavior relations as signatures of personality” (56). These conditional relations between the person and her/his world are captured in the statements: “I lose my sense of control when I am threatened,” and “Life seems to lose its meaning when someone important in my life leaves.” The notion of conditional patterns may offer clues to areas in which perceived benefits might arise.
Personal concerns, McAdams’s (54) second level of personality includes an individual’s current life tasks (57), strivings (58), personal projects (59), and current concerns (60). Personal concerns refer to what a person wants at a particular point in life, and how s/he plans to get what s/he wants (61, 62). These concerns are neither traits nor are they epiphenomena of the trait level of personality. People are quite aware of this second level of their personalities because personal concerns guide everyday activities. Unlike Level 1, Level 2 is contextual and motivated, and McAdams (54) makes a strong case for the ebb and flow of personal concerns throughout life.
Whereas personality correlates of benefit-finding have been investigated exclusively at Level 1, the actual benefits described by research participants seem to reflect changes in this second level of personality, though as we will soon argue, McAdams’s Level 3 may be even more closely related to experiences of personal growth. When a research participant states that an unforeseen benefit of having received a life-threatening diagnosis is that (p. 290) personal relationships have become a focus of her everyday life in a way that is new and rewarding, she is describing a benefit related to personality at Level 2. Or consider a man whose son died after a long illness. When asked whether he has experienced any benefits, he reports that despite his continuing grief he has shifted his priorities from his work to the community. He organized a community program for chronically ill children, volunteers at a local hospital, and shares freely his time and expertise with the town Little League. These generative efforts have given his life renewed purpose and reflect perceived benefits related to a change in personality at Level 2. Similarly, when we asked middle-aged heart attack victims about possible benefits from their heart attack (6), a common response was that a new found appreciation of life had led to radical lifestyle changes. This too is a benefit related to personality at Level 2.
Personality at Level 3 concerns the individual’s attempt to shape an identity by finding unity and purpose in life. McAdams and colleagues (63) refer to this level as “integrative narratives of the self” and suggest that contemporary Western adults construct life stories as a way of bringing purpose to their lives (64). This third level of inquiry into personality processes has gained momentum among investigators interested in personal crisis (65), and theoreticians interested in trauma (66, 67). It is also consistent with Snyder, McDermott, Cook, and Rapoff’s assertion that hope lives in the personal stories that children and adults construct about themselves (68). McAdams and others who draw on the narrative tradition to understand personality consider identity as an “evolving story that integrates a reconstructed past, perceived present, and anticipated future into a coherent and vitalizing life myth” (54, p. 306). Personal myth cannot be reduced to traits (Level 1) or personal concerns (Level 2). It is an internalized, unfolding narrative that is revised so as to give life a sense of direction, meaning, and continuity.
McAdams (64) speculates that whereas traits remain stable throughout adulthood and personal concerns change in response to circumstances and life stage, identity is continuously being shaped—both consciously and without awareness—to provide narrative coherence and a sense of meaning and purpose to life, and to fit personal experiences into this coherent account. Personal trauma or crisis (called “nuclear episodes” or “nadirs” in McAdams’s scheme) provides the individual an opportunity to fit the experience into her/his life narrative and even to use the incident to affirm personal transformation. Citing Taylor’s (69) concept of positive illusions, McAdams (54) describes how narrative explanations of serious illness and other forms of adversity shape and reshape personal identity. We believe that finding benefits in adversity is one way individuals reshape their life stories in an effort to bring coherence and meaning during threatening encounters.
Employing narrative methods including McAdams’s (70) life-story interview, McAdams et al. (63) examined how life narratives relate to Erikson’s (71) concept of generativity by comparing the narratives of highly (p. 291) generative and less generative adults. These investigators anticipated that “redemptive sequences in life scenes” would emerge more frequently among their highly generative participants. Redemptive sequences are narratives in which particularly bad events are subsequently redeemed or made better through some positive outcome or sequelae. Such sequences have much in common with Colby and Damon’s (72) description of the narratives provided by adult moral exemplars, in which misfortune or life tragedy contains a positive aspect or leads to a positive outcome.
McAdams et al. (63) indeed found that highly generative adults described more redemption sequences in their accounts of turning points and nadir experiences in their lives. Most germane to our discussion of benefit-finding is the redemption sequence characterized by “growth.” In their life stories, some participants, particularly highly generative participants, describe episodes in which adversity ultimately leads to some personal gain or benefit: a painful divorce leads a participant to develop a better relationship with his son; a father’s death brings someone closer to her family; and a failed love affair produces more assertive and confident behavior.
These narrative sequences show a remarkable similarity to the perceived benefits elaborated by participants in our studies of adaptation to threatening medical conditions, and they show the same positive association to psychosocial adaptation (73). This raises a fascinating issue for those of us who study cognitive adaptation to adversity: Might interview or questionnaire responses acknowledging benefits or gains from a threatening experience reflect a narrative redemptive sequence that certain individuals are inclined to bring to all of life’s slings and arrows? If so, and if McAdams (54) is correct in hinting that life stories themselves may be construed as personality constructs, then what investigators have interpreted as adaptive cognitions may actually be an aspect of personality. Whereas dispositional traits may be correlates of benefit-finding, and contextualized concerns may be reflected in the content of benefits found, integrative narratives of the self, particularly growth narratives, may be precisely what is being measured by investigators who study benefit-finding.
Benefit-Finding: An Adaptive Phenomenon in Search of a Conceptualization
We have summarized the prevalence of benefit-finding, the range of threatening events in which its role has been examined, its association with personality and emotional well-being, and its capacity to predict health outcomes months and years later, even after controlling for likely confounds. The evidence is clear: Benefit finding enhances emotional and physical adaptation in the face of adversity. But unlike the adaptational benefits of sharing one’s story (see chapter 4 in this volume), of focusing on emotions (see chapter 5 in this volume), of optimism (see chapters 8 and 9 in this volume) and hope (see chapter 10 in this volume), and of rebuilding shattered (p. 292) assumptions (see chapter 14 in this volume), benefit-finding lacks a reliable conceptual “home.” Although theorists have moved beyond blanket interpretations of benefit-finding as a form of denial or as a maladaptive reality distortion (1), and investigators have freely offered their own conceptual frameworks for benefit-finding, alternative formulations have for the most part been ignored. We now suggest five ways to understand benefit-finding among individuals in adverse circumstances.
Benefit-Finding as Cognitive Reappraisal
The most common interpretation of benefit-finding in the stress and coping literature is that it represents a “selective evaluation” (2). Along with finding a sense of order and purpose in the threatening experience, imagining “worse worlds,” and making comparisons to less fortunate others, construing benefits or gains help individuals restore valued assumptions and cherished beliefs about themselves as worthy and relatively invulnerable and their world as orderly, predictable, meaningful, and benevolent or at least benign (2, 74, 75).
Implied in this constructivist interpretation of benefit-finding is that it is the appraisal of benefits that helps people adapt to victimization. Yet when individuals identify greater family harmony as an unexpected benefit of a crisis, might the adaptational benefits associated with this appraisal be due to their improved ability to obtain social support? If so, the inferred cognitive adaptation may be an epiphenomenon, of interest only as a marker of an influential change that has occurred (13). The working hypothesis of investigators coming from the “selective appraisal” perspective is that the accuracy of benefits construed by victims is less important to adaptation than the belief that positive changes have occurred. From this perspective, when people construe a beneficial change, true or not, they create a reality to which they then respond (13).
Benefit-Finding as a Personality Characteristic
McAdams’s (64) speculation that trauma or crisis provides an opportunity to recreate one’s life narrative and to structure a life story with coherence and meaning shares the constructivist perspective on benefit-finding, but places it in the context of a personality characteristic. If, in fact, there are individuals who characteristically provide narratives in which misfortune or life tragedy contains a positive aspect or leads to a positive outcome, and if highly generative people typically describe episodes in which adversity ultimately leads to some personal gain or benefit, the generative qualities interpreted by an investigator as an adaptational consequence of benefit-finding may in reality be a characteristic of those individuals who are more likely to generate “redemptive sequences” in which personal benefit or gain is an integral part.
(p. 293) Benefit-Finding as a Reflection of Growth or Change
An emerging literature on post-traumatic growth (4) and thriving in the midst of adversity (5) approaches the claim of benefits not as a cognitive construction designed to protect threatened assumptions, but as a potential indicator of genuine positive change. The distinction between benefit-finding as a selective appraisal and reported benefits as a veridical perception of change is critical to how we interpret research findings linking benefit-finding to adaptational outcomes. Consider the woman with breast cancer who responds to an interviewer’s query about benefits or gains by claiming that her surgery and chemotherapy has made her see what is important in life. Along with her new perspective, she finds that she is far less anxious about anticipated daily hassles and is now able to accept everyday disappointments without becoming despondent. How should the investigator interpret her scores on measures of well-being? Is her positive adaptation a product of selective appraisal, for example, benefit-finding, or is her selective appraisal an accurate representation of her positive adaptation? In the only study to our knowledge that has attempted to corroborate reports of personal growth derived from negative events, Park et al. (19) found significant intrapair agreement between the reports of participants and those of close friends and relatives who served as informants. We believe that these findings present a genuine challenge to a purely constructivist view of benefit-finding.
Benefit-Finding as a Rationalization of Temperament
McCrae (personal communication, May, 13, 1996, cited in 20) has suggested that some of the benefits reported by individuals facing adversity may represent a mechanism for restoring their characteristic hedonic level (76). The well-adjusted extrovert who typically feels relatively happy regardless of her circumstances may find herself feeling happy despite her recently experienced life crisis. She may explain her continued positive emotional state by attributing it to her appreciation of life’s small pleasures or what may seem like a new found capacity to feel grateful for past good fortune. When asked in a research interview if she has experienced any benefits or gains from her untoward experience, she is likely to offer her appreciation of the little things in life and her sense of gratitude. McCrae believes that she may be rationalizing her temperament. He asserts that because distressing events are incompatible with high hedonic levels, the people who are most likely to experience benefits are those who already are well functioning. Individuals who are chronically distressed (e.g., those who score higher on indicators of neuroticism) have no need for cognitive reappraisal when they face adversity because their emotional states fit their circumstances. (p. 294) The notion that benefit-finding is motivated by a need to rationalize temperament poses yet another challenge to most current formulations of cognitive adaptation to adversity and underscores the need for prospective inquiry and outcome indicators that move beyond self-report.
Benefit-Finding as Coping
Finding benefits in threatening circumstances also has been construed by investigators, at least implicitly (2), as an emotion-focused coping strategy. Largely due to the influence of Richard Lazarus (77, 78), but anticipated by others (79), coping researchers have come to appreciate that “not all adaptive processes are coping. Coping is a subset of adaptational activities that involves effort and does not include everything that we do in relating to the environment” (77, p.132, italics added). Although not all theorists agree that coping strategies require conscious effort (80, 81), we maintain the distinction between coping and other adaptational behaviors that do not require conscious effort.
Despite Lazarus and Folkman’s (77) care to focus on the effortful and strategic nature of coping, they included perceived benefits as an indicator of emotion-focused coping. The Ways of Coping Questionnaire (82), for example, includes the following items: changed or grew as a person in a good way, came out of the experience better than when I went in; found new faith; and discovered what is important in life. Yet coping theory, as currently formulated, distinguishes among adaptive behaviors that do not require effort, beliefs (which any of these questionnaire items may reflect), and coping strategies.
Lazarus and Folkman’s widely accepted definition of coping excludes beliefs that can be held without corroborating evidence, even if they enhance emotional well-being and health. Although adaptive, these beliefs are not coping strategies as now defined. Thus, if a seriously ill individual actively searches for evidence of benefits, she is coping. If she takes the time to remind herself of these perceived benefits, she is coping. If she eventually concludes that there have indeed been benefits associated with her illness and reports this belief when provided the opportunity during an interview, she is no longer coping. That her conclusion may have been reached through selective evaluations or convoluted reasoning or is biased by objective standards is irrelevant to its status as a coping strategy. Its adaptive function is equally irrelevant to whether it is a coping strategy (83).
Consider Dunkel-Schetter, Feinstein, Taylor, and Falke’s (84) factor analysis of the Ways of Coping Questionnaire (82) among cancer patients. One of the five strategies derived was positive focus, “characterized by efforts to find meaning in the experience by focusing on personal growth” (85, italics added). We can imagine someone with cancer trying to find meaning in the illness experience or trying to grow as a person from the (p. 295) experience. But items measuring positive focus do not measure such efforts. Rather, as we asserted above, they measure conclusions, for example, “I came out of the experience better than I went in.” And to the extent that such conclusions are veridical, we should be neither surprised nor impressed if they are associated with positive psychological or health outcomes. The confusion between benefit-finding as a coping strategy and benefit-finding as a conclusion reflects a confusion in the broader coping literature that has only rarely (83, 86) been addressed.
Under what circumstances can benefit-related cognitions be effortful? Consider an individual with a chronic pain disorder facing an extended period of intense pain who may be trying to remind herself of some of the benefits she has found from living with this disease as a way of making her pain more bearable. This effort to savor the benefits she has construed from her illness can justifiably be called a coping strategy. It captures the intentional, strategic quality of coping and in this way “behaves” like other cognitive pain-coping strategies such as diverting attention or reinterpreting pain sensations (87).
Whereas only those who already have discovered benefits from their adversity can use this discovery to comfort themselves in difficult times, there is nothing about the admission of benefits per se which implies that benefit-related cognitions will be used as effortful coping strategies. In a recent study of fibromyalgia pain, we examined this and related questions. This investigation is unique in its measurement of benefit cognitions in a daily process design that permits within-person analysis of relations among variables over time and the combination of idiographic and nomothetic methods (see 88 and 89 for detailed discussions of the benefits of this design).
Daily Process Findings on Benefit-Reminding
Our study of 89 women with fibromyalgia uses a prospective daily design which entails time-intensive self-monitoring of daily symptoms, experiences, behaviors, emotions, and cognitions for 30 days. We describe below their effortful daily use of benefit cognitions (benefit-reminding) and its relation with benefit-finding and personality/dispositional variables, and characterize the within-person relations of these comparison processes with fluctuating levels of daily pain and daily mood.
The time-intensive self-monitoring methodology used in this study combines a nightly structured diary with a computer-assisted “real-time” assessment of pain intensity and mood several times each day. The hardware for the electronic diary is a PSION palmtop computer programmed to deliver auditory signals to complete an on-screen interview at randomly selected times during the mid-morning, mid-afternoon, and mid-evening. The interview responses were time-stamped and stored in the palmtop computer for subsequent uploading to a desktop system. Shiftman and colleagues (p. 296) (90, 91) have established the feasibility of similar electronic diaries for self-monitoring studies, and we have demonstrated its many advantages over traditional paper-and-pencil methods (92, 93).
One item on the nightly questionnaire measured benefit-reminding: participants used a 0 (not at all) to 6 (very much) scale to describe how much that day they had “reminded [themselves] of some of the benefits that have come from living with their chronic pain.” The average daily mean for this item was .70 (SD = 1.12); the mean percentage of days the average respondent reported any benefit-reminding was 24.3% (SD = 33.1). Thirty-three participants never reminded themselves of benefits; 31 participants reported benefit-reminding on 1–9 days; 10 participants did so on 10–20 days; and 15 participants did so on 21–30 days. Clearly, there are considerable individual differences in how frequently these individuals actually reminded themselves of any benefits they had construed from their illness. Some who had cited many benefits never reminded themselves of these during a month’s time span, whereas some who had cited only one or a few reported benefit-reminding on many days.
Personality Correlates of Benefit-Reminding
As expected, individuals who had scored higher on the benefit-finding subscale of the IPCB did report more days of benefit-reminding (r=.51, p<.001). Potential confounds including participants’ duration of symptoms, education, and level of daily pain intensity were unrelated to benefit-finding or benefit-reminding. Older participants did report more benefits (r=.36, p<.001) as well as more days of benefit-reminding (r=.22, p<.05), but the age-partialed relation between benefit-finding and benefit-reminding remained significant (r=.48, p<.001). Several personality measures, including scores on the NEO Personality Inventory neuroticism and extraversion scales and the LOT’s pessimism and revised and original optimism scores, were unrelated to benefit-reminding frequencies.
The personality measure which did correlate with benefit-reminding was the Hope scale (r=.28, p<.01). Recall that we noted earlier that the Hope scale also correlated with benefit-finding in this sample. Because the relation between Hope and benefit-reminding became nonsignificant when benefit-finding was partialed from this association, while the relation between benefit-finding and benefit-reminding remained significant when Hope was partialed from that association, we can conclude that the relation between Hope and benefit-reminding is mediated by the tendency of hopeful individuals to find more benefits in their illness.
Within-Person Analysis of Benefit-Reminding
The design of our study enables within-person analysis of day-to-day differences in benefit-reminding and other daily processes. To examine within-person relations across persons, independent of between-person differences in the daily data, a series of multilevel models with random subject intercepts (94) were tested using SAS proc mixed (95). One such analysis related daily benefit-reminding to (p. 297) daily pain intensity, measured by electronic diary entries of daily ratings of 14 areas of the body, and to daily mood scores, measured by electronic diary data on a 16-item mood adjective checklist, capturing all octants of the circumplex model of mood pleasantness and mood arousal (96): pleasant mood, unpleasant mood, aroused mood, unaroused mood, pleasant-aroused mood, pleasant-unaroused mood, unpleasant-aroused mood, and unpleasant-unaroused mood. Days characterized by more benefit-reminding did not differ in pain intensity, but were accompanied by significant differences in mood, specifically increased levels of pleasant (i.e., happy, cheerful) mood; aroused mood (active, lively); and aroused-pleasant (i.e., peppy, stimulated) mood. When all three of these mood dimension scores were examined together as correlates of benefit-reminding frequency, there remained a unique relation only with pleasant mood. Thus, on days when these chronic pain sufferers made greater efforts to remind themselves of the benefits that have come from their illness, they were especially more likely to experience pleasurable mood, regardless of how intense their pain was on these days.
This within-person analysis of efforts to remind oneself of the benefits of living with chronic pain strengthens the hypothesis that benefit-reminding can improve one’s emotional well-being on more difficult days. Interested readers can consult articles that provide various multilevel data analytic strategies for modeling individual differences due to personality in stress-symptom and stress-mood relations across time (97, 98).
Research Directions and Clinical Implications
If this chapter could offer only one message for investigators, it would be to underscore the need for detailed, prospective studies of coping with threatening events, including the role of benefit-finding and benefit-reminding in the process of adaptation to adversity. We are convinced that coping is an unfolding process, and that cross-sectional studies seeking correlations between perceived benefits and well-being at a particular moment are rarely revealing and often misleading. We are committed to studying people over time, and we have been impressed at how readily research participants let us into their lives at their darkest moments and allow us to stay with them as they face adversity, most often to better times.
If we could offer only one message for practitioners, it would be to respect the adaptational value of benefit-finding and benefit-reminding, while resisting the understandable desire to directly influence these adaptational processes. Nothing in this chapter should be construed as evidence that deliberate attempts by family, friends, or helping professionals to shape or influence the perception of benefits will be helpful. Although there may be some people who appreciate being reminded by someone else to “look at all the good that has come from this experience,” and it is even possible that family, friends, or treating physicians helped shape the benefit perceptions (p. 298) of some individuals (2), our research participants have told us spontaneously and repeatedly that they view such efforts as insensitive and inept. They are almost always interpreted as an unwelcomed attempt to minimize the unique burdens and challenges that need to be overcome. Although clinical impressions suggest that sensitive health care professionals might be able to facilitate benefit-finding (2), the empirical literature offers few clues regarding how or when to offer such facilitating interventions. Whereas finding benefits and reminding oneself of benefits enhance emotional and health outcomes in the face of adversity, our research participants indicate that directed, imposed, or suggested benefits will almost surely fail to achieve their desired goal. Most people have a remarkable capacity to withstand and overcome threatening events without our well-intentioned efforts to provide them with a different way to interpret their plight. As provocative as the present findings on benefit-finding and benefit-reminding may be, they demand a caveat: There is a great deal more we need to know before we apply these findings to therapeutic endeavors.
The unpublished findings reported in this chapter come from a study funded by the National Institute of Arthritis, Musculoskeletal, and Skin Diseases Grant #AR-20621 to the University of Connecticut Multipurpose Arthritis Center. We appreciate Susan Urrow’s and Micha Abeles’s collaboration, the aid of Jeffrey Siegel of National Technology Services for programming the electronic diary described in this chapter, and the assistance of Pamela Higgins and Debra Begin with data collection and management.
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