Personal Growth Initiative and Search for Meaning in Life: Moderate Illness Perception and Chronic Illness Coping.
Marlena M. Kossakowska, Ph.D. Department of Clinical and Health Psychology, SWPS University of Social Sciences and Humanities, Sopot, Poland
Corresponding author: Dr. Marlena M. Kossakowska, Department of Clinical and Health Psychology, SWPS University of Social Sciences and Humanities, Sopot, Poland: firstname.lastname@example.org
The aim of this study was the verification of the theoretical Model of Personal Growth in Chronic Illness (MPGCI). The model was inspired by the two following theoretical approaches: 1) the Leventhal’s Common Sense Model (Leventhal et al., 2003) and 2) Park and Folkman’s Meaning Making Model (1997; Park, 2006, 2010). The first theory assumes that illness perceptions determine the behavior of chronically ill people in coping with their disease. The second one pays attention to the meaning-making process in dealing with chronic disease. MPGCI assumes that all the efforts, which are undertaken by people who suffer from a chronic condition, may lead to positive outcomes, which is referred to as personal growth.
Personal growth, in terms of Carol Ryff’s theoretical approach to well-being, is a sense of continued growth and development as a person (Ryff & Keyes, 1995). In the following research, personal growth includes hedonic and eudaimonic aspects of well-being as the signs of: high self-esteem, meaningful life, positive emotions, and benefit-finding / benefit-reminding from going through a disease.
The Model of Personal Growth in Chronic Illness also contains two moderators: Personal Growth Initiative (PGI) (Robitschek et al., 2012) and search for meaning in life (Steger et al., 2006), which interact with each other. The PGI is defined as the intentional engagement in the process of personal growth. PGI encompasses the cognitive components of self-efficacy, including beliefs, attitudes, and values that support personal growth (Robitschek, 1998). It includes behavioral components that involve implementing these cognitions across growth domains. In other words, the behavioral components put into practice the cognitions related to personal growth. For example, if I want to change something in my life, I initiate the transition process. PGI can be thought of as a metacognitive construct, that is, awareness and control of intentional engagement in growth-enhancing cognitions and behaviors in all areas of life. Search for meaning is the drive and orientation toward finding meaning in one’s life (Steger et. al., 2006), and is a very important mechanism in the meaning-making process.
The assumptions of the MPGCI model are that, despite going through a challenging experience such as a chronic disease (in terms of illness perceptions), a human being has relevant psychological predispositions. Illness perceptions are cognitive and emotional representations of the illness and include the subjective appraisal of illness impact on a patient’s life (consequences), severity of the illness (identity), concern, personal and cure control, understanding, emotional response, and the timeline of the (Leventhal, Nerenz, & Steele, 1984). They play a significant role in the MPGCI model as independent variables. These are adapted to search for meaning, personal growth initiative, and coping strategies that allow them to live a good life (as defined by positive psychology) and derive some benefits from it, namely personal growth.
Therefore, the theoretical MPGI results in 1) the subjective role of illness perceptions, 2) the interaction of search for meaning in life, and 3) the personal growth initiative, as well as 4) coping strategies in achieving personal growth in chronic illness (see moderated mediation Model 11 according to Hayes, 2013).
The study participants, 188 adults with multiple sclerosis (MS), filled out several questionnaires to measure their illness perceptions. The first, the Brief Illness Perceptions Questionnaire (B-IPQ; Broadbent et al., 2006) was shown in a prior analysis (Kossakowska, 2018) to be a three-factor tool that consists of subscales: functional and cognitive illness perceptions and timeline. Only functional and cognitive illness perceptions were incorporated in the MPGCI model, as listed above in describing the concept of functional illness perceptions.
The second questionnaire measuring personal growth used the Personal Growth Initiative Scale –version I (PGIS I; Robitschek, 1998). A third measuring searching for meaning (ML-S) used one of the two scales from the Meaning in Life Questionnaire (Steger et al., 2006). A fourth measuring coping strategies used the Coping Orientations to Problems Experienced (COPE; Carver, Scheier, & Weintraub, 1989). The sum of all strategies was the variable tested in the MPGCI model.
In this research, personal growth was understood as 1) self-valued self-esteem, 2) the presence of meaning in life, 3) the intensity of feeling positive emotions in life, and 4) benefit-finding/ benefit reminding. Personal growth was the aggregate indicator of four questionnaires scores: Positive Emotions Scale (PES; Kossakowska, 2018), Rosenberg’s Self-Evaluation Scale (SES; Rosenberg, 1964), Silver Lining Questionnaire (McBride et al., 2008) and one of the scales of the MLQ: Meaning in Life – Presence (ML-P; Steger et al., 2006). All questionnaires were Polish versions and adaptations of the original measures.
The macro Process for SPSS was used to verify the model of “moderated moderated” mediation model 1 (Hayes, 2013). Two separated models with two different independent variables (functional and cognitive illness perceptions) were tested. Only functional illness perceptions (perceptions of illness severity) were significant for the Model of Personal Growth in Chronic Illness: R²= .20; MSE= .12, F(7, 180)=6.44; p< .0001 (Figure 1). The three-way interaction of functional illness perceptions, personal growth initiative and search for meaning was confirmed: b7= -.02; t(180) = -2.23, p = .027; 95% Cl [-.029; -.002].
Figure 1. “Moderated moderated” mediation of personal growth in multiple sclerosis. Functional illness perceptions as an independent variable. All coefficients are unstandardized. Note: *p< .05; **p< .01; *** p< .001; **** p< .0001.
Due to the three-way interaction, the indirect, conditional effect of functional illness perceptions on coping strategies as a function of personal growth initiative and search for meaning was confirmed in the following configuration. With the low level of search for meaning in life and high initiative of personal growth occurring at the same time, the patients who experience their illness as severe, apply more various coping strategies in order to gain personal growth in illness. The same situation we can find when patients have high (or average) level of search for meaning with any level of personal growth initiative.
The conditional indirect effect of functional illness perceptions on personal growth when coping strategies are mediators does not exist in the case of low level of search for meaning in life and low (or average) level of personal growth. Regardless of the quality of the functional illness perceptions, patients apply a similar number of various coping strategies to achieve personal growth.
The research demonstrates that personal growth in a chronic illness is a complex issue. However, the extremely significant two factors facilitating the personal growth in multiple sclerosis apparently are the search for meaning in life and personal growth initiative. They determine personal growth and depend on the level of these two factors. This phenomenon I named “ultra-reinforcement” of coping with chronic disease in achieving the personal growth.
Conclusions from this study are:
1. The mechanism of obtaining personal growth in illness differs, depending on functional illness perceptions
2. The ultra-reinforcement mechanism was discovered i.e.: searching for meaning in life driven by personal growth initiative.