Characterizing Post-Traumatic Growth and the Cognitive Engagement and Disengagement Strategies that Promote Growth in Caregivers of Children with Cancer

Abstract

Despite considerable distress and negative adjustment outcomes reported by caregivers of children with cancer (Pai et al., 2007; Patiño-Fernández et al., 2008; Sultan et al., 2016), many caregivers also report positive changes or personal growth (López et al., 2019). The term post-traumatic growth (PTG; Calhoun and Tedeschi, 1996) was coined to capture the experience of positive developments that directly result from the struggle with challenging circumstances. Multiple conceptual models (Joseph et al., 2012; Picoraro et al., 2014; Tedeschi & Calhoun, 2004) have been presented to help guide our understanding of how one moves from disruption to reintegration and growth, and models consistently identify cognitive processing as a key factor underlying the formation of PTG. However, research examining the association between cognitive engagement with the difficult aspects of cancer and PTG is mixed, with some research finding positive associations, some finding no associations, and some finding negative associations. Furthermore, the opposing cognitive strategy of disengagement is also conceptually and empirically linked to PTG, but again, the research is divided.The current study sought to clarify contradictions in prior work linking cognitive engagement and disengagement strategies and PTG through improved study methodology. We carried out a series of complementary aims that increased measurement precision (with regard to timing of cognitive engagement and disengagement strategies and the possibility of non-linear relationships with PTG) and depth of context (with regard to caregiver role, the concurrent use of engagement and disengagement strategies, and the relationship between PTG and traditional measures of adjustment). Findings from each aim are presented separately, then integrated in the discussion. Primary caregivers (PCs) and secondary caregivers (SCs) of children aged 2-17 recently diagnosed with cancer (N = 143, diagnoses: 37% leukemia, 23% CNS malignancies, 11% lymphoma, 10% sarcomas, 9% Wilms tumor, 4% neuroblastoma, 5% other) completed measures of cognitive engagement and disengagement (Responses to Stress Questionnaire), depressive symptoms (Center for Epidemiological Studies – Depression 10), and post-traumatic stress symptoms (Impact of Events Scale – Revised) at 1-, 6-, and 12-months post-diagnosis. Reports of PTG (Post-Traumatic Growth Inventory) were collected at 12-months post-diagnosis. Results demonstrated that primary control engagement was the single cognitive strategy with the strongest evidence of association to PTG among both caregivers. Some evidence showed that secondary control engagement promoted growth, particularly among SCs. As an individual strategy, disengagement was only found to be a helpful for promoting PTG in SCs and only at moderate levels. Additionally, the ability to flexibly use all three volitional strategies (primary control, secondary control, and disengagement) was also seen to promote PTG in both caregivers. Higher levels of involuntary engagement and disengagement stress responses were also seen to promote PTG among SCs, but not PCs. Finally, despite links to traditionally “maladaptive” engagement and disengagement responses as well as conceptual links to distress and disruption, PTG was largely orthogonal to trajectories adjustment, with the one exception being that SCs with greater post-traumatic stress symptoms also reported greater PTG. Taken together, results emphasize taking a contextual and ideographic approach to understanding which cognitive engagement and disengagement strategies are helpful, when they are helpful, and for whom they are helpful in promoting PTG in the context of childhood cancer. A broader range of strategies than previously assumed advantageous may promote PTG, especially among SCs and when used in conjunction with conventionally adaptive strategies. Results are discussed with regard to challenges in measuring and defining PTG, given that some researchers have proposed that there may be two faces to PTG: one that is true and adaptive and one that is illusory and maladaptive (Maercker & Zoellner, 2004). Limitations and directions for future work are discussed alongside implications of findings.