We would like to thank the MUSIC collaboration for inviting us to participate in this cross-site study. This article is dedicated to the loving memory of Madeleine Rose Woo.
Role of Meaning in the Prediction of Depressive Symptoms Among Trauma-Exposed and Nontrauma-Exposed Emerging Adults
Article first published online: 24 JUN 2013
© 2013 Wiley Periodicals, Inc.
Journal of Clinical Psychology
Volume 69, Issue 12, pages 1269–1283, December 2013
How to Cite
Woo, C. R. S. and Brown, E. J. (2013), Role of Meaning in the Prediction of Depressive Symptoms Among Trauma-Exposed and Nontrauma-Exposed Emerging Adults. J. Clin. Psychol., 69: 1269–1283. doi: 10.1002/jclp.22002
- Issue published online: 23 OCT 2013
- Article first published online: 24 JUN 2013
This study investigated the role of searching for meaning, finding meaning, trauma exposure, and their interaction in the prediction of depressive symptoms among trauma-exposed and nontrauma-exposed emerging adults.
Eight thousand seven hundred and eighty-four college students (73% female; mean age of 19.8 years) completed self-report measures. Hierarchical regression analysis was conducted to evaluate the three-way interaction in the prediction of depressive symptoms.
Searching for and finding meaning as well as the three-way interaction significantly contributed to the prediction of depression. Specifically, searching for meaning was associated with increased symptoms, irrespective of meaning levels among nontrauma-exposed and low frequency trauma-exposed emerging adults. Among high frequency trauma-exposed individuals, an increase in the search-by-find meaning interaction predicted fewer symptoms.
The findings suggest that searching for and finding meaning are important mechanisms in the prediction of depression among emerging adults facing daily stressors and traumatic events. Clinical implications are discussed.
Traumatic experiences are pervasive and can have a severe negative effect on mental health, including posttraumatic stress disorder (PTSD), other anxiety disorders, depression, and substance abuse (e.g., Kilpatrick et al., 2003). Traumatic events are particularly prevalent among emerging adults (aged 18–25 years; Arnett, 2005), a period during which many individuals attend college. In fact, the incidence of trauma (i.e., dating violence, sexual assault, homicide, robbery, physical assault, motor vehicle collisions, and/or suicide attempts) during emerging adulthood is 84%–90% (Arnett, 2005; Bureau of Justice Statistics, 2009; Katz, Carino, & Hilton, 2002; Strauss, 2004). Because 50% of adolescents report a lifetime prevalence of direct or witnessed interpersonal violence (e.g., Kilpatrick et al., 2003b), almost half of emerging adults have been multiply traumatized. Repeated trauma exposure is associated with severe, chronic psychopathology (Finkelhor, Ormond, & Turner, 2009; Scott, 2007), over and above that accounted for by pretrauma symptom levels and revictimization.
Examining the mechanisms for processing trauma in emerging adults may explicate the development and amelioration of trauma-related mental health problems in college students. Developmental characteristics of emerging adulthood, namely, exploration of roles and worldviews, may compromise individuals’ capacity to cognitively process traumatic events (Arnett, 2000; Arnett, 2005; Schulenberg & Maggs, 2002). According to a study on college students, most individuals abandon their childhood worldviews and religious views by the end of college education without an alternative framework of the world, thereby subscribing to a tenuous set of core beliefs or worldviews (Arnett & Jensen, 2002; Reifman, Arnett, & Colwell, 2005). The effect of trauma further challenges the validity of the new and fluctuating framework of the world, thereby increasing susceptibility to current and future psychopathology. To date, there have been no studies of the interrelation among trauma, meaning making, and psychopathology in emerging adults. The purpose of the current study is to examine whether meaning making moderates the relation between trauma exposure and depression in emerging adults.
Searching for and Finding Meaning After a Traumatic Experience
One mechanism for processing traumatic experiences is meaning making. According to information processing theorists (e.g., Hollon & Garber, 1988), new or schema-discrepant information initiates a meaning-making process, such that the information can be accurately perceived and organized. Because most people possess a schema of the world that is benevolent, just, and predictable (Janoff-Bulman, 1992), searching for meaning after trauma includes a negotiation of the discrepant information and redefinition of new meaning to the traumatic event and/or schema to narrow the gap between our worldview and the new information (Gilbert, 1997; Hollon & Garber, 1988; Neimeyer, 1998; Resick & Schnicke, 1992).
Specifically, a traumatic event can be processed in two ways: (a) by reframing or “assimilating” the traumatic event to fit into the existing schema or (b) by reconstructing the existing schema to “accommodate” the schema-discrepant traumatic event (Hollon & Garber, 1988; Payne, Joseph, & Tudway, 2007; Resick & Schnicke, 1992). For example, a rape victim can (a) assimilate the trauma by reframing the incident as “not rape” because she dressed inappropriately or (b) by adjusting the worldview as “sometimes bad things happen” to accommodate the traumatic rape experience. Resick and Schnicke (1992) proposed a third alternative, overaccomodation, in which individuals alter their worldviews excessively (e.g. “the world is a dangerous place and I will never be safe”) to make sense of the discrepant traumatic experience. According to this framework, finding meaning through accommodation protects against psychopathology, whereas assimilation, overaccomodation, and failing to find meaning places trauma survivors at risk for psychopathology.
The information processing theory is one of four major theories explicating psychopathology that may result from experiencing a traumatic event. First, Mowrer's (1960) two-factor learning theory of fear and anxiety proposes that fear is reinforced through classical conditioning to the exposure to a traumatic event, whereas avoidance is developed through instrumental conditioning, specifically negative reinforcement. Second, Foa and Kozak (1986) proposed the emotional processing theory of fear. The theory purports that neutral stimuli are capable of activating pathological fear memory structures, which are developed consequent to a traumatic event. Third, cognitive theory (e.g., Beck, Emery, & Greenberg, 1985) suggests that it is one's interpretation of an event that contributes to psychopathology after a traumatic event.
Empirical Evidence Supporting the Positive Effects of Finding Meaning
Researchers have found that failing to find meaning (vs. finding meaning) after a traumatic event is predictive of poor psychological adjustment, including symptoms of PTSD (Owens, Steger, Whitesell, & Herrera, 2009), depression and anxiety (Bonanno, Wortman, & Nesse, 2004; Davis, Nolen-Hoeksema, & Larson, 1998; Davis, Wortman, Lehman, & Silver, 2000; Wu et al., 2008), chronic or pathological grief (Bonanno et al., 2004; Keesee, Currier, & Neimeyer, 2008; Uren & Wastell, 2001), and negative affect (Davis et al., 1998; Davis, Wortman, Lehman, & Silver, 2000). This association is consistent across child, parent, and conjugal deaths due to AIDS (Davis et al., 1998), cancer (Davis et al., 1998; Wu et al., 2008), motor vehicle collisions (Davis et al., 2000), or sudden infant death syndrome (Davis et al., 2000), up to 7 years postbereavement (Davis et al., 2000). Finding meaning has been found to predict psychological functioning beyond variance accounted for by cause of death (Keesee et al., 2008), time since death (Keesee et al., 2008), and prebereavement distress (Davis et al., 1998; Wu et al., 2008).
Searching for Meaning After Trauma and Bereavement
Despite the general consensus that finding meaning protects against trauma-related psychopathology, few researchers have studied the independent role of searching for meaning. Although the information processing theory proposes that a schema-discrepant traumatic event necessitates searching for meaning (e.g., Hollon & Garber, 1988; Janoff-Bulman, 1992), a protracted search for meaning may negatively affect psychological adjustment. Specifically, prolonged searching for meaning may compromise emotional processing (e.g., Ehlers & Clark, 2000; Foa & Kozak, 1986), promote experiential avoidance (Hayes, Wilson, Strosahl, Gifford, & Follette, 1996), and mimic rumination (Nolen-Hoeksema, 1991; Papageorgiou & Wells, 2003).
Searching for Meaning as Cognitive and Experiential Avoidance
Foa and Kozak (1986) propose that anxiety disorders are developed because of abnormal pairing of stimuli and responses. Neutral cues, such as a smell or an object, when paired with a potentially life-threatening traumatic experience, will elicit future fear responses, even in the absence of imminent threat. For example, fear may be elicited in an assault victim from a friendly tap on the shoulder, or from coming into contact with a person of a similar build to the perpetrator. According to Foa and Kozak, emotional processing is necessary to reduce such fear responses. This involves activation of fear response by the conditioned stimulus, followed by the acquisition of new cognitive and affective responses (e.g., Bryant et al., 2008; Foa & Kozak, 1986; Foa et al., 2005; Resick, Nishith, Weaver, Astin, & Feuer, 2002). Excessive searching for meaning may act as cognitive avoidance by inhibiting emotional processing, thereby prolonging and solidifying the memory structure of fear.
A protracted search for meaning also is consistent with the theory of experiential avoidance, a mechanism believed to underlie various psychological disorders (Hayes et al., 1996). Experiential avoidance allows individuals to avoid images or negative thoughts that prompt physiological arousal and negative affect associated with anxiety or depressed mood. Although experiential avoidance temporarily reduces physiological arousal and negative affect, it perpetuates future negative emotions by preventing emotional processing (e.g., Ehlers & Clark, 2000). Thus, a protracted search for meaning may serve a similar function as experiential avoidance in maintaining psychopathology related to trauma.
Behaviorally, this cognitive and experiential avoidance may appear as rumination. Defined as frequent, repetitive, and self-focused thinking about past negative experiences (Nolen-Hoeksema, 1991; Papageorgiou & Wells, 2003), rumination is shown to predict as well as maintain depression and PTSD symptoms (Clohessy & Ehlers, 1999; Michael, Halligan, Clark, & Ehlers, 2007; Nolen-Hoeksema, 1991). Specifically, researchers found that self-focused, analytic, evaluative rumination predicted increased negative mood, whereas experiential rumination, characterized by a nonevaluative narrative of experiential awareness, predicted lower levels of negative affect (Lo, Ho, & Hollon, 2010; Teasdale, 1999; Watkins, 2004). The abstract analytic mode of rumination is similar to prolonged searches for meaning, as individuals engage in a perseverative focus on abstract “why” and “what if” questions (e.g., Michael et al., 2007). The effect of extensive searching for meaning requires further investigation.
Empirical Evidence for the Effects of Searching for Meaning
More recently, researchers have shown that an excessive search for meaning is associated with elevated symptoms of anxiety and general distress (Davis et al., 1998, 2000; Eton, Lepore, & Helgeson, 2005; Kernan & Lepore, 2009; Wu et al., 2008). In a prospective study examining mothers’ adjustment to their children's death after hematopoietic stem cell transplantation, Wu et al. (2008) found that increased postdeath search for meaning predicted increased distress, over and above mothers’ reported predeath distress levels. Eton et al. (2005) found that among spouses of men with prostate cancer, women who reported greater search for meaning evidenced increased distress levels relative to individuals who reported less engagement in search for meaning. In a similar vein, Kernan and Lepore (2009) investigated the role of searching for meaning among women diagnosed with breast cancer who were undergoing treatment. Controlling for reported negative affect at 11 months after diagnosis, they found that women who engaged in a continuous search for meaning (relative to those who reported less or delayed search for meaning) evidenced greater negative affect.
Simultaneous Examination of Searching for Meaning and Finding Meaning
With increasing support for the independent contribution of finding meaning and searching for meaning in the adjustment to traumatic experiences, there remains a paucity of research on the relationship between searching for meaning and finding meaning. This is particularly important as finding meaning appears to act as a protective factor, whereas excessive searching for meaning seems to act as a risk factor for psychopathology. To date, only three studies systematically investigated finding meaning in relation to searching for meaning in the prediction of adjustment to trauma. Davis et al. (1998, 2000) conducted a longitudinal qualitative study with parents who experienced Sudden Infant Death Syndrome and family members coping with death from motor vehicle collision. Respondents who did not search for meaning reported similar distress levels to individuals who searched for and found meaning. Individuals who searched for meaning but did not find meaning reported the highest distress levels three and 18 months postdeath.
In another study, Lepore and Kernan (2009) investigated the interaction between searching for meaning and finding meaning in the prediction of negative affect among women receiving treatment for breast cancer. They did not find a significant interaction effect, but found that protracted search for meaning predicted the greatest negative affect (vs. little or delayed search for meaning). Contrary to previous studies, there was no significant relation between finding meaning and negative affect. Further studies are needed to elucidate these associations.
A number of methodological limitations in the studies on the interaction between searching for and finding meaning in the prediction of psychopathology diminish our confidence in the findings. Previous research involved qualitative interviews (Davis et al., 2001) and single-item measures (Eton et al., 2005; Lepore & Kernan, 2009; Wu et al., 2008) of meaning that were not comprehensive or psychometrically robust. Additionally, the only studies that investigated both searching for and finding meaning categorized participants as (a) not searching for meaning, (b) searching for and finding meaning, or (c) searching for, but not finding meaning, without measuring the role of not searching for but finding meaning (Davis et al., 2000). Meaning may be attained without active searching if individuals’ schema readily incorporates the traumatic event. For example, potentially traumatic events are not discrepant from frameworks that purport “Things happen” or “It was God's will.” A more thorough investigation would include the 2×2 interaction between searching for meaning and finding meaning, assessed using robust measures.
Searching for Meaning and Finding Meaning Among Nontrauma-exposed Emerging Adults
The influence of searching for and finding meaning on adjustment may not be unique to trauma survivors. Cognitive processing of daily hassles may mirror that of traumatic events. Rumination about daily hassles has been associated with depression and correlates of depression, including negative attributional style, hopelessness, pessimism, and self-criticism (e.g., Nolen-Hoeksema, 1991; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007; Papageorgiou & Wells, 2003). An overall sense of meaning, such as sense of coherence in life, has been found to correlate with a sense of well-being among individuals coping with daily hassles (e.g., Ryan & Deci, 2001; Seligman & Csikszentmihalyi, 2000). Perhaps the protective aspects of finding meaning apply to both traumatic and everyday events. This comparison has not been examined and will be a focus in this study.
The aim of the current study was to investigate the relations between searching for and finding meaning in the prediction of depression in trauma-exposed and nontrauma-exposed emerging adults. We proposed that the relation between searching for meaning and depression would be moderated by finding meaning. Specifically, we hypothesized that an increased search for meaning (vs. less searching for meaning) would be associated with higher depression, especially when low (vs. high) levels of meaning were reported. We examined whether this relationship differed between trauma-exposed and nontrauma-exposed college students, and by frequency of trauma exposure. A three-way interaction among searching for meaning, finding meaning, and trauma frequency was hypothesized, such that the interaction between searching for meaning and finding meaning in the prediction of depression would be more pronounced among emerging adults who experienced a traumatic event relative to those who were not exposed to trauma. Further, it was hypothesized that the interaction between searching for meaning and finding meaning would be more pronounced among individuals exposed to high frequencies of traumatic events relative to those who were exposed to fewer traumatic events.
The data for this study were collected as part of a larger project involving 31 universities and colleges across the United States (see Castillo & Schwartz, , for details). Participating schools recruited undergraduate students to complete online questionnaires as part of their psychology course requirement. A subset of these measures was used in the current study.
Data were collected from 8,794 college students (aged 18 to 25 years), with a mean age of 19.8 (standard deviation [SD] = 1.62). Seventy-three percent of the participants were female. Participants self-identified as White (62.6%), Hispanic (15.2%), Black (9.4%), and Asian (10.5%). Religious affiliation included Protestant (34.7%), non-Protestant Christian (33.7%), Jewish (3.1%), Mormon (3.2%), other religions (8.4%), and no religion (19.5%). Seventy-five percent of the participants reported having experienced at least one type of traumatic event (see Castillo & Schwartz, in press, for further details on participants).
Participants’ demographic information was measured using a 73-item measure (S. Schwartz, personal communication, 2008), including questions to assess participants’ age, gender, ethnicity, family relationships, religious practices, religious affiliation, school involvement, and extracurricular involvement. Only age, gender, ethnicity, and religious affiliation were used in this study.
The Traumatic Events Screening Inventory (TESI; Edwards & Rogers, 1997) is a 24-item scale of participants’ exposure to trauma and bereavement. The TESI was developed as a structured clinical interview and was modified to be a self-report trauma checklist, using simple yes/no responses. Inter-rater reliability for different forms of trauma ranged from Kappas .50 to .70 (Edwards & Rogers, 1997). Items were added by Brown (2009, personal communication) to reflect the frequency with which each participant was exposed to the endorsed traumatic event. Frequency items were summed across trauma types (excluding bereavement because of its ubiquity) to create a Frequency subscale, with good internal consistency (Cronbach's α = .86).
Searching for meaning and finding meaning
Searching for meaning and finding meaning were measured using the Meaning in Life Questionnaire (MLQ; Steger, Frazier, Oishi, & Kaler, 2006), a self-administered 10-item measure. The MLQ was modified from a 7-point to a 6-point response scale for the current study to eliminate the neutral response “Can't Say True or False.” The responses range from 1 (totally false) to 6 (totally true). Factor analyses have shown that the 10 items load onto two factors: Presence of Meaning (MLQ-Presence; “a subjective sense that one's life is meaningful”) and Search for Meaning (MLQ-Search; “drive and orientation toward finding meaning in one's life”; Steger et al., 2006). Both subscales demonstrated good internal consistency (Cronbach's α = .87, .87) with the current sample. The MLQ also has been shown to have adequate test-retest reliability (Steger et al., 2006). A total score of 5, a minimum score on the MLQ-Search subscale, was considered low searching for meaning (MLQ-Search low), and a total score of 30, a maximum score on the MLQ-Search subscale, was considered high searching for meaning for the purpose of this study.
The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a 20-item scale of the symptoms of depression. Individuals’ responses are measured on a 4-point Likert scale ranging from 0 (never or rarely) to 3 (most of the time), with summary scores ranging from 0 to 60. The CES-D has good internal consistency, moderate test-retest reliability, concurrent validity, and construct validity (Radloff, 1977). With the current sample, the CES-D total score showed strong internal consistency (Cronbach's α = .86).
Participants were recruited through (a) web-based research participation systems from the university's psychology department and (b) advertisements in undergraduate classes to participate in the study for extra credit. Participation was voluntary, and students were offered other means to obtain the extra credit.
Missing data that were less than 15% of the total number of items were imputed using mean substitution (Tabachnick & Fidell, 2001). Scales with more than 15% of the items missing were excluded from analysis. Normality of data was assumed given the large sample size; the F test is robust to violations of normality when there are at least 20 degrees of freedom for error in univariate analyses of variance (Tabachnick & Fidell, 2001). TESI-Frequency (mean [M] = 12.9; SD = 15.24) was winsorized to remove upper bound outliers indicated on stem-and-leaf plot, such that trauma frequencies above 95th percentile (i.e., TESI- Frequency > 84.25) were replaced by the value at the 95th percentile, 84.25. 6416 participants reported experiencing at least one incident of traumatic event, including witnessing parents “yelling and screaming at each other.” Independent variables, MLQ-Presence, MLQ-Search, and TESI-Frequency were centered to reduce multicollinearity and to ease interpretation (Cohen, Cohen, West, & Aiken, 2003). Categorical variables, gender, ethnicity, and religious affiliation, were dummy-coded (Cohen et al., 2003). For the hierarchical regression analyses, the following interaction terms were created: (a) MLQ-Presence × MLQ-Search, (b) MLQ-Presence × TESI-Frequency, (c) MLQ-Search × TESI-Frequency, and (d) MLQ-Presence × MLQ-Search × TESI-Frequency.
For emerging adults exposed to trauma, finding meaning was predicted to moderate the relations between searching for meaning and depression. More specifically, increased symptoms of CES-D total associated with high MLQ-Search (vs. low MLQ-Search) were predicted to be ameliorated by the protective effects of finding meaning (high levels of MLQ-Presence).
MLQ-Search, MLQ-Presence, and TESI-Frequency were hypothesized to interact to predict CES-D total. More specifically, the same two-way interaction between MLQ-Search and MLQ-Presence was hypothesized, but the strength of this interaction in the prediction of CES-D total was predicted to vary according to TESI-Frequency.
Univariate analyses of variance (ANOVAs) were conducted to examine differences within demographic variables (gender, ethnicity, religious affiliation) on CES-D total. As there were no significant relations between demographic characteristics and CES-D total, demographic variables were not entered into the hierarchical regressions. Correlations among study variables are presented in Table 1, and descriptive statistics are presented in Table 2.
|4. CES-D total||−.251**||.164**||−.016||1|
The Three-Way Interaction of Finding Meaning, Searching for Meaning, and Trauma Frequency in the Prediction of CES-D Total
To test the hypothesis that a three-way interaction among MLQ-Search, MLQ-Presence, and TESI-Frequency contributes to the prediction of CES-D total, hierarchical regression analysis with a total of seven blocks was conducted. MLQ-Search was entered in the Block 1, followed by MLQ-Presence in Block 2, TESI-Frequency in Block 3, MLQ-Search × MLQ-Presence in Block 4, TESI-Frequency × MLQ-Search in Block 5, TESI-Frequency × MLQ-Presence in Block 6, TESI-Frequency × MLQ-Presence × MLQ-Search in Block 7. The overall model reached statistical significance, F(7,6487) = 80.33, p < .01; R2 = .08. Further, the hypothesized three-way interaction among MLQ-Search, MLQ-Presence, and TESI-Frequency reached statistical significance (see Table 3).
|Step and predictor variables||B||SEB||B||sri2|
|MLQ-Presence × MLQ-Search||.011||.004||.031||.001|
|MLQ-Search × TESI-Frequency||−.001||.001||−.012||.000|
|MLQ-Presence × TESI-Frequency||.000||.001||−.003||.000|
|MLQ-Presence × MLQ-Search × TESI- Frequency||.000||.000||−.027*||.001|
To further interpret the three-way interaction, simple slopes of CES-D total on MLQ-Presence at two levels of MLQ-Search (MLQ-Search low and MLQ-Search high) were plotted in four different graphs (Cohen et al., 2003): no trauma exposure (i.e., TESI-Frequency = 0; see Figure 1); low frequency of trauma exposure (i.e., TESI-Frequency = 1; see Figure 2); mean frequency of trauma exposure (i.e., TESI-Frequency = 7; see Figure 3); and high frequency of trauma exposure (i.e., TESI-Frequency = 19; see Figure 4). Specifically, participants who engaged in a protracted search for meaning (i.e., MLQ-Search high) experienced more symptoms of depression relative to participants who were less involved in searching for meaning, irrespective of the level of meaning attained when there was no trauma exposure. When participants experienced low frequencies of traumatic experiences (see Figure 2), a high search for meaning (vs. low search for meaning) was also associated with increased symptoms of depression irrespective of the level of meaning obtained. Among participants exposed to mean frequencies of traumatic events, finding meaning and searching for meaning had a synergistic effect in the prediction of CES-D total. More specifically, increased searching for meaning was associated with fewer symptoms of CES-D total.
Further, high (vs. low) conviction that one's life is meaningful was related to reduced symptoms of depression. When participants reported high frequencies of traumatic events, a similar pattern to mean frequencies of traumatic events was observed (see Figure 4). Increased searching for meaning and increased conviction in having found meaning were associated with fewer symptoms of depression.
The interaction terms, MLQ-Search × TESI-Frequency, MLQ-Presence × TESI-Frequency, and MLQ-Presence × MLQ-Search, were not significantly predictive of CES-D total (see Table 3). TESI-Frequency did not predict CES-D total but MLQ-Search and MLQ-Presence each added unique variance to the prediction of CES-D total. In particular, a 1-unit increase in MLQ-Search evidenced .12 increase in CES-D total, and 1-unit increase in MLQ-Presence evidenced .23 decrease in CES-D total.
The current study is the first to investigate the search-by-finding-meaning relation to depression as a function of trauma exposure in emerging adults. In addition, it is the only study to use continuous, psychometrically robust measures of searching for and finding meaning and a sample size of this magnitude. Our findings reflect the importance of simultaneous examination of these constructs with a large sample size.
The results showed that finding meaning moderated the relation between searching for meaning and depression, as a function of trauma frequency. Searching for meaning's relations with depression was dependent on the frequency of traumatic experiences and the level of meaning attained. Specifically, finding meaning was associated with fewer symptoms of depression only when emerging adults were exposed to mean or high frequencies of trauma. This pattern of results suggests that searching for meaning and finding meaning are important mechanisms in the prediction of depression when faced with both daily stressors and traumatic events. It highlights that previous studies have overlooked the inter-relations between searching for meaning and finding meaning (e.g., Bonanno et al., 2004; Davis et al., 1998, 2000; Wu et al., 2008), as they investigated only their main effects in the prediction of psychological adjustment.
Further, it suggests that low frequencies of traumatic experiences and mean-to-high frequencies of traumatic experiences may have qualitatively different adjustment trajectories. That adjustment trajectories differ as a function of trauma frequency is similar to the concept of complex trauma (e.g., Dorahy et al., 2007; Herman, 1992), which is purported to result from polyvictimization (e.g., Finkelhor, Ormrod, & Turner, 2007; Finkelhor et al., 2009). Complex trauma characterizes the trauma sequelae of individuals who were chronically exposed to a number of different traumatic experiences, and evidence difficulties with emotion regulation, attention, self-perception, interpersonal relationships, as well as systems of meaning. This cluster of difficulties is qualitatively different from individuals who are exposed to fewer traumatic events and experience symptoms of PTSD, anxiety, and depression (e.g., Dorahy et al., 2007; Herman, 1992), and may require additional or different forms of psychotherapy.
Among nontrauma-exposed college students, increased searching for meaning evidenced increased symptoms of depression, and finding meaning did not protect against this deleterious effect. This set of results is contrary to the exploratory hypotheses that finding meaning protects against the negative effect of searching for meaning, and is contrary to results of previous studies that examined the main effects of presence of meaning (vs. absence of meaning) in the prediction of psychological well-being among college students (Steger, Oishi, & Kashdan, 2009). The association between a high search for meaning and depression is preliminary evidence that searching for meaning may be a form of rumination. Perhaps when finding meaning interacts with searching for meaning, the deleterious effects of searching for meaning suppresses the protective effects of finding meaning. Further, meaning making may not be protective against nontrauma-related depression (e.g., depression caused by genetically predisposed biochemical imbalance; Bianchi, Moser, Lazzarini, Vecchiato, & Crespi, 2002).
Consistent with previous findings (e.g., Eton et al., 2005; Wu et al., 2008), searching for meaning also was maladaptive for emerging adults exposed to low frequencies of trauma. The hypothesized protective effects of finding meaning (e.g. Davis et al., 1998, 2000; Keesee et al., 2008) was not supported in this study when examined in relation to searching for meaning. This suggests that examining the independent contribution of finding meaning in the prediction of psychological adjustment may be limited, necessitating future studies to replicate the interaction effects examined in this study.
Among individuals exposed to mean and high frequencies of trauma, the observed synergistic effect between searching for and finding meaning against depression was contrary to predictions. It is discrepant from previous research that found deleterious effects of extended searches for meaning among traumatically bereaved individuals (e.g., Davis et al., 1998, 2000; Eton et al., 2005; Kernan & Lepore, 2009; Wu et al., 2008). One possible explanation is that previous studies were conducted with individuals coping with single traumatic events, whereas the current sample tended to be multiply traumatized.
Upon further examination, the search-by-finding meaning interactions found in this study may be consistent with the information processing theory (Hollon & Garber, 1988; Resick & Schnicke, 1993). The theorists argued that distress related to a traumatic experience is due to discrepancy between information associated with the traumatic event and people's general understanding of the world as just, benevolent, and predictable. It is possible that when individuals are exposed to low (vs. chronic, complex) levels of traumatic experiences, adequately resolving the schema-discrepant traumatic experience within the existing framework of the world (i.e., accommodation) may be more readily achievable. For example, when individuals are exposed to a single episode of traumatic experience, they may believe that the world is largely just, benevolent, and predictable, save a few incidents/circumstances. Extensive searches for meaning in these instances may suggest individuals’ inability to flexibly adjust their worldviews.
In contrast, when emerging adults are chronically traumatized, both a thorough search for meaning/accommodation and finding of meaning appear to be necessary to resolve the schema-discrepant chronic traumatic encounters. Sobel, Resick, and Rabalais (2009) suggested that accommodating one's worldview to account for a number of different traumatic experiences is much more difficult. Park (2008) provided some support for the increase in searching for meaning among individuals who reported increased discrepancy between their understanding of the death of a loved one and their worldviews; she found that positive affect was associated with reduced discrepancy between bereaved participants’ understanding of the death of a loved one and their world view.
The results have a number of implications for clinical practice with nontrauma- and trauma-exposed college students. Assessments of college students’ meaning making and trauma exposure are recommended. In the absence of trauma histories, extensive searching for meaning was association with depression and would warrant interventions. Limiting rumination and inaction are central tenets of behavioral activation (Sturmey, 2009). Behavioral activation involves scheduling pleasant activities, adhering to a regular routine, and setting short- and long-term behavioral goals, thereby limiting rumination. Reducing rumination/experiential avoidance is desirable because these processes may initiate and maintain depression (Ehlers & Clark, 2000; Michael et al., 2007). A refocus/exposure to avoided emotions and experiences is central to Beck's (2008) cognitive behavioral therapy (e.g., facilitating emotional processing, addressing cognitive distortions, and problem solving).
With regards to chronically traumatized emerging adults, the results suggest adaptations to evidence-based treatments. Both prolonged exposure (e.g., Jaycox, Foa, & Morral, 1999) and cognitive processing therapy (CPT; Resick & Schnicke, 1993) involve a shift in the cognitive framework (i.e., meaning making) related to the trauma. CPT specifically involves reducing assimilated maladaptive beliefs and overaccomodation/overgeneralization of beliefs related to traumatic events. CPT is based on the information processing theory (Hollon & Garber, 1988), purporting that reducing discrepant information about traumatic events and existing cognitive frameworks about the world reduces distress levels. In CPT, this is achieved through modifying maladaptive beliefs and engaging in exposure-based written accounts of the traumatic experience. Sobel et al. (2009) found increased reference to accommodation in patients’ written accounts of the traumatic experiences by the end of treatment. Narratives involving more assimilation or overaccomodation were associated with increased symptoms of PTSD. Similar processes may be conducive to reducing symptoms of depression among college students exposed to chronic trauma. Perhaps assessing for and incorporating an existential focus in the narratives may be particularly beneficial for college students exposed to trauma.
Threats to internal validity include measurement and design limitations. The assessment of searching for and finding meaning had no reference point (i.e., they did not refer to the traumatic events). As a result, participants may have considered daily hassles and/or life stressors and/or trauma when completing the measure. In addition, there was no assessment of trauma characteristics (e.g., presence/absence of life threat, relation to perpetrator), consistently shown to be associated with psychological adjustment (e.g., English, Graham, Litrownik, Everson, & Bangdiwala, 2005). Further, participants may have errors in recall due to the lapse in time since the traumatic event(s). Last, the cross-sectional design of this study fails to account for the temporal sequence of trauma exposure, meaning making, and psychopathology.
Characteristics of participants may be a threat to external validity. Only participants enrolled in college/university were recruited, which may omit emerging adults unable (for financial, emotional, or academic reasons) to attend school (Crum et al., 2006). This is particularly pertinent to studying chronically traumatized emerging adults who often become disconnected to such institutions (Bergman, Ortiz, MacDonald, & Brown, 2010; Kiser, Donahue, Hodgkinson, Medoff, & Black, 2010). As a result, the generalizability of the findings to the most severely traumatized emerging adults may be compromised.
Recommendations for Future Research
The current study offers insight into the ways in which emerging adults cope with traumatic experiences in relation to searching for and finding meaning. Because this is the first study to explore the search-by-meaning interaction as a function of trauma frequency, the results offer preliminary support for the relations and call for further replication. The proposed next step is to further evaluate these mechanisms while addressing the methodological constraints of this current study. To examine the process of searching for meaning and finding meaning, measures of experiential avoidance and rumination should be incorporated, as should qualitative assessments of the content of meaning. Understanding the content of meaning is particularly important as researchers have suggested that finding positive meaning (i.e., perceiving benefit from the traumatic experience) and finding negative meaning (e.g., perceiving that the world is a dangerous place) differentially predict adjustment (e.g., Davis et al., 1998; Park, Chmielewski, & Blank, 2010).
Future research also should examine the course of meaning making. It remains unclear whether searching for meaning is terminated after meaning is found, or whether searching for meaning can be delayed after experiencing a traumatic event. Last, the aforementioned research should aim to understand not only the processes after trauma but also the role of searching for and finding meaning in daily stressors.
The treatment outcome literature on trauma exposure would benefit from a more comprehensive assessment of the roles of searching for and finding meaning. To specifically assess the role of meaning making in current evidence-based treatments (i.e., CPT) and its role in symptom reduction, studies should include repeated administration of psychometrically robust measures from baseline through follow-up. By including such measurement, researchers could examine the moderating and mediating influence of meaning making. The processes of accommodation, assimilation, and overaccomodation, in relation to symptom improvement, also should be explored. In addition, examining meaning making in relation to other trauma-related psychopathology, including substance abuse and delinquent behavior, may better represent the complex symptom picture that follows trauma (e.g., Danielson et al., 2010).
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