Why Small Effects for PTG in Aims 2 and 3?

It is important to understand the possible reasons for the relative dearth of effects for PTG in Aims 2 and 3. The first reason could be that perhaps the sample did not experience trauma. The posttraumatic growth concept has been defined by coming from a struggle with a traumatic event (Tedeshi & Calhoun, 1996).

The literature suggests that the number of traumatic life events experienced is correlated to a larger number of positive outcomes (Cordova et al., 2001; Fromm et al., 1996; McFarland & Alvaro, 2000). Additionally, distress that is more challenging can also be more likely to forecast positive outcomes than less intense distress. As Taylor’s (1983) theory of cognitive adaption teaches, threatening or traumatic events can cause a reprioritization of one’s life, whereby the change toward toward positive outcomes can serve as a means of coping with the distress of the trauma. Similarly, Tedeschi and Calhoun (1996) identified that the requisite need for pain and struggle to be experienced for PTG to emerge.

A growing body of research suggested that individuals who experience more traumatic life events report more positive outcomes than those who experience trauma less often (Cordova et al., 2001; Fromm et al., 1996; McFarland & Alvaro, 2000). Therefore, people who have a more challenging disease may be more likely to find something positive associated with their experiences. Construing the good with the bad may be a way of coping with distress. Indeed, according to Taylor’s (1983) theory of cognitive adaptation, individuals rethink their attitudes

and reprioritize their lives following a threatening or traumatic event. Similarly, Tedeschi and Calhoun (1996) reported that the pain and struggle associated with an illness is what leads to PTG. Therefore, it is possible that childhood cancer survivors in our sample did not experience the precursor of trauma that is necessary for PTG.

In the case of our sample, the perception of trauma may not have been fully experienced as many in the sample were young (less than 9 years old with an average of 3 years old).

Therefore, they probably did not have memories of the diagnosis and may not have been able to process it in a way to find meaning after the trauma. And to perceive positive impact, PTG theory implies that they have an immediate reaction after trauma, which was considered the most important predictor than objective characteristics of trauma exposure (Linley & Joseph, 2004; Tedeshi & Calhoun, 2004). As childhood cancer survivors during diagnosis had probably not felt that immediate reaction of life threat and helplessness because of their young age, they were less likely to perceive a positive impact. Indeed, around 25% of the sample did not perceive any positive impact from their cancer experience (they responded 0 in the scaling measure from 0 to 5, which means that the cancer experience did not have a positive impact in their life). This situation is probably unique with young children. The life threat and feeling of helplessness may be reported more for adult cancer or older childhood cancer survivor who have an understanding of death and cancer as a life-threatening disease. Indeed, breast cancer survivors more often report PTG (Lechner et al., 2006). Their level of PTG is similar and even higher than the ones found for this sample (Lelorain et al., 2004). Young children may just have memories from the treatment itself without understanding the role of the treatment to cure their disease (Manne, Alfieri, Taylor, & Dougherty, 1999; Miser, 1993), which may give them more fear of treatment

103 and somatization symptoms later in life (Liossi, 1999). It would be interesting to know if they had any fear of treatment during their treatment experience and if there was a relationship with somatization in the future. The somatization result was the highest mean (M=47.04) from the BSI measurement and was a little higher than the ones in the normative sample (M=46.6).

Second, potentially effects could have been masked in the study’s analyses by examining linear effects instead of curvilinear effects. As Powell et al. (2003) pointed out in their overview of differing severities of trauma, there seems to be an inverted U-relationship between the severity of trauma and the perception of PTG, with medium stress producing the highest growth. Lechner et al (2003) also found a curvilinear effect between severity of disease and PTG, where cancer patients in stage II experienced more PTG than patients in stage I, however, stage IV patients experience less PTG than stage II patients. This curvilinear effect may explain why the previous studies found mixed results. Therefore, the relationship between PTG and other variables may be that treatment, mental health issues, medical conditions, health perception and other cancer-related variables must be intensive enough such that cancer survivors perceive how their life is better now without cancer but not too intense as to not be overwhelmed.

Finally, small effects may be due to a problem of timing in assessing PTG. It is possible that cancer survivors experience PTG few years after facing trauma and distress, but when they face distress in the long term, they may have more difficulty to experience PTG and therefore may feel trapped in the trauma. It is also possible that the beneficial effects from the trauma experience remain for few years and then fade. For some people, the perception of some positive outcomes may influence their daily life experiences (Zoellner, & Maercker, 2006). For example, cancer survivors may decide to change their life style, to take more care of themselves, and to

enjoy life in more meaningful ways with all the people they care about. However, 10 or 20 years after diagnosis, cancer survivors may return to a more normal life dealing with routine issues and the positive outcomes from cancer may seem less obvious. In this study, PTG was assessed in 2003 and children were diagnosed with cancer between 1984 and 1992, which represents a time lapse between 10 and 20 years. Therefore, the perception of PTG may need to be examined closer in time to trauma because cancer survivors could better assess the difference between their life with treatment and uncertainty to cure the disease, and suddenly being free from disease and treatment (though, there is also a risk for the disease to reoccur).

Nevertheless, even if small effects were found with PTG, it is important to note that there are large intervals between diagnosis of cancer and PTG as well as between PTG and their predictors and outcomes. This small effect over a large time period may have been larger effect in smaller time periods. Therefore, these small effects are not completely negligible.