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Embodying psychological thriving: physical thriving in response to stress - Thriving: Broadening the Paradigm Beyond Illness to Health
Journal of Social Issues, Summer, 1998 by Elissa S. Epel, Bruce S. McEwen, Jeannette R. Ickovics
Measures
Psychological Thriving. The Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1991, 1995; see also Cohen, Cimbolic, Armeli, & Hettler, this issue) is a scale that indicates tendency to thrive psychologically after facing crises. The 21-item questionnaire assesses how much one's life changed in positive ways as a result of the most stressful event experienced in adult life. The measure has satisfactory test-retest reliability, internal consistency, and discriminant validity. For this sample, four of the five subscales had satisfactory internal consistency: Appreciation of Life (alpha = .77), Spiritual Growth (alpha = .75), New Possibilities (alpha = .81), and Relating to Others (alpha = .85). The Personal Strength subscale was not internally consistent (alpha = .61) and thus was not used.
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Cortisol. Cortisol was measured in two ways: total cortisol response each day and adaptation across days. Total cortisol response for each session was measured as area under the response curve (AUC), in ug/dl*minute. This allowed us to test across participants whether psychological thriving was related to total cortisol secreted on each day.
Cortisol adaptation to stress across days was measured using a coding scheme. Two independent raters compared graphs of the first day of challenge to the two subsequent days of challenge for each individual. Adaptation was coded as habituation if cortisol on stress day 1 was significantly higher than on stress days 2 or 3. Adaptation was coded as nonhabituation if day 2 or 3 cortisol was equal to or higher than that on day 1. A third group, coded as low reactors, showed relatively no change in cortisol between sessions, and their cortisol levels remained low throughout each session (around .10 ug/dl). Reliability of ratings was good (90% agreement between coders).
Statistical analyses. ANOVAs were performed on cortisol response groups and PTGI subscales, as detailed below. Because of the a priori hypotheses, one-tailed p values were used for ANOVAs.
Results
First, correlations were performed between total cortisol secreted each day, as measured by cortisol AUC with the subscales of the PTGI. No relations were found between total cortisol on days 1 or 2 and PTGI. However, on day 3, those with higher cortisol reactivity tended to score lower on PTGI-Appreciation of Life (r = -.33, p [less than] .05) and PTGI-Spiritual Change (r = -.37, p [less than] .01), supporting our hypothesis that lack of adaptation by day 3 (reflected by high cortisol reactivity on day 3) would be related to lower posttraumatiC growth.
To assess adaptation across days within each individual (relative to each individual's prior cortisol levels), which we regard as the best indicator of one's cortisol adaptation and thus exposure over time, we used the cortisol adaptation to stress coding scheme described above. Cortisol adaptation was found to be related to two PTGI subscales. Women who did not adapt to the stressors (i.e., showing higher than or equal levels of cortisol on day 2 or 3 compared to day 1, n = 20), reported less spiritual growth [F(2, 57) = 2.49, p = .05] and less appreciation for life [F(2, 57) = 2.69, p = .04] than low reactors. These results confirm the findings using total cortisol secreted (AUC), above, and again support our hypothesis that psychological adaptation is related to physiological adaptation.
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