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Posttraumatic Growth Following the Loss of a Pet


Abstract and Figures

The current study examined posttraumatic growth (PTG) experienced by bereaved pet owners following the death of their pet. Using qualitative methodology, we analyzed responses of 308 participants who answered yes to a question about experiencing PTG. Within the five factors model of PTG, the most endorsed included the following: Relating to Others (n = 76), Appreciation of Life (n = 52), Personal Strength (n = 51), Spiritual Change (n = 32), and New Possibilities (n = 29). Other themes not captured by the PTG included as follows: relating to animals (n = 70), continuing bonds (n = 53), attachment relationship (n = 44), and unconditional love (n = 13). Our findings support the notion that PTG occurs for people who have experienced pet loss, with new emergent themes.
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Growth Following
the Loss of a Pet
Wendy Packman
*, Cori Bussolari
Rachel Katz
, Betty J. Carmack
, and
Nigel P. Field
The current study examined posttraumatic growth (PTG) experienced by bereaved
pet owners following the death of their pet. Using qualitative methodology, we
analyzed responses of 308 participants who answered yes to a question about experi-
encing PTG. Within the five factors model of PTG, the most endorsed included the
following: Relating to Others (n¼76), Appreciation of Life (n¼52), Personal
Strength (n¼51), Spiritual Change (n¼32), and New Possibilities (n¼29). Other
themes not captured by the PTG included as follows: relating to animals (n¼70),
continuing bonds (n¼53), attachment relationship (n¼44), and unconditional
love (n¼13). Our findings support the notion that PTG occurs for people who
have experienced pet loss, with new emergent themes.
posttraumatic growth, continuing bonds, pet loss
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!The Author(s) 2016
Reprints and permissions:
DOI: 10.1177/0030222816663411
Pacific Graduate School of Psychology at Palo Alto University, Palo Alto, CA, USA
Department of Counseling Psychology, University of San Francisco, CA, USA
Hospice Caregiver, Zen Hospice Project, San Francisco, CA, USA
School of Nursing, University of San Francisco, CA, USA
Corresponding Author:
Wendy Packman, Pacific Graduate School of Psychology at Palo Alto University, 1791 Arastradero
Road, Palo Alto, CA 94304, USA.
*The first two authors contributed equally to this work.
Introduction: Literature Review
Research exploring bereavement and grief has primarily focused on negative after-
effects of trauma or death (Hogan & Schmidt, 2002; Murphy, Johnson, & Logan,
2002; Neeleman, Sytema, & Wadsworth, 2002). More recently, there has been an
increasing body of literature suggesting that positive emotional and behavioral
changes can also result following these traumatic experiences (Linley & Joseph,
2003). For example, Linley and Joseph (2003) note that for survivors of trauma,
including bereavement, 30% to 70% report a positive change. This positive
change has been similarly defined with names such as meaning reconstruction
(Neimeyer, Burke, MacKay, & van Dyke Stringer, 2010), stress-related growth
(Schaefer & Moos, 1992), benefit finding (Davis, Nolen-Hoeksema, & Larson,
1998), and posttraumatic growth (PTG; Calhoun & Tedeschi, 2001), as well as
flourishing, positive emotions, and thriving (Park, 2010). PTG has been defined by
Tedeschi and Calhoun (2004) as the positive changes that can occur due to strug-
gles with highly challenging life crises. According to Calhoun, Tedeschi, Cann,
and Hanks (2010), changes in self-concept following trauma are captured in the
paradoxical phrase ‘‘more vulnerable, yet stronger’’ (p. 127).
Tedeschi and Calhoun (2004) define PTG as
the experience of individuals,whose development, at least in some areas, has surpassed
what was present before the struggle with crises occurred. The individual has not only
survived, but has experienced changes that are viewed as important, and that go
beyond what was the previous status quo. PTG is not simply a return to baseline –
it is an experience of improvement that for some persons is deeply profound. (p. 4)
According to Tedeschi and Calhoun (2004), PTG can be manifested in an assort-
ment of ways, including an increased appreciation for life, more meaningful inter-
personal relationships, an increased sense of personal strength, changed priorities,
as well as a richer existential and spiritual life. In many ways, PTG can also be
described as a qualitative transformation of someone’s response to a significant
hardship or suffering (Linley & Joseph, 2003). The Posttraumatic Growth
Inventory (PTGI; Tedeschi and Calhoun, 1996) was created to measure the con-
structs most central to this paradigm. The five domains include the following:
Relating to Others, New Possibilities, Personal Strength, Spiritual Change, and
Appreciation of Life. Because it is probable that people who experience growth
(PTG) will also concurrently experience posttraumatic depreciation, Baker, Kelly,
Calhoun, Cann, and Tedeschi (2008) most recently developed the PTGI-42 to allow
individuals to report depreciation in the same areas that they reported growth.
Posttraumatic Growth and Bereavement
One of the most commonly reported life crises is the death of a loved one, and
the subsequent bereavement process, yet much research into the grief process has
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failed to address the possibility of growth (Calhoun et al., 2010). In a review of
the existing literature, PTG was found to exist in bereaved individuals (Calhoun
et al., 2010; Michael & Cooper, 2013), and active coping strategies and social
support helped facilitate growth (Michael & Cooper, 2013). Calhoun et al.
(2010) continue to support the theory that growth and benefits can be experi-
enced independently of a reduction in psychological distress or an overall sense
of well-being, and posit that some distress may serve as a reminder of the growth
that has occurred.
In a recent comprehensive mixed-methods review of 70 published journal
articles, Michael and Cooper (2013) examined PTG following bereavement,
noting the scarcity of previous research in this arena. A total of 15 empirical
studies were found to have connections between PTG and bereavement.
Emergent themes included positive personal transformation in self-concept,
reappraisal of life and priorities, and experience of less negative symptoms.
Michael and Cooper (2013) also found that certain factors acted as mediators
for PTG following bereavement such as age, time since death, social support,
religion or spirituality, and cognitive coping such as meaning making.
According to Calhoun et al. (2010), the death of a loved other disrupts one’s
core beliefs about how the world is supposed to work. Higher levels of anguish
and disruption relate to higher levels of posttraumatic stress disorder and the
potential for PTG. ‘‘ is the level of disruption of core beliefs which best
predicts growth’’ (p. 132). The authors also note that bereavement differs
from other stressful events in relation to PTG. For example, using a sample
of 800 participants from the United States who completed the PTGI and the
Core Beliefs Inventory (Cann, Calhoun, Tedeschi, Kilmer, et al., 2010), there
were differences between those individuals reporting on a death and those
reporting another event. Specifically, those reporting on a death demonstrated
more growth in Relationships with Others, Appreciation of Life, and Spiritual
Change, with less growth reported in the areas of Personal Strengths and New
Possibilities (Calhoun et al., 2010).
Continuing bonds, PTG, and pet bereavement. Research into the human–animal bond
has consistently demonstrated that the loss of a pet can be equal to or exceed the
psychological pain and social upheaval of the loss of a valued human attachment
relationship (Field, Orsini, Gavish, & Packman, 2009; Packman, Field,
Carmack, & Ronan 2011; Quackenbush, 1985). In recent bereavement literature,
the concept of continuing bonds (CB) has received growing attention, especially
its function in relation to coping following a death (Field & Friedrichs, 2004;
Field, Gao, & Paderna, 2005; Klass, Silverman, & Nickman, 1996; Stroebe,
Gergen, Gergen & Stroebe, 1992). Despite the permanence of physical separ-
ation, the bereaved can be emotionally sustained through a CB to the deceased
(Field, Nichols, Holen, & Horowitz, 1999). Examples of CB include reminiscing
about the loved one, memorials and rituals, dreams, and holding onto special
Packman et al. 3
possessions as remembrances. Thus, resolving grief does not involve ending a
relationship with the deceased, but rather a renegotiation and transformation of
the meaning of the loss over time (Field, 2008; Klass et al., 1996).
Until 2011, the concept of CB had not been described in the pet bereavement
literature (Packman et al., 2011). Earlier writers described phenomena that were
experienced as CBs but not labeled as such (Carmack, 2003; Cowles, 1985;
Podrazik, Shackford, Becker, & Heckert, 2000; Weisman, 1990/1991).
Packman et al. (2011) examined and quantified CB expressions (CBE) experi-
enced by bereaved pet owners. The most frequently endorsed CBE about the pet
were recalling fond memories (85%), holding onto or using belongings (79%),
reminiscing with others (79%), and lessons learned or positive influences (76%;
Packman et al., 2011).
While there are an increasing number of studies exploring the PTG experi-
ences of bereaved individuals following the death of a beloved human, to our
knowledge, there is presently only one study examining PTG following the death
of a beloved companion animal (Packman et al., 2011). Results of that study
indicated that there was an overall tendency for bereaved pet owners to find CB
more comforting than distressing. At the same time, there was a direct relation-
ship between deriving comfort from CBE and PTG.
The aim of the current study is to qualitatively investigate the construct of
PTG in a sample of participants who have lost their companion animal. First,
we investigated to what extent the responses of the participants mapped on to
the five factors of the PTGI (Tedeschi & Calhoun, 1996). Second, we explored
the other categories of PTG that are unique to individuals who have lost a pet,
such as CB and unconditional love.
Participants and Procedure
Bereaved pet owners were recruited via requests posted online and per-
sonal solicitations to pet loss support groups. A cover letter explaining
the goal of the study, the researchers’ affiliations, and link to the Survey
Monkey website were sent to potential participants. Eligible participants
were required to be at least 18 years of age and must have lost a pet through
death. The study was approved by the institutional review board at Palo Alto
Participants had the option of completing the pet loss survey on the internet
or could request that hard copies be mailed to them. An informed consent page
was at the beginning of the survey. Whether participants completed the survey
or not, they were given links to pet loss support services and resources.
Participants completed a demographic questionnaire followed by a six objective
measures. In addition to the objective measures, there were three open-ended
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questions. In this article, we focus on responses to the following question con-
cerning PTG since the loss:
Despite the painful experience of losing your pet, people sometimes describe having
found something of personal value in having had to face such a loss. For example,
some people report having become more spiritual, having become closer to others,
or having become stronger as a result of facing the loss. Have you discovered
something of personal value that has come out of your experience of the loss of
your pet? (please answer yes or no)
If people answered yes, they were asked ‘‘please describe ways this is true for
At the time of data analysis, there were 3,804 respondents to the survey.
Of those, 1,956 (49.8%) answered yes to the above question about PTG and
1,848 (50.2%) answered no. Due to the large number of responses, a repre-
sentative sample of 308 was selected from the 1,956 respondents who
answered the last open-ended question using a systematic sampling method.
The starting point was randomized, and every sixth subsequent person was
selected. Respondents were not pre-examined to ‘‘cherry-pick.’’ As long as the
starting point is randomized, systematic sampling is considered to be a type
of probability sampling for selecting essentially a random sample (Finlay &
Krueger, 2011).
Research Design: Qualitative Analytic Procedure
The transcribed interviews were uploaded into ATLAS.Ti 6.0, a software pro-
gram that provides a systematic approach to organization, coding, and analysis
of qualitative data. We used directed content analysis, a qualitative method that
is guided by theory or prior research (Potter & Levine-Donnerstein, 1999) to
analyze participants’ responses to the last question. ‘‘The goal of a directed
approach to content analysis is to validate or extend conceptually a theoretical
framework or theory’’ (Hsieh & Shannon, 2005). Content analysis using such an
approach is a more structured process than conventional content analysis
(Hickey & Kipping, 1996). Investigators begin by identifying key concepts as
initial coding categories (Potter & Levine-Donnerstein, 1999). Next, operational
definitions for each coding category are determined based on theory. In the
current investigation, PTG and depreciation, bereavement and CB theories
(Doka, 2008; Field, 2008) as well as prior research on pet loss (Carmack,
2003; Orsini, 2005; Packman et al., 2011) guided the development of initial
coding categories. The major strength of directed content analysis is that
‘‘existing theory can be supported and extended’’ (Hsieh & Shannon, 2005).
The responses were first independently coded by the authors and then
reviewed by all four together until consensus was reached. Our primary aim
Packman et al. 5
was to investigate the extent to which the bereaved pet owners’ responses
mapped onto the 42 items of the PTGI (Baker et al., 2008; Tedeschi &
Calhoun 1996). The PTGI (Tedeschi & Calhoun, 1996) is a 21-item scale that
measures positive changes reported by individuals who have experienced trau-
matic events. The PTGI (Tedeschi & Calhoun, 1996) was created to provide a
measure of PTG using the five factors that the researchers proposed were central
to this construct: (a) Relating to Others, (b) New Possibilities, (c) Personal
Strength, (d) Spiritual Change, and (e) Appreciation of Life. The Paired
Format Posttraumatic Growth Inventory (PTGI-42; Baker et al., 2008) is a
revision of the PTGI (Tedeschi & Calhoun, 1996), and it assesses both growth
and depreciation. The inventory includes the 21 items from the original PTGI
and 21 matched but negatively worded items developed by Baker et al. (2008) to
measure posttraumatic depreciation. Data that did not map onto the PTGI were
identified and analyzed to determine if they represented a new theme or a sub-
category of an existing category. Thus, emerging themes were identified and
categorized, and new codes developed as needed.
Data Analysis: Descriptive Statistics
Background characteristics, parameters of the loss, and self-reports of the
strength of attachment and grief (ICG) are detailed later.
Standardized measures. The Pet Attachment Scale (PAS; Gosse, 1988) is an 11-
item measure assessing the strength of attachment the participant has to his
or her deceased pet. Each item is rated on a 5-point scale ranging from
almost never to almost always. The scale has a demonstrated high level of
internal consistency with Kerlinger (1986) finding a Cronbach’s alpha coeffi-
cient of .74 for the 11-item intimacy subscale. Gosse found a Cronbach’s
alpha coefficient of .74 and Jarolmen (1996) found a Cronbach’s alpha coef-
ficient of .77.
The Inventory of Complicated Grief (ICG; Prigerson & Jacobs, 2001) is a
19-item self-report questionnaire that measures symptoms of grief.
Respondents rate their feelings with respect to their deceased pet over the
month regarding the symptoms described on a 5-point scale. The total score
is a summation of the item scores and indicates the severity of grief symp-
toms. This study used 9 of the original 19 items of the ICG in order to create
a shorter scale which did not include items that are more useful for describ-
ing CBs with the deceased (Filanosky, 2003). Filanosky (2003) validated use
of this instrument using only 9 of the original 19 items in his study on grief
and CB in an adult sample of grievers. The ICG is internally consistent
(Cronbach’s alpha ¼.095) and has an acceptable level of criterion-related val-
idity (Prigerson & Jacobs, 2001).
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Quantitative Findings: Characteristics of the Sample
Participants and procedures. Demographic variables, contextual factors, and other
aspects associated with the loss are detailed in Table 1. A total of 308 individuals
between the ages 18 and 69 (average age of 42 years) participated in the study.
The sample included 251 females and 57 males; 87% (n¼268) of the sample
were Caucasian. In terms of education, 30% had attended graduate school and
21% attended college. Of the total sample, 60.7% (n¼193) lost their dogs, while
35.4% (n¼115) lost their cats. The deceased pet’s age ranged from less than
1 year to 21 years with an average age of 11 years. A total of 69% of participants
made the decision to euthanize their animal. With respect to relationship to the
deceased, the Best Friend (45%) category comprised the largest percentage of
the relationships, followed by Parental (33%), Partner/Significant Other (1%),
and Other (soulmate, protector; 11%) categories. Time Since Death ranged from
1 day to 4 years.
Pet Attachment Scale. The mean score was 3.49 (SD ¼1.64). In Orsini’s (2005)
study of pet loss, participants reported a mean score of 3.63.
Inventory of Complicated Grief. The mean score was 2.98 (SD ¼1.39). In a study
looking at bereavement in humans, the mean score on the ICG was 2.55
(Filanosky, 2003). In Orsini’s (2005) study of pet loss, participants reported a
mean score of 2.20 on the ICG.
Qualitative Findings
Relating to Others. The most prominent theme was Relating to Others (19%;
Table 2). The two items that were coded most frequently were I have a greater
sense of closeness with others and I have more compassion for others. As a result
of the loss, participants felt closer to members of their nuclear family because of
the significant shared loss experience. For example, ‘‘I feel a stronger bond
between my son and my husband. I was distant from my husband until this
tragedy. Now, I’m starting to see how great he is.’’
I have more compassion for others was exemplified by comments such as,
‘‘It has tested the strength of my faith and reinforced my ability to maintain
empathy and consideration for others despite my tremendous sense of loss and
sadness’’ and ‘‘I feel that all the love I felt for my pet can be given to people and
my current pet.’’ Another participant stated, ‘‘I think I have been kinder, more
conscious of people’s feelings. I have been kinder to my patients, and going out
of my way more to ease their pain. I make them more comfortable.’’ It appears
that a sense of caring and compassion extended beyond family to include their
Packman et al. 7
Table 1. Demographic and Background Information (N¼308).
Characteristic N%
Male 57 19
Female 251 81
Relationship to deceased
Best friend 225 73
Parental 95 31
Partner/significant other 75 24
Other (soul mate, protector, family member,
sister, mentor, guardian angel)
88 29
Most important role
Best friend 138 45
Parental 102 33
Partner/significant pther 34 1
Other (soul mate, protector, family member,
sister, mentor, guardian angel)
34 11
Marital status
Single 83 27
Married/partnered 176 57
Divorced 38 12
Separated 8 3
Widow/widower 3 1
Cause of death
Natural 54 18
Unexpected 71 23
Major disease 121 39
Other (mauled by dog, taken by coyote,
perceived vet incompetence)
62 20
Yes 213 69
No 95 31
Yes 120 39
No 188 61
Less than high school 3 1
High school 30 10
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surviving pets and others’ experiences of loss. It is noteworthy that very few
participants were coded for the item I know I can count on people in times of
trouble. This is perhaps a specific consequence of pet loss being disenfranchised
and feeling unable to reach out for support beyond a very close circle.
Personal Strength. This was the second most coded theme, along with Appreciation
of Life (12%). I have discovered that I am stronger than I thought I was is the single
most coded item in the study, most likely due to the participants’ experience with
euthanasia. For example, ‘‘I am stronger than I thought I was. I had always said I
couldn’t be there when she died let alone make the decision to put her to sleep. But
I was there till her last breath’’ and ‘‘I can survive soul crushing grief. It did not
kill me when it felt like it could have.’’ In many ways, there was a level of surprise
that they had the strength to go through with it. For the most part, euthanasia was
Table 1. Continued
Characteristic N%
Vocational/trade 15 5
College 65 21
Graduate school 91 30
Less than $25,000 22 7
$25,000–$49,999 66 21
$50,000–$74,999 69 22
$75,000–$100,000 72 23
More than $100,000 0 0
Spiritual practice
Yes 212 69
No 97 31
African American 2 1
Latino 15 5
Native American 4 1
Caucasian 268 87
Asian Pacific Islander 10 3
Multiethnic 2 1
Other 7 2
Other data Mean SD
Age of owner (years) 42 11.82
Age of pet (years) 11
Time since death (days) 152
Packman et al. 9
Table 2. Responses Captured by PTGI (N¼412).
PTG factors NPercent
I. Relating to Others 78 19
Knowing that I can count on people in times of
A sense of closeness with others 27
A willingness to express my emotions 10
Having compassion for others 27
Putting effort into my relationships 5
I learned a great deal about how wonderful
people are
I accept needing others 4
II. New Possibilities 29 07
I developed new interests 0
I established a new path for my life 7
I am able to do better things with my life 2
New opportunities are available which
wouldn’t have been otherwise
I am more likely to try to change things which
need changing
III. Personal strength 51 12
A feeling of self-reliance 4
Knowing I can handle difficulties 11
Being able to accept the way things work out 4
I have discovered that I am stronger than
I thought I was
IV. Spiritual Change 32 08
A better understanding of spiritual matters 23
I have a stronger religious faith 10
V. Appreciation of Life 51 12
My priorities about what is important in life 25
An appreciation for the value of my own life 3
Appreciating each day 23
Total 58
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Table 2. Continued
PT depreciation factors NPercent
I. Relating to Others 6 01
Knowing that I cannot count on people in
times of trouble
A greater sense of distance from others 1
Less willingness to express my emotions 0
Having less compassion for others 0
Putting less effort into my relationships 0
I learned a great deal about how disappointing
people are
I find it harder to accept needing others 1
II. New Possibilities 1 0.2
I have fewer interests than before 0
A less clear path for my life 1
I am less capable of doing better things with my life 0
Fewer opportunities are available than would
have been before
I am less likely to try to change things which
need changing
III. Personal Strength 4 0.9
A diminished feeling of self-reliance 3
Less certain that I can handle difficulties 0
Less able to accept the way things work out 1
I have discovered that I am weaker than I
thought I was
IV. Spiritual Change 4 02
A poorer understanding of spiritual matters 4
I have a weaker religious faith 4
V. Appreciation of Life 0
Difficult to clarify priorities about what is
important in life
Less of an appreciation for the value of
my own life
Appreciating each day less than before 0
Total 4.1
Packman et al. 11
perceived as an act of kindness and compassion, as one respondent noted, ‘‘I feel
that it is a gift to be with a special being when it passes, that is an important last
thing you do with your pet.’’
I know that I can better handle difficulties was the second most coded item within
this theme, again most likely due to euthanasia. For example, ‘‘I realized the day I
had to put my dog to sleep that I was an adult. This was a very tough decision and
it forced me to look at life in a new light’’ and ‘‘Having the courage to make a
there during the last minutes, made me a stronger person.’’ The death of their pet
was a sobering rite of passage, and through the process of euthanasia, they learned
that they could tolerate even the most unbearable emotions.
Appreciation of Life. I have changed my priorities about what is important in life was
the most coded item within this theme. Respondents’ priorities seemed to have
broadened from immediate family to pets and an extended circle of connections.
For instance, ‘‘Cherish every moment you have with loved ones’’ and ‘‘Do not
Table 2. Continued
Additional responses
Theme NPercent
Relating to animals 68 17
Attachment relationship 44
Unconditional Love 13
Reciprocity 9
Tenacity 2
Continuing bonds/coping with loss 60 15
Lessons learned 31
Reunited 15
Fond memories 5
Dreams 1
Sense of presence 1
Drawn to places 1
Everyday decisions 1
Retaining possessions 1
After life 3
Growth 24 06
Anticipatory growth 11
Too early 6
No personal growth/no value 7
Total 38
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take life and those you care about for granted, they may suddenly not be there.’’
What also seemed clear was that participants experienced life as fleeting and
precious. For example, ‘‘I realize that death is the only certain thing in life and
that I must appreciate my two dogs even more.’’
The second most highly coded item was I can better appreciate each day.
Bereaved pet owners were largely inspired by the lives of their animals. For
example, ‘‘I try to remember to live in the ‘‘Now’’ like a dog does.’’ In addition,
they viewed life and friendship with a fresh perspective, ‘‘Each loss reminds me
to value those in my life, to appreciate each one of them, humans and animals.’’
The item I have a greater appreciation for the value of my own life was one of the
least coded items.
Spiritual Change. Only 8% of participants’ responses were coded for this theme,
although I have a better understanding of spiritual matters was one of the higher
endorsed items within this theme and overall. Being more present in the moment
and experiencing a greater connection with the universe emerged. For example,
‘‘I have a fonder appreciation of all living creatures. I am less attached to material
items and have a sense of connection to the universe’’ Another respondent noted,
‘‘Your faith was strong, but you needed proof’’ is a song lyric that has struck a
chord in me differently since she died. I am still in awe from all of the connectivity
that is involved. Strength. Bravery. Increased trust in myself, in Spirit, in others.
While a greater percentage of people admitted to being spiritually connected,
fewer participants found that the death had strengthened their faith. Of those
that did, it became a source of great comfort. For example,
God and I had not had a relationship until now ...I’ll tell you, my sweet, little man
is running and jumping free and clear in heaven ...At some level God helped me to
know it was my little man’s time. I hope he helps my grief.
New Possibilities. This theme was the least coded for participants (7%). The most
common item was I am more likely to try to change things which need changing,
with specific comments related to how they would make life better for their
surviving pets. It appears that respondents were more conscious of the need to
take better care of their other animals. While several respondents talked about
taking better care of their health, this was predominately so they were healthy
enough to take better care of their surviving pets. For example, ‘‘I have wanted
to take action and improve my own health so I can take care of all my cats for
years to come.’’ Of interest, the comments coded for the item I established a new
path for my life can be characterized by animal rescue themes. For instance,
‘‘I feel I am meant to rescue animals and give them the gift of a good life’’ and
Packman et al. 13
‘‘I have also realized that my purpose in life is to help animals, especially since
my dog was a stray that we adopted, and he touched my life forever. Other
strays like him deserve a chance in life.’’ In general, their comments did not focus
on any new possibilities for themselves or for other people.
Depreciating Factors
As noted previously, people can also experience negative symptoms in addition
to PTG (Baker et al., 2008). Within our sample, there was a small percentage of
comments (4.1%) that could be related to posttraumatic depreciation. The most
common depreciating factor was Spiritual Change (.2%). Comments included:
‘‘I have found myself questioning my faith’’ and ‘‘I’m angry, I’m mad at God.
God promised me I wouldn’t lose my dog. I hate God.’’ The second most coded
depreciation factor was Relating to Others (.1%) Respondents noted, ‘‘Generally
it (the death of his or her pet) has highlighted that most people are disappointing
in character,’’ ‘‘No one truly loves or appreciates me for who I am’’ and ‘‘People
Anticipatory Growth
In the area of Anticipatory Growth (.06%), respondents indicated that while
they were currently not experiencing growth because the loss might have been
too recent, they still acknowledged the potential for personal growth to happen
in their future. For example, ‘‘I believe I will discover personal value as time
passes,’’ ‘‘It only happened yesterday, however, I feel that she will be the catalyst
for important life changes including exercise and meditation,’’ and ‘‘The death is
too new. I am hoping I can learn to love as unconditionally as he did.’’
Pet Loss: Emergent Growth Themes
In addition to the PTGI themes (Baker et al., 2008), we also found that many
participants’ responses could be coded within other areas: Relating to Animals
and Continuing Bonds/Coping with Loss.
Relating to animals. A total of 17% of the responses were coded within Relating to
Animals, only second to Relating to Others, our highest coded theme. Within this
theme, 44 participants were coded for the item Attachment Relationship.Of
these, a vast majority were only coded for Attachment Relationship and none
of the other PTGI items. Some respondents were surprised by how much they
missed and loved their pet. For example, ‘‘I have learned that I took for granted
how much a part of my life my pet was and am surprised at how grief stricken
I am.’’ Research findings have consistently shown the greater the attachment to
a pet, the higher the level of grief (Field et al., 2009). Similarly, participants also
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commented on how the loss highlighted a capacity for attachment they were not
fully aware of. For example,
Loving/missing her made me realize the extent to which I could love something, the
lengths to which I would go to take care of her, what it was to feel genuine and
irrevocable happiness and love . . .
Not surprisingly, some participants’ responses were coded for Unconditional
Love. In addition, a majority of participants’ responses were only coded for
Unconditional Love and none of the other PTGI items (Baker et al., 2008).
For example,
She taught me about unconditional love. In her final hours, I think she was hanging
on because she was afraid to leave me. I told her she had my permission to leave,
and when she did go, I feel, it was an actual privilege to be holding her paw at the
last minute.
The unconditional love of their pet also seemed different than human love, as
one participant noted, ‘‘My pet showed me love in its truest sense. It was the first
living creature I was able to love outside of my nuclear family.’’
Continuing Bonds/Coping with Loss. The third most commonly coded theme, overall,
was Continuing Bonds/Coping with Loss (15%). Within this theme, 31 partici-
pants’ comments were coded for the item Lessons Learned, specifically reflecting
upon their animals and the qualities they would like to emulate. For example,
I use my pet as a symbol or motivation and courage to accomplish things. He
taught us so much in his lifetime he has left a legacy that I hope to live up to
one day. Tolerance, humour, kindness, boldness, I could go on forever
‘‘The love I have/had for my cat enabled me to open my heart more and be more
openly sensitive and loving,’’ as well as ‘‘not fearing death, if that little dog can
do it without fear, should not be a big deal when my day comes.’’ In the same
vein, respondents believed that the death of their animals brought powerful
teachings. One respondent noted,
She taught me about responsibility before I had children, she’s now teaching me
about coping with grief and loss before I lose my parents or any other human close
to me. She has been the first in several of tough life lessons.
The second most coded item was Reunited. For many, the thought of being
reunited with their animals was quite comforting and made them less fearful
of death. For instance, ‘‘I’m more open to the idea of God and Heaven and
Packman et al. 15
all of that, because if any of that does exist on some plane of existence,
I want to be there to see my babies again’’ and ‘‘I now have a calm peaceful
feeling about death. I’m no longer afraid to die. For I know, when I do, my
cat will be there waiting for me. No matter how long it takes.’’
To our knowledge, this is one of the first studies to investigate the PTG
construct in a sample of participants who have lost their companion
animal. Using qualitative methodology, we investigated the extent to which
participants’ responses mapped onto the five factors of the PTGI (Baker
et al., 2008; Tedeschi & Calhoun, 2004). Next, we identified other categories
of PTG not captured by the PTGI that are unique to individuals who have
lost a pet.
A total of 58% of responses mapped onto the five factors of the PTGI put
forth by Tedeschi and Calhoun (2004). Relating to Others was our most pre-
dominant theme. This is consistent with the research findings of Calhoun et al.
(2010) for bereavement following loss. In our study, participants’ primarily
focused upon a sense of closeness with their nuclear family and surviving pets.
Rarely did they mention feelings of connectedness to people outside their close
circles. It is also important to note that very few endorsed the item I know I can
count on people in times of trouble. This could be due to the disenfranchised
nature of pet death, which contributes to a perceived or experienced lack of
support and social isolation (Doka, 2008).
In contrast to Calhoun et al.’s (2010) PTG bereavement findings, Personal
Strength was highly endorsed by our sample of pet loss participants. This finding
may be due to the experience of euthanasia, unique to pet loss. The participants
wrote about having to make a choice and go through with something they did
not think they would be able to do. Thus, they realized they were ‘‘stronger than
they thought.’’
Participants indicated that they were inspired to appreciate each day and live
in the present the way their animal did (Appreciation of Life). One of the least
coded items—I have a greater appreciation for the value of my own life—might
have been more strongly endorsed had the respondent’s life been directly threa-
tened in some way (Shakespeare-Finch, Marinek, Tedeschi, & Calhoun, 2013).
In the spiritual realm, participants’ comments were coded within I have a better
understanding of spiritual matters, yet their faith did not seem strengthened by
the loss. Participants described future change or opportunities (New
Possibilites), with responses primarily focusing upon animal rescue ideals such
as adopting strays. Our open-ended question allowed for participants to write
about positive or negative changes following the death of their pet. Similar to
findings from a previous study (Cann, Calhoun, Tedeschi, & Solomon, 2010),
respondents reported both positive and negative experiences. However, of those
16 OMEGA—Journal of Death and Dying 0(0)
who endorsed PTG, very few noted concurrent posttraumatic depreciation
In summary, 58% of responses were categorized within the PTGI. Unique to
our study, however, 38% of the responses were categorized within new and
emergent themes. Research has historically shown that we similarly attach to
both humans and animals (Nebbe, 2001; Rynearson, 1978), and that the stron-
ger the attachment, the higher the level of grief (Field et al., 2009). For our
participants, PTG following pet loss is often expressed through experiences of
the Attachment Relationship and Unconditional Love, specifically with their
animal. It is, therefore, not surprising that 17% of participants were coded for
Relating to Animals, the second most endorsed theme, overall.
The third most endorsed theme was Continuing Bonds/Coping with Loss
(15%). Over time, participants were able to transform the meaning of the loss
and cope through CB such as being reunited with their pet and Lessons Learned.
Many participants were dually coded for the CB of Lessons Learned and the
PTGI item I can better appreciate each day. Had we just coded responses under
the themes of Appreciation of Life and Relating to Others, we would have
missed these novel growth factors specific to the pet loss sample.
Future Research Implications
Similar to the loss of a human, our current research supports the notion that
PTG can and does occur following the loss of a pet. The themes that emerged
were remarkably similar to growth following the loss of a human (Calhoun
et al., 2010). Future research in pet loss should focus on using the traditional
PTGI-42 (Baker et al., 2008) items, while also including and validating the new
themes and items found within our current study: Attachment Relationship,
Unconditional Love, and CB. The latter themes capture the unique concept of
growth after pet loss and are not captured by the PTGI. Our findings also
highlight that using coping skills such as CB following the loss of a pet can be
a growth-enhancing component of bereavement.
As noted within this study, there are other factors that impact and interact
with PTG. Future research should include an in-depth exploration of contextual
factors related to the relationship between pet loss and PTG, which may impact
participants’ growth responses, such as disenfranchised experiences.
Disenfranchisement is often reported by bereaved pet owners, and it may greatly
impact resiliency and growth. Because a pet’s death is often disenfranchised,
thus resulting in minimal or no support, it would be important to look at the
relationship between experiences of disenfranchisement and PTG.
The process of euthanasia includes having the authority to give permission to
end a life and is unique to pet loss. Some respondents reported that their experi-
ences of euthanasia allowed them to recognize how strong they really were.
Therefore, we recommend examining the situational factors related to
Packman et al. 17
euthanasia and the impact on PTG. Of interest would be the connections
between the euthanasia decision-making process, subsequent intensity and dur-
ation of grief, and PTG.
In addition, the question of time since death affects the experience of PTG.
Several participants wrote that it was too soon to identify PTG but anticipated
experiencing such growth. Research regarding PTG and time since death is
conflicting. Some studies indicate that time since trauma does not correlate
with PTG (Shakespeare et al., 2013) while others reflect the opposite
(Wolchik, Coxe, Tein, Sandler, & Ayers, 2009). Within our professional experi-
ence with pet loss, however, we have seen that time since death may in fact
impact PTG experiences, meaning making and healing. Calhoun et al. (2010)
encourage clinicians and researchers to remember that bereavement and its psy-
chological consequences can last much longer than typically expected in Western
culture. We agree with their suggestion that further research on bereavement and
related treatment approaches focus on both distress and growth several years
following the loss. It is important to consider that in order to fully capture PTG
experiences following the death of a pet, we must also assess time since death.
Thus, prospective-longitudinal designs are needed to enhance understanding of
the PTG process.
While the literature shows that PTG factors have the potential to correlate
with increased quality of life, general functioning, and well-being (Helgeson,
Reynolds, & Tomich, 2006), it is valuable to keep in mind that not all people
who experience a traumatic event will experience growth (Wortman, 2004). For
our current study, 3,804 respondents, about 50% did not endorse PTG when
they filled out the survey. Given the open-ended and unstructured question
regarding growth and value, respondents might not have recognized when
they in fact had experienced growth, or that they had even been engaging in
activities to cope with loss that were growth enhancing. Therefore, we recom-
mend a more structured methodology, as it might have detected growth at those
times. Finally, it would be essential for future research to explore the degree to
which PTG in pet loss is a cultural phenomenon. A multicultural approach
might indicate specific differences in this area across cultural, racial, ethnic,
age, and socioeconomic dimensions that could lead toward a clearer understand-
ing of the PTG process.
There are some limitations to the study, and the current findings should be
interpreted with caution for several reasons. One limitation is that the quanti-
tative data were based on self-report measures (ICG, PAS). It is possible that
these measures cannot adequately capture the complex nature of strength of pet
attachment and grief. Although the response rate was very high, these results
cannot be considered representative for all individuals who have lost a pet.
18 OMEGA—Journal of Death and Dying 0(0)
It is possible that the individuals who chose to participate in our internet study
differed substantially from those who did not. In addition, depending upon time
since death, memory bias may occur and impact accuracy of grief perceptions
(Safer, Bonanno, & Field, 2001)
Another limitation of our study involves its cross-sectional design. Future
research should use a longitudinal research design and repeated measures of
PTG and other constructs. It would then be possible to clarify the normative
course of various PTG in pet loss. The current study findings provide insight
into how bereaved pet owners respond and cope with the loss of their pet and
extend and enhance our understanding of PTG processes.
The authors thank Scott Hines for his technical expertise and assistance, Paige Naylor for
her administrative support, and Dr Rama Ronen and Dr Tara Cronin for their data
management. Above all, the authors thank the participants for taking their time to
share with us the nature, depth, and intensity of their grief experiences and consistently
emphasized the profound importance of companion animals in their lives.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publica-
tion of this article.
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Author Biographies
Wendy Packman, JD, PhD, is a professor of Psychology at Palo Alto University
(PAU). She is the director of the joint JD-PhD program in Psychology and Law
at PAU and Golden Gate University Law School. Dr. Packman has studied,
presented, and written extensively on sibling bereavement and continuing bonds,
the impact of a child’s death on parents, and the psychological sequela of pet
loss. She is the primary investigator of an international cross-cultural study
examining the use of continuing bonds following a pet’s death.
Cori Bussolari, PsyD, is a licensed psychologist and credentialed school psychol-
ogist. For most of her professional clinical career, she has worked with indivi-
duals and families coping with illness, death, or a significant life transition. In
addition to her clinical work in private practice in San Francisco, she is an
associate professor at the University of San Francisco in the Counseling
Psychology Department. While her current research involvement is in the area
of pet loss and grief, she has always been immersed within the area of bereave-
ment and trauma, especially in regard to positive and lifelong coping. She is an
active consultant for schools, families, and community mental health clinics
regarding issues related to illness, bereavement, or learning difficulties. She
also facilitates the San Francisco SPCA Pet Loss Support Group.
Rachel Katz, MA, Med, is a San Francisco-based spiritual director in private
practice, researcher and writer. Her scope of expertise includes death/dying, the
human/animal bond, grief/loss, spirituality and chronic illness. Her writing has
appeared in a number of publications and blogs, including her own. She is the
founder of Besotted, a Facebook community dedicated to the human animal
22 OMEGA—Journal of Death and Dying 0(0)
Betty J. Carmack, RN, EdD, is a professor emerita at the University of San
Francisco School of Nursing and has worked in the area of pet loss since 1982.
She initiated and has led the monthly pet loss support groups at the SF/SPCA
from 1982 to 2015. In addition to working with individuals grieving the death of
their companion animals, she has worked with the staff of humane societies,
veterinary hospitals, and animal care organizations vis-a
`-vis their specific grief
and stress issues as these relate to their work with and care of animals. She is
particularly interested in Compassion Fatigue. She has authored articles in both
the professional and lay literature, presented at numerous professional confer-
ences, engaged in research related to pet loss and mentors others who feel called
to this work. She has conducted research on the lived experience of losing a
companion animal as well as the continuing connections people have after a
beloved animal’s death. She is the author of the book Grieving the Death of a
Pet. She continues to collaborate on research related to continuing bonds and
pet loss. She served on the Board of Trustees of Pet Unlimited in San Francisco
and the Advisory Board of VET Street Outreach Services also in San Francisco.
She was on the faculty of the Schools of Nursing at both the University of
California, San Francisco, and the University of San Francisco.
Nigel P. Field, PhD, was a professor of Psychology at Palo Alto University from
1994 until his death in 2013. He is best known in thanatology as one of the
earliest and most sophisticated investigators of the continuing bond that the
bereaved often maintain with their deceased loved ones, pioneering in methods
for tracking variations in this sense of connection using self-report scales, time-
sampling procedures over the course of the day and week, and novel recording
and analysis of empty-chair monologues to a deceased spouse. In these and
other studies of adaptation to the death of a spouse, memory bias in bereave-
ment, pet loss and cultural factors in grieving, Nigel Field left a substantial
legacy of over 60 published papers that will continue to shape future scholarship
and research in the study of grief and loss.
Packman et al. 23
... Tzivian and Friger (2014) interviewed dog owners in the two weeks following their pet's euthanasia procedure and found that nearly 83% were certain that their choice was in the best interest of their animal and offered their pet an "honorable death". Some pet owners may even gain personal strength through the process of euthanasia, as they feel they had to be "strong" or "courageous" in the best interest of their companion animal Packman et al., 2017). Regardless of confidence in the euthanasia decision, nearly 30% of pet owners who euthanized their companion animal experience severe grief (Adams et al., 2000;Davis et al., 2003). ...
... Social support is essential to prevent the development of a complicated grief response (Packman et al., 2014) and may help facilitate improved quality of life (Tzivian et al., 2015b) and positive growth following pet loss Michael & Cooper, 2013;Packman et al., 2017;Wong et al., 2017). ...
The loss of a companion animal results in millions of pet owners grieving annually. To date, little information has been synthesized on the grief response and coping mechanisms of bereaved pet owners. The aim of this review was to examine the relationship between pet loss and owner grief response. Major themes included: factors that influence the grief response, the disenfranchised nature surrounding pet loss, ambiguous pet loss and coping mechanisms used. Across the 48 studies included in this review, bereaved pet owners frequently reported feelings of embarrassment and loneliness following the loss of their pet. Types of coping mechanisms used by bereaved pet owners were identified and included: isolation, social support, continuing bonds, memorialization, religion, and relationships with other animals. Overall, this review was able to identify a consensus among the literature that bereaved pet owners are likely to experience disenfranchisement surrounding their loss. Based on the present findings, suggestions for future research include a focus on the effectiveness of coping mechanisms used by bereaved pet owners.
... It is not surprising, therefore, that dogs are often seen as part of the family [27] or even as surrogate children [29]. For many people, the relationship they have with their dog is one of their most significant connections, and as a result, the loss of this relationship when a dog dies is often profound [30][31][32]. ...
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Considerable growth has occurred in research on various aspects of human-animal interaction in recent years. This chapter provides an integrated overview of the current state of empirical research in each of the four core domains of veterinary social work: animal-assisted interventions, animal-related grief and bereavement, compassion fatigue and management, and links between animal and human maltreatment. We discuss strengths and limitations of available knowledge alongside opportunities for future research and, where applicable, data-driven implications for programs and policy.KeywordsAnimal crueltyAnimal-related grief and bereavementAutismCompassion fatigueFamily violenceOlder adultsResilienceTrauma
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Mammalian species form unique bonds between mothers and infants. Maternal care, including suckling, is necessary for infant survival, and the mother and, sometimes, the father require a lot of effort in nurturing infants. An infant's probability of survival depends on the extent of the investment of care by the mother. In parallel, mothers must identify their offspring and invest only in those who possess their genes to achieve evolutionary benefits. Therefore, they need to recognize their offspring and show a strong preference for them. For this reason, bond formation between mothers and infants is important. The mother monitors her offspring's physical condition and stays close to them. The offspring also form strong bonds with their mothers. Therefore, a separation between the mother and infant causes severe stress for both parties. Although it was initially thought that such bonds between mother and infant are limited to the same species, we have also observed a similar phenomenon in the human-dog relationship. In this article, we discuss the neuroendocrine mechanisms that underlie bond formation and separation based on findings of neurobiological research in mice and the relationship between humans and dogs.
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Introducción: el aumento de personas mayores en Colombia sumado a la pobreza y a la falta de soporte familiar y redes de apoyo para estas personas constituye un reto para el Estado. Ante esta problemática se exploran alternativas como la influencia de las mascotas en su salud. El objetivo de este manuscrito es comprender el vínculo persona mayor-mascota en la vida cotidiana y las implicaciones para su salud. Metodología: se trata de un estudio cualitativo con perspectiva etnográfica focalizada. Se realizaron 14 entrevistas semiestructuradas y observación a mayores de 60 años que conviven con mascotas en Medellín-Colombia. Participaron 8 mujeres, 6 hombres, entre 60 y 85 años. Mascotas: 17 perros y 7 gatos. Resultados: emergieron cuatro categorías principales: la mejor compañía, un día con la mascota, relación familia-mascota y beneficios de la mascota para la promoción de la salud de los mayores. Discusión: para los mayores lo más satisfactorio de tener mascota es su compañía, comparable a la de un hijo o un ser querido, seguido de la posibilidad que les brinda de expresar emociones placenteras, aumentar su interacción social y sentirse útiles y activos; beneficios que trascienden al resto de la familia. Conclusiones: el vínculo persona mayor-mascota es un coadyuvante para la promoción de la salud.
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The initial months of COVID-19 forced people to quickly adapt to dramatic changes to their daily lives. As a result of the inevitable decrease in access to social support available during the lockdown phase of COVID-19, countless individuals relied upon their companion dogs and cats. Given the strong connections people often have with their companion animals, this study hypothesized that companion dogs and cats would positively impact guardians’ mental health. Anonymous, cross-sectional online surveys were used to test this premise. A total of 5061 responses, primarily females (89%) from the United States (84%), were analyzed. Results suggest that companion animals played a critical role in helping reduce feelings of depression, anxiety, isolation, and loneliness for a majority of pet guardians. Companion animals also helped increase guardians’ experiences of self-compassion, ability to maintain a regular schedule, feel a sense of purpose and meaning, and cope with uncertainty. This was most pronounced for women under the age of 40 who were highly bonded to their companion animal. In conclusion, our study suggests that a companion dog or cat can buffer the effects of extreme stress and social isolation as witnessed during the COVID-19 pandemic.
Animal owners who experience the death of a beloved family pet or companion animal may experience feelings of grief and loss that are synonymous with the death of a human. This systematic review synthesized 19 qualitative papers from 17 studies that explored the psychosocial impact of bereavement and grieving the loss of a pet. The analysis revealed five themes: Their Relationship; Their Grief; Their Guilt; Their Supports; and Their Future. By looking beyond grief, health professionals can respond to bereaved pet owners the same way they would for other forms of human bereavement and provide the necessary support to transition bereavement.
Much of the research on human-animal interaction measures the impact of the presence of a companion animal or the interaction with a specific type of animal on human well-being. Little attention has been given to measurement of the animal’s well-being and the impact of a companion animal’s declining health or death on the human caregiver. Caring for a sick or aging animal can be time consuming, emotionally draining, and financially expensive. Some of the conflicting results in the human-animal interaction literature may be accounted for by such factors as the level of attachment to the animal, involvement with the animal, and in particular the age and health status of the animal. Research challenges and the need to recognize and measure the effects of companion animal caregiving are discussed, particularly in the context of chronic illness, aging, and bereavement.
• There appears to be a tendency among continuing bonds (CB) proponents to equate any reference to assertion that the bereaved must relinquish some aspect of the bond as adherence to wholesale relinquishment. This unidimensional way of conceptualizing CB may stem from a tendency of CB proponents to conflate relinquishing the bond to the deceased with grief work. In this chapter, I argue that the two need to be distinguished to facilitate an understanding of the full complexity of the relationship between CB and bereavement-related adapt. I propose that a more constructive approach toward determining the adaptiveness of CB is to attempt to identify what can be continued and what needs to be relinquished in contrast to simply whether to continue or to relinquish the bond. This perspective entails conceptualizing CB as multidimensional, regarding the endpoint of grief work not as detachment but as involving reconstruction of the relationship with the deceased. I believe that this will be a more fruitful way of clarifying the function of CB and inspiring systematic research toward investigating the conditions under which CB is adaptive or maladaptive. (PsycINFO Database Record (c) 2015 APA, all rights reserved) • There appears to be a tendency among continuing bonds (CB) proponents to equate any reference to assertion that the bereaved must relinquish some aspect of the bond as adherence to wholesale relinquishment. This unidimensional way of conceptualizing CB may stem from a tendency of CB proponents to conflate relinquishing the bond to the deceased with grief work. In this chapter, I argue that the two need to be distinguished to facilitate an understanding of the full complexity of the relationship between CB and bereavement-related adapt. I propose that a more constructive approach toward determining the adaptiveness of CB is to attempt to identify what can be continued and what needs to be relinquished in contrast to simply whether to continue or to relinquish the bond. This perspective entails conceptualizing CB as multidimensional, regarding the endpoint of grief work not as detachment but as involving reconstruction of the relationship with the deceased. I believe that this will be a more fruitful way of clarifying the function of CB and inspiring systematic research toward investigating the conditions under which CB is adaptive or maladaptive. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
This article describes the concept of posttraumatic growth, its conceptual foundations, and supporting empirical evidence. Posttraumatic growth is the experience of positive change that occurs as a result of the struggle with highly challenging life crises. It is manifested in a variety of ways, including an increased appreciation for life in general, more meaningful interpersonal relationships, an increased sense of personal strength, changed priorities, and a richer existential and spiritual life. Although the term is new, the idea that great good can come from great suffering is ancient. We propose a model for understanding the process of posttraumatic growth in which individual characteristics, support and disclosure, and more centrally, significant cognitive processing involving cognitive structures threatened or nullified by the traumatic events, play an important role. It is also suggested that posttraumatic growth mutually interacts with life wisdom and the development of the life narrative, and that it is an on-going process, not a static outcome.
The Posttraumatic Growth Inventory (PTGI) is the most commonly used measure of positive psychological change that can result from negotiating a traumatic experience. While the PTGI has strong internal reliability, validity studies are still sparse. The present research details trauma survivors' understanding of items comprising the PTGI in order to qualitatively assess content validity. Participants were 14 trauma survivors who completed the PTGI and participated in a semistructured interview. Thematic analysis was conducted on participants' transcribed interviews. One latent theme was identified reflecting that questions were consistently understood. A relationship was found between the constituent themes identified and the five factors of the PTGI. Participants answered the PTGI statements in a way that is consistent with the purpose of the instrument, with only a small discrepancy found when some participants used the PTGI scale to indicate when a decrease in an element of the inventory had been experienced. Overall results supported the content validity of the PTGI.