Posttraumatic Growth and Dyadic Adjustment among War Veterans and their Wives

Abstract

The controversy regarding the nature of posttraumatic growth includes two main competing claims: one which argues that posttraumatic growth reflects authentic positive changes and the other which argues that posttraumatic growth reflects illusory defenses. While the former might suggest that posttraumatic growth enhances intimacy and close relationships, the latter might imply that posttraumatic growth hinders interpersonal relations. The present study aimed to test these claims by investigating the association between posttraumatic growth and dyadic adjustment over time at both the individual and dyadic levels, and the potential role of posttraumatic stress symptoms. Former prisoners of war and comparable war veterans and their wives (n = 229) were assessed twice, 30–31 (T1) and 35–38 (T2) years after the 1973 Yom Kippur War in Israel, with regard to posttraumatic growth, posttraumatic stress symptoms and dyadic adjustment. Results indicated that posttraumatic growth was associated with both elevated posttraumatic stress symptoms and low dyadic adjustment among both husbands and wives. Posttraumatic stress symptoms at T1 and T2 mediated the association between posttraumatic growth and dyadic adjustment. Wives' posttraumatic growth at T1 predicted posttraumatic growth and dyadic adjustment of the husbands at T2. The higher the wives' posttraumatic growth, the higher the posttraumatic growth and the lower the dyadic adjustment of the husbands in the subsequent measure. The findings suggest that posttraumatic growth reflects defensive beliefs which undermine marital relationships and that posttraumatic growth might be transmitted between spouses and implicated in the deterioration of the marital relationship over time.

Full text

ORIGINAL RESEARCH
published: 30 June 2017
doi: 10.3389/fpsyg.2017.01102
Frontiers in Psychology | www.frontiersin.org 1June 2017 | Volume 8 | Article 1102
Edited by:
Adam D. Brown,
Sarah Lawrence College, NYU School
of Medicine, United States
Reviewed by:
Sara Freedman,
Bar-Ilan University, Israel
Alexandre Luiz De Oliveira Serpa,
Hogrefe Publishing Group, Brazil
*Correspondence:
Yael Lahav
lahav.yael62@gmail.com
Specialty section:
This article was submitted to
Psychopathology,
a section of the journal
Frontiers in Psychology
Received: 17 November 2016
Accepted: 14 June 2017
Published: 30 June 2017
Citation:
Lahav Y, Kanat-Maymon Y and
Solomon Z (2017) Posttraumatic
Growth and Dyadic Adjustment
among War Veterans and their Wives.
Front. Psychol. 8:1102.
doi: 10.3389/fpsyg.2017.01102
Posttraumatic Growth and Dyadic
Adjustment among War Veterans and
their Wives
Yael Lahav 1, 2*, Yaniv Kanat-Maymon 3and Zahava Solomon2, 4
1Department of Psychology, University of Southern Denmark, Odense, Denmark, 2I-Core Research Center for Mass Trauma,
Tel-Aviv University, Tel-Aviv, Israel, 3Interdisciplinary Center Herzliya, Herzliya, Israel, 4Bob Shapell School of Social Work,
Tel-Aviv University, Tel-Aviv, Non-US/Non-Canadian, Israel
The controversy regarding the nature of posttraumatic growth includes two main
competing claims: one which argues that posttraumatic growth reflects authentic positive
changes and the other which argues that posttraumatic growth reflects illusory defenses.
While the former might suggest that posttraumatic growth enhances intimacy and close
relationships, the latter might imply that posttraumatic growth hinders interpersonal
relations. The present study aimed to test these claims by investigating the association
between posttraumatic growth and dyadic adjustment over time at both the individual
and dyadic levels, and the potential role of posttraumatic stress symptoms. Former
prisoners of war and comparable war veterans and their wives (n=229) were
assessed twice, 30–31 (T1) and 35–38 (T2) years after the 1973 Yom Kippur War
in Israel, with regard to posttraumatic growth, posttraumatic stress symptoms and
dyadic adjustment. Results indicated that posttraumatic growth was associated with
both elevated posttraumatic stress symptoms and low dyadic adjustment among both
husbands and wives. Posttraumatic stress symptoms at T1 and T2 mediated the
association between posttraumatic growth and dyadic adjustment. Wives’ posttraumatic
growth at T1 predicted posttraumatic growth and dyadic adjustment of the husbands at
T2. The higher the wives’ posttraumatic growth, the higher the posttraumatic growth
and the lower the dyadic adjustment of the husbands in the subsequent measure. The
findings suggest that posttraumatic growth reflects defensive beliefs which undermine
marital relationships and that posttraumatic growth might be transmitted between
spouses and implicated in the deterioration of the marital relationship over time.
Keywords: posttraumatic growth, dyadic adjustment, posttraumatic stress symptoms, war combat, prisoners of
war, secondary traumatization, trauma
INTRODUCTION
Combat and war captivity are highly traumatogenic experiences. Combat exposes the individual to
the threat of death and injury. War captivity includes, in addition to combat exposure, prolonged,
and deliberate psychological torture aimed at breaking the prisoner’ spirit (Herman, 1992). The
psychopathological implications of combat and war captivity are not limited to primary trauma
survivors, and may be transmitted to their significant others, a phenomenon known as secondary
traumatization (e.g., Figley, 1986).

Lahav et al. Posttraumatic Growth and Dyadic Adjustment
Exposure to a traumatic event might lead to a posttraumatic
reaction, most commonly known as posttraumatic stress disorder
(PTSD). According to the DSM-IV-TR (American Psychiatric
Association, 2000), which the current study relies upon, PTSD
symptoms (PTSS) include intrusion (e.g., flashbacks), avoidance
(e.g., numbness), and hyper-arousal (e.g., alertness). Research
has consistently documented PTSS to be the most common
psychiatric consequence of combat and war captivity (Engdahl
et al., 1997), and has indicated high rates of PTSS among
combatants, former prisoners of war (ex-POWs; Page, 1992), and
their spouses (e.g., Galovski and Lyons, 2004), even decades after
the traumatic event.
However, it has been suggested that exposure to traumatic
events can also result in positive gains or transformations. Most
notably, posttraumatic growth (PTG), is defined as the tendency
to report enhanced changes in the aftermath of traumatic events
in three domains: self-perception, interpersonal relationships,
and world view (e.g., Calhoun and Tedeschi, 2006).
Research has documented PTG among individuals who have
experienced various traumatic events, both first hand (for reviews
see Calhoun and Tedeschi, 2006) and indirectly through intimate
interactions with trauma survivors (e.g., Manne et al., 2004). PTG
has also been documented following exposure to combat and war
captivity in combat veterans (e.g., Aldwin et al., 1994), ex-POWs
(e.g., Ursano et al., 1986; Feder et al., 2008), and their wives (e.g.,
McCormack et al., 2011).
Although PTG has been documented in numerous
psychosocial studies, there remains a controversy regarding
its nature and long term implications. According to one
perspective, PTG is seen as a genuine transformation of basic
beliefs about the self and the world, which results from struggling
with the effects of trauma (e.g., Calhoun and Tedeschi, 2006).
However, according to an alternative perspective, PTG might
have an illusory quality that may be maladaptive and hinder
coping in the long term (e.g., McFarland and Alvaro, 2000;
Lahav et al., 2016). The Janus-face model (Maercker and
Zoellner, 2004), suggests that PTG simultaneously includes both
a constructive aspect and an illusory aspect. The constructive
aspect of PTG is the result of an active struggle with the
trauma, and is related to heightened adjustment and well-
being, both in the short and long term. However, the effects
of the illusory aspect depend on the timing of its usage and
the extent of denial involved. Specifically, it is claimed that
when the illusory aspect of PTG serves as an acute short term
palliative strategy, and co-exists with deliberate thinking about
the trauma and the coping effort, it has neither positive nor
negative long-term aftereffects. Yet, under conditions in which
PTG is solely illusory and serves in the long run as avoidance
strategy, strengthening efforts to evade the acknowledgment
of the traumatic event and the multiple losses it entails, it has
deleterious effects on adjustment. The present study explores
reports of PTG decades after the trauma has ended, and not
the usage of PTG occuring shortly after the exposure. Hence,
drawing upon the Janus-face model also indicates both positive
and negative potential implications of PTG, depending on the
dominance of the constructive side of PTG and the involvement
of denial.
The dispute about the nature of PTG is highlighted by mixed
results regarding the association between PTG and PTSS (e.g.,
Helgeson et al., 2006). While some studies have revealed a
negative association between PTG and PTSS (e.g., Frazier et al.,
2001), i.e., higher PTG associated with lower PTSS, others have
indicated a positive correlation (e.g., Dekel et al., 2012), or a
non-significant relationship between the two (e.g., Zoellner and
Maercker, 2006).
Although there is ample research on the implications of
PTG on the individual’s mental health, its consequences with
regard to the interpersonal domain, and specifically to the
marital relationship, have not been studied. The present study
investigates the implications of PTG reported many years after
the trauma on dyadic adjustment and the role of PTSS within
these associations. In the following sections we will first present
the literature regarding dyadic adjustment and PTSS among
ex-POWs, combatants and their wives. We will then present
perspectives with regard to PTG, dyadic adjustment and the role
of PTSS.
A considerable body of research has consistently
demonstrated that traumatic events have negative implications
on marital relationships. Empirical studies have indicated that
for couples in which one partner has experienced combat or
war captivity, there have been reports of lower relationship
satisfaction and dyadic adjustment (Neria et al., 2000), more
communication problems and conflicts (Cook et al., 2004), and
more impairments in intimacy and sexual relations (e.g., Zerach
et al., 2010).
PTSS is one of the most widely accepted mechanisms
underlying the low dyadic adjustment in the aftermath of
combat and war captivity (e.g., Cook et al., 2004). For
example, intrusive symptoms can amplify preoccupation with
the self at the expense of the relationship; avoidance symptoms
might lower self-disclosure; and hyperarousal symptoms might
amplify interpersonal conflict (e.g., Cook et al., 2004). Research
conducted among combat veterans or ex-POWs and their wives
indicated that the veterans’ PTSS was associated with lower
marital satisfaction for both partners (e.g., Cook et al., 2004)
and mediate the association between exposure to trauma and
low dyadic adjustment among ex-POWs (Dekel et al., 2008).
Furthermore, a longitudinal study conducted among fathers
in the Army National Guard from a Brigade Combat Team
indicated that increases in PTSS over time was associated with
poorer dyadic adjustment at a subsequent measurement (Gewirtz
et al., 2010).
Despite the fact that PTG refers to the interpersonal
domain and also assumes to reflect enhanced changes in
relationships, research regarding the implications of PTG on
marital relationships is limited. In fact, to the best of our
knowledge, former studies that investigated PTG with regard
to marital relationships have assessed dyadic adjustment as a
predictor of PTG and not as a consequence of growth (e.g.,
Manne et al., 2004; Weiss, 2004).
Given that the quality of a couple’s relationship affects both
partners’ psychological health (e.g., Proulx et al., 2007), it is
important to study the effects of PTG on dyadic adjustment.
Furthermore, as PTG by definition is assumed to be linked to
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
enhanced changes in relationships, examining the effects of PTG
on the quality of the marital relationship might illuminate the
nature of PTG. The present study aimed to fill this gap in the
knowledge by investigating the associations between PTG and
dyadic adjustment, and the role of PTSS within this association,
among war veterans and their wives.
As noted above, the literature implies two main alternatives
regarding the implications of PTG in dyadic adjustment, when
it is reported long after the trauma ended. The first assumes
that if PTG mainly reflects an authentic change it will be linked
to strengthened dyadic adjustment (e.g., Maercker and Zoellner,
2004). According to Calhoun and Tedeschi (2006), PTG reflects
positive schemas regarding interpersonal interactions. Trauma
survivors who experience growth become more emotionally
expressive, utilize social supports more than before, and show
efforts to improve relationships and greater sensitivity to others
(Calhoun and Tedeschi, 2006).
However, according to the alternate view, if, in the long
run, PTG serves mainly as an illusory defense that involves
denial, it could negatively affect coping with the trauma (e.g.,
Maercker and Zoellner, 2004) leading to subsequent difficulties in
adjustment. These adverse ramifications could, in turn, permeate
the individuals’ most intimate relationship, resulting in lower
dyadic adjustment.
A similar split in the literature arises regarding the potential
mediator role of PTSS in the association between PTG and dyadic
adjustment. The first alternative assumes that if PTG mainly
reflects an authentic transformation, it might ease the survivors’
distress and PTSS in the long term (e.g., Maercker and Zoellner,
2004), which, in turn, would enhance dyadic adjustment.
Alternatively, if PTG mainly reflects illusory defenses that
serve as a way to deny one’s adversity, it might affect PTSS
negatively, which in turn undermines dyadic adjustment. Beliefs
of growth might act as an avoidance strategy (e.g., Maercker and
Zoellner, 2004; Lahav et al., 2017) thereby inhibiting processing
the traumatic event and leading to elevated PTSS. This possible
negative effect, might, in turn, lead to low dyadic adjustment.
The inter-dependence between spouses is a well-established
notion as they affect each other in a multitude of dimensions.
Research has consistently demonstrated that veterans’ mental
health states are implicated in their spouses’ well-being (e.g.,
Renshaw et al., 2011) and the increased distress exhibited by
veterans is associated with lower marital satisfaction for both
veterans and their partners (e.g., Renshaw et al., 2008). Given that
the mental state of the husband and wife are interrelated, one
would assume that their PTG and dyadic outcomes would also
prove to be interrelated. However, to the best of our knowledge,
there has not been a study that has assessed whether PTG and
dyadic adjustment in one spouse affects the PTG and dyadic
adjustment in the other. The third aim of the present study is to
investigate the mutual and reciprocal effects between husbands’
and wives’ PTG and dyadic adjustment in a longitudinal design.
The present study will examine: (1) the associations between
PTG, PTSS, and dyadic adjustment among war veterans and
their wives, separately; (2) the mediating role of concurrent,
prospective and difference over time in PTSS in the relationships
between PTG and dyadic adjustment among war veterans
and their wives, separately and; (3) the associations between
husbands’ and wives’ PTG and dyadic adjustment over time.
MATERIALS AND METHODS
Procedure and Participants
The present study used data from a longitudinal study on the
psychological implications of war among veterans and their wives
(Greene et al., 2014, for full details). A cohort of Israeli veterans
from the 1973 Yom Kippur War and their wives were followed
over time. The current study used data which were collected at
two points in time: 2003/2004 (T1) and 2008/2011 (T2), from
both veterans and their wives.
In order to locate veterans, we used Israel Defense Forces
(IDF) files. Wives of veterans were recruited via their spouses.
Both husbands and wives were contacted by telephone and asked
individually to take part in the study. A battery of questionnaires
were administered in their homes or in another location of their
choice. Before filling out the questionnaires, participants signed
an informed consent form. This study was approved by the Tel
Aviv University ethics committee.
War Veterans
According to records of the Israeli Ministry of Defense, 240
soldiers who served in the IDF land forces were taken prisoner
in the 1973 Yom Kippur War. In addition, 280 comparable
veterans were sampled from IDF computerized data banks.
These individuals participated in the same war, but were not
taken captive and were matched on military background and
sociodemographics. A total of 227 veterans participated in T1. Of
these, 121 were ex-POWs (53.3%) and 106 were combat veterans
(46.7%). In T2 there was a total of 294 participants. Of these, 176
were ex-POWs (59.9%) and 118 were combat veterans (40.1%).
For all veterans the mean age at T1 was 52.62 (SD =4.56),
mean years of schooling was 13.94 (SD =3.46); the majority were
secular (61.7%), with an over-average income (35.6%).
Veterans’ Wives
In T1, 213 veterans were married. A total of 165 wives
participated in T1. Of these, 90 were ex-POWs’ wives (54.5%) and
75 were controls’ wives (45.4%). In T2, the number of married
veterans increased to 250. Hence, the number of veterans’ wives
who participated also increased, to 171. Of these, 114 were ex-
POWs’ wives (66.6%) and 57 were controls’ wives (33.1%). The
mean age for wives of veterans at T1 was 50.70 (SD =6.36),
mean years of schooling was 14.18 (SD =3.18); the majority were
secular (57.9%), with an over-average income (35.0%).
In the present study, we used an anchor wherein couples were
included in the sample only if both partners participated in at
least one wave of measurement. The current sample consisted of
229 couples.
Handling Missing Data
Substantial attrition, and in several cases, addition, are very
common in longitudinal designs (Collins et al., 2001). In the
current study, both of these occurred from T1 to T2. Of the
current sample of 229 couples at T1 and T2, respectively: 179
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
(78.17%) and 187 husbands (81.66%), and 156 (68.12%) and 160
(69.87%) wives had data in regards to the study variables. In
addition, data were missing across variables, with some variables
having more missing data than others. Hence, we assessed the
differences between valid and missing data in each variable and
for each spouse and measurement. Overall 19.2–38.9% data were
missing across both waves and variables.
To decide whether the data had missing values in a pattern
that was random, we conducted analyses of differences between
these groups in all of the variables, using Little’s Missing
Completely at Random (MCAR) test (Collins et al., 2001). The
analysis revealed that the data were not missing completely at
random, χ2
(889) =1021.356, p=0.001. Supplementary analyses
revealed that the husbands of wives with missing data regarding
PTSS at T2, endorsed significantly lower PTSS symptoms at T1
(t=2.8, p=0.006) and lower PTG at T1 (t=2.1, p=0.04) than
husbands of wives without missing data.
As the mechanism of missingness was unknown and there
were indications that the missingness was related to the observed
data, we assumed that the data were missing at random (MAR).
Missing data were handled with maximum likelihood (ML) via
the SPSS 22 and AMOS 22 programs. Compared to conventional
methods, such as arithmetic mean, listwise or pairwise deletion,
ML method was recommended as an optimal method for both
attrition and addition of participants over time (Collins et al.,
2001). The final sample (after ML was implemented) comprised
of 229 Israeli couples (134 ex-POW couples and 95 control
couples).
Measures
PTSS (PTSD Inventory) (PTSD-I; Solomon et al., 1993)
Husbands’ and wives’ PTSS was assessed via the PTSD-I, a
well-validated, 17-item, self-report questionnaire. The items on
the PTSD-I correspond to the DSM-IV-TR diagnosis for PTSD
(American Psychiatric Association, 2000). Respondents rated the
symptoms experienced in the previous month on a scale ranging
from (0) not at all to (4) almost always. Wives’ PTSS scores were
obtained by asking wives to rate their symptoms related to their
husbands’ experiences of combat or captivity. The number of
positively endorsed symptoms was calculated by counting the
items in which the respondents answered “3” or “4.” The PTSD-I
has proven psychometric properties and convergent validity (e.g.,
Solomon et al., 1993). In the present study, Cronbach’s alphas
were 0.95, 0.96 for husbands and 0.91, 0.91 for wives, at T1 and
T2 respectively.
Post Traumatic Growth Inventory (PTGI; Tedeschi and
Calhoun, 1996)
The PTGI was used to assess the salutary impact of trauma for
both husbands and wives. The scale includes 21-items scored on a
4-point scale from (1) I didn’t experience this change at all, to (4) I
experienced this change to a very great degree. The PTGI includes
five subscales, however, in the current study only the total score
was calculated. The PTGI has good internal consistency as well as
good construct, convergent and discriminant validity (Tedeschi
and Calhoun, 1996). In the present study, Cronbach’s alphas were
0.94, 0.93 for husbands, and 0.96, 0.94 for wives, at T1 and T2
respectively.
Dyadic Adjustment Scale (DAS; Spanier, 1976)
Husbands’ and wives’ dyadic adjustment levels were assessed by
the DAS which consists of 32 items divided into four subscales:
satisfaction, cohesion, consensus, and affection expression. In
addition, the total score was computed by summing the ratings
on the 32 items. Participants were asked to indicate the extent to
which each item describes their current marital relationship. The
scale has good convergent and discriminant validity (Heyman
et al., 1994). In the current study, Cronbach’s alphas were 0.94–
0.96 for the total score and 0.90–0.96 for the subscales.
Data Analysis
To assess the associations between PTG, on the one hand,
and PTSS and dyadic adjustment, on the other hand, while
controlling for study group, partial correlations were conducted.
Next, in order to examine whether PTSS at T1 and T2 mediated
the link between T1 PTG and T2 dyadic adjustment, we
used multiple step mediation (Hayes et al., 2011). Specifically,
we examined: (a) whether T1 PTG directly affected dyadic
adjustment at T2, controlling for PTSS at T1 and T2; (b) whether
T1 PTG indirectly affected dyadic adjustment via PTSS at any
of the time points (i.e., T1 and T2, separately); and (c) whether
T1 PTG indirectly affected dyadic adjustment via a two-step
mediation process (i.e., via PTSS at T1-T2). We controlled for
study group as well as for T1 dyadic adjustment in order to
take into account the stability of dyadic adjustment over time.
To examine whether these indirect paths were significant, we
employed accelerated bias-corrected bootstrap analyses.
In order to examine the associations between husbands’
and wives’ PTG and dyadic adjustment over time, we used an
Actor-Partner Independence Model (APIM; Kashy and Kenny,
2000) via AMOS statistics, Version 22. The APIM, “is a model
of dyadic relationships that integrates a conceptual view of
interdependence in two person relationships with the appropriate
statistical techniques for measuring and testing it” (Cook and
Kenny, 2005, p. 101). A good model fit to the observed data is
suggested if the comparative fit index (CFI), normed fit index
(NFI), and the Tucker-Lewis index (TLI) are greater than 0.90
and the root mean square error of approximation (RMSEA) is
lower than 0.07.
RESULTS
Associations between PTG, PTSS, and
Dyadic Adjustment
Among both spouses, partial correlation analyses indicated that
PTG was positively correlated with PTSS beyond the effect of
study group. The higher the PTG, the more the PTSS. Among
husbands, PTG at T1 was negatively correlated with the levels
of dyadic adjustment measures at T2 beyond the effect of
study group. Among wives, PTG at T1 and T2 were negatively
correlated with the levels of dyadic adjustment measures at T1
and T2 beyond the effect of study group. The higher the PTG, the
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
lower the dyadic adjustment (see Table 1 for husbands’ results;
see Table 2 for wives’ results).
Multistep Mediation of PTSS in the Relation
between PTG and Dyadic Adjustment
Multiple step mediation analyses among the husbands (Table 3)
revealed that PTG had a non-significant direct effect for dyadic
adjustment, except for the cohesion subscale. PTG indirectly
predicted the husbands’ dyadic adjustment via PTSS at T2 as
well as via both PTSS at T1 and T2 for the dyadic adjustment
total score and all subscales (See Figure 1 for dyadic adjustment
total score). Higher PTG at T1 predicted higher PTSS at T1 (B=
1.71, SE =0.38, P<0.001), which, in turn, increased the levels
of PTSS between T1 and T2 (B=0.70, SE =0.06, P<0.001).
Next, higher levels of PTSS at T2 were associated with low dyadic
adjustment at T2 (B= −1.35, SE =0.47, P=0.004; B= −0.54,
SE =0.19, P=0.005; B= −0.23, SE =0.09, P=0.02; B=
−0.53, SE =0.22, P=0.02; B= −0.13, SE =0.05, P=0.009, for
dyadic adjustment total score, satisfaction, cohesion, consensus,
and affection, respectively).
Analyses among the wives revealed (Table 3) that PTG had
a significant direct effect on dyadic adjustment, except for the
cohesion and consensus subscales. PTG did not have an indirect
effect on dyadic adjustment, apart from the affection subscale
(See, Figure 2). PTG indirectly predicted the wives’ affection via
PTSS at T2 as well as via both PTSS at T1 and T2. Higher PTG at
T1 predicted higher PTSS at T1 (B=2.22, SE =0.26, P<0.001),
which, in turn, increased the levels of PTSS between T1 and T2 (B
=0.69, SE =0.05, P<0.001). Next, higher levels of PTSS at T2
were associated with low affection at T2 (B= −0.21, SE =0.07,
P=0.003).
APIM Model for Wives’ and Husbands’ PTG
and Dyadic Adjustment
The fit indices of the APIM model indicated that the theoretical
model was a good representation of the data, χ2(6) =10.21,
p=0.116, χ2/df =1.701, CFI =0.98, NFI =0.97, TLI =
0.90, RMSEA =0.06. We wanted to estimate a simpler and
parsimonious model, containing only the significant paths found.
We compared its fit indices to the general model, arguing for
many paths of impact. Non-significant difference of the two
chi-squares suggest that the omission of the non-significant
parameters did not reduce model and indicate favors to the
simpler model (Ledermann et al., 2011).
No significant difference was found between the two chi-
squares, 1χ2(9) =7.125, p=0.624. Hence, we proceeded with
the more parsimonious simple model omitting non-significant
paths. Fit indices of the simpler model indicated that the model
was an excellent representation of the data, χ2(15) =17.335,
p=0.299, χ2/df =1.155,CFI =0.99, NFI =0.94, TLI =0.98,
RMSEA =0.03.
Figure 3 and Table 4 display the standardized coefficients and
significant paths for the parsimonious nested model. The analysis
revealed high stability of PTG and dyadic adjustment over time
among both partners. Those with high levels of PTG and dyadic
adjustment at T1 tended to have high levels of PTG or dyadic
TABLE 1 | Partial correlations between the study measures controlling for study group among husbands.
Measure 1 2 3 4 5 6 7 8 9 10 11 12 13 14
1. PTG, T1 –
2. PTG, T2 0.60*** –
3. PTSS, T1 0.28*** 0.23*** –
4. PTSS, T2 0.26*** 0.28*** 0.72*** –
5. DAS total, T1 −0.06 −0.05 −0.42*** −0.38*** –
6. DAS satisfaction, T1 −0.09 −0.07 −0.39*** −0.30** 0.91*** –
7. DAS cohesion, T1 0.05 −0.04 −0.30*** −0.26** 0.79*** 0.65*** –
8. DAS consensus, T1 −0.07 −0.02 −0.40*** −0.40*** 0.79*** 0.76*** 0.69*** –
9. DAS affection, T1 −0.06 −0.06 −0.31*** −0.35*** 0.79*** 0.70*** 0.54*** 0.69*** –
10. DAS total, T2 −0.12** −0.02 −0.44*** −0.46*** 0.60*** 0.59*** 0.56*** 0.49*** 0.39*** –
11. DAS satisfaction, T2 −0.17** −0.07 −0.37*** −0.39*** 0.42*** 0.47*** 0.45*** 0.27*** 0.28*** 0.90*** –
12. DAS cohesion, T2 −0.09 −0.09 −0.33*** −0.34*** 0.60*** 0.53*** 0.66*** 0.48*** 0.42*** 0.79*** 0.64*** –
13. DAS consensus, T2 −0.12* 0 −0.45*** −.46*** 0.61*** 0.58*** 0.50*** 0.56*** 0.36*** 0.94*** 0.74*** 0.66*** –
14. DAS affection, T2 −0.15* −0.09 −0.31*** −0.37*** 0.38*** 0.38*** 0.26*** 0.32*** 0.36*** 0.76*** 0.64*** 0.48*** 0.73*** –
M(SD) 2.34 (0.67) 2.17 (0.66) 6.96 (5.59) 6.82 (5.69) 106.19 (22.60) 36.70 (7.50) 15.09 (5.45) 46.32 (10.07) 8.08 (2.47) 95.22 (29.57) 31.28 (10.90) 14.08 (5.88) 42.48 (13.57) 7.38 (2.58)
Range 2.76 3 17 20.25 125 40 28.65 57 11 142 51.92 29.72 67.5 12
PTG, posttraumatic growth; PTSS, posttraumatic symptoms; DAS, dyadic adjustment scale; T1, assessment in 2003; T2, assessment in 2008. *p<0.05. **p<0.01. ***p<0.001.
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
TABLE 2 | Partial correlations between the study measures controlling for study group among wives.
Measure 1 2 3 4 5 6 7 8 9 10 11 12 13 14
1. PTG, T1 –
2. PTG, T2 0.78*** –
3. PTSS, T1 0.55*** 0.46*** –
4. PTSS, T2 0.57*** 0.52*** 0.78*** –
5. DAS total, T1 −0.29*** −0.18** −0.31*** −0.30*** –
6. DAS satisfaction, T1 −0.27*** −0.20** −0.29*** −0.30*** 0.90*** –
7. DAS cohesion, T1 −0.13* −0.13* −0.20*** −0.17** 0.84*** 0.70*** –
8. DAS consensus, T1 −0.30*** −0.16* −0.30*** −0.28*** 0.93*** 0.74*** 0.66*** –
9. DAS affection, T1 −0.29*** −0.12 −0.32*** −0.37*** 0.81*** 0.68*** 0.63*** 0.74*** –
10. DAS total, T2 −0.35*** −0.17* −0.32** −0.33*** 0.60*** 0.48*** 0.36*** 0.66*** 0.52*** –
11. DAS satisfaction, T2 −0.37*** −0.17* −0.33*** −0.27*** 0.62*** 0.62*** 0.32*** 0.66*** 0.45*** 0.83*** –
12. DAS cohesion, T2 −0.18** −0.10 −0.26*** −0.24*** 0.61*** 0.43*** 0.56*** 0.61*** 0.50*** 0.71*** 0.61*** –
13. DAS consensus, T2 −0.30*** −0.15* −0.26*** −0.29*** 0.43*** 0.29** 0.22** 0.52*** 0.41*** 0.91*** 0.56*** 0.47*** –
14. DAS affection, T2 −0.30*** −0.10 −0.17** −0.31*** 0.31*** 0.26*** 0.19** 0.31** 0.41*** 0.78*** 0.54*** 0.43*** 0.74*** –
M (SD) 2.30 (0.82) 2.24 (0.79) 3.82 (3.80) 4.13 (4.83) 105.69 (24.08) 36.41 (7.39) 15.07 (5.95) 45.98 (11.25) 8.22 (2.49) 103.09 (24.82) 36.07 (7.95) 14.82 (5.33) 44.60 (13.33) 7.60 (2.75)
Range 12.00 68.79 25.00 40.00 136.99 12.40 65.00 35.00 45.50 141.50 18.82 16.72 3.95 3.20
PTG, posttraumatic growth; PTSS, posttraumatic symptoms; DAS, dyadic adjustment scale; T1, assessment in 2004; T2, assessment in 2011. *p<0.05. **p<0.01. ***p<0.001.
adjustment at T2. More importantly, the analysis revealed that
the initial level of wives’ PTG at T1 predicted husbands’ dyadic
adjustment at T2, above and beyond the stability of husbands’
dyadic adjustment. The higher the wives’ PTG at T1, the lower
the husbands’ dyadic adjustment at T2. The analysis also revealed
that the initial level of wives’ PTG at T1 predicted husbands’ PTG
at T2, above and beyond the stability of husbands’ PTG. The
higher the wives’ PTG at T1, the higher the husbands’ PTG at
T2. Lastly, the analysis revealed that the initial level of husbands’
dyadic adjustment at T1 predicted wives’ dyadic adjustment at
T2, above and beyond the stability of wives’ dyadic adjustment.
The higher the husbands’ dyadic adjustment at T1, the higher the
wives’ dyadic adjustment at T2. The other prediction axes were
non-significant.
We explored the possibility that the reported findings change
as a function of participants’ study group (i.e., ex-POWs and
their wives vs. war veterans and their wives). To that end, we
conducted multigroup APIM models that estimated the relation
between husbands’ and wives’ PTG and dyadic adjustment,
separately for each group. The multigroup model did not fit the
data well, χ2(29) =57.57, p=0.001, χ2/df =1.99, CFI =0.87,
NFI =0.81, TLI =0.69, RMSEA =0.07. Furthermore, the chi-
square difference test (Brown et al., 1990) yielded non-significant
values, 1χ2(4) =3.411, p=0.492, suggesting that the results do
not change as a function of study group.
DISCUSSION
The current study explored PTG in the context of marital
relationships on both the individual and dyadic levels. The
present results revealed that among husbands who were exposed
directly to combat or war captivity, as well as their wives, who
were exposed indirectly to these traumatic events, PTG was
not only associated with elevated PTSS but also low dyadic
adjustment. PTSS mediated the association between PTG and
all of the dyadic adjustment subscales among husbands, and the
association between PTG and the dyadic adjustment affection
subscale among wives. Lastly, the wives’ PTG predicted higher
PTG and lower dyadic adjustment among the husbands over
time.
The current findings were inconsistent with previous findings
that indicated PTG to be related to enhanced adjustment,
manifested in lower PTSS (e.g., Frazier et al., 2001; Carver
and Antoni, 2004). It could be argued that the implications
of PTG depends upon the severity of the trauma; however, in
this study PTG was not found to alleviate subsequent distress
for either the ex-POW or control dyads. Alternatively, it might
be that the discrepancy between findings is rooted in the
measurement of PTG. While this study used the PTGI (Tedeschi
and Calhoun, 1996), a validated and widely-used questionnaire,
previous studies which indicated PTG to be adaptive, predicting
lower subsequent distress, often used unstandardized measures
of growth (Dekel et al., 2012).
The current findings were consistent with evidence indicating
a positive relationship between self-reported PTG and PTSS (e.g.,
Helgeson et al., 2006; Zalta et al., 2017). Moreover, our findings
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
TABLE 3 | Bootstrap 95% confidence intervals for predicting dyadic adjustment by PTG through PTSS in time 1 and time 2 among husbands and wives.
Measure DAS total DAS satisfaction DAS cohesion DAS consensus DAS affection
HUSBANDS
Direct {−4.9985, 4.2098} {−2.9297, 0.8421} {0.1477, 1.9502}* {−2.2557, 2.1195} {−0.7100, 0.2442}
Indirect through T1 PTSS {−3.4385, 1.2416} {−1.0888, 0.7898} {−0.5781, 0.2043} {−2.0401, 0.1158} {−0.2873, 0.1876}
Indirect through T2 PTSS {−1.9182, −0.0041}* {−.7487, −0.0047}* {−0.03053, −0.0071}* {−0.8828, −0.0050}* {−0.1910, −0.0007}*
Indirect through T1 and T2 PTSS {−3.4463, −0.2788}* {−1.4567, −0.1656}* {−0.7128, −0.1098}* {1.5546, −0.0741}* {−0.3794, −0.0382}*
WIVES
Direct {−8.6758, −0.6303}* {−3.3917, −0.8863}* {−1.0249, 0.7738} {−4.0650, 0.6634} {−1.1532, −0.1497}*
Indirect through T1 PTSS {−3.0300, 2.9537} {−1.8815, 0.1247} {−0.9924, 0.3929} {−0.9851, 2.1684} {−0.1602, 0.8889}
Indirect through T2 PTSS {−1.9934, 0.7487} {−0.1375, 0.7452} {−0.4428, 0.2028} {−1.4728, 0.1533} {−0.4323, −0.0526}*
Indirect through T1 and T2 PTSS {−3.0390, 1.2190} {−0.2423, 1.1903} {−0.7246, 0.3427} {−2.4080, 0.2991} {−0.6632, −0.0902}*
95% Confidence Intervals are presented in brackets. Confidence intervals that do not include 0 (null association) are significant. *Significant at 0.05. PTG, posttraumatic growth; PTSS,
posttraumatic symptoms; DAS, dyadic adjustment scale.
FIGURE 1 | Unstandardized coefficients b(SE) for the association between PTG and Dyadic Adjustment total score through the sequential mediation of PTSS at T1
and T2, among Husbands. Explained variance is located above all dependent variables. PTG, posttraumatic growth; PTSS, posttraumatic symptoms; DAS, dyadic
adjustment scale. **p<0.01, ***p<0.001.
demonstrated, for the first time, that PTG is not only related to
the intensification of PTSS over time, but also to negative changes
in dyadic adjustment. This pattern of results might suggest that
PTG reflects illusory defenses (e.g., Lahav et al., 2016) and are in
line with former studies that indicated a gap between reports of
PTG and actual interpersonal behavior among trauma survivors
(Hobfoll et al., 2007). Hence, while trauma survivors report
growth, they may suffer from the deterioration of their most
intimate relationship.
Holding beliefs of growth might reflect the efforts of primary
and secondary trauma survivors to cope with trauma’s negative
repercussions. Individuals who have been exposed to severe
traumatic events experience a dismantling of basic beliefs about
the self and the world and, as a result, suffer from intense feelings
of horror and helplessness (Janoff-Bulman, 1989). While facing
extreme distress they might find possessing growth beliefs to be
comforting and adopt these beliefs as a coping strategy. However,
our findings suggest that in the long term this method of coping
could be maladaptive and might be associated with low dyadic
adjustment.
One possible explanation for the association between PTG
and lowered dyadic adjustment is that maintaining positive
beliefs of growth might limit the trauma survivors’ ability to
authentically express emotions and receive support within the
marital relationship. While trying to cling on to the growth
beliefs, war veterans and their wives might avoid expressing
their vulnerabilities and sharing their difficulties regarding their
trauma. Emotions such as helplessness, hopelessness, frustration,
anger, accusation, and blame regarding their traumatic past
are not pronounced within the relationship and the current
difficulties, resulting from the traumatic experience, are not
genuinely expressed. Moreover, in order to keep the defensive
beliefs of growth, war veterans and their wives might avoid asking
their spouses for help, further lowering the chance of receiving
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
FIGURE 2 | Unstandardized coefficients b(SE) for the association between PTG and Dyadic Adjustment affection subscale through the sequential mediation of PTSS
at Tl and T2, among Wives. Explained variance is located above all dependent variables. PTG, posttraumatic growth; PTSS, posttraumatic symptoms; DAS, dyadic
adjustment scale. *p<0.05, **p<0.01, ***p<0.001.
FIGURE 3 | APIM nested Model of Husbands’ and Wives’ PTG and dyadic adjustment. Curved lines represent covariates between constructs. Solid lines represent
significant predictions. The other prediction axes were non-significant. *p<0.05, **p<0.01, ***p<0.001.
the much needed social support from within their relationship.
These tendencies might impair intimacy and satisfaction in
marital relationships (Swann et al., 1994), thereby undermining
the dyadic adjustment. It should be noted that the current
explanation is speculative in nature, as the present study did
not assess the previously mentioned mechanisms, such as wives’
emotional authenticity or support within the marriage. Future
prospective studies should explore the processes underlying the
relations between PTG and dyadic adjustment.
At the same time, as the current results indicated, PTG might
negatively impact dyadic adjustment through increased PTSS.
Trauma survivors, such as ex-POWs, war veterans and their
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
TABLE 4 | APIM nested model for the associations between husbands’ and
wives’ PTG and DAS over time—standardized coefficients.
Path βSE
PTG T1 (H) →PTG T2 (H) 0.52*** 0.07
DAS T1 (H) →DAS T2 (H) 0.52*** 0.09
PTG T1 (W) →PTG T2 (W) 0.69*** 0.07
DAS T1 (W) →DAS T2 (W) 0.37*** 0.10
PTG T1 (W) →PTG T2 (H) 0.18* 0.06
DAS T1 (H) →DAS T2 (W) 0.29** 0.11
PTG T1 (W) →DAS T1 (H) −0.20** 2.53
PTG, posttraumatic growth; DAS, dyadic adjustment scale, (H), husbands; (W), wives.
*p<0.05. **p<0.01. ***p<0.001.
wives, who maintain growth beliefs, may use it as a way to deny
the negative consequences of the trauma. Under these conditions,
PTG could serve as a way to avoid acknowledging their emotional
pain and losses resulting from the trauma, which prevents
working through the traumatic event (Maercker and Zoellner,
2004) and modifying the fear structure that is responsible for
posttraumatic reaction (Foa et al., 1989). This, in turn, enhances
distress and PTSS over time, which negatively affects marital
relations and thus lower dyadic adjustment (Cook et al., 2004).
The present results indicated, however, that the
aforementioned path, is more evident among husbands than
wives. While PTSS mediated the association between PTG and all
of the dyadic adjustment subscales among husbands, it mediated
only the association between PTG and the dyadic adjustment
affection subscale among wives. One possibility is that the results
reflect gender differences. Another possibility is that the results
are rooted in the type of exposure to trauma. While the negative
effect of PTG on dyadic adjustment is potentially explained
mainly by the amplification of PTSS among primary trauma
survivors, this might be apparent only in part among secondary
trauma survivors. Lastly, it might be that the differences in the
magnitude of posttraumatic reactions are responsible for the
results. Hence, PTSS has a broader role as a mechanism among
the husbands, who suffer from elevated PTSS, compared to the
wives, who reported lower levels. The present study does not
allow for differentiation between these alternatives, therefore we
offer only speculations.
Our results regarding the prediction of the husbands’ PTG
by the wives’ PTG are the first of their kind. The current
findings further the notion of transmission between spouses in
the aftermath of trauma. It seems that the transmission within
the marital dyad is not restricted to posttraumatic reaction, as
indicated in the contagion theory (Figley, 1986), but may also
occur in regards to posttraumatic growth beliefs.
Interestingly, growth cognitions were found to be transmitted
from the wives to the husbands, and not the other way around. It
could be that these findings reflect the important role of the wives
in shaping the way their traumatized husbands cope. As men tend
to rely primarily on their wives for intimacy (e.g., Hobfoll et al.,
1996), they might adopt their wives’ growth beliefs. Specifically,
one may speculate that interacting with a wife who maintains
growth beliefs could enhance the husband’s risk of implementing
defensive growth beliefs as an avoidant strategy.
Although the transmission of growth cognitions within the
marital dyad perhaps enhances the existence of a similar outlook
regarding the traumatic event, at the same time it could be
related to negative outcomes and specifically to lower dyadic
adjustment. Investigation of these associations between PTG and
dyadic adjustment among both spouses indicated that wives’ PTG
predicted a decrease in the husbands’ dyadic adjustment over
time, but not the other way around. One might offer two main
explanations for the present trend.
The directionality of the associations between spouses might
be rooted in gender roles. It is possible that both men
and women with high PTG not only avoid expressing their
own vulnerabilities, they are also defensive in the face of
others’ emotional distress, and experience it as a threat toward
their growth beliefs. However, while women often have close
relationships with other women, men tend to be more dependent
on their wives for emotional support (e.g., Hobfoll et al.,
1996). Therefore, men might feel more helpless in the face of
their spouses’ emotional defensiveness, compared to women,
and report lower dyadic adjustment as a consequence of their
wives’ PTG.
Alternatively, the present findings might be related to
the different types of exposure to trauma. Primary trauma
survivors, as the husbands in our study, exposed particularly
to manmade trauma, often suffer from elevated shame and
self-blame regarding the traumatic event (Leskela et al., 2002)
and are sensitive to others’ responses regarding their trauma
(Hong et al., 2011). Moreover, due to elevated emotional distress,
firsthand trauma survivors often tend to be more dependent
on their significant others for emotional support (Dekel, 2007).
Hence, it might be that trauma survivors who were exposed
directly to trauma, such as ex-POWs and war combatants, are
more vulnerable to their spouses’ growth beliefs, compared to
their wives, who were exposed indirectly. Ex-POWs and war
combatants might feel invalidated or ashamed of their difficulties
when facing their wives’ growth beliefs regarding the trauma, and
respond with heightened aloofness and emotional detachment
in the relationship. These, in turn, sabotage their relationship,
leading to low dyadic adjustment.
In our data, gender and type of trauma exposure are
intertwined. Hence, we were unable to distinguish between
these competing explanations regarding the directionality of the
associations between spouses. Moreover, the effects of gender
role and type of trauma exposure in association with PTG and
dyadic adjustment have not been studied. Therefore, no definite
conclusions can be reached.
Several limitations may have affected our findings. First, this
study was based on self-report measures, which may be subject to
response biases and shared method variance. Second, the present
study did not include data regarding PTG and dyadic adjustment
immediately after the trauma, rather only decades after the
traumatic event. This presented us with major constraints in
our ability to assess whether the ramifications of PTG on dyadic
adjustment depended on the amount of time it is in effect.
Third, the current study did not include data regarding PTG
or PTSS in relation to other potential traumatic events that
the participants might have experienced or data regarding the
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Lahav et al. Posttraumatic Growth and Dyadic Adjustment
suggested mechanism for the relations between PTG and dyadic
adjustment. This prevented us from controlling for the effects
of other important variables that may have shaped the present
results. Lastly, as was previously mentioned, gender and type
of trauma exposure were intertwined in the present data. This
prevented us from distinguishing between their different effects.
Future prospective studies should use PTG measures at different
time intervals to assess the temporal effects of PTG on dyadic
adjustment, and consider gender as well as type of trauma
exposure separately.
The present findings have important implications for theory
and treatment of direct and indirect survivors of trauma. Our
results call attention to the possible role of PTG with regard
to negative marital outcomes. War veterans, ex-POWs and
their wives who report PTG might be at-risk for low dyadic
adjustment. Moreover, this potential negative effect of PTG
on the marital realm may be transmitted from one spouse
to the other. This possibility suggests the need for caution
by the therapist when treating trauma survivors in regards to
encouraging reports of PTG—although in some cases these
reports might reflect true positive changes, in others they might
indicate efforts to deny the trauma and could have negative
implications. However, given the controversy regarding the
nature of PTG, we recommend that more studies be conducted
before any further conclusions can be drawn.
AUTHOR CONTRIBUTIONS
YL and YK Made substantial contributions to the conception
and design of the work as well as the analysis and interpretation
of data for the work; Drafted the work and revised it critically
for content; Gave final approval of the version to be published;
Agreed to be accountable for all aspects of the work in
ensuring that questions related to the accuracy or integrity
of any part of the work are appropriately investigated and
resolved. ZS Made substantial contributions to the conception
and design of the work as well as the analysis and interpretation
of data for the work; Drafted the work and revised it
critically for content; Gave final approval of the version to be
published.
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Conflict of Interest Statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
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Frontiers in Psychology | www.frontiersin.org 11 June 2017 | Volume 8 | Article 1102