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The role of purpose in life in recovery from knee surgery



This study examined the role of a sense of purpose in life (PIL) in recovery from knee replacement surgery in 64 surgery patients. Each of the surgery patients had been diagnosed with severe osteoarthritis of the knee. Regression analyses were conducted predicting changes in health 6 months after surgery. When considered alone, PIL was related to less anxiety, depression, negative affect, functional disability, stiffness, and more positive affect. When optimism, pessimism, and emotionality were controlled, PIL was still related to less negative affect, depression, and anxiety, and more positive affect. The results suggest that PIL may be an important positive personal characteristic and target for interventions.
The Role of Purpose in Life in Recovery from Knee Surgery
Bruce W. Smith and Alex J. Zautra
This study examined the role of a sense of purpose in life (PIL) in recovery from knee
replacement surgery in 64 surgery patients. Each of the surgery patients had been di-
agnosed with severe osteoarthritis of the knee. Regression analyses were conducted
predicting changes in health 6 months after surgery. When considered alone, PIL was
related to less anxiety, depression, negative affect, functional disability, stiffness, and
more positive affect. When optimism, pessimism, and emotionality were controlled,
PIL was still related to less negative affect, depression, and anxiety, and more positive
affect. The results suggest that PIL may be an important positive personal character-
istic and target for interventions.
Key words: purpose in life, knee surgery, osteoarthritis.
The examination of the effects of positive personal
characteristics on health has received increasing atten-
tion. Seligman (1999) has emphasized psychology’s
role in identifying these positive qualities and building
them through interventions. Several studies have ex-
amined the role of dispositional optimism and found
that it is often related to better mental or physical
health (Andersson, 1997). Other researchers have be-
gun to examine pathways by which positive affect may
improve coping with stress and enhance health
(Aspinwall, 1998; Fredrickson, 1998).
One of the positive characteristics that is frequently
mentioned but has received less attention than charac-
teristics such as optimism is a sense of meaning and
purpose in life. Viktor Frankl (1992) believed that a
sense of meaning and purpose was the distinguishing
feature between those who did and did not survive
World War II concentration camps. Wong and Fry
(1998) have asserted that “meaning seeking is a key to
unlocking the mysteries of optimal functioning at the
psychological, behavioral, and physiological levels”
(p. xxv).
Ryff and Singer (1998) have reviewed the philo-
sophical and psychological literature regarding mean-
ing and purpose in life. They tied it to research on sense
of coherence (Antonovsky, 1987) and personal mean-
ing (Baumeister, 1991). Ryff and Keyes (1995, p.720)
have defined a sense of purpose in life simply as “the
belief that one’s life is purposeful and meaningful. In-
dividuals possessing a sense of purpose in life have
goals in living, a sense that their lives have a direction,
and beliefs that give their lives a sense of meaning.
Scheier and Carver (2001) provided a conceptual
framework for understanding the significance of a
sense of purpose in life. They believe that both a sense
of purpose in life (PIL) and positive outcome expectan-
cies (POE; e.g., hope and optimism) are essential for
attaining valued goals. First, an individual must iden-
tify a goal or set of goals that are valued and worthy of
being sought. Valued goals provide the purpose in liv-
ing. Second, an individual must believe that it is possi-
ble to attain one’s valued goals and find a measure of
fulfillment in their sense of purpose in living. The hope
of attaining one’s goals enables one to stay engaged in
trying to attain them.
Within this framework, it is not difficult to see how
both PIL and POE may play important roles for indi-
viduals facing challenges to their health and survival.
The sense of having valued goals (e.g., PIL) can pro-
vide the motivation for maintaining mental and physi-
cal health in the midst of adversity. The sense of being
able to attain valued goals (e.g., POE) makes it possi-
ble to stay engaged and committed to reaching these
Despite the potential value of both PIL and POE,
surprisingly few studies have examined PIL or both
PIL and POE together. In addition, the few studies that
have included measures of PIL have examined only
cross-sectional relationships and only in relation to
mental health. In these studies, PIL has been related to
less neuroticism, negative affect, and depression and
more positive affect and life satisfaction (Addad, 1987;
Baum & Boxley, 1983; Ryff & Keyes, 1995). However,
PIL may be more a result than a cause of good mental
health, may be associated with it because of third vari-
International Journal of Behavioral Medicine
2004, Vol. 11, No. 4, 197–202
Copyright © 2004 by
Lawrence Erlbaum Associates, Inc.
Bruce W. Smith, Department of Psychology, University of New
Mexico Albuquerque,New Mexico, USA; Alex J. Zautra, Department
of Psychology, Arizona State University, Tempe, Arizona, USA.
This research was supported by biomedical grants from the Ar-
thritis Foundation, and the National Institute for Arthritis and Mus-
cular-Skeletal Diseases, 5 RO1 AAR41687-03 (Alex J. Zautra, Prin-
cipal Investigator).
Correspondence concerning this article should be addressed to
Bruce W. Smith, Department of Psychology, University of New
Mexico, Albuquerque, NM 87131. E-mail:
ables, or may merely indicate the absence of
The primary purpose of this study was to examine
PIL as a prospective predictor of health in the context
of a stressor in which PIL might play an important role
and where POE was also assessed. Both positive and
negative outcome expectancies were assessed because
of evidence of their independence (Chang,
Maydeu-Olivares, & D’Zurilla, 1997). Participants
were older adults who had severe osteoarthritis of the
knee and elected to have total replacement surgery
(TKR). Osteoarthritis is the most common form of ar-
thritis and joint replacement is a frequent alternative
for individuals with severe cases (Callahan, Drake,
Heck, & Dittus, 1994).
TKR was chosen because (a) it involves the common
expectation of improvement in physical health and (b)
the attainment and enjoyment of this health may depend
on having a sense of purpose in living. Because TKR al-
ready provides a basis for hope that improvement in
physical health can occur, PIL might be expectedto play
a critical role in providing the desire and motivation for
recovery and living a more satisfying life.
Emotional arousability was also assessed because it
is a central feature of neuroticism (Braithwaite, 1987)
and neuroticism has frequently been related to health
and symptom reports (Watson & Pennebaker, 1989).
Past studies have sometimes found that the relationship
between positive personal characteristics and health
disappears when neuroticism is controlled (Hart,
Hittner, & Paras, 1991; Smith, Pope, Rhodewalt, &
Poulton, 1989). Therefore, emotional arousability was
controlled to rule out the possibility that negative
affectivity might account for any relationship found
between PIL and health.
Changes in mental and physical health were exam-
ined as indicators of recovery. Mental health measures
included indicators of both psychological distress
(e.g., negative affect, anxiety symptoms, depressive
symptoms) and psychological well-being (e.g., posi-
tive affect). Physical health measures included were
those that are specifically relevant to individuals with
osteoarthritis on the knee (e.g., functional disability,
pain, stiffness).
The primary question addressed by this study was
whether PIL would predict recovery in the surgery
group, both alone and when controlling for outcome
expectancies and emotional arousability. It was ex-
pected that PIL would be related to improved health
because it may provide the incentive to recover and live
a satisfying life. PIL might be important beyond out-
come expectancies because it is important to actually
have valued goals as well as the belief that one can
reach them. Finally, it was expected that PIL would be
important beyond neuroticism because PIL is not just
the lack of negative affectivity but involves the belief
that there is a reason to live.
The sample consisted of 64 older adults who had se-
vere osteoarthritis of the knee and elected to have total
knee replacement surgery (TKR). Originally, there
were 72 participants, but 8 left the study for various
reasons (postponed surgery = 3; request to be discon-
tinued from the study = 3; out-of-state move = 1;
change to a nonparticipating surgeon = 1). The sample
was 52% women and the mean age was 67.2 (SD =
8.3). The mean level of education was 1 to 3 years of
college and 79% were married. The majority was
White (95%) and not employed (77%).
Nurses in rheumatologists’ offices recruited pa-
tients who had been diagnosed with osteoarthritis and
referred for TKR. Participants completed question-
naires at two points in time: 2 weeks prior to surgery
(T1) and 6 months after surgery (T2). The question-
naires at T1 included measures of PIL, other personal
characteristics, and of mental and physical health.
The questionnaires at T2 included the measures of
mental and physical health that had been adminis-
tered at T1.
Purpose in life. Purpose in life (PIL) was as-
sessed at T1 using a 14-item scale developed to mea-
sure the belief that one’s life is purposeful and mean-
ingful (Ryff & Keyes, 1995). The scale consists of
items such as “I have a sense of direction and purpose
in my life” and “I enjoy making plans for the future
and working to make them a reality.” Cronbach’s α
was .83.
Optimism and pessimism. Optimism and pessi-
mism were assessed at T1 using the Life Orientation
Test–Revised (LOT–R; Scheier, Carver, & Bridges,
1994). The LOT–R includes 3 items measuring opti-
mism and 3 items measuring pessimism. Cronbach’s α
was .70 for optimism and .75 for pessimism.
Emotionality. Emotionality was assessed at T1
using the general emotionality subscale of the Scale
of Emotional Arousability (Braithwaite, 1987). The
emotionality subscale was designed to tap the emo-
tionally labile facet of neuroticism. The items assess
the tendency to experience negative affect (e.g., “I
frequently get upset”). It consists of 6 items and
Cronbach’s αwas .75.
Positive and negative affect. Positive and nega-
tive affect were measured at T1 and T2 with the Posi-
tive and Negative Affect Schedule (Watson, Clark, &
Tellegen, 1988). It consists of 10 positive affect items
and 10 negative affect items. Cronbach’s αwas .88 for
positive affect and .89 for negative affect.
Mental health inventory. Anxiety and depres-
sive symptoms were assessed at T1 and T2 using the
Mental Health Inventory (Veit & Ware, 1983). The
anxiety subscale consists of 10 items and the depres-
sion subscale consists of 9 items. Cronbach’s αwas .90
for anxiety and .90 for depression.
Western Ontario and McMaster University
Osteoarthritis Index (WOMAC). Functional dis-
ability, pain, and stiffness due to osteoarthritis of the
knee was assessed at T1 and T2 by the WOMAC
(Bellamy, Buchanan, Goldsmith, Campbell, & Stitt,
1988). The WOMAC includes 17 items for functioning
disability, 5 items for pain, and 2 items for stiffness.
Cronbach’s αwas .96 for functional disability, .88 for
pain, and .81 for stiffness.
Table 1 displays the means and standard devia-
tions for the personal characteristics and the health
measures before surgery (T1) and at 6 months follow-
ing surgery (T2). Paired samples ttests were con-
ducted to compare the health measures at T1 and T2.
There was a significant decrease in functional disabil-
ity, t(63) = –10.26, p< .001; stiffness, t(63) = –8.12,
p< .001; pain, t(63) = –11.44, p< .001; and negative
affect, t(63) = –3.74, p< .001; and an increase in pos-
itive affect, t(63) = 3.45, p< .01.
Table 2 displays the correlations between the per-
sonal characteristics and health measures at T1. PIL
was positively related to optimism and negatively re-
lated to pessimism and emotionality. As for the health
measures, PIL was significantly related (ps < .05) to
more positive affect and less anxiety, depression, and
negative affect. Although the correlations between PIL
and these mental health measures were substantial,
r(62) = .317–.585, they were not strong enough to sug-
gest multicollinearity problems (Tabachnick & Fidell,
Table 1. Means and Standard Deviations of Personal Characteristics and Health Measures at Baseline and 6 Months
Baseline 6 Months
MSDMSDScale Range
Purpose in life 5.09 .67 1–6
Optimism 3.11 .62 0–4
Pessimism .86 .80 0–4
Emotionality 2.70 .79 1–5
Anxiety 2.26 .84 2.12 .83 1–6
Depression 1.70 .74 1.74 .89 1–6
Negative affect 1.91 .76 1.59 .78 1–5
Positive affect 3.22 .74 3.55 .89 1–5
Functional disability 2.19 .63 1.12 .77 0–4
Pain 2.15 .67 .87 .75 0–4
Stiffness 2.40 .93 1.39 .86 0–4
Note. N = 64.
Table 2. Correlations Between Personal Characteristics and Baseline Health Measures at Baseline
1. Purpose in life
2. Optimism .437***
3. Pessimism –.585*** –.382***
4. Emotionality –.300** –.306** .311**
5. Anxiety –.425*** –.265** .409*** .572***
6. Depression –.464*** –.268** .456*** .456*** .796***
7. Negative affect –.317** –.162 .212*.392*** .611*** .692***
8. Positive affect .379*** .175 –.165 –.222*–.233*–.188 –.240*
9. Functional disability –.125 –.261** .031 .068 .290** .319** .477*** –.307**
10. Pain –.081 .108 –.044 .159 .290** .295** .430*** –.312** .790***
11. Stiffness –.060 .176 –.040 .107 .151 .234*.343*** –.274** .638*** .580***
Note. N = 64.
*p< .10. **p< .05. ***p< .01.
Table 3 displays the partial correlations between the
personal characteristics and health measures at 6
months partialling out the corresponding T1 health
measure. PIL was significantly related to less anxiety,
depression, negative affect, functional disability, stiff-
ness, and more positive affect at 6 months. Of the other
personal characteristics, pessimism was related to
more negative affect, functional disability, and stiff-
ness, emotionality was related to more anxiety and less
positive affect, and optimism was related to less nega-
tive affect.
The hypotheses regarding the relationship between
PIL and improvements in mental and physical health
were tested using regression analyses predicting the
T2 health outcomes controlling for the corresponding
T1 outcomes. For each analysis, PIL was first entered
as the sole predictor and then entered with optimism,
pessimism, and emotionality. In addition, sex and ed-
ucation level were controlled because they were the
demographic variables that were related to the per-
sonal characteristics or health measures. Women re-
ported more positive affect, r(31) = .299, p< .05;
functional disability, r(31) = .416, p< .01; pain, r(31)
= .315, p< .05; and stiffness, r(31) = .388, p< .01.
Education was related to less functional disability,
r(62) = –.269, p< .01; and pain, r(62) = –.367, p<
.01. Age was not related to the personality character-
istics or health measures.
Table 4 displays the results for the regression analy-
ses for the mental health outcomes. When entered
alone, PIL was related to an increase in positive affect
and a decrease in anxiety, depression, and negative af-
fect. When entered with optimism, pessimism, and
emotionality, PIL was still related to an increase in pos-
itive affect and a decrease in anxiety, depression, and
negative affect. Thus, PIL explained a significant vari-
ance beyond the other personal characteristics. The ad-
justed R2for PIL was 2.3% for anxiety, 7.9% for de-
pression, 14.3% for negative affect, and 12.0% for
positive affect.
Table 5 displays the results for the regression analy-
ses for the physical health outcomes. When entered
alone, PIL was related to a decrease in functional dis-
ability and a decrease in stiffness. However, when en-
tered with optimism, pessimism, and emotionality, PIL
was no longer related to any of the physical health out-
comes. Thus, PIL did not make a contribution to physi-
cal health beyond the other personal characteristics. In-
deed, when considered together, none of the personal
characteristics were related to any of the physical
health measures.
Finally, because the optimism and pessimism mea-
sures were originally designed to be a part of the
same scale, the analyses using optimism and pessi-
mism were repeated substituting the combined scores
of the two scales combined into one score (pessimism
items were coded negatively). The results showed
that there were no differences in whether PIL was a
significant predictor of outcomes or in the direction
of the predictions.
Table 3. Partial Correlations Between Personal Characteristics and Change in Health Measures
Anxiety Depression Negative Affect Positive Affect Functional Disability Pain Stiffness
Purpose in life –.347*** –.393*** –.627*** .422*** –.288** –.093 –.308**
Optimism –.210*–.112 –.303** .107 –.135 –.021 –.164
Pessimism .235*.137 .463*** –.172 .356*** .155 .289**
Emotionality .334*** .206 .207 –.292** .246*.129 .180
Note. N = 64. The corresponding health measure at T1 was partialled out for each partial correlation coefficient.
*p< .10. **p< .05. ***p< .01.
Table 4. Standardized Beta Weights for Purpose in Life and Other Personal Characteristics Predicting Mental Health
Outcomes at Six Months
Anxiety Depression Negative Affect Positive Affect
Simple regressiona
Purpose in life –.254 –2.64 .011 –.330 –3.16 .003 –.573 –6.23 < .000 .407 3.64 .001
Multiple regressionb
Optimism –.020 –.21 .838 .050 .49 .630 –.039 –.38 .705 –.096 –.82 .416
Pessimism .027 .25 .806 –.080 –.67 .504 .099 .84 .405 .159 1.19 .239
Emotionality .265 2.40 .020 .165 1.45 .154 .034 .30 .766 –.243 –2.07 .043
Purpose in life –.238 –2.04 .046 –.398 –3.11 .003 –.521 –4.10 < .000 .486 3.37 .001
Note. N = 64. Sex and education level were controlled in all analyses. The corresponding pre-surgery health measure was controlled in all
aPurpose in life was the sole predictor. bPurpose in life was entered with optimism, pessimism, and emotionality.
The results indicate that PIL played an important
role in recovery for individuals electing to have TKR.
When considered alone, PIL was related to improved
mental and physical health. Even when controlling for
optimism, pessimism, and emotionality, PIL was still
related to improved mental health.
These findings make several contributions to our
understanding of PIL. First, PIL was a prospective pre-
dictor of improvement in mental and physical health
when entered alone and mental health when control-
ling for other personal characteristics. Past studies
have examined the concurrent relationship between
PIL and health or used PIL as a dependent variable
(Addad, 1987; Ryff & Keyes, 1995). This study dem-
onstrates that PIL may be related to positive changes in
health over time.
Second, the effects of PIL on improved mental
health were not accounted for by negative affectivity.
Controlling for emotionality did not completely erase
the effects of PIL as they have on occasion with other
negative characteristics (Hart et al., 1991; Smith et al.,
1989). The implication is that PIL is more than just the
absence of negative affectivity. Whereas having a
sense of purpose in living may result in less negative
affect, and vice versa, they are not merely opposite
ends of the same continuum.
Third, the effects of PIL on all four mental health
outcomes held when controlling for both optimism and
pessimism. PIL appears to represent a unique positive
personal feature and plays an important role beyond
that of outcome expectancies. While POE may be nec-
essary to be engaged in one’s valued goals, there may
first have to be the sense that one has valued goals and a
purpose for living. TKR may have provided hope and
the expectation for improved physical functioning.
However, the opportunity for improved functioning
may not have resulted in improved emotional health
unless there was a sense of purpose in life to help moti-
vate recovery.
Future research may do well to examine the role of
both PIL and POE to learn more about how they may
complement each other and when one may be more im-
portant than the other. It appears that the recent empha-
sis on positive personal characteristics needs to encom-
pass both the ability to identify value goals (e.g.,
finding a purpose in life) and the belief that these goals
can be reached. It is possible that while modern behav-
ioral science has concentrated on engendering hope,
confidence, and optimism as a means, it has neglected
the need to first identify and foster valued goals as an
This study has several limitations. First, it was
based on a relatively small sample. Thus, this should be
considered a preliminary study requiring replication
with a larger sample. Second, the mental and physical
health measures were self-report and not obtained
through interviews or clinician assessments. Third, it
would have been useful to acquire more information
about differences in the surgery procedure between
participants and on compliance to recovery regimens.
Each of these could have also helped to account for dif-
ferences in health outcomes. Examining compliance
could be particularly instructive because it may be a
partial mediator of the beneficial effects of PIL.
Despite these limitations, this study strongly sug-
gested that PIL is an important positive personal char-
acteristic and that it has implications for individuals
facing challenges that present opportunities for better
health. While some positive characteristics may be dif-
ficult to alter, there is evidence that interventions can
increase PIL. For example, logotherapy was developed
by Frankl (1992) and has been shown to increase the
sense of meaning and purpose in living. The findings
of this study suggest that interventions that enhance
PIL may help individuals successfully meet health
challenges and live a more fulfilling and satisfying life.
Table 5. Standardized Beta Weights for Purpose in Life and Other Personal Characteristics Predicting Physical Health
Outcomes at Six Months
Functional Pain Stiffness
Simple regressiona
Purpose in life –.297 –2.42 .018 –.131 –1.02 .310 –.279 –2.33 .023
Multiple regressionb
Optimism .103 .70 .488 .104 .70 .485 .002 .01 .989
Pessimism .254 1.61 .113 .092 .55 .586 .148 .94 .354
Emotionality .196 1.35 .182 .211 1.37 .176 .083 .57 .568
Purpose in life –.118 –.73 .468 –.056 .32 .747 –.166 –1.06 .319
Note.N= 64. Sex and education level were controlled in all analyses. The corresponding pre-surgery health measure was controlled in all
aPurpose in life was the sole predictor. bPurpose in life was entered with optimism, pessimism, and emotionality.
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... A possible explanation for this lack of strong evidence might be that most current psychological preparation techniques before surgery focus on reducing the negative affect (e.g., anxiety and depression). There is also evidence that coping strategies such as (pain) acceptance, engaging in beneficial social interactions and experiencing a value-based purpose in life are more appropriate for improving mental well-being and promoting resilience in the face of (chronic) pain (Smith and Zautra, 2004;Sturgeon and Zautra, 2010). A second limitation of current psychological preparation techniques is their primary focus on reducing distress in the shortterm, i.e., the period before the operation, whilst Sturgeon & Zautra (Sturgeon and Zautra, 2010) argued that sustainable resilience to chronic pain also requires skills promoting adaptation and mental health in the long term. ...
... PPIs and ACT have been found effective in the treatment of chronic pain (A-Tjak et al., 2015;Veehof et al., 2016;Hughes et al., 2017;Peters et al., 2017;Simpson et al., 2017) and in improving affect and functional ability after knee surgery (Smith and Zautra, 2004). As this positive approach that focuses on gaining skills for the longer term seems to work for pain patients, it could also be beneficial for spinal surgery patients in preparing them for surgery and reducing perioperative and chronic pain. ...
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Introduction: Spinal surgery patients often experience pain as well as stress, anxiety or even depression before surgery, highlighting the need for better mental preparation before undergoing surgery. Acceptance and Commitment Therapy and positive psychology have proven effective in coping with chronic pain and providing long-term skills that enhance psychological flexibility and mental well-being.The aim of this study is to develop a digital intervention (app) based on Acceptance and Commitment Therapy and positive psychology in co-creation with all stakeholders, including patients and professionals. The aim of the intervention is to increase psychological flexibility and positive skills of spinal surgery patients to promote long-term resilience. Materials and methods: In this qualitative study, individual, semi-structured interviews were held with healthcare professionals (N = 9) and spinal surgery patients (N = 12) to identify contextual factors and needs for the app. Subsequently, three focus-group sessions were held with healthcare professionals and newly recruited patients to specify relevant values. Also, a first version of the app, named Strength Back, was developed using a participatory design. Results: The interviews confirmed the need for information and digital support to cope with insecurity, anxiety and pain, both before and after surgery. Based on iterative steps in the focus-group sessions, thirteen modules were developed focusing on procedural information, pain education, psychological flexibility and mental well-being. Discussion: The intervention Strength Back, containing information as well as Acceptance and Commitment Therapy and positive psychology exercises, has the potential to increase psychological flexibility, enhance well-being and improve postoperative recovery after spinal surgery.
... A pesar del conocido papel protector del PV sobre la salud mental, su estudio ha recibido una limitada atención en la educación superior (Pfund et al., 2020). En este contexto, diversas investigaciones han asociado el PV en la población universitaria con una menor sintomatología internalizante, incluso controlando variables como el optimismo, el pesimismo y la emocionalidad (Pfund et al., 2020;Sherman y Simonton, 2012;Smith y Zautra, 2004;Vehling et al., 2011). Asimismo, estudios previos han reconocido que el PV de un estudiante universitario favorece la autogestión, con lo que dedicará su tiempo y esfuerzo a actividades relacionadas con el cumplimiento de sus objetivos (McKnight y Kashdan, 2009). ...
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El objetivo del presente estudio es investigar el papel supresor que pudiera tener el optimismo en la relación entre la intolerancia a la incertidumbre y el propósito en la vida en la población universitaria. Con el objetivo de establecer esta posible relación de supresión se toma como referencia inicial el rol protector del optimismo sobre la salud mental. Con el propósito de aproximarse a esta propuesta, se realizó un estudio transversal en la población universitaria con el fin de examinar la asociación que existía entre estas variables. Este estudio es de carácter no experimental. Contó con una muestra de 650 estudiantes de enseñanza superior de diferentes universidades de Chile. Para los análisis estadísticos se empleó el modelo de ecuaciones estructurales. Los resultados mostraron el efecto supretorio del optimismo sobre la intolerancia a la incertidumbre cuando se revisa su influencia sobre el propósito en la vida, variable de gran interés en esta población, ya que orienta sus esfuerzos en el desarrollo de un proyecto de vida.
... Another important line of research would be the study of meaning-making mechanisms and their mediator role in psychological wellbeing, specifically in depressive and anxious symptomatology (Marco & Alonso, 2019). As described in the introduction, in some studies, meaning in life seems to have a direct influence on health and psychological adjustment (e.g., Smith & Zautra, 2004), whereas in others it acts as a mediator (e.g., Heisel & Flett, 2004). ...
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Introduction Positive psychological variables, such as meaning in life and the capacity for enjoyment, are important resilience factors against negative behaviors and symptoms. These constructs are related to better emotional regulation strategies, a greater perception of control over one’s life, and better mental health in general. Adjustment disorder (AjD) is a prevalent condition defined as the failure to adapt to a stressful event. Objective This study presents secondary analysis data on the effect of an Internet-delivered cognitive-behavioral therapy intervention (iCBT) for AjD on meaning in life and capacity for enjoyment, compared to a control group. Method The sample consisted of 68 participants with AjD. 34 in the iCBT condition and 34 in the control group). Meaning in life was assessed by the Purpose-in-Life Test-10, and the Environmental Rewards Observation Scale was used to assess the capacity for enjoyment. The iCBT intervention focused on acceptance and processing of the stressful event. Intent-to-treat mixed-model analyses without any ad hoc imputations and using Cohen’s d effect comparisons were conducted. Results The results revealed a significant main effect of time and a significant group x time interaction in all the measures. Significantly higher pre-post score differences were found in the treatment condition. Discussion Meaning in life and capacity for enjoyment can change after an iCBT intervention for AjD. Therapeutic implications of the results and future lines of research about the role of meaning in life in AjD are discussed.
... PIL gathered much interest among health practitioners in recent years due to potential in promoting health outcomes. Smith and Zautra [12] showed that PIL is related to less depression, anxiety and other negative effects thus promoting recovery of the patients. A systematic review of 10 studies showed that a high score on PIL was associated with 17% reduced risk of all-cause mortality and cardiovascular events [13]. ...
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Purpose in life (PIL) is a psychological construct that reflects one’s life goals and the desire or determination to pursue them. Having a purpose provides an intrinsic motivation to adopt healthy behaviors as we age, which will help us to achieve positive health outcomes. Thus, promoting PIL is the cornerstone for successful aging and better health outcomes. This systematic review aims to identify how PIL is conceptualized, measured in the existing literature and what are the determinants of PIL in older adults (≥65 years). Electronic searches were conducted in five databases (Medline, PsychInfo, Embase, CINAHL and Web of Science). A total of 44 studies were included in the review. PIL was conceptualized in six different ways: health and well-being, meaningful goals and purpose, inner strength, social relationships, mattering to others, and spirituality and religiousness. There were six main questionnaires and semi structured interviews used to capture PIL. Female gender, higher education and income, being married, ethnicity, health and well-being, inner strength, social integration and spirituality were associated with PIL. Majority of the included studies had low to moderate Risk of Bias (RoB) assuring confidence in the results. The conceptual frameworks of PIL identified in the review underscore the complexity of the construct. Several sociodemographic and other determinants of PIL were identified.
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One of the developmental tasks that teenagers must go through is an identity crisis. Parents play a role in directing adolescents towards self-identity, but there are adolescents who lose their parents due to death. The resilience needed to help teens deal with these difficult situations. So this is important to do, especially for teenagers who have lost their parents because they died directly. Factors that play an important role in resilience, namely the purpose of life, the purpose of life will affect how to think and interpret certain events. This study aims to determine the relationship between life goals and resilience in adolescents who lost their parents due to murder. This study uses a quantitative approach with a correlational method. Participants in the study were 99 people with purposive sampling technique in accordance with the criteria determined by the researcher. The instrument used to measure consists of two scales, the life goals scale which was developed based on the theory of Crumbaugh and Maholik (1964) (α=0.961) and the resilience scale which was developed based on the theory of Conor-Davidson (2003) (α = 0.959). The data analysis technique used is the person product moment, the correlation coefficient value is 0.877 with a significance of 0.001 (α 0.05) which can be said that there is a relationship between life and resilience with a very strong degree of relationship, the direction of the relationship is positive, which means the higher the purpose of life, the higher the resilience Abstrak: Tugas perkembangan yang harus dilalui remaja salah satunya yaitu krisis identitas. Orang tua berperan untuk mengarahkan remaja menuju identitas diri yang positif, namun terdapat remaja yang kehilangan orang tua karena meninggal dunia. Resiliensi dibutuhkan untuk membantu remaja bangkit dalam menghadapi situasi sulit tersebut. Sehingga penelitian ini penting dilakukan, khususnya pada remaja yang kehilangan orang tua karena meninggal secara mendadak. Faktor yang berperan penting dalam resiliensi yaitu, tujuan hidup akan mempengaruhi bagaimana cara berpikir dan memaknai peristiwa tertentu. Penelitian ini bertujuan untuk mengetahui hubungan antara tujuan hidup dan resiliensi pada remaja yang kehilangan orang tua karena meninggal mendadak. Penelitian ini menggunakan pendekatan kuantitatif dengan metode korelasional. Partisipan dalam penelitian sebanyak 99 orang dengan teknik purposive sampling sesuai dengan kriteria yang ditentukan oleh peneliti. Instrumen yang digunakan untuk mengukur terdiri dari dua skala, skala tujuan hidup dikembangkan berdasarkan teori Crumbaugh dan Maholik (1964) (α=0.961) dan skala resiliensi dikembangkan peneliti berdasarkan teori milik Conor-Davidson (2003) (α = 0,959). Teknik analisis data yang digunakan yaitu person product moment didapatkan nilai koefisien korelasi sebesar 0,877 dengan signifikansi 0,001 (α ≤ 0,05) yang dapat disimpulkan bahwa terdapat hubungan antara tujuan hidup dengan resiliensi dengan derajat hubungan yang sangat kuat, arah hubungan pada variabel positif yang berarti semakin tinggi tujuan hidup maka semakin tinggi pula resiliensi
Purpose in life consists of having a sense of meaning and purpose regarding one's activities as well as an overall sense that life is meaningful. This study reports a comprehensive assessment of the relationship of purpose in life with depression and anxiety. A meta‐analysis (total n = 66,468, total k = 99) investigated the association of purpose in life with depression and anxiety. Across samples, greater purpose in life was significantly associated with lower levels of depression and anxiety. The mean weighted effect size between purpose in life and depression was r = −0.49, [95% confidence intervals, CIs: −0.52, −0.45], p < 0.001. For the purpose in life and anxiety the mean weighted effect size was r = −0.36, [95% CIs: −0.40, −0.32], p < 0.001. The association of purpose in life with mental health was stronger for clinical populations, especially with regard to the relationship with anxiety. Both approach deficits and avoidance motivation are argued to play a role in the relationship between purpose and psychopathology, with greater purpose potentially limiting avoidance tendencies and reducing the effects of depression and anxiety. Understanding the role that purpose in life may play in depression and anxiety could help to inform current conceptualizations of these disorders and improve treatment outcomes.
Postmaterial spiritual psychology posits that consciousness can contribute to the unfolding of material events and that the human brain can detect broad, non-material communications. In this regard, this emerging field of postmaterial psychology marks a stark departure from psychology's traditional quantum measurements and tenets. The Oxford Handbook of Psychology and Spirituality codifies the leading empirical evidence in the support and application of postmaterial psychological science. Sections in this volume include: personality and social psychology factors and implications; spiritual development and culture; spiritual dialogue, prayer, and intention in Western mental health; Eastern traditions and psychology; physical health and spirituality; positive psychology; and scientific advances and applications related to spiritual psychology. With articles from leading scholars in psychology, medicine, physics, and biology, this text is an interdisciplinary reference for a rapidly emerging approach to contemporary science.
Objectives There is a dearth of research on the psychological processes that underlie the negative relation between impaired instrumental activities of daily living (IADL) and depressive symptoms in older adults. Drawing on the stress process model and the resilience framework, we investigated whether purpose in life and resilience serially mediate the relationship between impaired IADL and depressive symptoms. Methods We recruited 111 cognitively healthy community-dwelling older adults (ages 54–85; M = 66.5) who scored a minimum of 25 points on the Mini-Mental State Examination. Results We found that purpose in life and resilience serially mediated the relationship between IADL and depressive symptomatology in older adults. This association held true when we controlled for covariates. Additional sensitivity analyses also supported these findings. Conclusions This study extends our understanding of how IADL limitations contribute to depressive symptoms. Using a community-dwelling, cognitively healthy sample, we demonstrate that functional limitations indirectly influence older adults’ depressive symptoms through a decreased sense of purpose in life and decreased resilience. Clinical implications Our findings have implications for intervention programs that aim to alleviate IADL limitations and mental health issues in an aging population and promote healthy aging by improving psychosocial resources (i.e., purpose in life and resilience).
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Objective: Meaning in life is consistently associated with better health outcomes across a range of mental and physical domains. However, meaning in life is a complex construct involving three distinct facets: coherence, purpose, and mattering. While these facets have been studied individually in relation to pain, they have not been assessed concurrently to parse out their potential distinct contributions to pain outcomes. We sought to identify the unique relationships of these individual facets of meaning with pain experiences and specify the components associated with pain-related resilience. Methods: The associations of coherence, purpose, and mattering with pain outcomes were examined across three studies. Study 1 used data from the Midlife in the United States National Survey to determine associations between facets and the frequency of various recently experienced pains, and the development of chronic pain nine years later. Study 2 cross-sectionally observed the association between facets and recent pain severity in young adults. Using a diary-type approach, Study 3 captured fluctuations of pain severity in relation to the facets across the span of four weeks. Results: Coherence was uniquely associated with less headache, backache, joint, and extremities pain frequency in Study 1, over and above purpose and mattering, controlling for other health variables. Coherence was also associated with lower odds of developing chronic pain. In Study 2, coherence was associated with less pain severity and fully mediated the relationship between global meaning in life and pain. Study 3 found that coherence predicted the most unique variance in weekly pain fluctuations. Conclusion: Across three studies and timescales, coherence was uniquely associated with fewer and less severe pain experiences over and above purpose and mattering. These findings provide support for the value of coherence as a resilience factor in the context of pain and suggest a potential benefit for coherence-specific interventions in clinical settings.
Emotional processes influence a wide range of mental and physical systems, which makes them difficult to understand from a single perspective. In this special issue of the Review of General Psychology, contributing authors present 4 articles that draw from several areas within psychology in the service of understanding a topic relevant to emotion. In this overview, the authors argue that the long neglect of the scientific study of complex processes such as emotion might be linked, in part, to the fractionation of the field into specialized subdisciplines. Just as emotions were of central concern in the early years of psychology (which was a generalist's era), as psychology moves toward more integration in the late 20th century broad phenomena such as emotions are once again central interests. The 4 articles of this special issue are briefly reviewed as exemplars of an integrated approach to understanding emotional phenomena.
This introduction to the two-part special issue reviews recent evidence that suggests that positive mood may play a beneficial, multifaceted, and flexible role in self-regulatory processes that cannot be explained by most current theories. First, under some conditions positive mood seems to facilitate careful processing of goal-relevant information, even negative information. Second, the relation of positive mood to cognition and behavior seems to be strongly moderated by goal-relevant features of the task context. Three frameworks (mood as input, processing advantages conferred by positive mood, and mood as resource) that may account for these facilitating effects of positive mood on self-regulation are discussed.
Antonovsky (1987) has proposed that the Sense of Coherence (SOC) scale assesses a personality-related “stress-resistance resource” that comprises the belief that life is comprehensible, manageable, and meaningful. To date, most of the research on the SOC scale has been conducted in Israel. One finding that appears to be particularly robust, at least among Israeli adolescents, is an inverse association between SOC total scale scores and trait anxiety. The first purpose of the present study, which examines American college students, is to attempt to provide some external validity evidence for the Israeli research linking SOC and anxiety. The present study also attempts to refine previous research by examining whether anxiety is differentially related to the comprehensibility, manageability, and meaningfulness SOC subscales. In addition, this study seeks to extend previous research by examining whether individuals scoring high on SOC would perceive social support to be more readily available than individuals scoring low on SOC. Finally, the present investigation provides preliminary reliability and validity data for the short form version of the SOC scale. Results showed that SOC total scores were strongly negatively correlated with levels of trait anxiety. The relative strength of the correlations of anxiety to the various SOC subscales could not be assessed accurately because the SOC subscales were unreliable. Other results showed SOC scores were unrelated to the perceived availability of four different types of social support. These data support the generalizability of Israeli research suggesting that individuals scoring high on SOC enjoy better mental health than their lower scoring counterparts. In addition, results showing that SOC is independent of socially based stress-resistance resources suggest the SOC scale has discriminant validity. Finally, the present results support the validity of the shortened version of the SOC scale, but suggest that use of short form subscale scores may be problematic.