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Construing Benefits from Adversity:

Adaptational Significance and


Dispositional Underpinnings
Glenn Affleck and Howard Tennen
University of Connecticut School of Medicine
ABSTRACT The discovery of benefits from living with adversity has been
implicated in psychological well-being in numerous investigations, is pivotal
to several prominent theories of cognitive adaptation to threat, and can be
predicted by personality differences. This article summarizes the prevalence
and adaptive significance of finding benefits from major medical problems,
locates the place of benefit-finding in stress and coping theories, and examines
how it may be shaped by specific psychological dispositions such as optimism
and hope and by broader personality traits such as Extraversion and Openness
to Experience. The distinction between beliefs about benefits from adversity
(benefit-^m/ing) and the use of such knowledge as a deliberate strategy of
coping with the problem {hene^t-reminding) is underscored and illustrated by
daily process research on coping with chronic pain.
Right after she was born, I remember having a revelation. Here she
was, only a week old, and she was teaching us something—how to
Many of the published and unpublished findings reported in this article come from
studies funded by National Institute of Arthritis, Musculoskeletal, and Skin Diseases
Grant AR-20621 to the University of Connecticut Multipurpose Arthritis Center. We
are grateful for the collaboration of Susan Urrows and Micha Abeles and for the assistance
of Pamela Higgins and Debra Begin with data collection and management.
We are also indebted to Jeff Siegel of National Technology Services for his help in
programming the electronic diaries described in this article and to Saul Shiffman for
his assistance with protocol development. Finally, we appreciate the assistance of Jerry
Suls, Shelley Taylor, and James Coyne in revising an earlier version of the manuscript.
Address correspondence to Glenn Affleck, Department of Community Medicine
MC-6205, University of Connecticut Health Center, Farmington, CT 06030. E-mail:
AFFLECK@NSOl.UCHC.EDU.
Jourrml of Persormlity 64:4, December 1996.
Copyright © 1996 by Duke University Press.
900 Af ileck and Tennen
keep things in their proper perspective, how to understand what's
important and what's not. I've learned that everything is tentative,
that you never learn what life is going to bring. I've come to realize
that I shouldn't waste any more time worrying about the little things.
Perhaps this is the way it was meant to be. Maybe I wasn't intended
to have children. It has made me a stronger person, and has made me
appreciate children so much more.
Living with this disease has taught me so many precious things that
I wouldn't have learned if I were healthy. I guess the most important
things it has taught me are to appreciate what life can hold for you
every day and to be grateful for the loving relationships in your life.
This young father of an acutely ill newborn, this middle-aged woman
with impaired fertility, and this older woman with rheumatoid arthritis
know that adversity, no less than prosperity, can change us for better as
well as for worse. A casual observer can easily appreciate the toll that
such adversities can take on someone's physical and psychological wellbeing.
But even a close observer may miss their perceived benefits,
gains, and advantages.
The search for uplifting meaning from threatening experiences is
pivotal to a number of prominent theories of psychological reorganization
in the aftermath of traumatic events. These include Taylor's
thesis of selective evaluation as a response to adversity (Taylor, Wood,
& Lichtman, 1983) and her more general theory of cognitive adaptation
to threat (Taylor, 1983); Janoflf-Bulman's analysis of assumptive
world restoration following victimization (Janoff-Bulman, 1992)
and her more general theory of deep-seated personal change (Janoff-
Bulman & Schwartzberg, 1991); Rothbaum's two-factor model of personal
control (Rothbaum, Weisz, & Snyder, 1982); and Thompson's
taxonomic theory of psychological control appraisals (Thompson, 1981,
1985). These formulations all share the premise that adversity can lose
some of its harshness through cognitive adaptations—including finding
the good in bad events—which can restore comforting views of ourselves,
other people, and the world. These adaptations can even nourish
the conviction that we are in some ways better oflFthan we were before.
Accumulating evidence that the ability to detect personal gains from
threatening experiences may enhance psychological and physical wellbeing
supports these theories' validity and value to stress and coping
researchers.
Construing Benefits from Adversity 901
Our own research program has examined at length the role of finding
benefits in adapting to major medical problems. Thus, we will restrict
most of our empirical coverage of this phenomenon to medical adversity.
We begin by summarizing the prevalence of construing benefits
from major medical problems and subsequent documented relations
with psychological and physical adjustment. Next, we locate the place
of benefit-finding in selected theories of coping with trauma and adversity.
We review theory and research concerning the role personality
factors may play in finding benefits in adversity and the connection of
these factors to successful adjustment. Finally, we draw an unnoticed
distinction between benefit-related cognitions that are adaptive beliefs
about the consequences of adversity, which we label benefit-finding,
and those that serve as coping strategies during difficult times, which we
call benefit-reminding. This distinction reflects more than alternative
empirical foci: It captures a fundamental difference between the way
adaptive beliefs and coping strategies are both conceptualized and measured
in the stress and coping literature (Tennen & Affleck, in press-a).
To underscore this point, we will accent the utility of a process-oriented
approach to studying benefit-finding, benefit-reminding, and their dispositional
underpinnings.
Prevalence a n d Adaptational Correlates of
Benefit-Finding in Major Medical Problems
For a variety of reasons, many investigators of the psychological aspects
of major medical problems have asked their research participants
to describe any gains, benefits, or advantages they have found after
weeks to years of contending with these problems. This evidence of
benefit-finding derives in large part from answers to direct interview
questions about what, if any, positive consequences have ensued from
their experience. Less frequently, participants have answered multiitem
questionnaires in which they endorse their agreement with certain
benefits that could have accrued from their experience (Affleck, Tennen,
Rowe, & Higgins, 1990; Tennen, Affleck, Urrows, Higgins, &
Mendola, 1992).
A review of this literature unearths a wide array of medical problems
for which nearly all or more than a majority of informants cited
benefits or gains from their adversity. This evidence comes from studies
of heart attack survivors (Affleck, Tennen, Croog, & Levine, 1987);
women with breast cancer (Taylor, Lichtman, & Wood, 1984); sur902
Affleck and Tennen
vivors of spinal cord injuries (Bulman & Wortman, 1977); individuals
who have lost their sense of taste and smell (Tennen, Affleck, &
Mendola, 1991a); women with impaired fertility (Abbey & Halman,
1995; Tennen, Affleck, & Mendola, 1991b); patients with chronic rheumatic
diseases (Affleck, Pfeiffer, Tennen, & Fifield, 1988; Liang et al.,
1984); stroke victims and their caregivers (Thompson, 1991); parents
of infants hospitalized on newborn intensive care units (Affleck, Tennen,
«fe Gershman, 1985; Affleck, Tennen, & Rowe, 1991); and mothers
of children with insulin-dependent diabetes (Affleck, Allen, Tennen,
McGrade, & Ratzan, 1985), among others.
Several categories of perceived benefits cut across these problems
and echo what has been found in studies of other types of threatening
events (e.g., Janoff-Bulman, 1992; Tedeschi & Calhoun, in press;
Thompson, 1985). One common theme is the strengthening of relationships
with family and friends. Another is the perception of positive
personality change, such as the development of greater patience, tolerance,
empathy, and courage. Yet another common benefit appraisal
is a valued change in life's priorities and personal goals. Other benefits
appear relatively specific to health-related adversity. For example,
many men who have had heart attacks believe that this event taught
them a lesson about the importance of health behavior practices to live
a long life (Affleck et al., 1987), and many mothers claim that their
infant's hospitalization on an intensive care unit opened their eyes to
the dedication and caring attitudes of health care professionals (Affleck
et al., 1991).
Is benefit-finding a proxy for denial? Before summarizing evidence
of the adaptational consequences of benefit-finding, we must address
briefly the possibility that benefit-finding signals denial and thus may
prove maladaptive over the long run because it interferes with effective
coping strategies for accepting the full severity of the problem
(Lazarus, 1983). If benefit-finding stems from or supports psychological
denial, then any associations found with reports of psychological
well-being might reflect a reluctance to concede the severity of the
stressor as well as one's emotional distress (Breznitz, 1983). This issue,
framed in broader terms of the relation between "positive illusions"
and mental health, was the subject of a fascinating exchange of views
between Taylor and Brown (1994) and Colvin and Block (1994).
Does finding good things in aversive experiences imply the denial
of such experiences' harmful aspects? Tedeschi, Calhoun, and Gross
Construing Benefits from Adversity 903
(1993) countered this view with findings from a study of college students'
appraisals of recent psychological traumas. Scores on a questionnaire
measuring the perception of benefits from these events were
positively correlated with ratings of both the event's negative and positive
impact on their lives. In a study of parents of infants treated on a
newborn intensive care unit, a questionnaire assessment of perceived
benefits from this crisis was uncorrelated with a companion instrument
measuring its harmful aspects (Affleck et al., 1990). Thus, the existing
evidence, which clearly deserves more study, refutes the hypothesis that
any apparent positive adaptational consequences of finding benefits in
traumatic experiences come at the cost of denying their adverse effects.
Adaptational outcomes of benefit-finding. Positive adaptational outcomes
of benefit-finding are evident in many self-report indicators of
psychological well-being. Studies using valid and reliable adaptational
outcome measures provide evidence that benefit-finding relates to less
negative affect in cancer patients (WoUman & Felton, 1983); less depression
and greater meaningfulness in life in stroke victims (Thompson,
1991); less psychological distress in infertile women (Abbey &
Halman, 1995; Tennen et al., 1991b) and people who have lost their
sense of taste and smell (Tennen et al., 1991a); superior psychological
adjustment in women with breast cancer (Taylor et al., 1984); and
less mood disturbance and intrusive thoughts in mothers of acutely ill
newborns (Affleck et al., 1985). Because it is difflcult to disentangle
temporal precedence in these cross-sectional studies, these findings can
also mean that those who are better adjusted to their problems find it
easier to construe positive aspects of their experience. What's more,
both the ability to find benefits and reports of positive adjustment may
be influenced by differences in the severity of the problem itself.
In a rare longitudinal study of the predictive significance of benefitfinding,
Affleck et al. (1991) asked mothers before their child's discharge
from a newborn intensive care unit whether they had found any benefits
from their child's hazardous delivery and prolonged hospitalization.
Seventy-five percent of the mothers cited at least one benefit, including
improved relationships with family and friends, the importance of keeping
life's problems in perspective, increased empathy, positive changes
in their personality, and the conviction that their child was now more
precious to them. Mothers who cited no benefits from their child's newborn
intensive care reported more mood disturbance and psychological
distress 6 and 18 months later, even when their mood at the time they
904 Affleck and Tennen
were asked to describe any benefits was partialled from these relations.
The ability of benefit-finding to predict later emotional well-being was
independent of an objective index of the severity of the child's medical
problems, echoing what Thompson (1991) found in a study of stroke
survivors and Tennen et al. (1991a) documented in a study of victims of
taste and smell loss. Thus, preliminary evidence suggests that benefitfinding
predicts emotional well-being and is unconfounded by objective
measures of the severity of the problem.
These mothers' ability to find benefits not only predicted their own
well-being but also their child's developmental test scores 18 months
later. This relation remained significant even when we controlled for
mothers' predischarge mood, age, education, parity, and the severity
of the infants' perinatal medical problems. This discovery is critical
because it extends the positive outcomes of benefit-finding beyond the
realm of self-report.
Another demonstration of the predictability of objective outcomes
from earlier benefit-finding comes from a cohort of heart attack survivors
who participated in an unusually long prospective study (Affleck
et al., 1987). After 7 weeks of recovery from their initial heart attack,
58% of these men cited benefits, most prominently anticipated changes
in lifestyle to increase enjoyment, valued lessons about the importance
of health behavior, and positive changes in their philosophy of life and
basic values. Eight years later, those who had construed benefits were in
significantly better cardiac health and were less likely to have suffered a
subsequent attack. These predictive relations remained significant even
after controlling for their age, socioeconomic status, and severity of
their initial attack.
In summary, research on the adaptational correlates of benefit-finding
among individuals facing serious medical problems is beginning to
document its unique ability to predict emotional well-being. This, along
with initial evidence that benefit-finding may also confer long-term
health benefits, is good reason to investigate why positive reappraisals
of threatening events are related to positive adaptational outcomes.
Tbere is no shortage of positive outcome possibilities in the health
arena, ranging from the invigoration of health behavior changes (Affleck
et al., 1987) to improvements in health-related social support (WoUman
& Felton, 1983). In line with the theme of this special issue, we will
examine the possibility that individuals bring life-long characteristics
to adverse experiences that shape both their capacity to find benefits
and their successful adjustment.
Construing Benefits from Adversity 905
But first we will review briefly the significance of benefit-finding for
several general theories of coping with trauma and adversity. Although
these theories have often been ignored as an explicit framework for the
empirical studies we have reviewed to this point and have not been well
integrated with research on personality and health, they provide a useful
scaffolding for the integration of stress and coping theory, personality
theory, and research on benefit-finding in adversity.