Volcano icon

Coping Processes and Dimensions
of Posttraumatic Growth

The Australasian Journal of Disaster
and Trauma Studies
ISSN:  1174-4707
Volume : 2007-1

Coping Processes and Dimensions of Posttraumatic Growth

Bronwyn A. Morris, School of Psychology, University of Tasmania, Locked Bag 1342, Launceston, Tasmania, 7250, Australia. Email: bamorris@utas.edu.au
Jane Shakespeare-Finch, School of Psychology and Counselling, Queensland University of Technology, Australia
Jennifer L. Scott, School of Psychology, University of Tasmania, Hobart, Tasmania, 7250, Australia
Keywords: Posttraumatic Growth, Cancer, Coping

Bronwyn A. Morris

School of Psychology,
University of Tasmania
Locked Bag 1342, Launceston
Tasmania, 7250

Jane Shakespeare-Finch

School of Psychology and Counselling
Queensland University of Technology

Jennifer L. Scott

School of Psychology,
University of Tasmania
Tasmania, 7250



The emergence of Posttraumatic Growth (PTG) research in an oncology setting is highlighting the different individual and situational characteristics that promote the perception of benefits, in particular the role of coping processes used post-diagnosis. These coping processes were assessed in a sample of 335 men and women, with heterogeneous cancer diagnoses, treated in a regional Australian hospital in a two year time period. Positive change and coping were measured with the Posttraumatic Growth Inventory (PTGI) and the COPE Inventory. Results show that positive reframing is positively correlated with all PTGI factors and focussing on/venting emotions, social support engagement, and active coping are associated with two dimensions of PTG (New Possibilities and Relating to Others). Furthermore, a comparable pattern of correlations between PTG and coping was found in a sample of emergency service workers’ perceptions of benefits following workplace trauma. The current study highlights the multidimensional nature of PTG and the coping processes associated with different areas of growth. Further research can be conducted longitudinally in order to identify the differential processes of adaptation that lead to each area of growth.

Coping Processes and Dimensions of Posttraumatic Growth

The authors are appreciative to the WP Holman Clinic at the Launceston General Hospital, Tasmania for their assistance in this project. We especially thank Dr Kim Rooney and Ms Loris Towers. We also express gratitude to the participants for their overwhelming and supportive response.

Coping Processes and Dimensions of Posttraumatic Growth

The number of people diagnosed with cancer is increasing every year; yet the mortality rate is not rising (Australian Institute of Health and Welfare, 2004). As more people are living with this illness, it is essential to direct research efforts toward the adaptation and adjustment that occurs post-diagnosis. A wealth of research has investigated the coping strategies used while adjusting to cancer diagnosis. However, most studies have generally documented resultant distress associated with the cancer experience rather than positive outcomes. This focus on the traditional pathogenic paradigm is now being supplemented by a body of research investigating the potential for positive change that may occur post-diagnosis. “Posttraumatic Growth” (PTG; Tedeschi & Calhoun, 1996) describes the potential for an individual to develop beyond their pre-trauma level of psychological functioning and experience substantial beneficial changes in cognitions and emotions as a result of negotiating their traumatic experience. Whilst psycho-oncology research is burgeoning, the current study addresses an area currently overlooked: Are divergent coping strategies associated with different dimensions of PTG?

Coping After a Diagnosis of Cancer
As a single coping strategy cannot be regarded as beneficial across all situations, it is argued that the type of coping strategies utilised will differ depending on the context of the traumatic event (Schulz & Mohamed, 2004). For example, the experience of cancer represents a sequence of events that are difficult to alter; therefore, while active coping may be appropriate in other situations, acceptance or positive interpretation may be more advantageous post-diagnosis (Schulz & Mohamed). To date, coping research within psycho-oncology has documented a number of adaptive and maladaptive coping strategies evident post-diagnosis. These studies have shown that a variety of coping strategies used during this period of time can impact on post-diagnosis psychopathology. For example, coping through acceptance (Stanton, Danoff-Burg, & Huggins, 2002) and emotional expression (Stanton et al., 2000) have been shown to be related to a reduction in distress and an improved quality of life.

In addition to the measurement of negative outcomes that can occur post-diagnosis, the emergence of PTG research within psycho-oncology indicates positive change is an important factor when considering the holistic pattern of coping and recovery. Whilst not denying the multitude of adverse affects that cancer and subsequent treatments have on the individual, the investigation of PTG implies that a positive outcome is not merely an absence of psychopathology. In Calhoun & Tedeschi’s (2006a) comprehensive model of PTG, management of emotional distress is essential in the initial stages post-trauma and the success of managing this emotional distress after a traumatic event is determined by the coping strategies that are implemented. Particular coping strategies that have been identified to promote PTG include positive reappraisal coping (Sears, Stanton, & Danoff-Burg, 2003; Thornton & Perez, 2006; Urcuyo, Boyers, Carver & Antoni, 2005), seeking emotional social support (Thornton & Perez, 2006), and emotional expression (Manne, Ostroff, Winkel, Goldstein, Fox, & Grana, 2004). Utilising a variety of coping strategies when facing traumatic challenges has also been suggested to be more beneficial than the use of a single strategy (e.g., Collins, Taylor, & Skokan, 1990; Franks & Roesch, 2006; Shakespeare-Finch, Smith, & Obst, 2002). The PTG psycho-oncology research investigating coping processes has predominantly been based on studies with breast cancer survivors (e.g., Manne et al., 2004; Sears et al., 2003; Urcuyo et al., 2005). Therefore, further research conducted with a variety of cancer types is needed to broaden this investigation of coping strategies associated with PTG.

Multidimensional Nature of PTG
PTG research to date suggests that positive post-trauma change is not a unitary construct, with quantitative analyses revealing multi-dimensional factor structures across varying cultural contexts (Calhoun & Tedeschi, 2006b). The development of the Posttraumatic Growth Inventory (PTGI) revealed a five-factor structure of Personal Strength, New Possibilities, Relating to Others, Appreciation of Life, and Spiritual Change (Tedeschi & Calhoun, 1996). This factor structure has since been replicated in an Australian sample (Morris, Shakespeare-Finch, Rieck, & Newbery, 2005). Janoff-Bulman (2004) suggests that these different domains of growth are perhaps achieved through disparate processes. The areas of positive change and the different psychological processes that may lead to the different PTG domains are not necessarily exclusive of each other; however, it is also erroneous to discuss them as one entity (Janoff-Bulman).

Despite this assertion that PTG should be considered as a multidimensional construct, very little research has been published that investigates predictor variables such as coping strategies, which are associated with the different growth domains. For example, the majority of studies using the PTGI do not utilise factor scores other than to report descriptive statistics, with analyses being conducted on total PTGI score rather than factor sub-totals. A study which has explored which coping strategies were associated with different areas of growth was conducted with an Australian sample of emergency service workers (Shakespeare-Finch, 2002). In this study, coping was measured with the Coping Resources in Rescue Workers Inventory (McCammon, Durham, Jackson Allison, & Williamson, 1988) with four coping strategies; Positive Reframing, Emotional Support and Expression, Non-work Activities, and Work-related Cognitions. The results revealed that these coping processes were positively correlated with only two of the five PTGI factors: New Possibilities and Relating to Others. Based on such research, further study is warranted in the psycho-oncology field to investigate the potential coping strategies that are associated with the different PTG domains.

Rationale and Aims of Current Study
Whilst there is considerable coping research based within the pathogenic paradigm, studies investigating the relationship between coping and positive change post-diagnosis are just taking form. As the majority of this research has been conducted with breast cancer survivors, studies are needed on a variety of cancer types to investigate coping within a broader context. Also, as PTG has been shown to be a multidimensional construct, a gap exists in the current literature investigating the varying coping strategies that are associated with different areas of positive change that may occur after being diagnosed with cancer. Therefore this study:


Participants comprised patients treated during 2003 and 2004 at a regional Australian Hospital. This oncology clinic is part of a regional hospital responsible for servicing the northern part of this Australian state. Three hundred and thirty-five completed surveys were returned comprising a 35% return rate. The participants were 150 male and 185 females with a mean age of 62.99 years (SD = 12.23). In terms of demographic data, they were predominantly married, Anglo-Australians, no longer had cancer, and were no longer being treated (see Table 1 for demographic data). The most frequently occurring diagnoses were categorized in consultation with oncologists at the WP Holman Clinic (see Table 1 for rates of most common diagnoses).

Table 1. Demographic data for the sample (N = 335)






Marital Status  

   Married/De facto  














   High school or below  




   Undergraduate University  


   Postgraduate University  

Current Cancer Status  

   Have Cancer  


   No longer have cancer  


   Don’t know  

Current Treatment Status  

   Still receiving treated  


   No longer being treated  


















In addition to demographic information and questions regarding cancer diagnosis and treatment, the following inventories were included in the survey:

Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996). The PTGI is a 21-item self-report measure designed to obtain an overall assessment of positive outcomes occurring after a traumatic event (Tedeschi & Calhoun, 1996). Participants were asked to indicate the degree to which each statement had occurred in their life as a result of being diagnosed with cancer. Each item required a response on a 6-point Likert-scale from 0 to 5 (not at all to very great degree). High Cronbach’s alpha coefficient revealed strong internal reliability in the development of this scale (α = .90 for total PTGI score), which has since been replicated in many studies including those conducted in Australia (e.g., Morris et al., 2005). The Chronbachs alpha coefficients found in the current study also reflect a strong internal reliability with alphas ranging from .81 to .89 for the PTGI factors and .94 for the PTGI total score.

COPE Inventory (Carver, Scheier, & Weintraub, 1989). The COPE inventory is a 60-item inventory assessing a broad range of adaptive and maladaptive coping strategies. Participants were asked to indicate the extent to which each item was applicable in their experience of trying to deal with their cancer, requiring a response on a 4-point Likert-scale from 1 to 4 (I haven’t been doing this at all to I’ve been doing this a lot). Ten out of the fifteen subscales of the COPE were included in this research, reducing this to a 40-item inventory: Positive Interpretation, Behavioural and Mental Disengagement, Focus on/Venting Emotions, Instrumental and Emotional Social Support, Active Coping, Denial, Humour, and Acceptance. Subscales were excluded to reduce the length of the overall survey as this study was part of a larger project utilising a variety of measures. The COPE Inventory has been used extensively in psycho-oncology research with acceptable to strong internal reliability scores [e.g., subscale alphas were found to range from α = .60 to .80 in prostate cancer survivors, Thornton & Perez, 2006]. The Chronbach alpha coefficients for the current study reveal three subscales with an alpha less than .70 (Mental Disengagement, Behavioural Disengagement, and Denial). These subscales have been removed from subsequent analyses.

Survey packages were mailed to everyone treated for cancer at the WP Holman Clinic during 2003 and 2004. All potential participants were mailed a survey through the hospital to ensure confidentiality of patient records. The survey package consisted of an Information Sheet, Consent Form, and Survey. A reply paid envelope was also supplied and participants remained anonymous as no identifying information was returned with the surveys to the researchers. Diagnoses were coded with assistance from oncologists at the Clinic in order to categorise major cancer types. For example, the Colorectal/Rectal cancer group comprises of individuals reporting a diagnosis of bowel cancer and also those reporting a rectal cancer diagnosis.


Descriptive Statistics
Means, standard deviations, and ranges for the PTGI are outlined in Table 2. PTGI scores did not differ as a result of marital status, ethnicity, education, or education. Females reported a significantly higher PTGI score when compared to males, t(326) = -4.26, p < .001 (see Table 2 for descriptive statistics). The question of gender differences require a deeper examination that is beyond the scope of this paper and have been discussed in depth elsewhere (Morris & Shakespeare-Finch, 2006). PTGI scores did not vary as a result of disease characteristics; including whether or not they currently had cancer, were currently receiving treatment, and their expected prognosis at time of diagnosis. Bivariate correlations show that age had a small significant correlation with PTG (r = -.14, p < .05). Bivariate correlations reveal that time since diagnosis was not significantly associated with PTG. However, as participants were recruited from patients treated at the hospital in 2003 and 2004, the range for time since diagnosis was limited (1.5 to 4 years). Thus results regarding this variable must be interpreted with caution.

Table 2. Posttraumatic Growth Inventory Descriptive Statistics

PTGI Total (all cancer types)  
PTGI Total (females)  
PTGI Total (males)  
PTGI Factor item mean:  

   Appreciation of Life  


   Relating to Others  


   Personal Strength  


   New Possibilities  


   Spiritual Change  


Inferential Statistics
Bivariate correlations between COPE subscales and PTGI five factors showed that Positive Interpretation significantly correlated with all PTGI factors; with correlations not exceeding .5 (Personal Strength, r = .40; Appreciation of Life, r = .39; New Possibilities, r = .50; Relating to Others, r = .34; and Spiritual Change, r = .30). Other coping subscales significantly correlated with growth only in the PTG domains of New Possibilities and Relating to Others. The significant COPE subscales were Positive Interpretation, Instrumental Social Support, Emotional Social Support, Focus On and Venting Emotions, and Active coping (see Table 3).

Table 3. Significant Bivariate Correlations between COPE subscales and PTGI factors

PTGI Factors
New Possibilities
Relating to Others
COPE subscales

   Positive Interpretation


   Instrumental Social Support


   Emotional Social Support


   Focus on/Venting Emotions


   Active Coping


Note. All correlations significant at p<.001


Overall, the coping processes found to be associated with PTG after a diagnosis of cancer indicate that positive interpretation, social support, active coping and venting emotions are important in adjusting to this experience. These coping strategies are comparable to suggestions from previous research that emotion-focussed coping would be evident post-diagnosis (Manne et al., 2004; Sears et al., 2003; Thornton & Perez, 2006). Contradictory to previous theoretical suggestions, the results from this study reveal that the COPE subscale of active coping was associated with PTG, whilst acceptance coping did not appear to be evident. The phrasing of the acceptance coping questions in the COPE Inventory included “I get (got) used to the idea this happened and that it can’t be changed” and “I learn(ed) to deal with it”. For an individual dedicated to doing everything they can to fight this disease, perhaps acceptance coping as phrased in the COPE Inventory is not beneficial to this situation, nor associated with PTG.

The COPE subscale of Positive Interpretation was found to be associated with all five areas of growth. While there is some conceptual overlap between positively interpreting the event and an outcome of positive change, the correlations in the current study did not exceed .50. These results, in addition with previous studies that have revealed unique predictors for positive interpretation coping and PTG (Sears et al., 2003; Thornton & Perez, 2006), suggest that these two constructs are related but distinct from each other. Further study is needed to explore these predictors and provide evidence for the conceptual distinction between positive growth as an outcome and positive interpretation as a coping strategy. For cancer survivors, seeking social support (both emotionally and instrumentally) was associated with the perception of new possibilities in life and improved relationships with others. Social support provides the opportunity to express feelings and receive practical assistance and advice after the diagnosis of cancer. Consequently, this type of support can aid in the promotion of cognitively processing the event and strengthening relationships with others. This benefit of expressing emotions is reiterated in the current study with the COPE subscale of Focussing on and Venting Emotions being positively associated with New Possibilities. Active coping is also found to be associated with PTG, suggesting that taking an active role in one’s own treatment or life direction after being diagnosed with cancer is important in terms of being able to perceive positive change in new possibilities. Interestingly, the COPE subscales in the current study that had low reliability and were removed from analyses were all maladaptive strategies (behavioural disengagement, mental disengagement, and denial).

Whilst theoretical implications indicated that the coping strategies used would be unique to the circumstance, the results from this study reveal that the coping processes associated with PTG for the cancer survivors were similar to that of emergency service workers (Shakespeare-Finch, 2002). The four coping processes identified as integral to emergency service workers (positive reframing, emotional support and expression, non-work activities, and work-related cognitions) are comparable to those COPE subscales (positive interpretation, emotional support, focus on/venting emotions, and active coping) that were significantly correlated with New Possibilities and Relating to Others with the cancer survivors. The similarity of results from these diverse Australian populations increases confidence in identifying salient coping variables that are of benefit in general post-trauma situations. This also indicates that the cancer experience does not produce a unique situation in terms of how the individual will cope post-trauma and how this will be related to PTG.

Strengths and Limitations of Current Study Leading to Future Directions
Coping processes were investigated in terms of PTGI factors, with these results lending support toward the theoretical assumption that divergent psychological processes lead to different areas of positive change (Janoff-Bulman, 2004). The current study addressed a unique question and provides new information in emergent coping and PTG literature; however, the cross-sectional design prevents identification of causality between coping strategies and perception of benefits post-diagnosis. It may be that people who have higher PTG are better able to utilise adaptive coping strategies, such as mobilizing their coping resources. The current study assessed coping in relation to how the individual has dealt with the cancer in general. The heterogeneity in the type of experiences faced post-diagnosis may have reduced sensitivity for detecting associations between specific coping strategies and PTGI. According to coping self-regulation theory (Carver & Scheier 1982, 1988, 1990), the efficacy of coping strategies that improve adjustment to stressful situations is specific to the challenge faced. Effective coping self-regulation requires that the person be adept in implementing a variety of coping methods, and be able to select coping strategies according to the demands of the challenges faced (Scott, Halford, & Ward, 2004). Therefore, future research that involves both a longitudinal design and measures of participants’ psychological adjustment to specific stressors within the disease experience will help to address these issues.

The current study also relied upon participants’ self-report of their current disease status and prognosis. This information may have been biased by the individual’s primary coping appraisals of the threat the cancer posed to their life and coping resources. Patients also have poor understanding of medical information and the implications that information has for their well-being. There is often low agreement between patients and treating cancer specialists about disease and treatment information. Future studies should include a subjective measure of threat or challenge the participant associates with the event and also include objective measures of prognostic and treatment information from medical records.


The results of this study indicate that individuals with cancer utilise both emotion and problem-solving coping strategies and that these are associated with the perception of positive life changes. These analyses were conducted on PTGI factors to provide a comprehensive picture of the divergent factors associated with each domain of positive life change. Coping processes were found to be related to growth in the areas of finding new possibilities in life and increased benefits in relationships with others. These results are comparable to those found with a distinct population; thereby increasing confidence when identifying salient coping variables that are of benefit in general post-trauma situations. The current study highlights the multidimensional nature of positive post-trauma change and the different coping processes associated with each area. Further research can be conducted longitudinally in order to identify the differential processes of adaptation that lead to each area of growth.


Australian Institute of Health and Welfare. (2004). Cancer in Australia 2001 (Cancer Series No. 28). Canberra, Australian Capital Territory: Author.

Calhoun, L. G., & Tedeschi, R. G. (2006a). The foundations of posttraumatic growth: An expanded framework. In L.G. Calhoun & R.G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research and practice (pp. 3-23). Mahwah, NJ: Lawrence Erlbaum.

Calhoun, L. G., & Tedeschi, R. G. (2006b). The assessment of posttraumatic growth in different cultural contexts. Symposium presented at the annual meeting of the International Society for Traumatic Stress Studies, Hollywood, California.

Carver, C. S., & Scheier, M. F. (1982). Control theory: A Useful conceptual framework for personality-social, clinical, and health psychology. Psychological Bulletin, 92, 111-135.

Carver, C. S., & Scheier, M. F. (1990). Principles of self-regulation: Action and emotion. In E. T. Higgins, & R. M. Sorrentino (Eds), Handbook of motivation and cognition: Foundations of social behavior, Vol. 2, (pp.3-52). New York: Guilford Press.

Carver, C. S., & Scheier, M. F. (1998). On the self-regulation of behaviour. New York: Cambridge University Press.

Carver, C. S., Scheier, M. F., & Weintraub, J. K.  (1989). Assessing coping strategies:  A theoretically based approach. Journal of Personality and Social Psychology, 56, 267-283.

Collins, R. L., Taylor, S. E., & Skokan, L. A. (1990). A better world or a shattered vision? Changes in life perspectives following victimization. Social Cognition, 8(3), 263-285.

Franks, H. M., & Roesch, S. C. (2006). Appraisals and coping in people living with cancer: A meta-analysis. Psycho-Oncology, 15(12), 1027-1037.

Janoff-Bulman, R. (2004). Posttraumatic growth: Three explanatory models. Psychological Inquiry, 15, 30-34.

Manne, S., Ostroff, J., Winkel, G., Goldstein, L., Fox, K., Grana, G. (2004). Posttraumatic growth after breast cancer: Patient, partner, and couple perspectives. Psychosomatic Medicine, 66, 442-454.

McCammon, S., Durham, T., Jackson Allison, E., & Williamson, J. (1988). Emergency workers' cognitive appraisal and coping with traumatic events. Journal of Traumatic Stress, 1(3), 353-372.

Morris, B. A., & Shakespeare-Finch, J. (2006). A psychosocial investigation of cancer type as a differentiator of posttraumatic growth. Paper presented at the International Society of Traumatic Stress Studies Annual Conference, Los Angeles, California, USA.

Morris, B. A., Shakespeare-Finch, J., Rieck, M., & Newbury, J. (2005). Multidimensional nature of posttraumatic growth in an Australian population. Journal of Traumatic Stress, 18(5), 575-585.

Scott, J. L., Halford, W. K., & Ward, B. G. (2004). United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynaecological cancer. Journal of Consulting and Clinical Psychology, 72(6), 1122-1135.

Schulz, U., & Mohamed, N. E. (2004). Turning the tide: Benefit finding after cancer surgery. Social Science & Medicine, 59, 653-662.

Sears, S. R., Stanton, A. L., & Danoff-Burg, S. (2003). The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping, and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22(5), 487-497.

Shakespeare-Finch, J. (2002). Posttraumatic Growth in the QAS. Invited speaker. Paper presented at the Queensland Ambulance Service 10th Anniversary Conference, Brisbane, Australia.

Shakespeare-Finch, J. E., Smith, S. G., & Obst, P. (2002). Trauma, coping and family functioning in emergency service workers. Work and Stress, 16(3), 275-282.

Stanton, A. L., Bower, J. E., & Low, C. A. (2006). Posttraumatic growth after cancer. In Calhoun & Tedeschi (Eds.). Handbook of posttraumatic growth: Research and practice (pp. 138-175). Mahwah, NJ: Erlbaum.

Stanton, A. L., Danoff-Burg, S., Cameron, C. L., Bishop, M., Collins, C. A., Kirk, S. B., et al, (2000). Emotional expressive coping predicts psychological and physical adjustment to breast cancer. Journal of Consulting and Clinical Psychology, 68(5), 875-882.

Stanton, A. L., Danoff-Burg, S., & Huggins, M. E. (2002). The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment. Psycho-Oncology, 11(2), 93-102.

Tedeschi, R.G., & Calhoun, L.G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455-471.

Thornton, A. A., & Perez, M. A. (2006). Posttraumatic growth in prostate cancer survivors and their partners. Psycho-Oncology, 15(4), 285-296.

Urcuyo, K. R., Boyers, A. E., Carver, C. S., & Antoni, M. H. (2005). Finding benefit in breast cancer: Relations with personality, coping, and concurrent well-being. Psychology and Health, 20(2), 175-192.


Bronwyn A. Morris, Jane Shakespeare-Finch & Jennifer L. Scott © 2007. The authors assign to the Australasian Journal of Disaster and Trauma Studies at Massey University a non-exclusive licence to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The author/s also grant a non-exclusive licence to Massey University to publish this document in full on the World Wide Web and for the document to be published on mirrors on the World Wide Web. Any other usage is prohibited without the express permission of the authors.

| Home | Current | Back Issues | Reports | Conferences | Books | Links | Information |

Comments to
Massey University, New Zealand
URL: http://trauma.massey.ac.nz/

Last changed June 5, 2007
Copyright © 2007 Massey University