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The Meaning Making Model: a Framework for Under- Standing Meaning, Spirituality, and Stress-Related Growth in Health Psychology

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The Meaning Making Model: a Framework for Under- Standing Meaning, Spirituality, and Stress-Related Growth in Health Psychology www.ehps.net/ehp the meaning making model keynote article The Meaning Making Model: A framework for under- standing meaning, spirituality, and stress-related growth in health psychology Crystal L. Park Research on the topics of meaning, Discrepancies can be spirituality, and stress-related growth is reduced in many ways, University of Connecticut proliferating, promising to illuminate these including problem-focused essential but relatively ignored aspects of coping and emotion-focused coping strategies human health and well-being. However, the (Aldwin, 2007). However, in low control sheer amount of information coming from situations not amenable to direct repair or disparate areas requires organization and problem-solving, such as trauma, loss, and integration. I propose here that the Meaning serious illness, meaning-making is often the Making Model (Park, 2010a, 2010b) is a useful most adaptive (Park, Folkman, & Bostrom, theoretical framework for understanding these 2001). Meaning making involves approach- phenomena and their interrelations within oriented intrapsychic efforts to reduce health psychology. In this article, I use this discrepancies between appraised and global model to frame a brief overview of current meaning. Meaning-making involves changing theory and research on meaning, spirituality, either the very meaning of the stressor and growth within health psychology. (appraised meaning) in a process of assimilation or changing one’s global beliefs and goals to The Meaning Making Model improve the fit between the appraised meaning The Meaning Making Model identifies two of the stressor and global meaning, akin to levels of meaning, global and situational (Park & accommodation (Park, 2010b). Meaning making Folkman, 1997). Global meaning refers to typically involves searching for a more favorable individuals’ general orienting systems and view understanding of the situation and its of many situations, while situational meaning implications. Meaning making may also entail refers to meaning regarding a specific instance. reconsidering global beliefs and revising goals Situational meaning comprises initial appraisals (Wrosch, 2010) and questioning or revising one’s of the situation, the revision of global and sense of meaning in life (Park, 2010a). Meaning appraised meanings, and the outcomes of these making comprises both effortful coping to processes. Components of the Meaning Making change one’s appraised or global meaning and Model are illustrated in Figure 1. The Meaning more unconscious processes (e.g., intrusive Making Model is discrepancy-based, that is, it thoughts; Greenberg, 1995; Lepore, 2001). proposes that people’s perception of discrepancies between their appraised meaning This rebuilding process may lead to better of a particular situation and their global adjustment, particularly if adequate meaning is meaning (i.e., what they believe and desire) found or created, although protracted and (Park, 2010a) creates distress, which in turn unproductive meaning making efforts may gives rise to efforts to reduce the discrepancy devolve into maladaptive rumination and resultant distress. (Segerstrom, Stanton, Alden, & Shortridge, 2003). That is, meaning making is helpful to the june | 201 3 ehp 40 Park Figure 1: The Meaning Making Model extent that it produces a satisfactory product, or the influence of spirituality, a common source of meaning made. Meanings made can include global meaning. changes in the way one appraises a situation as well as changes in global meaning, such as Global meaning and general health revised identity, growth, or views of the world Many global beliefs are related to health and (Park, 2010a). well-being. For example, copious research has linked a sense of control or mastery with Meaning in the context of health physical well-being, including mortality and psychology morbidity (e.g., Lachman & Agrigoroaei, 2010; Global meaning influences individuals’ Matthews et al., 2006). Similarly, goal processes general levels of health and well-being in myriad are related to physical health in many ways ways. Further, global meaning plays an essential (Mann, de Ridder, & Fujita, 2013). The third role in how individuals deal with situations of element of global meaning, a general sense of crisis or serious illness, influencing their meaning in life, has been associated with better adjustment and, some research suggests, even health in many studies as well (e.g., Matthews their survival. These two types of influence of et al., 2006; Holahan et al., 2008). global meaning within health psychology are described below, and exemplified with a focus on 41 ehp volume 1 5 issue 2 www.ehps.net/ehp the meaning making model Spirituality provides a useful illustration of mattering (Park, in press). Spirituality has been the many ways in which global meaning is associated with many aspects of general health, theorized to influence general health. Much of including mortality and morbidity, the spirituality/health research has been cardiovascular and immune system functioning, conducted in the United States, where people pain, and health behaviors, including screening generally report fairly high levels of spirituality and adherence (see Koenig, King, & Carson, (e.g., U.S. Religious Landscape Survey, 2008). 2012, for a review). These effects are thought People in other countries report lower levels of to be exerted through many different pathways spirituality than those in the US, but these (Figure 2, upper panel). (For reviews, see reports are still fairly high (e.g., Hank & Schaan, Aldwin, Park, Jeong, & Nath, in press; Masters & 2008; WHOQOL SRPB Group, 2006; Williams & Hooker, in press). Sternthal, 2007). Worldwide, about 85% of people report having some form of religious Meaning in the context of illness belief, with only 15% describing themselves as Pervasive as the effects of global meaning are atheist, agnostic, or nonreligious (Zuckerman, on general aspects of health, its effects may be 2005). While not all individuals are spiritual, even more potent in the context of illness. spirituality appears to be central in the meaning Being diagnosed with serious illness can violate systems of many individuals (Park, in press). important global beliefs, including the fairness, benevolence and predictability of the world and Spirituality can inform all aspects of global one’s sense of invulnerability and personal meaning, informing beliefs (e.g., the nature of control (Jim & Jacobsen, 2008; Holland & God and humanity, control, destiny, karma) and Reznik, 2005). Further, serious illness almost providing ultimate motivation and primary goals invariably violates individuals' goals for their for living and guidelines for achieving those current lives and their plans for the future goals, along with a deep sense of purpose and (Carver, 2005; Maes & Karoly, 2005). People Figure 2: Influences of spirituality on health june | 201 3 ehp 42 Park appraise the meaning of their illness based on of their illness in a more positive direction (e.g., information they receive from sources such as Maliski, Heilemann, & McCorkle, 2002) or they their healthcare providers (Leventhal, Weinman, may gradually reconsider their life goals or life Leventhal, & Phillips, 2008), their appraisals of meaning in light of the illness (see Park, 2010b) their ability to manage the illness and its anticipated impact on their future (Leventhal et As noted earlier, meaning making per se is al., 2008), and their general sense of control thought to be helpful when it results in over their lives (Weinstein & Quigley, 2006). meanings made, reducing the discrepancy Research indicates that the meanings that between situational and global meaning. For survivors assign to their illness predict their example, a longitudinal study of people with coping and subsequent adjustment. For example, spinal cord injury found that those who in a sample of CHF patients, we found that continued to search for meaning over time were threat appraisals predicted higher subsequent worse off, but those who increasingly reported levels of depression, although challenge found meaning over time had better adjustment appraisals were unrelated (Park, Fenster, Suresh (Davis & Novoa, 2013). These meaning making & Bliss, 2006). processes help people to change their understanding of their illness (changed According to the Meaning Making Model, the appraised meaning, such as its cause or degree to which one perceives one’s illness as implications for their lives or their ability to discrepant from one’s global beliefs, such as handle it). For example, in our study of young those regarding identity (e.g., I live a healthy to middle-aged cancer survivors, we found that life style) and health (e.g., living a healthy meaning making in the form of positive lifestyle protects people from illness), and global reappraisal led to increases in perceived growth goals (e.g., desire to live a long time with robust and life meaning, which led to reduced health) determines the extent to which the perceptions of the cancer as discrepant from a illness is distressing. For example, in our just world belief. This process was related to longitudinal study of survivors of various better psychological adjustment (Park et al., cancers, the extent to which they appraised 2008). People may also make changes in their their cancer as violating their beliefs in a just global goal and beliefs, such as shifting their life world predicted poorer psychological well-being goals to be more realistic in light of their
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