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Meaning in Life and Psychological Well-Being in Addiction, Cancer, and University Students

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Meaning in Life and Psychological Well-Being in Addiction, Cancer, and University Students Meaning in life and psychological well-being in addiction, cancer, and university students Sentido en la vida y bienestar psicológico en adicción, cáncer y estudiantes universitarios Tesis doctoral Autor: David Fernández Carreño Directores: José Manuel García Montes Nikolett Eisenbeck Una tesis presentada para obtener el título de Doctor en el programa de Salud, Psicología y Psiquiatría Universidad de Almería, España ii iii A mi abuelo José Carreño, por inculcarme el valor académico como vía de contribución a la sociedad. iv v Agradecimientos El doctorado es un arduo camino. Desde el inicio y la mayor parte del recorrido no ves el final. Y cuando te acercas al final, te encuentras con una vertiginosa pendiente la cual no sabes ni cómo has podido subir. Todo empezó con mi abuelo José cuando yo tenía unos ocho años. Recuerdo la primera vez que me enseñó la tesis doctoral en biología de mi tío Juan. Ver en sus ojos el orgullo que sentía hacia ese logro académico me marcó para siempre. Abuelo, tu entusiasmo hacia la academia y la contribución a la sociedad es lo que me ha llevado hasta aquí. Sé que desde dentro de nuestros corazones puedes disfrutar de mis logros. Son mayormente tuyos. A mis padres María Rosario y Paco por todo el esfuerzo que han invertido en mi educación personal y académica. Siempre he sentido vuestra incondicionalidad y orgullo por ser como soy. Con especial mención a mi pareja y al mismo tiempo codirectora Nikolett por su inmensa contribución en esta tesis. Tu constancia y fe en mi desarrollo profesional han sido mis pilares fundamentales durante estos años. Te quiero. A mis tan queridos hermanos Gonzalo y Francisco, dos pequeñas joyas que me han hecho entender realmente en qué consiste la auto-transcendencia. Espero que el día de mañana os inspiréis en esta tesis para ser lo que soñáis ser. A mi abuela Águeda, quien nos ha dejado recientemente. Su tesón, alegría y bondad me han hecho más sabio a la hora de caminar. A mis primos, tíos, abuelos María y Joaquín, y resto de familiares por creer en mí y demostrarme el valor de la unión familiar. Sin vuestra compañía, mi vida perdería color. A Paul Wong, tan parecido a mi abuelo. Lo que quiera que sea nos ha juntado en esta etapa de la vida. Doy gracias a eso y a ti por ser el mejor modelo académico que he tenido estos años. Esta tesis es una prolongación de tu enorme obra en la psicología. vi A mis directores Pepe y Adolfo por haberme apoyado e instruido durante el doctorado, dándome la libertad de la que tanto necesita la investigación. A mis compañeros y amigos Rubén, Juanjo y Cristian que han compartido este viaje conmigo. Vuestra entrega y sufrimiento han hecho más amenos los míos. A todos mis amigos “frikis” con los que he aprendido debatiendo largo y tendido sobre esta maravilla de profesión llamada psicología. Me vienen a la cabeza Jose, Adrián, Raúl, Escobar, Alex, Serafín, Fran y Paco Murcia, aunque habéis sido muchos más. A todos los que han participado en los estudios de la tesis, de los que me llevo grandes lecciones personales. Aprecio realmente la participación de todas las personas que se encontraban conviviendo con el cáncer, con una mención especial a quienes cedieron su valioso tiempo para nuestro estudio antes de fallecer. Esta tesis es una forma de honrarlos. Asimismo, agradezco la colaboración del Hospital de Torrecárdenas, en particular la ayuda recibida por Beatriz y Sergio. Finalmente, gracias a todos mis clientes por hacerme mejor persona durante estos años. Cuando se ponía todo cuesta arriba, me disteis ejemplo de cómo soportar el sufrimiento y seguir este viaje llamado vida. Sois todos unos maravillosos luchadores. Siento las molestias que hayan podido causar mis niveles de estrés, principalmente a mi pareja y a mis amigos más cercanos. Hasta mi querida gata, Wendy, no terminaba de entender qué estaba pasando conmigo. Reconozco que mi umbral de tolerancia ha bajado durante los últimos tiempos. Os prometo que volverá a situarse donde estaba. Aprecio de corazón vuestra incondicionalidad hacia mí a pesar de todo. vii Abstract The main aim of this doctoral dissertation was to advance research on meaning in life and its relationship with mental health. To this end, the role of meaning in life in the well- being of three distinct populations was analyzed: people with addiction, cancer patients, and university students. The thesis research is theoretically framed from existential positive psychology (PP2.0, Wong, 2009, 2011a), a paradigm that claims the importance of treating and integrating both the positive aspects of living (e.g., positive emotions and relationships) and the negative aspects of human existence (e.g., suffering and death) to achieve optimal functioning and personal flourishing. In line with Viktor E. Frankl’s ideas, positive existential psychology considers that the most adaptive coping mechanism that allows us to transcend suffering and find greater personal prosperity is the use of meaning in life. This dissertation includes a theoretical review on different topics related to meaning in life and three empirical studies that provide evidence on the importance of this construct in psychological well-being. As a starting point, a re-conceptualization of addiction was made by criticizing the brain disease model and supporting a meaning-centered approach. Addiction is widely considered a chronic brain disease. However, this biomedical model has serious epistemological and practical limitations. From a more pluralistic perspective, we discuss the problematic self-regulation often observed in people with addiction. People with this problem, whether related to substance abuse, gambling, surfing the internet and social networks, shopping, or eating, often manifest existential struggles that can explain their addiction’s development and maintenance. Relational problems, avoidance of guilt and responsibility, and lack of meaning in life have been evidenced in the literature. At the base of addiction, there seems to be both maladjustment in coping with the negative side of life and a problematic search for positive emotions that cannot be obtained naturally from social interactions. Therefore, the Meaning-Centered Approach (MCA) is proposed for addiction recovery. Based on positive existential psychology, this approach aims to help clients find purpose in life and integrate them with society. MCA can be an essential complement for conventional addiction treatments. Study 1 aimed to adapt the Personal Meaning Profile-Brief (PMP-B, McDonald et al., 2012) to the Spanish-speaking population and investigate its psychometric properties. The PMP-B is a 21-item instrument that measures meaning in life through viii seven sources: relationship, intimacy, achievement, self-acceptance, self-transcendence, fair treatment, and religion. Before this study, there was no Spanish instrument with validated scores to measure standardized sources of meaning in life. Participants in Study 1 were 546 Spanish adults composed of a community sample (n = 171) and university students (n = 375). The Spanish versions of the PMP-B, the Ryff's Scales of Psychological Well-Being (Díaz et al., 2006; original, Ryff, 1989), and the Depression Anxiety Stress Scale (DASS-21, Bados et al., 2005; original, Brown et al., 1997) were administered. The results showed that the Spanish version of the PMP-B has a bifactorial structure with one general factor (meaning in life) and seven sub-factors (sources of meaning). In addition, measurement invariance was found between ages, gender, and samples. Internal consistency and test-retest reliability were satisfactory. Older people showed higher PMP-B scores than younger people. The PMP-B scores, especially relational sources of meaning, were positively associated with psychological well-being and negatively with psychological distress, mainly with depression. The validity evidence collected in Study 1 supports the reliable use of the PMP-B to measure meaning in life among the Spanish adult population. The PMP-B can make a valuable contribution to the meaning-centered research. In the subsequent studies of this dissertation, this tool was used. Study 2 was carried out among the oncological population. Its purpose was to analyze the impact of a cancer diagnosis on personal values, exploring how adaptability in the values system influenced the patients’ quality of life. The study included 144 cancer patients registered in the Hospital of Torrecárdenas (Almería) and a healthy control group consisting of 158 adults with similar demographic characteristics. To measure the change in values retrospectively, we developed the Valued Living Questionnaire - Perceived Change (VLQ-PC), a modified version of the Valued Living Questionnaire (VLQ, Wilson et al., 2010). The psychometric properties of the VLQ-PC evaluated were satisfactory, showing various indices of reliability and validity. The results indicated that cancer patients had greater meaning in life, scored higher in the values of tradition and benevolence, showed higher self-acceptance levels, and greater use of religion than healthy adults. Besides, most cancer patients perceived a significant change in their personal values since diagnosis, compared to their counterparts. This values change consisted of giving greater importance and becoming more personally involved in areas such as family, intimate relationships, parenting, friendship, recreation, spirituality, citizenship, physical care, and self. However, values such as work, power, and stimulation decreased in importance after diagnosis. Those patients who showed this change in values ix benefited from higher levels of meaning in their lives and better indices of quality of life than patients who showed inflexibility in their values system. The findings of Study 2 demonstrate the clinical relevance of the adaptability of the patient’s meaning in life to the cancer experience, providing an instrument with validated scores to measure perceived changes in values. The VLQ-PC can be particularly useful in the growing interventions focused on meaning to the oncological population. Study 3 aimed to design and implement a pilot intervention to promote meaning in life through death awareness and prosociality in close relationships.
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