Meaning-making (052421)

Making sense of the meaning literature: An integrative review of meaning making and its effect on adjustment to stressful life events - Crystal L. Park

Operational definitions

Problematic translation of rich theoretical conceptualizations to operational definitions is perhaps the biggest limitation of current meaning research. Not only may individuals lack awareness of or ability to report on the inner processes assumed to be occurring, but most studies of processes related to meaning making assessed a limited scope (i.e., only part of what might constitute meaning-making). For example, some examined meaning-making coping using subscales from broad-spectrum coping measures such as the COPE (Carver et al., 1989; e.g., reinterpretation), and others assessed only emotional processing (focusing on understanding one's feelings) without including cognitive processes (e.g., Stanton, Danoff-Burg, & Huggins, 2002).

(...) Many studies assessed meaning making with very simple questions, such as "How often have you found yourself searching to make sense of your illness?" or "How often have you found yourself wondering why you got cancer or asking, 'Why Me?'" (e.g., Roberts, Lepore, & Helgeson, 2006). Although they perhaps have some face validity, such questions have been shown to have very different meanings to different people (Davis et al., 1998).

- For example, one study asked mothers who had been sexually abused as children to describe the meaning they had made or found. Results were diverse and alarmingly misaligned with typical research descriptions of meaning made. Among the predominant answers were shattered assumptions about the world and the self. Other meaning made involved negative changes in themselves (e.g., damaged trust), attributions, positive changes in self-views, and positive outcomes of their coping efforts (Wright, Crawford, & Sebastian, 2007). In a study of mothers of children undergoing bone marrow transplantation, the items "searching for meaning" and "searching for positive meaning" were not correlated, not were the items "found meaning" and "found positive meaning" (Wu et al., 2008).

The classification of intrusive thoughts vis-a-vis meaning making is also problematic. Sometimes used as a measure of distress (e.g., Pruitt & Zoellner, 2008), intrusions (or the entire Impact of Event Scale [IES]; Horowitz, Wilner, & Alvarez, 1979) have also been used as an index of meaning making (i.e., cognitive processing; e.g., DuHamel et al., 2004; Lepore & Helgeson, 1998)(...)

Empirical Evidence Regarding the Meaning-Making Model

This section addresses essential questions regarding specific aspects of the meaning-making model on the basis of available empirical research. Because the contours of research examining meaning making are nebulous, an exhaustive review of all relevant literature (Cooper, 2003) is impossible. For example, one type of meaning making involves positive reappraisal or reinterpretation; studies on that topic alone (as part of coping) number in the thousands (Aldwin, 2007; Folkman & Moskowitz, 2000). Therefore, this review focuses on quantitative studies that explicitly examined meaning-making processes and products (or variants such as sense making) or that directly address the core meaning-making issues reviewed below.

Conceptual definition of meanings made / Operational definition of meaning made

Affleck et al (1985) - Accommodations of the self to the environment, successfully ascribing a purpose to one's misfortune, in an attempt to rebuild shattered assumptions. / Having an answer to the question "Why me? Why am I the one whose child had to be hospitalized in an intensive care unit?"

Currier et al (2006) - Restoration of meaning (entails adapting one's personal worlds of meaning to make sense of the loss). / Single question, "How much sense would you say you have made of the loss?" (1=no sense to 4 = a good deal of sense)

Dirksen (1995) - Causal attributions to comprehend why an event occurred and the personal significance of that event (search for meaning was used to refer to meaning made). / Search for Meaning Scale : Summary score for attribution items (e.g., "I believe there is a specific reason as to why the cancer occurred") and impact of diagnosis on life (e.g., "I have found that due to the cancer experience my priorities in life have changed"); all rated on 1-5 scale

Draucker (1989) - The adaptation process involves searching for meaning in the experience, an "effort to understand the event: why it happened and what impact it has had." A "successful search includes both subjective satisfaction with the meaning found and the ability to then put the search aside." / Combined items: how successful they had been at finding meaning or discovering a way to make sense of their incest and how frequently they continued to search for meaning (not clear how these items were combined)

Holland et al (2006) - Making sense: "How much sense would you say you have made of the loss" (no sense to a good deal of sense). Benefit finding: "Despite your loss, have you been able to find any benefit from your experience of the loss?" (no benefit to great benefit). / Having made sense was related to less complicated grief, but benefit finding was unrelated. However, the interaction of benefit finding and having made sense was related to less complicated grief, such that lowest grief resulted from high sense making but low benefits.

Keese et al (2008) - The successful integration of "a seemingly incomprehensible loss into the pre-loss meaning structures that gave their life stories an overarching sense of purpose, predictability, and order" (p. 1147). / Sense making: "Have there been any ways in which you have been able to make sense of the loss of your child?" Benefit finding: "Despite the loss, have you been able to find any benefit from your experience of the loss?"

Koss & Figueredo (2004) - Cognitive processing, a set of constructs including attributions and beliefs that stimulate the psychosocial distress that characterized the long-term aftermath of rape (p. 1063). / Changes over time in global beliefs (combined scale scores from McPearl Belief Scale) and attributions of self-blame for the sexual assault

McLean & Pratt (2006) - The report of lessons or insights. Lessons are specific meanings that are often specific meanings that are behaviorally driven and are applied only to similar kinds of events in parallel situations. Insights are broader meanings that extend to other parts of the self beyond those indicated in the narrated event. / Participants wrote narratives regarding an important turning point., which were coded as 0 (no meaning reported); 1 (a lesson reported, defined as meanings that were often behavioral and did not extend the meaning beyond the original recalled event); 2 (vague meanings more sophisticated than lessons but not as explicit as insights); or 3 (insights, meanings that extend beyond the specific event to explicit transformations in one's understanding of oneself, the world, or relationships).

Moore et al. (2006) - Finding meaning involves 2 routes, identifying a cause or explanation (not really possible with EVT) and making positive appraisals about the impact of the threat. Thus a person may engage in cognitive appraisals of the personal implications of the event and, as a result, may restructure and reprioritize certain aspects of his or her life. / Extent to which patients had shifted their perspectives and priorities as a result of EVT.

Neimeyer et al. (2006) - Products of meaning reconstruction (making sense, benefit finding, reorganizing identity) / Sense making: "How much sense would you say you have made of the loss?" (1 = no sense to 4 = a good deal of sense). Benefit finding: "Despite the loss, have you been able to find any benefit from your experience of the loss?" (1 = no benefit to 5 = great benefit). Identity change: "Do you feel that you are different, or that your sense of identity has changed, as a result of this loss?" (1 = no different to 5 = very different) / Amount of identity reconstruction was positively related to separation distress and traumatic distress. Benefit finding and sense making were associated with less separation distress and traumatic distress.

Pakenham (2007) - Sense making: Rebuilding one's assumptive world in the face of significant adversity; meaning as comprehensibility (sense making) / "People make sense of their having an illness is like a 'wake-up call' to change their life style. Do you feel that you have been able to make sense of, or comprehend, your having MS? Yes/No." If the respondents answered yes to this question, they were asked to "explain what sense you have made of your having MS." Items were coded, factor analyzed, and turned into the Sense Making Scale, which was given at Time 2 and had six subscales.

Pakenham (2008a) - Meaning reconstruction: Making sense of adversity is achieved through developing new worldviews or via modifying existing assumptive schemas or worldviews. / Same as Pakenham (2008c). Analyses were conducted with the specific categories as predictors of adjustment. These six categories were: catalyst for change, relationship ties, incomprehensible, causal attribution, spiritual perspectives, and acceptance.

Pakenham (2008b) - Sense making refers to "the extent to which people have managed to integrate or reconcile their appraised (or reappraised) meaning of the event with their global meaning" / Two questions: Do you feel that you have been able to make sense of or comprehend your having MS? Yes/No." If respondents answered yes, they were asked to explain "what sense you have made of your having MS" (an open-ended question). Number of sense-making categories was used in analyses.

Pakenham (2008c) - Meaning reconstruction: Making sense of adversity is achieved through developing new worldviews or via modifying existing assumptive schemas or worldviews. / Two questions: "Do you feel that you have been able to make sense of or comprehend . . . having MS and your caring for and/ or supporting him/her? (Yes/no)." If respondents answered yes, they were asked to "explain what sense you have made of [care recipient's name] having MS and your caring for and / or supporting him/her." Open-ended responses were coded and analyses were conducted with number of sense-making categories.

Pakenham et al. (2004) - Meaning making (development of an understanding of the event and its implications by first trying to make sense of the situation; sense making) and then identifying benefits (finding some benefit in the experience for one's life) / Two items assessed having made sense: "Do you feel that you have been able to make sense of (developed an understanding of) having a child with Asperger syndrome." Open-ended responses were coded and analyses were conducted with total number of categories identified. Two items assessed benefit finding: "Have you found any benefits from having a child with Asperger syndrome?" If respondents answered yes, they were asked to "please describe the benefits you have found from having a child with Asperger syndrome."

Rini et al. (2004) - Basic beliefs can be challenged by severe stressors, and adjustment to such events involves rebuilding basic beliefs / 

Russell et al. (2006) - Prioritizing values and goals, seeking answers to existential questions, and reflecting upon the story of one's life / Answers to 3 questions considered together an coded as having made meaning (high, moderate, low). Question 32: "What is your belief about why MS came into your life when it did? How do you make sense of the questions: 'Why me?' 'Why now?' 'Why MS?' " Question 47: "How have you tried to make meaning out of your experience of having MS?" (e.g., religion/ spirituality, talking with friends). Question 48: "What has been most helpful to you in making meaning out of your experience of having MS?"

Samios et al. (2008) - Developing explanations for adverse circumstances and events; achieved through developing new worldviews or by modifying existing worldviews / Sense-Making Scale for Parents of Children with Asperger Syndrome. Six subscales: Spiritual Sense Making, Causal Attributions, Changed Perspective, Reframing, Luck/ Fate, and Identification

Thompson (1985) - "To make sense of the experience = To determine why it happened, who (if anyone) is to be held responsible, and what meaning the event has for one's life and one's view of the world (p. 280) / Found positive meaning (combined score of questions about extent of focus on the positive: identified side benefits, made social comparisons, imagined worse situations, forgot the negative, and redefined the fire)

Tunaley et al. (1993) - Search for meaning (an understanding of the event) / Asked whether the woman had any explanation for her loss (yes/no)

Wood & Conway (2006) - A process that results in an integration of an event with one's positive sense of self / Summary measure : (a) "This past event has had a big impact on me"; (b) "I feel that I have grown as a person since experiencing this past event"; (c) "Having had this experience, I have more insight into who I am and what is important to me"; (d) "Having had this experience, I have learned more about what life is all about"; (e) "Having had this experience, I have learned more about what other people are like"; (f) "Even when I think of the event now, I think about how it has affected me"' and (g) "I have often spent time thinking about what this event means to me." (Primarily meaning made but mixed with some meaning making).

Wright et al. (2007) - Cognitive restructuring focuses on changing one's perspective regarding a traumatic event. Two restructuring, strategies are benefit finding ("seeing the silver lining" in a trauma) and meaning making (finding purpose in, or a reason for, the trauma) / (...) Those who had perceived some benefit were asked to provide a written answer detailing the types of benefit.

What aspects of global meaning are important to assess?

According to the model, meaning making is set into motion when some fact or feature of the environment or reality is appraised in a way that is discrepant with one's global meaning. Thus, conceptualization and assessment of global meaning is a critical issue. Some researchers (...)

In addition, as noted above, the subjective sense of life meaningfulness or purpose is sometimes considered an aspect global meaning (e.g., Johnson-Vickberg et al., 2001; Park, Edmondson, Fenster, & Blank, 2008). A broad conceptualization of the composition of global meaning is clearly important, but there is no agreement on what constitutes "broad enough." Perhaps a better approach is to identify aspects of global meaning that are most central and whose violation are most likely to create distress and initiate meaning making. Empirical research on this issue is nonexistent.

How have meaning making and meaning made been characterized in the literature? How well have these characterizations captured meaning-making processes and meanings made? These issues are critical because study results are often widely disseminated and cited without close attention to the particulars of their methods (Davis et al., 2000). (...) Although meaning making has generally been characterized as efforts to restore congruence between global meaning and situational meaning, the specific emphases vary.