Earthquake in Haiti: relationship with the sacred in times of trauma.
O'Grady, Kari A. ; Rollison, Deborah G. ; Hanna, Timothy S. 等
The devastating earthquake in Haiti on January 12, 2010 killed over
230,000 people and injured many more. One year later, 1.2 million people
were still living in tents. Haiti is only one of many places around the
globe that have been struck by community-wide disaster in recent years,
including the United States' own devastating tornadoes in Joplin,
Missouri and Tuscaloosa, Alabama. Although several studies have
demonstrated strong links between spirituality and resilience, the field
is only just beginning to break ground on the role of spirituality in
large-scale disaster situations (Koenig, 2006).
In this article we briefly review the literature on spirituality
and trauma, followed by a description of the current study within a
relational framework. The study aimed to investigate the impact of the
Haitian people's relationship with the divine on their
psycho-spiritual transformation following the earthquake. Results are
considered from a cross-cultural perspective.
Growth Following Trauma
A growing body of research suggests that many traumatic life
events, including natural disasters, precipitate positive psychological
changes, such as a broadened view of life, an increased sense of meaning
and purpose for existence, and an increase in spirituality (Sigmund,
2003). Posttraumatic growth occurs when individuals are faced with a
traumatic event such as a natural disaster, and consequently positive
psychological effects take place (Tedeschi & Calhoun, 1996).
Although traumatic life events may produce precarious health outcomes
for some individuals and devastating consequences for communities,
research indicates that posttraumatic growth is possible when
appropriate factors are in place (Richards, Smith, Berrett,
O'Grady, & Bartz, 2009; Tedeschi & Calhoun, 2004).
The extent to which trauma develops into posttraumatic growth or
decline is in part mediated by the meaning an individual assigns to the
stressful life event (Cole, Hopkins, Tisak, Steel, & Carr, 2008;
Feder et al., 2008). According to cognitive adaption theory, positive
reinterpretation of a traumatic event serves an adaptive role for
experiencing stress-related growth (Karanci & Erkam, 2007; Taylor,
Collins, Skokan, & Aspinwall,1989). When individuals are able to
create positive meaning out of tragedy, they are often able to activate
critical recovery attributes such as a sense of self-efficacy and a
sense of purpose in life.
The study of posttraumatic growth is not only the consideration of
factors that contribute to growth following trauma, but it is also the
examination of the nature of growth outcomes. Previous research has, for
instance, reported positive correlations between the experience of
trauma and improved social relationships, positive changes in beliefs,
renewed faith, cohesiveness in the community, identification of new
possibilities, newfound talents and strengths, changes in self-image,
and transformed comprehension of way of life (Affleck & Tennen,
1996; Linley & Joseph, 2004; Tedeschi & Calhoun, 1996, 2004).
Many individuals who have felt "stuck" in their lives or who
have been unwilling to make important life transitions feel an increased
desire and strength to do so following a traumatic life event. From this
understanding, community disaster may be the impetus towards a
psychologically healthier and more satisfying lifestyle for some people.
Trauma impacts most people, not only physically, socially, and
psychologically, but also spiritually. For those who are engaged in a
spiritual life, trauma that threatens this aspect of their experience
can generate a great deal of internal distress. "When issues of the
soul may be at stake many are driven to reconsider their belief systems
including their views about God or a higher power (Pargament,
Murray-Swank, Magyar, & Ano, 2005, p. 247). As individuals
reevaluate their beliefs and values, they are likely to undergo a form
of spiritual transformation. Spiritual transformation can prompt other
important life transitions, such as overcoming or assuming addictions,
relationship adjustments, altered value systems, changes in vocation,
and disruption in typical coping patterns (O'Grady & Bartz,
2011). As spirituality has been shown to have strong associations with
trauma recovery and overall psychological well-being, the evaluation of
both psychological and spiritual transformation of trauma victims have
important clinical implications (Cole et al., 2008).
Spirituality and Trauma
Traumatic events often provoke individuals to re-examine and
incorporate post-trauma meaning into their lives. For many individuals,
their spirituality or faith is central to their meaning-making process;
this is expanded when individuals and communities draw upon religious
and spiritual practices to help them cope with trauma. Studies have
evidenced strong associations between religious coping, religious
practices, religious and spiritual beliefs, spiritual and religious
meaning making, and resilience (Sigmund, 2003). There seems to be a
unique and powerful potentiality within the spiritual faith and
expression of many individuals who have encountered trauma. Walsh (1999)
proposed that the resilient feature within people's spirituality is
that:
Faith supports the belief that we can overcome adversity. This
involves more than simply being religious; studies suggest that
what matters most is being able to give meaning to a precarious
situation, matters most is being able to give meaning to a
precarious situation, having faith that there is some greater
purpose or force at work, and finding solace and strength in these
outlooks." (p. 38)
Studies do indicate that those who are spiritually involved and
practice their faith reveal higher levels of posttraumatic growth than
those who are not. In addition, research has found that a strong
personal identification with their faith aids individuals in achieving
posttraumatic growth (Cadet Regehr; & Hemsworth, 2003; Kira et al.,
2006; Laufer & Soloman, 2006; Shaw, Joseph, & Linley, 2005).
Furthermore, studies have shown that intrinsic religiosity is associated
with an increase in posttraumatic growth a few months subsequent to the
trauma (Schaefer, Blazer, & Koenig, 2008).
There are limited findings about the relationship between
spirituality and large-scale community disasters, however, a U.S. survey
conducted following 9/11 found that relying upon prayer or religious or
spiritual feelings was the second most common way of coping (90%),
second only to talking with others (98%; Schuster et al., 2001). Perhaps
people turn to prayer and spiritual feelings because spirituality
provides a meaning system that offers a sense of coherence within the
chaos of disaster (Peres, Moreira-Almeida, Nasello, & Koenig, 2007).
Relationship with God and Trauma
Men et al. (2008) conducted a qualitative study that explored God
images of survivors of Hurricane Katrina. Among a number of themes, many
participants reported that they felt God's presence throughout the
disaster, and they also reported feeling that God was distant at various
times throughout the event. Likewise, Lawson (2010) conducted in-depth
interviews with older African American hurricane survivors. Without
exception, all participants reported that their faith had helped them
cope with the event, and many stated that reliance upon a higher power
was essential for their coping during and following the hurricane.
Survivors stated that ongoing conversation with a higher power was
paramount in their ability to cope with the hurricane and its aftermath.
Male survivors were more prone to attending church, testifying and
witnessing, and thought-blocking. Female survivors, on the other hand,
relied more on personal, family, and community resources; moaning and
crying; cognitive reframing; and construing positive meaning, the latter
of which has been explained as helping by means of "its
reinterpretation of adverse conditions to create an optimistic world
view based on human justice" (Lawson, 2010, p. 465).
In a related vein, Bhui, King, Dein, and O'Connor (2008)
interviewed 116 individuals from six ethnic groups in a study exploring
ethnicity and religious coping with mental distress. Results indicated
that religious coping was most commonly practiced among Bangladeshi
Muslims and African Caribbean Christians. Along with other forms of
religious coping, participants reported that talking to God, having a
relationship with God, and trusting in God were helpful in coping and
generating positive emotional states. Participants also indicated a
sense of acceptance in their experiences with trauma because they
presumed that God was accepting of the event. Additionally, those who
described a conversational style in their relationship with God
experienced a greater sense of personal choice and responsibility.
Authors of this study proposed that conversing with God or a higher
power might constitute a form of psychotherapy that fosters resilience
in times of distress.
Perceiving that God cares, along with the use of other religious
coping strategies, has been found to predict spiritual transcendence and
spiritual transformation for those dealing with stressful life events
(Greenway, Phelen, Turnbull, & Milne, 2007). Similarly, connection
with God and perceiving God as benevolent were associated with positive
appraisals of terminal illness (Gall, 2000). Siegel and Schrimshaw
(2002) reported findings of a study of perceived benefits of religious
and spiritual coping among older adults living with HIV/AIDS. Results
indicated that participants experienced a greater sense of vicarious
control through their personal relationship with God that helped them
cope with the stress associated with their illness. Participants also
reported alleviation in their feelings of despair from the belief that
they could lean on God and work with God to solve their problems.
Additionally, participants reported feeling strengthened by allowing God
to handle the unresolvable problems of a chronic illness.
Although not all of these studies address community disaster, they
do converge on the importance that a relationship with God may have on
those struggling with traumatic life events. Relationship with God seems
to mediate important coping strategies that lead to posttraumatic growth
and spiritual transformation.
We recognize that many people experience enduring negative symptoms
as a result of trauma, such as posttraumatic stress symptoms and other
serious declines in health. The respectable body of research
demonstrating the potential deleterious effects of trauma for
individuals and communities has advanced our clinical acumen in treating
those who have endured such experiences. Likewise, many who have
encountered traumatic life events have experienced spiritual and
religious crises that are not easily resolved. Some lose their faith in
a God who could allow such experiences to happen to them or to those
they love. From a strengths-based perspective, we hope that
investigating factors that may contribute to psycho-spiritual growth
following traumatic events will lead to greater insights about how to
lessen some of the harmful effects of trauma and encourage genuine
transformations (Roberts, 2005).
The Current Study
The purpose of this study was to explore the role of spirituality
in the lives of earthquake survivors in Haiti. More specifically we were
interested in learning about how people's interaction or
involvement with the transcendent influenced their ability to experience
psychological and spiritual growth following the earthquake.
Posttraumatic Growth and Spiritual Transformation
Posttraumatic growth research indicates that trauma does not
necessarily lead to deleterious outcomes alone, but that for many
individuals trauma activates a desire for growth and change (Karanci
& Erkam, 2007). For some, the crisis of trauma thrusts them into a
state of disequilibrium in which their previous ways of understanding
and coping in the world are no longer sufficient, thus facilitating a
process of re-evaluation and reemergence (Greene, Lee, Trask, &
Rheinscheld, 2005; Sigmund, 2003). Likewise, research has indicated that
when individuals encounter traumatic life events, the spiritual aspects
of these individuals' worldviews may become threatened, triggering
a spiritual struggle in which the individuals are thrust into a position
of either conserving or transforming their spirituality (Pargament,
Murray-Swank, et al., 2005; Pargament, Magyar, Benore, & Mahoney,
2005). Mental health and spirituality are intertwined such that a
transformation in one's spirituality necessarily transforms many
aspects of one's psychological well-being and vice versa. Research
has found that although spiritual transformation and posttraumatic
growth are differing constructs, they have strong associations with one
another (Sigmund, 2003). Therefore, it can be assumed that trauma has
the potential to transform people's spirituality in
health-promoting ways. Testing this assumption has important clinical
applications for both counselors and clergy members who may be called
upon to assume the role of counselor when access to mental health
professionals is limited. Thus, we were interested in investigating the
relationship of a number of psycho-spiritual variables with both
posttraumatic growth and spiritual transformation. Posttraumatic growth
is not easily detected immediately following a traumatic event; in fact,
some longitudinal research suggests a timeframe of six months or more
needs to pass after a loss before meaning-making and potential
benefit-finding can occur (Davis, Nolen-Hoeksema, & Larson, 1998;
Park, Cohen, & Murch, 1996). Therefore, we opted to conduct our
study six months following the earthquake, assuming this time frame
allowed adequate time for individuals to demonstrate posttraumatic
growth or decline.
Relational Perspective of Spirituality. The aims of the study were
to explore the relationship of individuals' daily interaction with
the transcendent and their propensity towards psycho-spiritual
transformation following a large-scale disaster. There have been some
studies that have investigated the relationship between posttraumatic
growth and religious and spiritual coping, religious virtues, religious
social support, religious beliefs, and meaning making (Shaw, Joseph,
& Linley, 2005). However, we were interested in exploring
posttraumatic growth and spiritual transformation from a relational
perspective. To gain understanding about the impact of people's
relationship with the sacred in times of trauma, we chose measures that
tapped into experiences with the transcendent rather than assessment of
spiritual beliefs and behaviors. We selected a scale that measured
individuals' substantive thoughts and feelings about their
perceived interaction with a higher power in everyday life (Daily
Spiritual Experiences Scale; Underwood & Teresi, 2002). As the
majority of Haitians are theistic (Roman Catholic 80%, Protestant 16%,
none 1%, other 3%; CIA: The World Factbook, 2010), we determined that
considering spirituality in terms of individual's relationship with
"God" was appropriate for our population and consistent with
the aims of the study.
Subsequently, we wondered if the nature and degree of
individuals' perceived relationship with God would affect whether
or not they experienced growth and/or spiritual transformation following
disaster trauma. Along with a measure that assessed individuals'
perceived relationship with transcendence more generally, we also chose
a scale that measures individuals' relationship with God
specifically (Spiritual Assessment Inventory; Hall & Edwards, 1996,
2002). We hypothesized that those who perceived positive involvement and
interaction in their relationship with God would experience
psychological growth and spiritual transformation despite the nature and
severity of their losses.
Finally, analysis of the Spiritual Transformation Scale
demonstrated that spiritual transformation and posttraumatic growth were
distinct constructs, with some correlation with one another (Underwood
& Teresi, 2002). We were interested in investigating both the
relationship of spiritual transformation with posttraumatic growth as
well as considering spiritual transformation and posttraumatic growth as
distinctly separate outcome variables. We were also interested in
exploring if our sample had encountered specific religious and spiritual
experiences during the earthquake, so we included such questions in our
design.
Methods
Participants
The participants were adult male and female Haitians (N = 108) who
were living in Haiti at the time of the earthquake on January 12, 2010.
The sample consisted of 64 females and 44 males, with ages ranging
between 15 and 73, and a mean age of 30.2 years. Participants were
recruited from Port-au-Prince, Jacmel, and Pitionville, Haiti. All
locations surveyed were impacted by the earthquake. All participants
experienced some degree of loss (e.g., loss of family members, health,
job, home, school, vocation, etc.).
Procedures
Participants were solicited six months after the earthquake from
local church communities, a secondary school, and a tent
community--locations where participants were receiving assistance to
cope with the effects of the earthquake in their lives. Materials were
completed in groups of 10-20 volunteers, with a few exceptions in which
volunteers completed the survey packets individually. As quantitative
questionnaire formats are mainly a Western-European concept most
participants were unfamiliar with a Likert-type scale format of sharing
their experiences. Prior to filling out the survey packets, participants
were given a brief description of the quantitative survey process,
including instruction about the process of responding to Likert-type
scale questions.
Measures
Five individual surveys were presented to the participant. The
first measure, The Daily Spiritual Experience Scale (DSES; Underwood
& Teresi, 2002), is a 16-item, 6-point Likert scale that was
designed to measure everyday, ordinary spiritual experience rather than
particular beliefs or behaviors. Some sample items include: "I feel
guided by God in the midst of daily activities." "I experience
a connection to all life." "I feel God's love for me,
through others."
The Spiritual Assessment Inventory (SAI; Hall & Edwards, 1996,
2002) is a relationally based, 54-item, 5-point Likert scale. The SAI is
designed to assess two dimensions of spiritual development: Awareness of
God and Quality of Relationship with God. The measure consists of five
subscales: Awareness (e.g., "I am aware of God attending to me in
times of need"), Disappointment (e.g., "I feel betrayed by
God"), Grandiosity (e.g., "I seem to be more gifted than most
people in discerning God's will"), Realistic Acceptance (e.g.,
"When [God disappoints me] I still have the sense that God will
always be with me") and Instability (e.g., "My emotional
connection with God is unstable").
The Inventory Loss scale has three items that assess injury to self
and/or family members, damage to housing, and degree of threat.
Additionally, two open-ended items were included in the Inventory Loss
portion of the survey packet: "Please describe your losses: and
"Please describe how the disaster has affected your
spirituality"
The Posttraumatic Growth Inventory Short Form (PTGI-SF; Tedeschi
& Calhoun, 1996), is a 10-item, 6-point psychological assessment
Likert scale. The PTGI is designed to measure positive outcomes reported
by people who have experienced traumatic life events. Items include
questions such as: "I am more likely to change things that need
changing." "I discovered that I'm stronger than I thought
I was."
The Spiritual Transformation Scale (STS; Cole, et al., 2008) is a
32-item, 6-point Liken scale of spiritual growth and transformation.
This scale assesses individuals' perception of their spiritual
movement over time (e.g., "Spirituality has become more important
to me." "I more often have a sense of gratitude." "I
am more spiritually wounded.").
Eight individual items that assessed spiritual and religious
resources and experience were included in the demographic portion of the
survey packet. They were preceded by a statement of informed consent,
and questions about the participants' demographic information. The
survey packets, originally in English, were translated into French by a
local Haitian fluent in English and trained as a translator. The surveys
were then reviewed for accuracy by a French-speaking, U.S. citizen.
Results
Correlates of Spiritual Variables and Posttraumatic Growth
A bivariate correlational analysis was conducted to explore
zero-order correlations among the variables of interest in our five
surveys (DSES, PTGI-SF, STS, five subscales of the SAI, and the three
Inventory Loss questions). As illustrated in Table 1, significant
correlations were found between the total scores for Daily Spiritual
Experiences (DSE) and Posttraumatic Growth (PTGI) (r = .35, p <
.001); SAI awareness (r = .32, p < .01); SAI realistic (r = .28, p
< .01); and STS (r = .32, p < .01). In addition, PTGI was
significantly correlated with SAI awareness (r = .38, p < .001) and
STS (r = .42, p < .001). Significant correlations were also indicated
between STS and SAI awareness (r = .40, p < .001); and SAI
grandiosity (r = .24, p > .05). Inventory Loss Total correlated
significantly only with one variable, SAI disappointment (r = .26,p <
.01). In summary, high scores in positive and realistic perceptions and
expectations of God's awareness of and involvement in their lives
correlated positively with posttraumatic growth and spiritual
transformation, as did a sense of "being special or better
than." Those with greater amounts of loss also had a greater sense
of disappointment in their relationship with God, and as expected, there
was a positive relationship between posttraumatic growth and spiritual
transformation.
TABLE 1 Intercorrelations Between Resource Loss and Religious
Variables Related to Posttraumatic Growth (PTG, in Haitian
Earthquake Survivors
Measures 1 2 3 4 5 6
l. DSEtotal 1.00 .35 *** .32 ** -.004 -.007 .28 **
2. PTGItotal -- 1.00 .38 ** -.119 .27 ** .16
3. SAIawareness -- 1.00 -.142 .32 ** .37 ***
4. SAIdisappointment -- 1.00 .15 .24*
5. SAIgrandiosity -- 1.00 .10
6. SAIrealistic -- 1.00
7. SAIinstability --
8. STStotal
9. ResourceLossTotal.
Measures 7 8 9
l. DSEtotal -.037 .32 ** -.092
2. PTGItotal .12 .42 *** -.055
3. SAIawareness .11 .40 *** .08
4. SAIdisappointment .31 ** .08 .26 **
5. SAIgrandiosity .25 ** .24 * .17
6. SAIrealistic .40 *** .11 .006
7. SAIinstability 1.00 .11 .09
8. STStotal -- 1.00 .11
9. ResourceLossTotal. -- 1.00
Note. N = 108.
* p < .05, two-tailed.
** p < .01 (two-tailed).
*** p < .001 (two-tailed).
Gender Differences in Spiritual
Variables One-way analyses of variance (ANOVAs) were conducted to
explore the effects of gender and marital status. Analyses showed a
significant effect for gender on DSE, F(1, 101) = 5.23, p < .05 [p =
.024]; also for STS, F(1, 101) = 9.66, p < .01 [p = 002]. No
significant results for the effect of marital status for any of the
variables emerged. Post hoc analyses using Tukey's post hoc
criterion for significance indicated that women scored significantly
higher on DSE (M = 68.83, SD = 11.75) than men = 64.59, Si) = 8.90 ),
F(1, 106) = 4.10, p < .05. Post hoc analysis also indicated that
women also scored higher on STS (M = 157.91, SD = 30.12) than men (M =
143.39, SD = 24.42 ), F(1, 106) = 7.04, p < .01. Women scored higher
on a measure of individuals' substantive thoughts and feelings
about their perceived interaction with a higher power in everyday life
and on overall spiritual transformation than did their male
counterparts.
TABLE 2 Means and Standard Deviations fir Psychospiritual
Variables, Posttraumatic Growth, and Resource Loss by
Gender/hr Haitian Earthquake Survivors (N = 108)
Men Women
(n = 44) (n = 64)
M SD M SD
DSEtotal 64.59 8.92 68.83 11.75 *
PTGItotal 43.75 8.90 43.75 8.92
SAIawareness 72.89 9.89 75.48 7.17
SAIdisappointment 13.93 5.93 14.31 4.80
SAIgrandiosity 18.86 4.71 19.84 5.04
SAIrealistic 26.20 4.31 26.09 4.79
SAIinstability 26.52 6.41 25.67 5.25
STStotal 143.39 24.41 157.91 30.12 *
ResourceLossTotal 3.64 1.69 3.80 1.60
* p. <.05
Predictors of Posttraumatic Growth and Spiritual Transformation
A series of hierarchical regression models were conducted. The
first hierarchical multiple regression (forced-entry) was conducted for
the dependent variable, Posttraumatic Growth, analyzing in order the
total scores for Resource Loss, Daily Spiritual Scale, each of the five
subscales for the Spiritual Awareness Inventory ("SAT
awareness," "SAI disappointment," "SAI
grandiosity," SAI realistic," and "SAI
instability"), and the Spiritual Transformation Scale as the
independent variables. In Step 1, Resource Loss was entered; in Step 2,
the scores for DSE; in Steps 3-7, the five SAI subscale totals were
entered in the order listed above; and in Step 8, the STS total scores.
R differed significantly from zero in Steps 2, 3, 5, and 9. In Step 2,
after DSE was added to Resource Loss, DSE added 12% of the explained
variance to PTGI, [R.sup.2] = .12, F(2, 105) = 7.24, p < .001. In
Step 3, which added SAI awareness to Resource Loss and DSE, SAI
awareness contributed an additional 8% of explained variance to PTGI,
[R.sup.2] = .20, F(3, 104) = 8.56, p < .01). After the five SAI
subscale scores were entered in Steps 4-8, only SAI grandiosity
contributed a modest additional explained variance of .5%, [R.sup.2] =
.25, F(5, 102) = 6.91; in Step 9, STS also only contributed just .5%
additional variance, R2 = .26, F(8, 99) = 5.73, p < .01 (See Table
3). These results suggest that practices of daily spiritual experiences
predict 12% of the variability in posttraumatic growth, with SAI
awareness contributing an additional 8% to the prediction. Thus,
individuals' substantive thoughts and feelings about their
perceived interaction with a higher power in everyday life and their
perception of God's awareness explained a significant amount of
variance in posttraumatic growth above and beyond the degree of loss
experienced.
TABLE 3 Summary of Hierarchical Regression Analysis for
Psychospiritual Variables of Posttraumatic Growth (N = 108)
Variable B SEB [beta] R
Step 1 ResourceLossTotal -.30 .53 -.06 .055
Step 2 ResourceLossTotal -.12 .50 -.02
DSEtotal .20 .08 .25 *** .348
Step 3 ResourceLossTotal -.28 .48 -.05
DSEtotal .20 .08 .25 **
SAIawaueness .31 .10 .29 ** .445
Step 4 ResourceLossTotal -.17 .50 -.03
DSEtotal .21 .08 .26 **
SAIawarcncss .30 .10 .28 **
SAIdisappointment .18 .16 -.06 .450
Step 5 ResourceLossTotal -.31 .49 -.06
DSEtotal .22 .08 .27 **
SAIawaueness .20 .10 .19 *
SAidisappointment -.18 .15 -.11 **
SAIgrandiosity .44 .17 .24 .503
Step 6 ResourceLossTotal -.31 .50 -.06
DSEtotal .22 .08 .27 **
SAIawareness .20 .11 .19
SAIdisappointment .18 .16 -.11
SAIgrandiosity .44 .17 .24 **
SAIrealisric .00 .19 .00 .503
Step 7 ResourceLossTotal -.30 .50 -.06
DSEtotal .24 .08 .29
SAIawarcncss .21 .11 .20 **
SAIdisappointment -.22 .17 -.13
SAIgrandiosity .40 .17 .22 *
SAIrealistic .01 .21 -.04
SAIinstabilitv .18 .16 .12 .513
Step 8 ResourceLossTotal -.39 .48 -.07
DSEtotal .18 .08 .22 *
SAIawareness .12 .11 .12
SAIdisappointment -.27 .16 -.16
SAIgrandiosity .33 .17 .18 *
SAIrealistic .002 .20 -.001
SAIinstability .15 .15 .10
STStotal .08 .03 .27 ** .563
Note. Step 1: [R.sub.2] = .003 (p = ns), adjusted [R.sub.2] =
-.006; Step 2: [DELTA][R.sub.2] = .118 (p <.001), adjusted
[R.sub.2] = .104; Step 3: [DELTA][R.sub.2] .077 (p < .01),
adjusted [R.sub.2] = .175; Step 4: [DELTA][R.sub.2] = .004 (p =
ns), adjusted [R.sub.2] = .171; Step 5: [DELTA][R.sub.2] = .051 (p
< .01), adjusted [R.sub.2] = .217; Step 6: [DELTA][R.sub.2]
.000 (p ns), adjustcd [R.sub.2] = .209; Step 7: [DELTA][R.sub.2] =
.010 1 (p = ns), adjusted [R.sub.2] = .2 12; Step 8: [DELTA]
[R.sub.2] = .053 (p < .01), adjusted [R.sub.2] = .261.
ResourceTotalLoss = sum of Earthquake damage to home + sense of
life in danger + injuries to self and/or others; DSEtotal = Daily
Spiritual Experiences Scale total score; = SAIawareness,
SAIdisappointment, SAIgrandiosity, SAIrcalistic, and SAIinstability
= five subscale totals of the Spritual Assessment Inventory (SAI);
and STStotal ss total score. * p < .05, two-tailed test. ** p
< .01, two-tailed test.
*** p < .001, two-tailed test.
The second hierarchical multiple regression repeated the same
sequence of analyses with STS as the dependent variable. In this
seven-step regression, only Steps 2 and 3 contributed additional unique
variance to STS. Step 2, which added DSE to Resource Loss, contributed
an additional 11%, [R.sup.2] = .13, F(2, 105) = 7.55, p < .001. Step
3, which added SAI awareness, contributed an additional 7% of explained
variance, [R.sup.2] = .20, F(3, 104) = 8.59, p < .01 (see Table 4).
None of the subsequent variables added any significant variance. These
results provide further evidence suggesting that daily spiritual
experiences and spiritual awareness contribute an additional 18% of
explained variance to spiritual transformation. Thus, individuals'
substantive thoughts and feelings about their perceived interaction with
a higher power in everyday life and their perception of God's
awareness explained a significant amount of variance in ST above and
beyond the degree of loss experienced.
TABLE 4 Summary of Hierarchical Regression Analysis for
Psychospiritual Variables of Spiritual Transformation (N = 108)
Variable B SE B [beta] R
Step 1 ResoureeLossTotal 1.99 1.70 .11 .225
Step 2 ResoureeLossTotal 2.54 1.62 .14
DSEtotal .89 .24 .34 *** .367
Step 3 ResourceLossToral 2.05 1.57 .12
DSEtotal .65 .25 .24 **
SAIawareness .97 .32 .29 ** .452
Step 4 ResoureeLossTotal 1.53 1.63 .09
DSEtotal .62 .25 .24 *
SAIawareness 1.04 .32 .31 **
SAIdisappointment .38 .50 .11 .457
Step 5 ResoureeLossTotal 1.26 1.62 .07
DSEtotal .66 .25 .25 **
SAIawareness .86 .34 .25 *
SAIdisappointment .45 .51 .15
SAIgrandiosity .89 .55 .15 .505
Step 6 ResoureeLossTotal 1.06 1.62 .06
DSEtotal .71 .25 .27 **
SAIawareness 1.04 .36 .31 **
SAIdisappointment .69 .53 .13
SAIgrandiosity .87 .55 .15
SAIrealisric -.55 .63 -.14 .505
Step 7 ResoureeLossTotal 1.07 1.63 .06
DSEtotal .74 .25 .28 **
SAIawareness 1.05 .36 .31 **
SAIdisappointment .62 .55 .11
SAIgrandiosity .78 .56 .13
SAIrealistic -1.01 .68 -.16
SAIinstability .35 .51 .07 .516
Note. Step 1: [R.sub.2] .013 (p = ns), adjusted [R.sub.2] = .003;
Step 2: [DELTA][R.sub.2] = .113 (p < .001), adjusted [R.sub.2]
=.109; Step 3: [DELTA][R.sub.2] = .073 (p <.01), adjusted
[R.sub.2] = .175; Step 4: [DELTA][R.sub.2] = .010 (p = ns),
adjusted [R.sub.2] = .178; Step 5: [DELTA][R.sub.2] = .020 (p = ns),
adjusted [R.sub.2] = .191; Step 6: [DELTA][R.sub.2] .013 (p ns),
adjusted [R.sub.2] = .197; Step 7: [DELTA][R.sub.2] = .004 (p =
ns), adjusted [R.sub.2] .193. ResourccTotalLoss = sum of Earthquake
damage to home + sense of life in danger + injuries to self and/or
others; DSEtotal = Daily Spiritual Experiences Scale total score;
and SAIawareness, SAIdisappointment, SAIgrandiosity, SAIreafistic,
and SAIinstabiiity = five subscalc totals of the Spritual
Assessment inventory (SAl). * p < .05, two-tailed test. ** p
< .01, two-tailed test. *** p < .001, two-tailed test.
Frequency of Spiritual and Religious Experiences
Frequencies analyses were conducted on three of the demographic
questions intended to explore potential changes in relationship with
God/a higher power since the earthquake and/or experiences of God's
inspiration during the earthquake. Results indicated that 80% of people
agreed or strongly agreed with the statement, "My faith in a God/
higher power has grown since the earthquake," 71% said that they
practice their religion more regularly since the earthquake, and 52%
indicated that their faith community helped them cope with the
earthquake. On the other hand 23% of participants agreed or strongly
agreed that they felt more distant from God/a higher power since the
earthquake and 20% indicated that they were less spiritual since the
earthquake. In addition, 82% agreed or strongly agreed that they have
felt God's inspiration during or following the earthquake.
Discussion
The 2010 earthquake in Haiti left an unprecedented amount of
destruction in its wake. Two years after the devastating earthquake,
people are still in need of basic necessities such as water, food, and
security. The hardship of recovery and reconstruction was intensified by
a persisting cholera epidemic. Furthermore, much energy has been
invested in security efforts since the "rule of law" in Haiti
is particularly weak. The results of our study do not in any way negate
the loss and suffering, but rather help us understand how some of the
people in Haiti were able to rise above the tragedies and experience
posttraumatic growth and positive spiritual transformation. The majority
of participants reported that their faith in a higher power increased
following the trauma and that they felt a renewed interest in practicing
their religion. It was also of interest that the vast majority of
participants reported that they felt God had inspired them during and
following the trauma. This is illustrated by a response to an open-ended
question in the survey packet: How has the earthquake affected your
spirituality? The participant replied by stating, "The earthquake
has not affected my spirituality; on the contrary, it has reinforced it.
If not for the strong hand and power of God, my son would be dead. My
faith increases over time."
Women scored higher on a measure of individuals' substantive
thoughts and feelings about their perceived interaction with a higher
power in everyday life and on overall spiritual transformation than did
their male counterparts. We did not find significant gender differences
in posttraumatic growth, suggesting that both genders experienced equal
levels of posttraumatic growth, but that women tended to grow more
spiritually following the trauma. The finding that women tended to
experience a greater degree of positive spiritual transformation is not
surprising given that women tend to score higher on measures of
spirituality in general and endorse more personal experiences with a
higher power (i.e., Skarupski, Fitchett, Evans, & de Leon, C. 2010).
We also found that Spiritual Transformation and Posttraumatic
Growth themselves are positively correlated, suggesting the key role
that spirituality might play in transforming a traumatic event from a
moment of destructiveness to a moment of challenge and new perspective.
Additionally, people's perceptions of God's ongoing
involvement in their lives, their view that God is aware of and
responsive to them, and their sense of "specialness" to God
significantly contributed to their psychological growth and spiritual
transformation. This finding suggests that those who feel God is near
them and considers them to be special were able to draw upon these
beliefs to propel them through their adversity in growth-promoting ways.
Less surprising, people's perception of God's awareness of
them and God's involvement in their lives contributed towards their
spiritual transformation following the trauma. It is likely that
participants found comfort and a sense of direction from a connection
with spiritual transcendence and specifically in a relationship with God
(O'Grady & Richards, 2007).
Additionally, since posttraumatic growth includes the process of
meaning-making following traumatic events, individuals who consider
their spirituality as important may gain significant support from their
spiritual beliefs. Spirituality is frequently employed to help make
sense of or to instill meaning in people's suffering. Posttraumatic
growth is a process of regaining meaning following a distressing ordeal;
therefore, for individuals who view spirituality as a central
meaning-making component, a relationship with God may present a channel
through which meaning reconstruction can take place.
In light of the trauma experienced by these Haitian participants in
the aftermath of the earthquake, we see that not all people experience
positive transformation following disaster. Not surprisingly, those who
suffered greater amounts of loss reported a greater sense of
disappointment, frustration, and betrayal in their relationship with
God; however, these feelings did not seem to significantly impact their
overall psychological and spiritual transformation. Some participants in
our study indicated that they felt more distant from God and less
spiritual following the trauma of the earthquake. For instance, one
participant stated, "After the disaster I felt a little hopeless
and alone, Traumatized also." However, the overall findings of
growth, rather than decline, found in this population are worth
consideration; other study populations have not produced such optimistic
findings (Connor, Davidson, & Li-Ching, 2003; Deal et al., 2012). In
interpreting these findings it is important to consider the influence of
community trauma and recovery in comparison to more individual or
isolated experiences of trauma. Collective suffering and recovery may
serve as a protective factor against trauma events. Likewise, cultural
factors involved with the study populations may significantly influence
the outcome of traumatic events in the lives of survivors.
Cultural Considerations
To avoid transposing meaning onto the findings of a population,
researchers should be sensitive to cultural interpretations that may
differ from their own. For instance, our findings about the relationship
between posttraumatic growth and grandiosity may seem surprising
initially and deserve further consideration. The SAI subscale of
Grandiosity is intended to be a measure of pathology, and
diagnostically, the field of mental health generally tends to view such
narcissistic patterns in a negative light. However, some theoretical
perspectives are inclined to distinguish between healthy and unhealthy
narcissism, with the former serving to bolster the sense of personal
identity and to protect the self against perceived threats (Camassa
& Negri, 2009; Knox, 2003).
In light of Haiti's complex history of slavery, oppression,
and revolution, this theme of grandiosity may be reflecting just that.
The Haitian people have experienced "a 'disavowed'
modernity ... of negation, repression, disidentification, and
denial" (Drexler, 2008, p. 454). At the risk of over-simplifying an
intricate cultural phenomenon, this finding may be in part a result of
the Haitian people, over time, developing psychic defenses to protect
themselves against the perpetual barrage of personal exclusion by their
oppressors. Given the key role that their spiritual and religious
orientations play in the Haitian people's daily lives (Daut &
Richman, 2008; Desmangles, 1979; Richman, 2007), it is not surprising
that a protective mechanism such as spiritual grandiosity would emerge
as a significant mitigating factor of traumatic stress. Moreover, some
of the spiritual practices of the Haitian culture further lend
themselves to an individual's sense of "special access"
to God, thereby buttressing any Western measures of this perceived
grandiosity (Johnson, 2006). Participants also seemed to garner feelings
of "specialness" from being a survivor, as illustrated in the
following participant quote,
All that has happened to me has affected my spirituality. I believe
that the earth is desperate, and I realize that my life was not
destroyed because I need to finish certain tasks that God has asked
me to do.
This sense of grandiosity may help alleviate tendencies towards
survivor's guilt and promote a sense of purpose for one's
future.
Participants in our study were African Caribbean, similar to those
in the Bhui et al. (2008) study reported above. It is interesting to
note the consistencies in the findings about relationship with God and
religious coping between the two studies. The current study and the Bhui
et al. (2008) study both found that the perception of an involved and
trusting relationship with God promoted healthy coping in times of
trauma. The emergence of grandiosity in our study demonstrates the need
to consider study findings in a culturally sensitive way, including the
importance of fostering an ongoing curiosity about the links between
cultural peculiarities and unique study findings. The similarity in our
findings to those of other African Caribbean cultures informs the
interpretation of the findings and the consideration of future research
directions, and reminds those researchers studying in the fields of
psychology and spirituality of the need to gather data from diverse
populations.
Suggestions for Future Studies
This brief examination of some of the cultural dynamics of the
Haitian population reveals the importance of further demographic
exploration. In both the collection and analyses of our data we are
aware of possible cultural limitations to our study. The questionnaires,
although translated into French, are likely to contain foreign cultural
concepts or unfamiliar perceptions. The Haitian people's very
perceptions of "faith" and "spirituality" are
undoubtedly nuanced and particular to a culture that may not have the
same distinctions common in our Western presumptions.
As just one example, we were aware that "roughly half of the
[Haitian] population practices voodoo," most alongside their
professed and predominantly Christian faith (CIA: The World Factbook,
2010). We chose not to assess the role of voodoo in individual's
experiences with the earthquake, because many Haitians find questions
posed by Western researchers about their voodoo practices to be
offensive, and as noted, most Haitians who do adhere to voodoo beliefs
and practices also adhere to monotheistic belief systems as well.
Despite the lack of demographic information about adherence to this
practice for the study population, it is possible a heritage of voodoo
practices influenced the way participants responded to the survey
questions. This possibility could still be considered when attempting to
interpret results, if done so in a non-stereotypical and culturally
sensitive manner (Potter, 2009).
Future studies hold the potential to explore more explicitly these
cultural differences, as well as follow up in a longitudinal fashion the
dynamic progression of the population's posttraumatic growth.
Additionally, our study had a small sample size, although comparable to
similar studies of disaster populations. We hope our findings will be
tested in other disaster populations with larger sample sizes. For
instance, replicating this study with survivors of the tornadoes in the
U.S. and the earthquake and tsunami of Japan could provide opportunities
for cross-cultural comparisons. Future studies might also include the
investigation of the relationships between spirituality and PTSD in
community disaster populations six to eighteen months following the
disaster.
Further, we believe that quantitative measures have the potential
to impose a framework of meaning that is inconsistent with the cultural
background of those under investigation. Therefore, qualitative
investigation may be more appropriate for the study of posttraumatic
growth and spiritual transformation in populations unfamiliar with the
'Western scientific tradition of reporting experiences in a
numerical manner, and for accessing some of the rich data that are not
as obtainable through quantitative approaches. We recommend that future
research be conducted on community trauma survivors through culturally
sensitive qualitative approaches.
Implications for Research and Practice
The findings from this study support previous research that
suggests that trauma can be an impetus for spiritual growth and renewal,
and that some people perceive and value God's involvement during
times of trauma. Study findings also support our hypothesis that
individuals who perceived positive involvement and interaction in their
relationship with God would experience growth and spiritual
transformation despite the nature and severity of their losses.
This study also has important clinical implications. We encourage
counselors and psychotherapists to explore clients' relationships
with God and the impact of this relationship on their trauma recovery
and spiritual transformation. Based on our study, clients who believe
that God is mindful of them and interacts with them in positive and
consistent ways may be more equipped to handle traumatic life events in
psychologically healthy ways than those who experience God as more
distant. When working with theistic clients, counselors and
psychotherapists should invite clients to discuss their feelings and
perceptions about God's interaction in clients' lives during
past trauma events. If clients express disappointment in God, or
distance from God during the trauma, psychotherapists may wish to
explore these experiences more thoroughly, and when appropriate, discuss
possible ways to reframe those experiences, or to make meaning from
those experiences that foster more complex and potentially positive
perceptions of the role of God during difficult times. Our study
findings also support the need for a contextual understanding of the
spiritual language of the client. Psychotherapists and counselors should
be careful not to assume that their understanding of spiritual terms and
concepts is the same as their clients, but rather invite clients to
explicitly define and describe spiritual constructs from their own
cultural perspective.
The broader implications of this study may advance mental health
assistance, with attention to spirituality as a necessary element of
relief efforts. These findings may also prove helpful in formulating a
culturally sensitive and collaborative model for training clergy as
mental health "helpers" in populations where mental health
professionals are limited or unavailable.
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Author Information
O'GRADY, KARI A. PhD. Address: Pastoral Counseling Department,
8890 McGaw Road Suite 380N, Columbia, MD 21045. Email:
[email protected]. Title: Assistant Professor, Pastoral Counseling
Department. Degrees: BS, Brigham Young University; PhD (Counseling
Psychology) Brigham Young University. Specializations: integration of
spirituality & psychology and counseling/ psychotherapy.
ROLLISON, DEBORAH G. PhD. Address: 1232 Windmill Ln, Silver Spring,
MD 20905 [or use Loyola Address: Pastoral Counseling Department, Loyola
University Maryland, 8890 McGaw Rd., Suite 380, Columbia, MD 21045].
Title: Affiliate Faculty Member, Loyola University Maryland; Pastoral
Counselor, Ft. Meade Family Life Center and Safe Harbor Christian
Counseling. Degrees: PhD, MS (Pastoral Counseling) Loyola University,
MD; MA (Management & Supervision) Central Michigan University; BA,
Catholic University of America. Specializations: Applied gratitude,
including as a potential buffer for stress; grief, loss, &
bereavement; career transition and counseling; issues of faith &
meaning in times of trauma.
HANNA, TIMOTHY S. Email:
[email protected]. Title: PhD
Candidate--Pastoral Counseling, Loyola University Maryland. Degrees: MS
(Pastoral Counseling) Loyola University Maryland; MTS (Theology) Weston
Jesuit School of Theology; BA (Psychology) University of South Florida;
BS (Microbiology) University of Florida. Specializations: none at this
time.
SCHREIBER-PAN, HEIDI. Email:
[email protected]
RUIZ, MANUEL A. Address: 8715 1st. Ave., #429C. Silver Spring, MD
20910-3534. Email:
[email protected]. Title: Counseling Program
Coordinator at the Family Crisis Center of Prince George's County.
Degrees: MA (Pastoral Counseling) Loyola University Chicago;BS
(Psychology) Pontificia Universidad Javeriana, Bogota, Colombia.
Specializations: intimate partner violence (IPV).
