Post-Traumatic Growth in Cancer Survivors: Narrative Markers and Functions of The Experience's Transformation

Nowadays it is a general opinion that oncological illness leads to a traumatic experience (Burke & Sabiston, 2012; Cordova et al., 2007; Sumalla, Ochoa, & Blanco, 2009; Freda & Martino, 2015). The onset of an oncological illness forces the patient to face a strenuous therapeutic process, which according to the cancer staging and location may require local surgery (operation and radiotherapy) or systemic treatment (chemo and hormone therapy). Cancer is a traumatic experience of specific and peculiar nature, owing to the difficulty of recognizing: a unique stressful event, the internal triggering process, its temporal continuity (hereditary or possible relapse) (Mehnert & Koch, 2007). The psychological trauma, which may occur as a result of such a severely distressing event, in this case the communication of diagnosis (De Luca Picione, Dice, & Freda, 2015), within a socio-constructivist and semiotic perspective (Salvatore & Freda, 2011), is due to: the sudden and unexpected alteration of the basic elements governing the relation between the patient and the external world (Freda, De Luca Picione, & Martino, 2015; Janoff-Bulman, 2004; Joseph & Linley, 2005) and the interruption of the temporal continuity resulting in a crisis of meaning processes that support the personal self-narrative of life (Bonomi, 2003; Brockmeier, 2000; Frank, 1998; Martino, Onorato, & Freda, 2015; Margherita, Troisi, & Nunziante Cesaro, 2014; Neimeyer, 2004, 2006). During the last fifty years, the research activity has had its focus on the pathological outcomes which this traumatic event generates (Joseph & Linley, 2005; Lindstrom & Triplet, 2010; Norris & Sloane, 2007). Only recently, the research moved away from analysing the negative changes placing emphasis on the need of a better understanding of the positive ones. It was realized that such a traumatic experience could also deliver the possibility of improving life, relationships, health and well-being. The possibility that traumatic events may lead to a positive change/transformation has been named "post traumatic growth" (PTG; Calhoun & Tedeschi, 2004, 2006). This construct offers a better comprehension of the consequences of a severely traumatic event, pointing out the positive possible changes, although it is well known that the negative changes must be also taken into account (Hussain & Bhushan, 2013; Janoff-Bulman & Yopyk, 2004; Lindstrom & Triplet, 2010). The positive changes, to which this construct refers, are meant to deal with the three main domains of life: improvements in self, improvements in interpersonal relationships, and enhanced spiritual or religious experiences (Tedeschi & Calhoun, 2004). Until recently, much research has been undertaken by using quantitative methods (Barakat, Alderfer, & Kazak, 2006). A comparison between cancer survivors with a selected sample of healthy people highlights that the former show a general growth against the latter in many aspects (Tomich, Helgeson, & Nowak Vache, 2005). The PTG-process cannot be seen as a natural psychological development. That can only happen in the aftermath of a traumatic event, although it could still fail in case that this traumatic event would not be felt as a traumatic experience (Margherita & Troisi, 2013; Martins da Silva, Moreira, & Canavarro, 2011). The positive changes experienced by the cancer survivors are mainly due to more specific goals in appreciation of life and its priorities, the revaluation of oneself, a new awareness and relationship with the body, and a new spirituality. These changes are: a greater sense of self-efficacy and mastery in difficult situations, a greater appreciation of interpersonal relationships, a new sense of altruism and empathy with people in difficulty, and a reorganization of the time line (Barakat, Alderfer, & Kazak, 2006; Hefferson, Grealy, & Mutrie, 2009; Lindstrom & Triplett, 2010). …