# Finding meaning in the meaningless. How narrative meaning-making relates to post-traumatic growth and post-traumatic stress disorder in victims of the Strasbourg Christmas market attack

Amaury Mengin, Pierre Orselli, Floriane Lalaus, Julie Rolling, Pierre Vidailhet, Fabrice Berna

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Amaury Mengin, Pierre Orselli, Floriane Lalaus, Julie Rolling, Pierre Vidailhet, et al. Finding meaning in the meaningless. How narrative meaning-making relates to post-traumatic growth and post-traumatic stress disorder in victims of the Strasbourg Christmas market attack. Journal of Psychiatric Research, 2025, 186, pp.354-363. 10.1016/j.jpsychires.2025.04.037. hal-05394751

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# Finding meaning in the meaningless. How narrative meaning-making relates to post-traumatic growth and post-traumatic stress disorder in victims of the Strasbourg Christmas market attack ☆

Amaury C. Mengin<sup>a,b,c,d,*</sup> <sup> ID </sup>, Pierre Orselli<sup>c,e</sup>, Floriane Lalaus<sup>c,e</sup>, Julie Rolling<sup>a,b,d,f</sup>, Pierre Vidailhet<sup>a,b,c,d</sup>, Fabrice Berna<sup>a,c,d ID</sup>

## ARTICLE INFO

**Keywords:**

Meaning-making

Post-traumatic growth

Post-traumatic stress disorder

Terrorist attack

Autobiographical reasoning

## ABSTRACT

**Background:** Traumatic events may deeply modify one's views on oneself, others and the world. Finding meaning after traumatic events may be determinant to psychological adjustment and post-traumatic growth.

**Objectives:** Our study aims at investigating the association of narrative meaning-making with post-traumatic growth and post-traumatic stress disorder among individuals exposed to a terrorist attack.

**Methods:** We recruited participants exposed to December 2018 Strasbourg Christmas market attack. The participants narrated three memories: their experience of the terrorist attack (TAM) and two self-defining memories (SDMs). Each narrative was assessed in terms of meaning-making. A total meaning score was calculated to express the cumulated presence of meaning in the three memories. Post-traumatic growth and PTSD were assessed by the Post-traumatic Growth Inventory (PTGI) and the Post-traumatic Checklist for DSM-5 (PCL-5), respectively.

**Results:** Thirty-six participants took part to the study and 108 memories were recorded. Post-traumatic growth was relevantly associated with meaning-making for TAMs (Pr (meaning > no meaning) = 0.993) and with the total meaning score (Pr (β > 0) = 0.998); while PTSD was not (Pr (meaning > no meaning) = 0.941 and = 0.618, respectively). In multivariate analyses, both meaning-making for TAMs (Pr (meaning > no meaning) = 0.984) and the total meaning score (Pr (meaning > no meaning) = 0.976) remained associated with post-traumatic growth.

**Conclusions:** A general meaning-making ability after striking life-events may contribute to the emergence of post-traumatic growth after a traumatic event. Our findings suggest new directions emphasizing on meaning-making in trauma-focused therapies.

## 1. Introduction

The paths leading to positive life changes despite a traumatic event remain debated to this day. The occurrence of a traumatic event is a sudden break with a previous life balance. By its very nature, a traumatic event is violent, unpredictable and involves the risk of death or serious

injury, or sexual violence (Association, 2013). In the immediate wake of such an event, the first reactions are stress-related, and enable people to flee, take cover and survive. However, it is not easy for everyone to recover from the experience and “move on”. The most common psychological disorder after a traumatic event is Post-traumatic Stress Disorder (PTSD), characterized by memory intrusions of the event,

<footnote><sup>a</sup> Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France</footnote>

<footnote><sup>b</sup> Regional Great East Center for Psychotraumatism, Strasbourg, France</footnote>

<footnote><sup>c</sup> INSERM U1329, Strasbourg Translational NEuroscience and Psychiatry (STEP), Team Psychiatry, Strasbourg France</footnote>

<footnote><sup>d</sup> Strasbourg University, Faculty of Medicine, Strasbourg, France</footnote>

<footnote><sup>e</sup> Strasbourg University, Faculty of Psychology, Strasbourg, France</footnote>

<footnote><sup>f</sup> Centre National de la Recherche Scientifique Unité Propre de Recherche 3212 (CNRS UPR 3212), Institute for Cellular and Integrative Neurosciences (INCI), Strasbourg, France</footnote>

<footnote>* This research received no specific grant from any funding agency, commercial or not-for-profit sectors. We have no known conflict of interests to disclose. The data are not publicly available due to legal restrictions that could compromise the privacy of research participants.</footnote>

<footnote>* Corresponding author. Department of Psychiatry, Mental Health & Addictology, Strasbourg University Hospital, Strasbourg, France.</footnote>

<footnote>E-mail address: amaury.mengin@chru-strasbourg.fr (A.C. Mengin).</footnote>
avoidance of situations or internal reminders of the event, and a sense of persistent threat (Association, 2013; Cloitre et al., 2019). Perceptions of oneself, others and the world are shattered after a trauma, and the negative beliefs that arise have a decisive adverse effect on people's meaning of life and behavior (e.g. withdrawal, avoidance) (Janoff-Bulman, 2010). In contrast, the idea of the existence of positive psychological changes after a traumatic event has developed, particularly through the concept of post-traumatic growth (Tedeschi and Calhoun, 1996; Tedeschi and Moore, 2021). This “positive legacy” of trauma is characterized by five dimensions of change (personal strength, relating to others, new possibilities, appreciation of life, spiritual changes) and appears in varying proportions, from 10 to 77 % across studies, depending on the type of traumatic event and the population exposed (Wu et al., 2019). The field of post-traumatic growth has been widely explored in many situations: bereavement, chronic pathologies such as cancer or HIV, acute or repeated traumatic events (accidents, assaults, terrorist attacks, etc.) (Chi et al., 2022; Fausor et al., 2022; Rosenthal et al., 2023; Tanyi et al., 2020).

Understanding how positive outcomes emerge for individuals after a traumatic event is determinant as it may constitute a component of trauma-focused therapies (Tedeschi and Moore, 2021). Yet many questions remain unanswered as to the nature and causal processes of post-traumatic growth (Jayawickreme et al., 2021). Joseph & Linley consider post-traumatic growth as a construct that is merely overlapping with well-being, while Tedeschi & Calhoun consider it to be both a process developing over the long term and an outcome in itself (Joseph and Linley, 2005; Tedeschi and Calhoun, 2004). Questioning the link between post-traumatic growth and well-being, Maercker & Zollner advocate a dual form of growth: illusory (unrelated to enhanced well-being) and real (associated with increased psychological adjustment) (Maercker and Zoellner, 2004). Hobfoll et al. assert that real post-traumatic growth exists when actual behaviors reflect growth (e.g., more openness to others) (Hobfoll et al., 2007). Post-traumatic growth may also be promoted by personality factors such as extraversion, openness and optimism (Jayawickreme and Blackie, 2014). Post-traumatic growth may emerge from events forming a reference point in one's life, i.e., highly central events for one's identity; although high event-centrality may also be linked to higher PTSD symptoms (Boals and Schuettler, 2011). In addition to these factors, post-traumatic growth involves remembering the event and may require a memory that remains vivid. However, the influence of memory characteristics on post-traumatic growth remains unexplored (Henson et al., 2021). Finally, the idea of post-traumatic growth as a result of a meaning-making process is a key theme in the literature (Park, 2010; Park et al., 2012). Park's model postulates that confrontation with a traumatic event creates a discrepancy between global meaning (life purpose, goals and values) and the meaning attributed to the event. This discrepancy triggers a meaning-making process which, if successful, can lead to positive psychological changes, such as those described by post-traumatic growth (Park, 2010). Among victims whose attributed meaning matches their global meaning, the meaning-making process may not be initiated, due to a weak post-traumatic impact (and therefore, low PTSD symptoms). In contrast, among those who begin a meaning-making process due to high distress and meaning discrepancy, finding meaning seems associated to lower levels of PTSD symptoms and higher post-traumatic growth (Triplett et al., 2012). While meaning-making and post-traumatic growth seem correlated, their measurement has often been conducted through declarative methods or self-questionnaires, leading to measurement biases and preventing the exploration of freely elaborated meaning-making processes (Jayawickreme et al., 2021; Park, 2010; Park et al., 2012). The study of narratives makes it possible to observe the emergence of new understandings in individuals confronted with traumatic events, and their influence on their present identity. For instance, a study explored personal growth in the narratives of military exposed to highly stressful events and found a negative association with post-traumatic stress

symptoms and a modest positive association with well-being (Tappenden et al., 2022). Unfortunately, this study did not explore potentially traumatic event, and the events recalled by the participants could be of very different nature. In addition, the study of narratives enables to explore the development of meaning after other striking life events and to compare meaning-making after a traumatic event with meaning-making after other experiences.

In the context of narratives' study, meaning-making belongs to the field of autobiographical reasoning, which is “the activity of creating relations between different parts of one's past, present, and future life and one's personality and development” (Habermas, 2011). Autobiographical reasoning connects autobiographical memories to the narrative self, that is, the set of stories that people tell about themselves and that define them (Gallagher, 2000; Habermas, 2011; McLean and Fournier, 2008).

Autobiographical reasoning belongs to the field of research on narrative identity. Narrative identity is an internalized and evolving life story narrative, integrating the reconstruction of the past and the imagined anticipation of the future. It enables individuals to define and share where they came from, how they became who they are and who they will become. Narrative identity provides one with some degree of unity, purpose and meaning in life (McAdams and McLean, 2013). Autobiographical reasoning helps restore continuity (or establish a coherent turning point) in the narrative identity of people exposed to traumatic events (Habermas and Köber, 2015). A substantial literature has shown that individuals who tend to report redemption stories (which begin with a negative event and end positively) among important life stories have higher levels of well-being than individuals who do not report such stories (Dunlop, 2021). These individuals could also present more generative attitudes (interest in future generations) or more appropriate health attitudes (McAdams and Guo, 2015). However, this literature is mainly based on non-clinical populations and the results concerning the association between redemption stories and well-being appear contrasted (Dunlop, 2021). Studies exploring clinical populations or populations exposed to the same event are therefore lacking.

Furthermore, although meaning-making may belong to the field of redemption stories, a recent model has shown that redemption stories can end positively in a variety of ways (in particular, either through a return to a previous equilibrium ('return'), or through a new understanding ('emergence')) (Perlin and Fivush, 2021). Meaning-making in the context of a traumatic event could correspond to a sub-section of redemption stories, i.e. the emergence of new lessons or insights after a negative life event. Thus, our study intends to understand how the restoration of a coherent narrative identity, through the emergence of a new meaning, is linked to increased post-traumatic growth and well-being in individuals exposed to the same traumatic event.

Autobiographical reasoning is usually assessed by identifying narrative features marking the attribution of meaning, the learning of a lesson in relation to oneself, others or the world following an event (Singer and Bluck, 2001). Some memories of striking life-events called self-defining memories, are particularly relevant to explore autobiographical reasoning (Singer and Blagov, 2004). They are vivid and affectively intense memories that are focused on an enduring concern or unresolved conflict of the personality and usually linked to other memories sharing the same central topic. Accordingly, traumatic memories may be considered as traumatic SDM and share similar characteristics (e.g., vividness, centrality), along with the characteristics of traumatic memories (e.g., intrusiveness, uncontrollability, negativity). When individuals narrate SDMs, they tend to spontaneously reflect upon or attribute a meaning to those events, and by doing so, to integrate those memories into the self (Singer and Blagov, 2000). Previous empirical evidence suggests that the integration of a traumatic memory into the long-term self can promote growth and psychological adjustment (Singer et al., 2013). For example, it has been shown that the integration of negative experiences is linked to stress-related growth and that the ability to see links and find meaning in traumatic or stressful
experiences is associated with personal growth (Woike et al., 1999).

In the present study, we explore meaning-making processes in the narratives of civilians exposed to a terrorist attack which took place in Strasbourg. On the evening of December 11, 2018, an assailant armed with a gun and a knife attacked civilians at the Christmas market in Strasbourg, France (Mengin et al., 2021). This famous market attracts millions of tourists to the city center every year. Strasbourg city center is surrounded by 2 arms of the Ill river and some of the streets are very narrow and crowded, and in one of them, passers-by heard gunshots around 7.50 p.m. The assailant then strolled through the streets of the city center, attacking people in his path. Five civilians were killed and 11 injured, some seriously. As the assailant remained unaccounted for several hours, the authorities confined the population for part of the night to Strasbourg city center shops and public places (e.g., restaurants, bars, libraries), the European Parliament, and the city stadiums. The assailant was finally tracked down and neutralized by police forces after he went into hiding in a Strasbourg neighborhood on December 14.

The main objective of our study is to investigate to which extent the presence of meaning-making in the narratives of civilians exposed to a terrorist attack is associated with post-traumatic growth. The secondary objectives are to explore (1) the association of narrative meaning-making with PTSD and well-being, (2) the difference of event-centrality and memories characteristics between the memory of the terrorist attack and self-defining memories, and the influence of these variables for the attack memory on post-traumatic growth. We hypothesized a positive association of meaning-making after the traumatic event with post-traumatic growth and well-being. We also expected a positive association of the general ability to give meaning to striking life events with post-traumatic growth and well-being. In contrast, we expected no association of meaning-making with PTSD. We expected that the terrorist attack memories would be as central and vivid but more intrusive than self-defining memories, and that higher centrality and vividness of the terrorist attack memory would be associated with higher post-traumatic growth levels. This work will serve (1) to substantiate Park's theoretical model linking meaning-making and post-traumatic growth, (2) to prolong this model by including the ability of meaning-making after other life events and, (3) to investigate the association of meaning-making with PTSD and well-being.

# 2. Materials and methods

## 2.1. Study population

We recruited participants exposed to the December 11, 2018, Strasbourg Christmas market terrorist attack between January and April 2021 by e-mail (from 25 to 28 months after the event). We used a database collected during a precedent study (Mengin et al., 2021). Inclusion criteria were: exposure to the terrorist attack (being in Strasbourg city center or confined in a public place during the attack), being fluent in French language and aged between 18 and 75. Exclusion criteria were: suffering from substance use disorder or psychotic disorder and being under guardianship. Participants were informed about the purpose of the study and signed a written consent form before being anonymized. The study protocol was approved by a local ethics committee (CER/2019-22).

## 2.2. Procedure

The participants came for a unique 2 h visit. They specified socio-demographic data and their level of exposure during the attack. Then, the investigators asked the participants to orally tell three memories: their terrorist attack's memory (TAM), and two self-defining memories (SDMs) drawn from any life period. The order of memories to be told was randomized between participants. The memories were audio-recorded and transcribed to be analyzed. The participants gave a title to each memory and specified the date of the event and their age when it

happened. The participants self-assessed the characteristics of their memories through 13 questions and the Centrality of Event Scale (CES) and completed questionnaires on post-traumatic growth and PTSD.

## 2.3. Measures

Sociodemographic characteristics included age, gender and educational level.

Meaning-making was measured through the analysis of transcribed memories. The criteria for choosing the self-defining memories (SDMs) were explained to the participants, following the instructions of the task adapted from Singer and Moffitt (1992). Self-defining memories are vivid, affectively intense and well-rehearsed. They reflect individuals' enduring concerns or unresolved conflicts (Moffitt and Singer, 1994). The participants could choose memories from any life period. Once the narratives had been collected and transcribed, they were manually rated by three independent raters for the dimension of meaning-making, as described in the SDM rating manual (Lardi and Van der Linden, 2006; Singer and Blagov, 2000). This dimension relates to the learning or meaning that the individual has extracted from the event about oneself, others or the world in general. Therefore, it reveals autobiographical reasoning (e.g., "It gave me a different vision of who I am, I thought that in front of such event I would be stunned or escape but I realized I had a tendency to search and reassure the others.") (Singer and Bluck, 2001; Singer and Moffitt, 1992). The task was divided in two parts. First, the participant was asked to narrate his/her memory spontaneously (S), without any intervention from the investigator. Then, at the end of each recollection, the following question was asked to the participants to cue (C) their autobiographical reasoning: "To what extent is this event important to you and helps you to describe who you are?" The purpose of the latter question was to avoid misinterpreting the absence of meaning making in the spontaneous narrative as reflecting a missing capacity to draw meaning upon important events (Berna et al., 2011). The scoring of meaning-making was binary: the narrative was scored "1" if meaning was present, and "0" if not. Meaning-making was scored for spontaneous and cued narratives (see Table 1).

The interrater reliability was high for spontaneous meaning-making (κ = 0.69) and moderate for cued meaning-making (κ = 0.60). Disagreements were discussed to establish a final rating. A total meaning score was calculated by summing the number of spontaneous narratives containing meaning for each participant (from 0 to 3). Consequently, the scoring of meaning-making for TAMs reflected the capacity to find meaning after the traumatic event; whereas the total meaning score reflected the general ability of each subject to find meaning after striking life events.

Post-traumatic growth was measured using the Post-traumatic Growth Inventory (PTGI) questionnaire adapted in French (Cadell et al., 2015; Tedeschi and Calhoun, 1996). This questionnaire contains 21 items divided into 5 dimensions: relationship with others (7 items), new possibilities (5 items), personal strength (4 items), appreciation of life (3 items), and spiritual changes (2 items). The total score ranges from 0 to 105. The reliability of the French version of the PTGI is 0.87 (Cronbach's α). The reference event used for PCL-5 and PTGI was the terrorist attack.

PTSD was assessed with the Post-traumatic Checklist for DSM-5 (PCL-5). This questionnaire assesses psychological reactions to a specific event. The questionnaire contains 20 items divided into 4 dimensions: intrusions (items 1–5), avoidance (items 6–7), negative alterations in cognition and mood (items 8–14), alterations in arousal and reactivity (items 15–20). Each item is rated on a Likert scale ranging from 0 (not at all) to 4 (extremely). To diagnose complete PTSD, at least 1 item must be rated 2 or higher in each of the first 2 dimensions and at least 2 items in each of the last 2 dimensions. The diagnosis of partial PTSD is made by validating at least 2 of the 4 dimensions (McLaughlin et al., 2015). The reliability of the French version of PCL-5 is 0.94 (Cronbach's α) (Ashbaugh et al., 2018).

Well-being was measured with the Ryff scale comprising 18 items and
<table><caption>**Table 1**
Assessment of meaning-making in the narratives.</caption><thead><tr><th></th><th>CASE 1</th><th>CASE 2</th><th>CASE 3</th></tr></thead><tbody><tr><td><strong>PART 1: Spontaneous narrative</strong><br>Investigator: "Tell me about the event, specifying where you were, with whom, what happened, how you or others reacted. Give details that will help me see and feel what you experienced."</td><td>No meaning</td><td>No meaning</td><td>Meaning is present<br>"I think it helped me build up a lot, especially in terms of working in a hurry, always looking for funding and so on. And so, what marked me at that time was learning a bit about everything that is, autodidact."</td></tr><tr><td><strong>PART 2: Cued narrative</strong><br>Investigator: "To what extent is this event important to you and helps you to describe who you are?"</td><td>No meaning</td><td>Meaning is present<br>"I thought I'd be more prone to flee, to run or to take someone with me to run, but I was, I was more inclined to take my girlfriend and her friend to, to reassure them, to console them, that's all. It's a side of me that I didn't think I had so much of, and I realized it when I was there."</td><td>No additional meaning<br>OR Additional meaning</td></tr><tr><td><strong>FINAL ASSESSMENT</strong></td><td></td><td></td><td></td></tr><tr><td><strong>Spontaneous meaning</strong></td><td>0</td><td>0</td><td>1</td></tr><tr><td><strong>Cued meaning</strong></td><td>0</td><td>1</td><td>1</td></tr></tbody></table>

Legend: This table depicts three different cases of meaning-making assessment in the narratives (columns). The “part 1” line displays the presence or absence of meaning-making in the spontaneous narrative. The “part 2” line displays the presence or absence of meaning-making in the cued narrative. The final assessment for spontaneous and cued meaning is displayed in the lower section of the table. In case 1, meaning making appears neither in the spontaneous nor in the cued part: the memory is assessed “0” for spontaneous and cued meaning. In case 2, meaning making appears only in the cued part: the memory is assessed “0” for spontaneous and “1” for cued meaning. In case 3, meaning making appears in the spontaneous part, the memory is assessed “1” for spontaneous and cued meaning-making, whether or not additional meaning appears in the cued part.

6 dimensions: autonomy (items 1–3), mastery of the environment (items 4–6), personal development (items 7–9), positive relationships (items 10–12), giving meaning to life (items 13–15) and self-acceptance (items 16–18). The scale score ranges from 18 to 108. This measure has a reliability of 0.77 (Cronbach's α) (Van Dierendonck, 2004).

Memories characteristics were measured through eleven self-rated questions on a 1 to 7 Likert scale and two specific questions inspired from Johnson et al. (1988). The questions assessed: 1/Precision of the memory (setting and context of the event), 2/Vividness, 3/Strength of the impression of reliving the event, 4/Continuity and coherence, 5/First person or Third person visualization, 6/Valence of associated emotions, 7/Flashback manifestations, 8/Frequency of intrusive manifestations of the memory, 9/Uncontrollability (level of impression that the memory is stronger than oneself), 10/Sense of ownership of the memory, 11/Level of certainty concerning the event. Participants finally specified whether recalling the memory affected their mood (negatively, positively) or not, and whether they experienced a physical reaction while recalling the memory.

Centrality of each event recalled was measured by the Centrality of Event Scale (CES) – 7 items version (Berntsen and Rubin, 2006). This scale measures how central an event is for one's identity. It consists of 7 items rated on a Likert scale ranging from 0 to 5 (total score ranging

from 0 to 35). This measure has a good reliability (Cronbach's α = .88).

## 2.4. Statistical analysis

We performed statistical analyses using Bayesian methods. A descriptive analysis of the data was performed for sociodemographic characteristics and self-rated memories' characteristics. Separate multilevel beta regression analyses were performed to compare the subjective memories characteristics between TAMs and SDMs.

Univariate beta regression analyses were performed to analyze the association between sociodemographic characteristics, PTSD levels and meaning-making on the one side and post-traumatic growth on the other. The result section reports statistically relevant effects, namely those associated with a probability higher than 0.975 or lower than 0.025 that a difference is greater than 0 (or that an odds ratio is greater than 1). For instance, the difference of meaning-making between TAMs and SDMs will be considered statistically relevant if Pr (TAM > SDM) or Pr (TAM < SDM) are either > 0.975 or < 0.025 (reminding also that Pr (TAM > SDM) = 1 – Pr (TAM < SDM)). Probabilities lower than 0.05 or higher than 0.95 will be reported as marginally relevant.

Multivariate regression analyses were then conducted with post-traumatic growth as a dependent variable to address our main hypothesis, including each relevant predictive variable revealed by the univariate regression analyses and data identified in the literature for their association with PTG (gender, age) (Vishnevsky et al., 2010). The Deviance Index Criterion (DIC) was used to compare models when a new variable was introduced. A lower DIC indicates a model that better balances fit to the data and complexity. Statistical analyses were performed using lowly informative priors. Sensitivity analyses were performed to test the robustness of our final models by modifying the priors set for meaning-making variables. All analyses were performed with R software version 4.2.3 (R Core Team, 2021).

# 3. Results

## 3.1. Sociodemographic characteristics

Among the 212 participants reached in a previous study, 143 agreed to be recontacted for the present study (67 %). Among them, 37 participants took part to the present study (26 %). One participant was excluded due to insufficient French level. Our sample included 26 women (72.2 %), with a mean age of 33.8 years (SD = 12.1). The educational level of our sample was high (89 % had a bachelor's degree or higher). All the participants were directly exposed to the attack: 86.1 % were in downtown area and 13.9 % were confined in a public or private place during the night of the attack.

## 3.2. Memories characteristics

One hundred and eight memories were recorded and assessed. We described and compared the characteristics of terrorist attack's memories (TAMs) with those of self-defining memories (SDMs) (see Table 2).

Meaning was less frequent in TAMs than SDMs, both when memories were recalled spontaneously (Pr (TAM > SDM) < 0.001) and cued (Pr (TAM > SDM) < 0.001)) (see Fig. 1). We provided examples of meaning-making and non-meaning making extracted from TAMs and SDMs in Supplementary Table S1.

## 3.3. Factors associated with post-traumatic growth

### 3.3.1. Meaning-making

The mean PTGI score was 34.5 (SD = 21.2) on a total score ranging from 0 to 105. Post-traumatic growth was positively associated with both spontaneous and cued meaning-making in TAMs (Prs (meaning > no meaning) = 0.993) and with the total meaning score (Pr (β > 0) = 0.998). Appreciation of life was the only dimension of growth relevantly
<caption>**Table 2**</caption>

Comparison of memories' characteristics between terrorist attacks' memories (TAMs) and self-defining memories (SDMs).

<table><thead><tr><th rowspan="2"></th><th colspan="2">TAM (n = 36)</th><th colspan="2">SDM (n = 72)</th><th rowspan="2">Pr (β > OR)</th></tr><tr><th>m</th><th>(±sd)</th><th>m</th><th>(±sd)</th></tr></thead><tbody><tr><td>Precision</td><td>6.75</td><td>(±0.87)</td><td>6.08</td><td>(±1.37)</td><td>0.971</td></tr><tr><td>Vividness</td><td>6.33</td><td>(±1.31)</td><td>5.44</td><td>(±1.71)</td><td>.996<sup>a</sup></td></tr><tr><td>Strength</td><td>5.42</td><td>(±1.86)</td><td>4.97</td><td>(±1.82)</td><td>0.861</td></tr><tr><td>Continuity &amp; Coherence</td><td>6.17</td><td>(±1.30)</td><td>4.64</td><td>(±2.02)</td><td>&gt;.999<sup>a</sup></td></tr><tr><td>First-person to Third-person vision</td><td>4.11</td><td>(±2.67)</td><td>4.21</td><td>(±2.33)</td><td>0.442</td></tr><tr><td>Emotional valence</td><td>1.81</td><td>(±1.09)</td><td>3.75</td><td>(±2.49)</td><td>&lt;.001<sup>b</sup></td></tr><tr><td>Flashbacks frequency</td><td>5.56</td><td>(±2.18)</td><td>4.50</td><td>(±2.28)</td><td>0.969</td></tr><tr><td>Intrusions</td><td>4.11</td><td>(±2.00)</td><td>2.78</td><td>(±2.02)</td><td>.999<sup>a</sup></td></tr><tr><td>Uncontrollability</td><td>3.94</td><td>(±2.23)</td><td>2.36</td><td>(±1.95)</td><td>&gt;.999<sup>a</sup></td></tr><tr><td>Sense of ownership</td><td>6.67</td><td>(±1.10)</td><td>6.57</td><td>(±1.10)</td><td>0.621</td></tr><tr><td>Certainty</td><td>6.58</td><td>(±0.91)</td><td>6.26</td><td>(±1.34)</td><td>0.833</td></tr><tr><td>Duration of the narrative (min)</td><td>8.0</td><td>(±4.0)</td><td>4.0</td><td>(±3.0)</td><td>&gt;.975<sup>a</sup></td></tr><tr><td>Mean age (years)</td><td>31.0</td><td>(±13.0)</td><td>22.9</td><td>(±13.5)</td><td>&gt;.975<sup>a</sup></td></tr><tr><td>Remoteness in time (years)</td><td>2.2</td><td>(±0.1)</td><td>11.4</td><td>(±12.3)</td><td>&lt;.025<sup>b</sup></td></tr><tr><td>Centrality</td><td>24.4</td><td>(±7.5)</td><td>24.0</td><td>(±7.5)</td><td>0.681</td></tr></tbody></table>

Legend: SDM, Self-defining memories; TAM, Terrorist Attack's Memory.

<sup>a</sup> Pr (β > OR) > 0.975, indicating a relevantly higher level of the memory characteristic in the reference group (TAM) than in SDM.

<sup>b</sup> Pr (β > OR) < 0.025, indicating a relevantly lower level of the memory characteristic for the reference group (TAM).

associated with spontaneous meaning-making (Pr (meaning > no meaning) = 0.995). Relationship with others were associated with spontaneous meaning-making (Pr (meaning > no meaning) = 0.961), with marginal relevance. In contrast, every dimension of post-traumatic growth was associated with the total meaning score (Prs (β > 0) > 0.980).

### 3.3.2. *Trauma memories' characteristics*

Post-traumatic growth was relevantly and positively associated with more vivid and central trauma memories, a higher feeling of strength of the memories and the presence of a physical reaction at their recall (Prs (β > 0) > 0.977). PTG was associated with a higher frequency of flashbacks (marginally relevant (Prs (β > 0) = 0.972)).

### 3.3.3. *Multivariate analyses*

To investigate to which extent meaning-making contributed to post-traumatic growth after considering adjusting variables, we tested five separate multivariate regression models (see Table 3). Post-traumatic growth remained positively associated with both spontaneous and cued meaning-making for TAMs (Prs (meaning > no meaning) > 0.982). The total meaning score was also associated with post-traumatic growth (Pr (β > 0) = 0.976).

### 3.4. PTSD and meaning-making

PCL-5 scores indicated a PTSD or partial PTSD among 16.7 % and 25 % of the participants respectively. Positive associations between PTSD score and both spontaneous and cued meaning in TAMs were found but only the latter was marginally relevant (Pr (β > 0) = 0.941, and Pr (β > 0) = 0.955, respectively). PTSD score was not associated with the total meaning score (Pr (β > 0) = 0.618).

### 3.5. Well-being and meaning-making

The mean well-being score was 69.4 (sd = 8.7) on a total score ranging from 8 to 108. Well-being was not relevantly associated with either spontaneous or cued meaning for TAMs (Pr (β > 0) = 0.794, and (Pr (β > 0) = 0.174), respectively). However, well-being was positively associated with the total meaning score, with Pr (β > 0) = 0.950 (marginally relevant). Autonomy was the only dimension of well-being relevantly associated with the total meaning score (Pr (β > 0) = 0.983).

## 4. Discussion

Our study showed that post-traumatic growth (PTG) was positively associated with the ability of individuals to give meaning to the traumatic event experienced. Post-traumatic growth and well-being were also positively associated with a higher ability to give meaning to both the traumatic event and self-defining memories.

In contrast, although a positive association was observed between meaning-making and PTSD scores, this remained not relevant. PTSD was not associated with the ability to give meaning to both the traumatic event and self-defining memories.

<figure><img src="image_3.png" /><figcaption>**Fig. 1.** Comparison of meaning-making between Terrorist Attack Memories and Self-Defining Memories</figcaption></figure>

Legend: ***Pr (SDM > TAM) > 0.999, i.e., the probability that meaning-making for self-defining memories (SDM) is more frequent than meaning-making for terrorist attack memories (TAM) is greater than 0.999, both for spontaneous and cued conditions.
<table><caption>**Table 3**
Multivariate analysis of factors associated with post-traumatic growth.</caption><thead><tr><th rowspan="2"></th><th colspan="3">Model 1</th><th colspan="3">Model 2</th><th colspan="3">Model 3</th><th colspan="3">Model 4</th><th colspan="3">Model 5</th></tr><tr><th>M</th><th>2.5 %</th><th>97.5 %</th><th>M</th><th>2.5 %</th><th>97.5 %</th><th>Pr</th><th>M</th><th>2.5 %</th><th>97.5 %</th><th>Pr</th><th>M</th><th>2.5 %</th><th>97.5 %</th><th>Pr</th></tr></thead><tbody><tr><td>Intercept</td><td>-0.53</td><td>-1.23</td><td>0.14</td><td></td><td>-0.52</td><td>-1.21</td><td>0.16</td><td>-0.50</td><td>-1.16</td><td>0.15</td><td></td><td>-0.95</td><td>-1.74</td><td>-0.17</td><td></td></tr><tr><td>Sex</td><td>1.05</td><td>0.49</td><td>2.36</td><td>0.551</td><td>1.11</td><td>0.46</td><td>2.28</td><td>0.87</td><td>0.38</td><td>1.76</td><td>0.289</td><td>1.13</td><td>0.50</td><td>2.26</td><td>0.546</td></tr><tr><td>Age</td><td>0.33</td><td>-0.03</td><td>0.69</td><td>0.963<sup>§</sup></td><td>0.26</td><td>-0.11</td><td>0.62</td><td>0.17</td><td>-0.20</td><td>0.52</td><td>0.822</td><td>0.19</td><td>-0.17</td><td>0.54</td><td>0.851</td></tr><tr><td>PCL-5</td><td></td><td></td><td></td><td></td><td>0.12</td><td>-0.29</td><td>0.51</td><td>0.26</td><td>-0.10</td><td>0.61</td><td>0.927</td><td>0.18</td><td>-0.19</td><td>0.54</td><td>0.834</td></tr><tr><td><strong>Meaning</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>4.30</td><td>1.12</td><td>11.90</td><td>.984*</td><td></td><td></td><td></td><td></td></tr><tr><td>Spontaneous</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td>2.37</td><td>1.07</td><td>4.55</td><td>.983*</td></tr><tr><td>Cued</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Total score</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>DIC</td><td>-6.4</td><td></td><td></td><td>-8.6</td><td></td><td></td><td></td><td>-11.3</td><td></td><td></td><td></td><td>-11.3</td><td></td><td></td><td>-10.4</td></tr></tbody></table>

**Legend:** This table presents the results of the separate multivariate Bayesian beta regression analyses performed with post-traumatic growth as a dependent variable. Each line presents the result for a predictive variable, in five successive models. "Spontaneous" and "cued" meaning are considered for the terrorist attack's narratives only. The "total score" line presents the total score of spontaneous meaning-making on the three memories for an individual (scored from 0 to 3). M: mean of the posterior distribution of regression coefficient β (and its 95% credible interval) for each linear variable, expressed in odds-ratio for the binary variables (e.g., sex). Pr: probability that the regression coefficient β > 0 (Pr (β > 0)). DIC: Deviance Index Criterion (DIC) assesses the goodness of fit and complexity of each model. A lower DIC indicates a better model. <sup>§</sup>Pr (β > 0) > 0.950; *Pr (β > 0) > 0.975.

PCL-5: Post-traumatic Checklist for DSM-5.

### 4.1. Meaning-making after a traumatic event is linked to post-traumatic growth

First, our study corroborates Park's meaning-making model, stating that meaning-making after a distressing experience is linked to positive outcomes (Park, 2010). A previous study on the general US population after a terrorist attack demonstrated that having made sense out of the traumatic event (as assessed by the question "How much do you feel that you have been able to make sense of the 9/11 terrorist attacks?") was correlated with PTG (Park et al., 2012). However, our study is, to our knowledge, the first to demonstrate the association between meaning-making and PTG by assessing autobiographical reasoning in the narratives of traumatic events. Although this method is time-consuming in comparison to questionnaires, it offers the advantage of exploring how meaning is personally and spontaneously formulated by the participants in the case of a specific traumatic event. Indeed, many pathways leading to post-traumatic growth have been explored. Among cognitive factors, Joseph and Williams stressed the role of post-event appraisals and ruminations in post-traumatic growth (Joseph and Williams, 2005; Lancaster et al., 2013). Mainly, cognitive appraisal of the event is linked to the occurrence of PTG (Joseph and Linley, 2005). Similarly, the use of cognitive words (e.g., "I understand why", "I know now") in narratives has been shown to be correlated with meaning-making (Boals et al., 2011). Our study specifies the content and the outcome of the cognitive reappraisal process (i.e., meaning-making) leading to post-traumatic growth. This confirms how post-traumatic growth reveals significant identity changes after a traumatic event.

Interestingly, appreciation of life was the only dimension of post-traumatic growth associated with meaning-making. This may be related to specific meanings learned from traumatic events, due to the confrontation to an imminent risk of death (Janoff-Bulman and Berger, 2000). For example, a participant stated: "Because I've met death, so it's left its mark, and, as a result ... You have a different thirst for life afterwards."

Finally, we suspected that the level of event centrality would participate in variance absorption, as its association with post-traumatic growth is widely documented (Lancaster et al., 2013; Schuettler and Boals, 2011). We performed additional multivariate regression models including event centrality and found that the latter was positively associated with PTG but not with PTSD. In addition, when centrality was added to the model, the total meaning score remained relevantly associated with PTG while spontaneous and cued meaning-making for the terrorist attack remained only marginally associated with post-traumatic growth (see Supplementary Table S2).

### 4.2. Meaning-making after striking life events, post-traumatic growth and well-being

The robust association between the general ability to find meaning in striking life events and post-traumatic growth after an attack completes Park's meaning-making model. Indeed, the reduction of the discrepancy between global life meaning and attributed meaning may not be an isolated explanatory factor of positive outcomes as supposed in this theoretical model (Park, 2010). Instead, our study points the importance of individuals' general ability to find meaning in striking life events in the path leading to post-traumatic growth after a traumatic event. The emergence of meaning-making after striking life events can reveal personality elements such as a propensity to search for meaning out of challenging situations (Singer and Blagov, 2004). For instance, the personality trait 'optimism' was shown to be associated to the ability to make sense of experiences, while 'openness' is associated with searching for meaning in life (Nes and Segerstrom, 2006; Steger et al., 2008). Finally, our results reveal that the ability to give meaning to several life events may be associated with a greater well-being, where giving meaning to the traumatic event only was not (Li et al., 2021).

Our results are in line with findings in the literature showing that
individuals reporting more redemption stories would present higher levels of well-being (Dunlop, 2021). More broadly, our result could be linked to specific cognitive abilities among meaning-making individuals. Thus, we performed additional analyses showing a positive association between having a master's degree or higher and the total meaning score but remaining far from the relevance threshold (Pr = 0.790). Noting that the educational level of our sample was high (89 % having a bachelor's degree or higher), meaning-making differences could be observed in more heterogeneous populations in terms of educational level. However, previous studies did not reveal an association between meaning-making and cognitive abilities (Allé et al., 2015; Berna et al., 2011). We recall here that a low socio-educational level is a risk factor for PTSD, which could be linked to low levels of elaboration and cognitive flexibility (Shalev et al., 2019). In parallel, high cognitive flexibility and a self-compassionate attitude (i.e., a self-caring and compassionate attitude in the face of suffering) could contribute to meaning-making and remission of PTSD (Bonanno et al., 2023; Daneshvar et al., 2022). Accordingly, one study has shown an indirect link between self-compassion and post-traumatic growth, mediated by the presence of meaning and positive reframing among students exposed to at least one negative life-event (Wong and Yeung, 2017).

Similarly, our results point toward different adaptive coping strategies in individuals who find meaning in comparison to those who do not. Meaning-making itself is considered as a coping strategy, differing from problem-focused and emotion-focused coping. Meaning-making coping could be particularly relevant in low control post-traumatic situations that are not amenable to direct repair or problem-solving (Folkman, 2011).

### 4.3. The role of event-centrality in meaning-making and growth

Contrary to our hypothesis, our results remind us that meaning-making do not guarantee psychological adjustment, as total meaning-making score was not associated with lower PTSD symptoms (Park, 2016). In contrast, the association was positive though not statistically relevant for spontaneous meaning-making, and marginally relevant for cued meaning-making. Indeed, meaning-making may indicate that a traumatic event remains “too” central in one’s identity, as revealed by the correlation between event centrality scores and spontaneous meaning-making (Pr (meaning > no meaning) > 0.995). Actually, centrality has been repeatedly shown to be correlated with higher levels of PTSD (Gehrt et al., 2018). In contrast, Glad et al. showed that event centrality mediated the relation between peritraumatic reactions and post-traumatic growth after a terrorist attack (Glad et al., 2020). In other contexts (political narratives), event centrality mediated the relation between meaning-making and well-being so that meaning-making was only a significant predictor of well-being at high levels of event centrality (Meisels and Grysman, 2021). Boals et al. also observed this double association of centrality with PTSD and PTG, describing centrality as “a double-edged sword, allowing for both debilitation and growth” (Boals and Schuettler, 2011). Additional multivariate regression models with PTSD as a dependent variable showed that event centrality (but not meaning-making) was constantly associated with PTSD (see Supplementary Table S3). These complementary results confirm that event centrality plays a key role in PTSD while finding meaning to a central traumatic event may soothe its effect. Indeed, while centrality expresses the importance taken by an event in one's life story, meaning-making reflects the outcome of an active coping process aiming at reducing one's own psychological distress (Gehrt et al., 2018; Park et al., 2012).

Post-traumatic growth has also been regularly pointed for its correlation with both positive adaptive factors and psychological distress (Blix et al., 2013; Cann et al., 2010; Dekel et al., 2012; Jayawickreme et al., 2021). These paradoxes were emphasized by the “Janus-faced” theory, a two-component model of post-traumatic growth, where PTG may be either illusory and self-deceptive or constructive and

self-transcending (Maercker and Zoellner, 2004). More recently, Hamby et al. (2022) tried to disambiguate illusory and real PTG. They proposed a dual-factor model of post-traumatic responses where they combine post-traumatic stress symptoms with post-traumatic growth levels. Their study reveal that the resilient group (low symptoms, high growth) and prevailed group (high symptoms, high growth) scored above the detached group (low symptoms, low growth) on most measures of meaning-making and well-being. Thereby, our study is in line with the latter observations, stating that meaning-making processes may be associated with higher levels of fulfillment, whether they do lead to symptom resolution or not. However, Park & Folkman indicated two other paths of meaning-making that are uncovered by our study: 1/revising goals and planning goal-directed problem-focused coping, fostering meaning in terms of a sense of purpose and control (i.e. future-directed meaning); 2/activating spiritual beliefs and experiences, through which individuals find existential meaning (Park and Folkman, 1997). Participants may have activated one of these meaning-making paths that do not consist in meaning reappraisal of the traumatic event.

### 4.4. Meaning-making as a result of a therapeutical process

Finally, our study does not assess whether the meaning extracted from the traumatic event result from one own's post-event reflection or from a therapeutic process. Indeed, as a traumatic event may deeply modify one's beliefs and vision of life, the spontaneous meaning attributed by an exposed person may remain negative and painful. Knutsen & Jensen demonstrated that after trauma-focused cognitive and behavioral therapy (TF-CBT), there was an increase in organized thoughts and internal reports of internal events while narrative fragmentation decreased (Knutsen and Jensen, 2019). However, this study, conducted in only 13 participants, failed to demonstrate a link between the evolution of narratives and PTSD recovery. To our knowledge, though studies investigating the evolution of meaning in the context of depression exist (Singer and Blagov, 2004), there is a lack of study exploring traumatic memory integration before and after trauma-focused psychotherapy. Assessing the changes in beliefs before and after trauma-focused therapies and their association with PTSD and PTG may allow for a better understanding of the impact of reshaping meaning made after a traumatic event. Lastly, our study draws stimulating therapeutic perspectives, as meaning-making aligns with principles of trauma-focused therapy, who allows participants to vividly recall more details of the events and integrate resolutive aspects (Foa, 2011). For instance, new constructivist narrative interventions are being designed to foster meaning-making, self-concept clarity and agenitivity after stressful life events to rebuild narrative identity (Yusefzade et al., 2023).

### 4.5. Limitations and strengths

Our study has some limits. First, the transversal design of our study does not allow to conclude on the causal link between meaning-making and post-traumatic growth. A longitudinal perspective exploring the evolution of these variables over time would allow to specify their relations. Secondly, there is no control group to compare meaning-making and PTG among unexposed civilians, impeding to compare how meaning-making emerges in participants distant from a collective event (Malle et al., 2018). In addition, the post-traumatic context of our study may have influenced the content of self-defining memories. However, only 13 (18 %) self-defining memories concerned a life-threatening event, which is comparable to healthy subjects interviewed in previous studies (13–18 %) (Allé et al., 2015; Blagov and Singer, 2004). Thirdly, interrater reliability was high for spontaneous narratives but only moderate for cued narratives. However, the raters maintained an independent coding and discussed each disagreement. The raters found an agreement for every narrative. Linear scoring methods have shown more precise definitions of meaning-making and satisfactory inter-rater
correlations and could be used in future studies (McLean et al., 2020). Fourthly, our study did not measure other confounding variables that might have contributed to post-traumatic growth beyond meaning-making. Studies including measures of cognitive flexibility, coping strategies, personality traits or self-compassion would allow us to explore other factors contributing to post-traumatic growth. Finally, our sample size was low despite a large number of participants contacted (143 participants, participation rate 26 %), resulting in a lack of power of our study, as more participants were expected (number of subjects necessary = 90). Nevertheless, our sample remained comparable to the source sample in terms of age, gender and education level (Mengin et al., 2021). PTSD rates were also comparable to previous literature (16.7 % of PTSD two years after the event in our sample vs. 20.7 % in the literature (Diamond et al., 2022)). The low participation rate was explained by the difficulty to recruit participants as many people present during the Christmas market were tourists not living in Strasbourg and that our study was delayed by the COVID-19 pandemic. Thereby, we performed sensitivity analyses to test the robustness of our models. We modified the prior set for the spontaneous meaning for TAM and the total meaning score variables to build predictions against our main hypotheses (setting the 95 % confidence interval for an odds-ratio located between 0.01 and 0.8). We showed that spontaneous meaning attributed to TAM was no more associated with PTG (Pr (meaning > no meaning) = 0.855), while the total meaning score remained marginally associated with post-traumatic growth (Pr (meaning > no meaning) > 0.950), indicating a good robustness of our model.

## 5. Conclusion

Making meaning from a traumatic event constitutes a challenging process, but this process may lead an individual to highlight the positive outcomes of such a negative life event. Our study provides support for this view and adds that the general ability of an individual to make sense from striking life events is related to a higher post-traumatic growth and well-being after a traumatic event. These results emphasize the importance of dispositional meaning-making abilities in addition to adaptive meaning-making on the path toward post-traumatic growth. Our findings suggest that emphasizing on meaning-making in trauma-focused therapies could foster the emergence of post-traumatic growth.

### CRediT authorship contribution statement

**Amaury C. Mengin:** Writing – original draft, Methodology, Investigation, Formal analysis, Conceptualization. **Pierre Orselli:** Writing – review & editing, Writing – original draft, Formal analysis. **Floriane Lalaus:** Writing – review & editing, Methodology, Investigation, Formal analysis. **Julie Rolling:** Writing – review & editing. **Pierre Vidailhet:** Writing – review & editing, Supervision. **Fabrice Berna:** Writing – review & editing, Supervision, Formal analysis, Conceptualization.

### Data availability statement

The data are not publicly available due to legal restrictions that could compromise the privacy of research participants. Aggregated data that support the findings of this study are available from the corresponding author upon reasonable request.

### Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

### Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence

the work reported in this paper.

### Acknowledgments

The authors would like to thank all the participants for their engagement in this research, as all the rescue teams involved during and after Strasbourg Christmas Market terrorist attack. They also thank the teams involved in the "Mémoire 13 Novembre" research program, Francis Eustache, Denis Peschanski, Peggy Quinette, Lucie Quibeuf, with whom they had the opportunity to regularly discuss their common research interests.

## Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.jpsychires.2025.04.037.

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