Benefit finding, affective reactions to diabetes stress, and diabetes management among early adolescents.

Adolescence is a difficult time for managing type 1 diabetes as evidenced by deteriorating metabolic control, poorer adherence, and heightened emotional distress (Helgeson, Snyder, Escobar, Siminerio, & Becker, 2007; Korbel, Wiebe, Berg, & Palmer, 2007). Such difficulties may occur, in part, because the increases in negative affect and emotional lability that occur normatively during adolescence (Larson, Moneta, Richards, & Wilson, 2002) may be exacerbated by the stress of diabetes, and may undermine diabetes self-management (de Groot, Anderson, Freedland, Clouse, & Lustman, 2001; Holmes et al., 2006). Understanding factors that predict these diabetes management patterns is important because self-management behaviors established during adolescence may carry into adulthood (Dovey-Pearce, Doherty, & May, 2007; Ickovics et al., 2006). We examined how one potential factor – benefit finding – is related to affective reactions to diabetes stress and to diabetes management among early adolescents with type 1 diabetes. Defined as the experience of identifying positive outcomes in the face of adversity, benefit finding has often been examined as a factor in positive emotional adjustment to illness (Helgeson, Reynolds, & Tomich, 2006; Linley & Joseph, 2004). Study of benefit finding among adolescents is limited (see Helgeson, Lopez, & Mennella, 2009 for review), but we theorized it may be an important resource for adolescents with diabetes particularly because it has been implicated in illness-related affective experiences. Benefit finding has been associated with better psychosocial well-being and lower affective distress in numerous chronic illness populations such as cancer, HIV/AIDS, multiple sclerosis, and rheumatoid arthritis (see Algoe & Stanton, 2009 for review). In some instances, however, benefit finding is unrelated or even negatively related to emotional well-being, and the processes by which it may be adaptive remain unclear (Helgeson et al., 2006; Mohr et al., 1999; Tomich & Helgeson, 2004). These inconsistencies have raised questions about whether benefit finding is an effective resource for adapting to illness or whether it is primarily a cognitive defense to manage negative emotion (Affleck & Tennen, 1996; Park & Helgeson, 2006; Siegel & Schrimshaw, 2007). It is possible that benefit finding serves both functions by developing in a context of illness-related distress, but once developed, working to buffer the adverse consequences of negative affective experiences. Benefit finding is based on the theory that the experience of adversity can alter one’s views of the self and the world, generating distress and anxiety; through re-evaluating these views, however, a new sense of meaning and self-worth can emerge (Janoff-Bulman & Frieze, 1983; Taylor, 1983). This meaning-making process may be accompanied by periods of stress and tumult, as individuals accommodate adverse circumstances into their understanding of themselves and the world, and set new life goals and priorities. If benefit finding develops in this context of distress, the result may be a positive relationship between benefit finding and negative affect. To the extent that these experiences of change and growth are adaptive, however, benefit finding should ultimately be associated with improved well-being and may buffer negative affect by allowing adolescents to positively reframe the meaning of their diabetes-related distress (Pakenham, 2005; Siegel & Schrimshaw, 2007). The primary objective of the present study was to examine whether benefit finding buffers the adverse associations between negative affective reactions to diabetes stress and adolescent well-being. In addition to examining benefit finding as a moderator of negative affect, it is important to consider how benefit finding may interface with positive affect. A large literature suggests positive affect is distinct from negative affect, rather than opposite ends of a single continuum, and is related to well-being through different processes. Benefit finding is consistently associated with enhanced positive affect (Hart, Vella, & Mohr, 2008), and the ability to maintain positive affect in the face of diabetes stress may facilitate adolescents’ diabetes management. Limited research has focused on the role of positive emotions for promoting illness management, but positive affect has been argued to facilitate creative problem-solving and greater access to coping resources (Aspinwall, 1998; Folkman, 2008; Fredrickson, 2001). Fortenberry et al. (Fortenberry, Butler, Butner, Berg, Upchurch, & Wiebe, 2009) found support for this possibility among adolescents with diabetes. Specifically, daily experiences of positive affect were associated with enhanced perceptions of competence in managing diabetes-related problems which, in turn, predicted better daily blood glucose control among adolescents with diabetes. If benefit finding is related to greater positive affective reactions to diabetes stress, this may be reflected in higher coping effectiveness and better illness management. A second objective of this study was to examine whether positive affect mediates associations between benefit finding and better diabetes self-management. Adolescence provides an important opportunity for studying benefit finding given the cognitive, social, and emotional changes that occur during this time of development. Future-oriented thoughts and concerns develop during early adolescence (Massey, Gebhardt, & Garnefski, 2008), which may provide a context for benefit finding to emerge as youth begin to grapple with the long-term implications of their illness. Early adolescents also have newly acquired secondary coping skills to manage the psychological implications of their illness (Band & Weisz, 1990; Seiffge-Krenke, Aunola, & Nurmi, 2009), which may involve efforts to make sense of the illness and frame one’s developing self-conceptions to accommodate illness-related stressors and challenges. Such developments in stress and coping, coupled with the heightened emotional lability of adolescents in general (Larsen et al., 2002), makes benefit finding a potentially important resource for adolescents. In the present study, we explored age-related differences in benefit finding among early adolescents with diabetes. Although the paucity of research on benefit finding among children and adolescents prevented us from making strong predictions, we thought it plausible that benefit finding would increase or have stronger associations as adolescents’ cognitive and abstract thinking skills matured. In summary, the present study examined whether benefit finding buffers negative affective reactions and facilitates positive affective reactions to diabetes stress, and whether these associations are reflected in lower depressive symptoms, higher coping effectiveness, and better adherence and blood glucose control. Early adolescents provided detailed descriptions of recent diabetes-related stress, and reported their coping and affective responses to these stressful events. We predicted that: 1) benefit finding would buffer the adverse associations between stress-related negative affect and broader outcomes, suggesting that negative affect is less disruptive when adolescents endorse higher benefit finding; and 2) benefit finding would be associated with higher positive affect in the context of diabetes stress, which would mediate associations with higher perceived coping effectiveness and adherence.