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BACKGROUND: Co-occurring chronic pain and posttraumatic stress disorder (PTSD) is associated with poorer physical and mental functioning and well-being. Treatments often incorporate goal-setting around personally meaningful behaviors; however, it is unclear whether intentionally focusing on improving meaning and purpose in life (i.e., meaning-as-goal) may also serve as a helpful treatment target. The objective of the current study is to determine whether reported progress toward meaning-as-goal at 6 months is associated with pain severity and interference, physical and mental health functioning, and global meaning and purpose at 6- and 12-months. METHODS: Data were collected as part of an evaluation effort focused on VA's Whole Health System implementation efforts. VA electronic health records were linked to survey data across three time points (baseline, 6 months, and 12 months) from Veterans with both chronic pain and PTSD across 18 VA sites. A total of 1341 Veterans met inclusion criteria (mean age = 62, SD = 11.7). RESULTS: Regression analyses showed that progress toward meaning-as-goal was significantly associated with all 6-month variables, with standardized coefficients ranging from - 0.14 (pain severity and interference) to .37 (global meaning and purpose), in addition to all 12-month variables, with standardized coefficients ranging from - .13 (pain severity and interference) to .31 (global meaning and purpose). CONCLUSIONS: Efforts to intentionally promote meaning and purpose as part of evidence-based treatment for chronic pain and PTSD may lead to decreased pain and improved physical and mental health functioning and global meaning and purpose. With coefficients ranging from small to moderate effect sizes, more work is needed to better understand how best to maximize meaning-related goals.

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OBJECTIVE: Chronic pain is a global health concern and often interferes with multiple aspects of individuals' lives (e.g., physical activities), diminishing one's ability to engage in activities that promote meaning in life. However, it is not well understood how believing that one can live a meaningful life despite pain may contribute to improved function among individuals with chronic pain. The aim of the current study was to better understand the role that belief in living a meaningful life despite pain may have in adjustment to chronic pain. METHODS: Participants (N = 164) were individuals with chronic pain who completed baseline data from two closely related randomized clinical trials. Hierarchical regression analyses were used to examine the hypotheses that one's belief in living a meaningful life despite pain will be associated with function (pain interference and symptoms of posttraumatic stress disorder, depression, and anxiety) and that the belief in living a meaningful life despite pain would moderate the associations between pain intensity and function. RESULTS: Belief in living a meaningful life despite pain was significantly associated with less pain interference and less severe symptoms of PTSD, anxiety, and depression, supporting the potential role of this variable in adaptive adjustment to chronic pain. However, one's belief in living a meaningful life despite pain did not moderate the associations between pain intensity and function. CONCLUSIONS: Results provide important theoretical and clinical information about how believing that one can live a meaningful life despite pain may serve as an important process for adjustment to chronic pain.

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Religious struggles tend noticeably to influence the sphere of social well-being in emerging adulthood as individuals modify their religious beliefs and practices, form personal identity patterns, and rediscover new life purpose and values. The aim of the current study was to investigate whether meaning-making and meaning in life (presence and search) can serially mediate the hypothesized links between religious comfort vs. strain and social well-being. Self-report measures of religious struggles, meaning-making, meaning in life, and social well-being were completed by 368 emerging adults (aged 18 to 29, 52.2% female). The serial mediation analysis showed that the relationship between religious comfort vs. strain and social well-being was mediated by meaning-making and presence of meaning, but not by a search for meaning. These results suggest that religious struggles may represent unique aspects of developmental spiritual processes in emerging adulthood with implications for social well-being.

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Continuing bond manifesting as unexplainable experiences reflects bereaved´s attempts to restore connection with the deceased. As an experience unaligned with a person's overall schemas of meaning unexplainable experiences are a source of anxiety that individuals aim to alleviate by attribution thinking. This study describes how bereaved aim to explain unexplainable experiences related to the death of their loved ones. The study analysed 408 narratives of 181 bereaved individuals. Bereaved individuals (1) described the meaning of their experience to be receaving information, emotions or support by the experience and communicating about crossing the boundary between life and death. As (2) reflections on the cause of their experiences bereaved individuals described certain and uncertain explanations of the phenomenon, ruling out explanations and the compatibility or incompatibility of the experience with their prior worldviews. The process of attribution thinking must be perceived as meaningful regardless of the outcome of the bereaved person's reflection.

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BACKGROUND: Being the backbone of informal care for people living with dementia, caregivers suffer overwhelming physical and psychological challenges in their daily caregiving experience. Proactive coping strategies to alleviate the caregiving burden are of utmost importance. Meaning-making emerges as an effective coping approach to benefit caregivers and mitigate their care burden. However, the conceptualisation of meaning-making on its dimensions and process has been ambiguously identified. OBJECTIVES: To synthesise the qualitative research evidence on meaning-making in a dementia context to identify: (1) the situational dimension in making sense of caregiving scenarios, and (2) how the meaning-making process evolves during dementia caregiving. METHODS: This systematic review identified 62 qualitative studies published between 1969 and 2022 from the major databases. Eligible studies met the following inclusion criteria: (1) having informal caregivers of people living with dementia; (2) involving meaning-making of care experience; (3) adopting qualitative design; and (4) full-text of research articles. The risk of bias was evaluated using the Clinical Appraisal Skills Programme checklist. By using Qualitative Evidence Synthesis, themes relevant to critical dimensions and phases of meaning-making were generated from the extracted data. RESULTS: Sixty-two studies involving 2487 subjects were synthesised investigating the critical dimensions and process of meaning-making of dementia care experience. Results indicated that the dementia care experience can be made sense of in several folds: (1) it involved complicated demands from people living with dementia and requires customised care; (2) the dynamics of dyadic interactions with dilemma and ambivalence; and (3) adaptive coping encapsulating perceptions of loss and growth, complied and integrated values, balanced expectations of care and self, and improvement in self-efficacy. The meaning-making process underwent phases of meaning creation (meaning created in initial encounter with dementia symptoms), meaning appraisal (assimilation and accommodation pathways for appraisal), and meaning adherence (integration of the appraised meanings). CONCLUSION: Findings suggest meaning-making of dementia caregiving is a multi-faceted and multi-phased recursive process. Future implications give directions on the facilitation of meaning-oriented interventions to enhance the awareness of caregiving role and the knowledge of dementia care, learn techniques of reframing and restructuring, and seek meaningful perspectives; and to adopt strategies to overcome the barriers for meaning-making by empowering self-identity, roles and expectations, and the dyadic relationship. In addition, our findings inform future advancement in the conceptualisation and measurement of meaning-making in the context of family caregiving. Optimisation of the meaning-making process inspires professional assistance to enhance caregivers' coping for dementia care experience.

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BACKGROUND: Hematopoietic cell transplantation (HCT) is a highly invasive and life-threatening treatment for hematological neoplasms and some types of cancer that can challenge the patient's meaning structures. Restoring meaning (i.e., building more flexible and significant explanations of the disease and treatment burden) can be aided by strengthening psychological flexibility by means of an Acceptance and Commitment Therapy (ACT) intervention. Thus, this trial aims to examine the effect of the ACT intervention on the meaning-making process and the underlying mechanisms of change in patients following HCT compared to a minimally enhanced usual care (mEUC) control group. The trial will be enhanced with a single-case experimental design (SCED), where ACT interventions will be compared between individuals with various pre-intervention intervals. METHODS: In total, 192 patients who qualify for the first autologous or allogeneic HCT will be recruited for a two-armed parallel randomized controlled trial comparing an online self-help 14-day ACT training to education sessions (recommendations following HCT). In both conditions, participants will receive once a day a short survey and intervention proposal (about 5-10 min a day) in the outpatient period. Double-blinded assessment will be conducted at baseline, during the intervention, immediately, 1 month, and 3 months after the intervention. In addition, 6-9 participants will be invited to SCED and randomly assigned to pre-intervention measurement length (1-3 weeks) before completing ACT intervention, followed by 7-day observations at the 2nd and 3rd post-intervention measure. The primary outcome is meaning-related distress. Secondary outcomes include psychological flexibility, meaning-making coping, meanings made, and well-being as well as global and situational meaning. DISCUSSION: This trial represents the first study that integrates the ACT and meaning-making frameworks to reduce meaning-related distress, stimulate the meaning-making process, and enhance the well-being of HCT recipients. Testing of an intervention to address existential concerns unique to patients undergoing HCT will be reinforced by a statistically rigorous idiographic approach to see what works for whom and when. Since access to interventions in the HCT population is limited, the web-based ACT self-help program could potentially fill this gap. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06266182. Registered on February 20, 2024.

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BACKGROUND: People with cancer who have completed treatment still experience negative effects, such as an increased risk of experiencing cancer-related pain. Psychological factors tend to influence cancer patients' ability to cope with pain in various dimensions. Although personal resources are an important factor in buffering total pain, still little is known about the intervening variables and underlying mechanisms. PURPOSE: The current study examined the relationship between psychological flexibility, self-esteem, and total pain, while considering fear of recurrence, meaning-making, and coping as potential mediating factors. METHODS: Adults (N = 304) who completed medical treatment (radiotherapy, chemotherapy, and combined therapy) participated in this study. They completed questionnaires measuring the aforementioned variables. Structural equation models were used to examine mediation effects. RESULTS: Psychological flexibility, and partly self-esteem, were negatively related to the dimensions of total pain. However, to a large extent, these relationships were serially and parallelly mediated by fear of recurrence, meaning-making, and emotion-oriented coping. CONCLUSIONS: Consistent with the meaning-making model, cognitive (meaning-making), and affective (fear of recurrence and emotional coping) factors may be potential mechanisms underlying the association between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. In this study, they tended to interact in the area of physiological and psychosocial experiences of cancer-related pain.

A significant number of cancer patients who undergo medical treatment tend to experience pain as a consequence of medical and psychological factors. Personal resources such as psychological flexibility and self-esteem can play important roles in the pain experiences of cancer patients, including their physical, psychological, social, and spiritual symptoms. However, other factors related to anxiety and coping can also affect the relationships mentioned above. Therefore, we examined whether fear of recurrence, meaning-making, and coping serially mediated the relationships between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. A total of 304 cancer patients (159 women, 145 men) who had completed medical treatment participated in our study. Patients with higher psychological flexibility experienced lower physical, psychological, social, and spiritual pain, whereas patients with higher self-esteem felt only lower physical pain. Furthermore, posttreatment cancer patients characterized by well-defined goals and self-worth experienced lower fear of recurrence and were able to find meaning and emotionally cope with their daily predicament. As a consequence, they felt less total pain in physical, psychological, social, and spiritual dimensions. Experiencing lower fear of cancer recurrence combined with finding meaning and goals predisposes patients to more effectively deal with pain symptoms.

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PURPOSE: This study investigates how social categories work and intersect in siblings bereaved by drug-related deaths' (DRDs) stories about their relationships to their deceased brother or sister. The sociocultural embedded process of making meaning of the relationship with the deceased individual is essential in adapting to the loss. However, insight into such experiences of siblings bereaved by a DRD is scarce. Previous research has suggested that DRDs may be stigmatized life experiences for bereaved family members, and this paper furthers understanding of the experiences and issues involved in losing a sibling in a stigmatized death. METHODS: An intersectional analysis is applied to interviews with 14 bereaved siblings. By investigating and displaying how different categories intertwine, various positionings are identified. FINDINGS: Categorization of the deceased siblings as "addicts" constructs a troubled position. However, when "addict" intersects with the categories "unique," "sibling," and "uncle," the troubled subject's position as an "addict" can be concealed. CONCLUSIONS: Normative conceptions of addiction and DRDs produce troubled subject positions. By intermingling the category of "addict" with other categories, less problematic positions are created. Still, intersections of categories can also construct further complexities of remorse and self-blame for the bereaved siblings.

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PURPOSE: The Dutch Association for Occupational Medicine considers employee values to be an essential pillar in occupational medicine. The occupational physician should focus on what an employee finds valuable. However, it is unclear how occupational physicians comply with this policy and pay attention to employee values. The present study aims to fill this gap by mapping to what extent occupational physicians pay attention to employee values. METHOD: We used an exploratory qualitative research method through in-depth interviews with 10 Dutch occupational physicians. Additionally, two non-participating observations were conducted. RESULTS & CONCLUSION: The results show that values remain mostly implicit and are applied intuitively or unconsciously but not explicitly. Hence, the ethical requirements of the Dutch Association for Occupational Medicine policy remain underexposed and under-executed. Multiple facets foster or impede a conversation about values. As far values were mentioned they were mainly extrinsic, social, and prestige-oriented. Intrinsic values were hardly mentioned. However, a few occupational physicians explicitly stated that they pay attention to values and reported that heeding to employee values contributes to better collaboration and decision-making with the employee. We argue that paying attention to intrinsic values may improve the overall work quality of occupational physicians and benefit employee well-being.

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This article aims to renew the discussion about meaning in the field of psychology. A model is presented that, contrary to the classical view of meaning as an entity taken for granted, explains the dynamics through which it comes to be constituted, opening itself to the possibility of being experienced, as a psychological reality. The autoethnographic analysis carried out by von Fircks (IBPS 53(4):632-643, 2023) is used as example to show how such a model enables an understanding of local phenomena through the comprehension of the semiotic dynamics underlying them. Finally, this paper offers insights into the mechanisms that underlie the field of possibility of meaning-making processes, thus of human experience.

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Parents who are experiencing neonatal death need support in promoting and maintaining their parental role. This includes parenting their infant during end-of-life. Bedside nurses should partner with parents to help them maintain the parent-infant relationship by establishing effective communication, building trust, and promoting the parental role. By doing so, parents will utilize these experiences to process their grief through meaning-making.

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The negative impact of the COVID-19 pandemic on mental health has been widely demonstrated; however, few studies have investigated the psychological processes involved in this impact, including core beliefs violation, meaning-making disruption, interpersonal support, or one's relational functioning. This study explored the mental health of 215 Italian adolescents during the COVID-19 pandemic and the subsequent outbreak of the Russian-Ukrainian war. By administering a set of questionnaires, several cognitive and emotional variables were investigated, including core belief violation, meaning attribution to the pandemic and war, attachment, and emotion regulation, social media addiction, and relationships with significant others and teachers. We conducted some descriptive, mean difference, correlational, and predictive analyses that revealed a significant association between core belief violation caused by war and pandemic, ability to integrate war and pandemic within personal meaning universe, the relational support received, and mental health. The relationship with teachers during these challenging periods improved significantly according to the respondents' opinion, becoming both more authoritative and empathic. This study offers insights into what cognitive and relational processes are useful to intervene on to reduce the distress of adolescents who are facing significant moments of crisis due to events that challenge their cognitive and emotional balance.

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Identity formation among young people from refugee backgrounds is complex, as it occurs while they are both integrating into a novel cultural landscape and navigating the intricacies of adolescence. The present study explored sense of identity and experiences among refugee youth in the context of resettlement. Nineteen young people (15-18 years) from refugee backgrounds, settled in Brisbane, Australia, took part in the study. An individual semi-structured interview, drawing upon the Tree of Life method, was used. The thematic analysis (TA) methodology was adopted, and several themes emerged: experiencing changes in family roles; experience of belonging; experience of bonds with lost loved ones; dealing with emotions in a new context; experience of self in the context of change. There was one emergent overarching theme of meaning-making in the context of change. These themes were explicated within the framework of social identity and sociocultural theories, which emphasises the dynamic co-construction of identity through the interplay of belonging and meaning-making within specific contextual settings. This study highlights the fundamental role of social context, particularly the fostering of school belonging, in the multifaceted process of identity construction. The findings identify the importance of integrating multiple identities and experiences to develop a comprehensive and resilient sense of personal cohesion and selfhood.

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PURPOSE: Stressful life events have the capacity to disrupt an individual's worldview and life goals, leading to existential questions and identity loss. The subjective perception of identity is intricately linked with quality of life (QoL), and how individuals derive meaning from these stressful life events significantly influences their well-being. This article explored the impact of stressful life events on individuals' QoL, and examined the potential for enhancing QoL through meaning making and narrative reconstruction. METHODS: Qualitative interviews were conducted with 11 individuals reporting diminished QoL and analysed using thematic analysis. RESULTS: The study reveals that stressful life events confront interviewees with the vulnerability of their values in life and the limits of their control, leading them to question their own beliefs and purpose in life. Consequently, these events prompt individuals to reconstruction their narratives to adapt to new life circumstances. CONCLUSIONS: The study suggests that "securing the base," including strong social relations and security in economic and housing conditions, is a prerequisite for enhancing QoL. The insights on "the base" have profound implications for QoL. Recognizing their fundamental importance, policymakers, healthcare professionals, and social service providers can support mechanisms to enhance these foundations, improving overall well-being for individuals and communities.

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This essay aims to discuss the meaning and purpose of work by adopting an approach in cultural psychology that emphasizes the centrality of the meaning-making process. The central thesis of the paper is to demonstrate that the meaning and purpose of work is a paradox. On the one hand, work represents a set of actions of the human agent for producing things. That is to say, the purpose of work is located outside of it. On the other hand, work is an activity in itself, carried out as a way of developing human potentialities. In this case, the purpose of the actions performed at work coincides with the result of working (developing human potentialities). The paradox arises because, in current work conditions, the unity of human agency represented by these two dimensions of work is fragmented, meaning that not all forms of work permit the convergence among purposes, actions, and the results of these actions. We analyze how some cultural markers, which are products of the process of meaning-making of the human agent in culture, suggest dealing with this paradox. We explore its limits and propose the need for new cultural markers capable of reaffirming the integrality of the human agent at work.

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PURPOSE: As our ageing population is growing and diversifying, it is important to gain insight into the well-being of older migrants. However, the meanings of happiness can vary cross-culturally. Therefore, prior to exploring older migrants' happiness, their meaning-making of "happiness" should be explored. This way, cultural or individual variations can be considered when analysing older migrants' happiness. Not only migration background but also age could influence the meaning of well-being. For example, the meaning of well-being can change as people grow older. Therefore, both migration background and age are considered in exploring older migrants' meaning-making of happiness. METHODS: To do so, in-depth interviews with older migrants (n = 22) from various ethnicities were conducted in which their meaning-making of happiness was questioned via a semi-structured interview guide. RESULTS: After analysing the results via thematic analysis, three overarching themes are discussed: (1) happiness associations, (2) happiness-pursuing strategies, and (3) happiness obstructions. The analysis then further focuses on the role of migration background and ageing on the meaning-making of happiness. CONCLUSIONS: Participants' meaning-making of happiness seems strongly imbued with age-related references. On the contrary, the impact of migration background is rather limited. To explain this difference, the value of incorporating participants' life course experiences emerged.

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PURPOSE: The war metaphor is one strategy used frequently in breast cancer to inspire individuals in a "fight" against cancer and assist patients in navigating their illness experience. Despite prominent use, the emotional impact of this language has not been examined in the context of meaning making among women with metastatic breast cancer (MBC). METHODS: This study involved a semi-structured interview considering the war metaphor's impact on women's illness experience with MBC. Participants (n = 22) had been diagnosed with MBC for at least 6 months or following 1 disease progression and were undergoing treatment at an NCI-designated cancer center in Western Pennsylvania at the time of interview. Each participant underwent an individual interview exploring the war metaphor's impact on illness experience. Qualitative thematic analysis was performed to assess feelings about the war metaphor and emotional response to the lived experience of cancer. RESULTS: Two themes were identified surrounding metaphor use and participants' experiences with meaning making in cancer. First, women with MBC perceive the diagnosis as an "unfair fight" due to its incurable nature. Second, patients use alternative language of "living life" and communicate resistance to being defined by their cancer diagnosis. CONCLUSION: War metaphors are one collection of terminology people use to understand their diagnosis. However, their use may apply pressure to prioritize positivity in the face of diagnosis and treatment, in a unique clinical context where this may not be adaptive. These findings affirm a need to consider patients' lived experiences to best facilitate psychological adjustment to illness.

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Emotions are often thought of as internal mental states centering on individuals' subjective feelings and evaluations. This understanding is consistent with studies of emotion narratives, or the descriptions people give for experienced events that they regard as emotions. Yet these studies, and contemporary psychology more generally, often rely on observations of educated Europeans and European Americans, constraining psychological theory and methods. In this article, we present observations from an inductive, qualitative analysis of interviews conducted with the Hadza, a community of small-scale hunter-gatherers in Tanzania, and juxtapose them with a set of interviews conducted with Americans from North Carolina. Although North Carolina event descriptions largely conformed to the assumptions of eurocentric psychological theory, Hadza descriptions foregrounded action and bodily sensations, the physical environment, immediate needs, and the experiences of social others. These observations suggest that subjective feelings and internal mental states may not be the organizing principle of emotion the world around. Qualitative analysis of emotion narratives from outside of a U.S. (and western) cultural context has the potential to uncover additional diversity in meaning-making, offering a descriptive foundation on which to build a more robust and inclusive science of emotion.

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INTRODUCTION: Adolescent delinquency has been suggested to evolve from a normative motivation to establish independence and identity. However, few studies have examined this in detail, especially in young women. The aim was, therefore, to investigate identity formation in adolescent females with limited delinquency by focusing on identity status and identity processes in narratives about committing crimes and being convicted. METHODS: Interviews with 10 females, 15-18 years old, sentenced to youth service in three Swedish cities were conducted on Zoom. RESULTS: The results showed an equal distribution of all identity statuses within the group. Thematic analysis of their stories about crime and conviction showed that delinquency was described in terms of exploration and commitment, although commitment appeared more clearly. Social relations, in particular peers, played an important role in both committing as well as desisting from delinquency. In terms of narrative processes, the stories contained elements of agency, although diminishing of one's own capability and/or responsibility was common, and meaning making, mostly lesson learning, usually pertained to behaviors, interactional rules, or norms. CONCLUSION: These findings point to the importance of viewing delinquency among young women in a social and developmental context, where delinquency may be a part of the process of identity formation. Interventions focusing on expressing needs of belonging as well as finding oneself in more adaptive ways are warranted, where supporting pro-social relations and contexts is a suggested focus.

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