When tears turn into pearls: post-traumatic growth following childhood and adolescent cancer

It's hard to imagine a crueller fate than when a child receives a diagnosis of an illness as difficult as cancer. A young human being, still not fully formed, is suddenly and irrevocably thrown into a situation that many adults are unable to cope with. Each year, around 160,000 children and youngsters worldwide are diagnosed with cancer, and this trend is growing in industrialised societies. Faced with such facts, it is particularly important to understand how children cope. What traces of the experience remain in their psyche if they manage to survive?

Partial answers to these questions come from a trio of Australian researchers in their systematic review and meta-analysis of existing research into the psychological effects of cancer on children, published recently in Psycho-Oncology. Their findings give us reason for some optimism. It turns out children and adolescents affected by cancer are no more likely to develop post-traumatic stress symptoms than their healthy peers. In fact, several studies have found that children affected by cancer go on to experience greater than usual adjustment and quality of life and lower anxiety and post-traumatic stress symptoms. In psychology, we refer to this as the post-traumatic growth (PTG) effect, which can arise from the struggle with highly challenging life circumstances or trauma.

Results from the analysed body of research – 18 studies in all – indicated that participants who were older when surveyed, or older when diagnosed with cancer, were more likely to experience PTG. Most likely, this is a product of the development of abstract reasoning that occurs sometime after the 11th or 12th year of life, when adolescents begin to formulate their own value systems, take an interest in philosophical ideas, and think about the meaning of life – cognitive processes that are involved in the development of PTG.

The meta-analysis also revealed a small but statistically significant correlation between post-traumatic stress and PTG. By definition, the struggle with trauma is necessary for the development of PTG, because it is during such struggles with disease that a teenager may experience both obsessive thoughts about death, but also may begin to appreciate life more. The vision of losing the normalcy that healthy people take for granted can turn into affirmation of that very normalcy. It is precisely these difficult experiences in youth that contribute to the formation of individuals who psychologists refer to as "prematurely mature".

The least surprising result was the positive link between PTG and having greater social support, as well as between PTG and being more optimistic. Unfortunately, these correlations don't tell us whether social support and optimism lead to PTG, or if the reverse is true. Further studies may identify the causal relations between these factors. In turn this may help inform the development of support programmes targeting children with cancer and other difficult illnesses.

The new meta-analysis also looked for potential correlations between PTG and depression, anxiety, pessimism, and quality of life, but all were statistically nonsignificant. Jasmin Turner and her colleagues suspect that this could be caused by small sample sizes.

For decades, psychology has treated negative human experiences as unequivocally harmful to people, assuming that they lead to post-traumatic stress disorder, and poorer psychological and physical functioning. Regardless of their actual psychological state, people who have survived negative experiences have sometimes been treated like patients in need of help, and at times this help has even proved harmful to them. The discovery that following some traumatic situations, tears can turn into pearls is one of the more significant and promising discoveries of psychology. Understanding when and why this happens is a means for science to make a clear contribution to improving people's well-being. And while the new results are not very strong, nevertheless they may help guide future research, potentially helping social support and clinical interventions for cancer patients. Also important is consideration of the factors leading to PTG and how to share this information appropriately and sensitively with people suffering illnesses. However, before we can label any such programmes as "evidence based", further studies are necessary, particularly longitudinal research.

That said, it is not worth waiting passively for the results of such studies. With the knowledge that the experience of trauma can lead to PTG, we can begin providing intelligent support to people whose luck is down – encouraging reflection on the experience of trauma, rather than mechanical consolation with exhortations to think positively. Intelligent support should be an unobtrusive presence, without encouraging the rejection of negative emotions, and without attempts at eliciting positive ones. In all certainty, this kind of approach will be different from the offerings we have received for many years from some unreflexive positive psychologists.

Further reading

—Correlates of post-traumatic growth following childhood and adolescent cancer: A systematic review and meta-analysis

About the author

Post written by Dr Tomasz Witkowski for the BPS Research Digest. Tomasz is a psychologist and science writer who specialises in debunking pseudoscience in the field of psychology, psychotherapy and diagnosis. He has published over a dozen books, dozens of scientific papers and over 100 popular articles (some of them in Skeptical Inquirer). In 2016 his latest book Psychology Led Astray: Cargo Cult in Science and Therapy was published by BrownWalker Press. He blogs at https://forbiddenpsychology.wordpress.com/.