The Mediating Role of Cognitive Processing in the Relationship Between Negative and Positive Effects of Trauma Among Female Victims of Domestic Violence

Abstract

Exposure to domestic violence may lead not only to negative but also positive consequences of trauma. Negative effects are indicated by posttraumatic stress symptoms (PTSSs), and positive effects by posttraumatic growth (PTG) changes. PTG has been conceptualized to follow experiences of PTSSs. Therefore, the positive and negative effects of trauma appear to be related to one another. The cognitive processing may play a special role in determining whether the positive and negative consequences of trauma exposure are experienced. The aim of the study was to establish the mediating role of multiple patterns of cognitive processing, reflected by the cognitive strategies used to cope with trauma, in the relationship between negative and positive posttraumatic changes in women following domestic violence. Data were obtained from 63 Polish women who had experienced domestic violence. The age of the respondents ranged from 19 to 71 years (M = 42.25, SD = 14.81). The Polish versions of the following standardized tools were used: the Posttraumatic Stress Disorder Checklist (PCL-5), the Posttraumatic Growth Inventory (PTGI), and the Cognitive Processing of Trauma Scale (CPOTS). PTSS severity appeared to be negatively related to that of PTG. Negative coping strategies were positively related to the PTSS severity but negatively to PTG, while positive strategies were negatively related to the PTSS severity but positively to PTG. Cognitive strategies for coping with trauma, such as resolution/acceptance, downward comparison, and regret, appeared to play a mediating role in the relationship between PTSS severity and PTG. Positive coping strategies strengthen the occurrence of positive posttraumatic changes while strategy of regret weakens the PTG changes occurrence. The process of adaptation and human development among people who have experienced traumatic events is favored by the use of more frequent positive and less frequent negative strategies of dealing with trauma.

Keywords

cognitive processing of trauma domestic violence posttraumatic growth posttraumatic stress symptoms women

Introduction

Domestic violence is an intentional and forceful action directed against a family member. It violates personal rights and causes suffering and injury (Act on the Prevention of Violence in the Family, 2010). Domestic violence primarily affects women and children (Black et al., 2011), and the perpetrator is usually a husband, partner, or father (Smith et al., 2017). World Health Organization et al. (2013) data indicate that 30% of women experience violence from their partners. In Poland in 2018, of the 88,000 reported victims of domestic violence, approximately 65,000 (73.8%) concerned women: as indicated by the numbers of Niebieska Karta (Blue Card) issued by the Police, in response to domestic abuse (policja.pl, n.d.).

Domestic Violence as a Traumatic Experience

Domestic violence is an example of a recurring or chronic stressor that involves the abuse of trust as well as the violation of existing boundaries and expectations toward relationships with other people. It often has a sudden onset and is life threatening, and as such, meets the criteria of a traumatic stressor (Levendosky et al., 2012; Yalch et al., 2015). It can take physical, psychological, sexual, and economic forms. The data presented by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (Smith et al., 2017) show that in the United States, every fourth woman in an intimate relationship experiences physical violence, every 10th is exposed to sexual violence, while almost a half of women face psychological aggression from partner. Domestic violence survivors often struggle with patterns of thinking characterized by strong emotions of anxiety, anger, regret, shame, terror, helplessness, guilt, and often by negative self-image and social stigmatization (Lutwak, 2018). Moreover, domestic violence is associated with a wide variety of mental health concerns, depression, or anxiety, including posttraumatic stress disorder (PTSD; Bernard et al., 2019; Campbell, 2002; Coker et al., 2009; Devries et al., 2013; Dillon et al., 2013; Dutton et al., 2006; Ellsberg et al., 2008; McCaw et al., 2007; Trevillion et al., 2012).

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) divides posttraumatic stress symptoms (PTSSs) into four clusters: intrusions, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Experience of violence is one of the events most closely associated with PTSD (Crowell & Burgess, 1996). It has been found that the prevalence of PTSD among women experiencing intimate partner and domestic violence vary from 31% to 84.4% while it does not exceed 3.5% within the general population of adult U.S. residents (Bear et al., 2016; DeJonghe et al., 2008; Jones et al., 2001). Studies conducted in Poland show that nearly 90% of abused women displayed at least a moderate severity of PTSSs while 10% demonstrated low severity (Ogińska-Bulik, 2016).

The occurrence of PTSSs among women experiencing violence depends on different factors. Jones et al. (2001) indicate that unemployed, younger women with low income, relatively large numbers of children, and those with low levels of social support are most likely to experience PTSSs as a result of domestic violence. Other researchers emphasize that the type, intensity, duration, multiplicity of the forms of violence, interpretation and perception of threat, substance abuse, diversity and nature of the acts of violence (incarceration and solicitation mainly related to sexual violence), exposure to traumatic events in the past, especially sexual abuse in childhood may affect the severity of PTSS (Becker et al., 2010; Brown et al., 2005; Griffing et al., 2006; Hegarty et al., 2013; Perez & Johnson, 2008; Scott, 2007; Swopes et al., 2017; Wijma et al., 2000; Yalch et al., 2017). Moreover, some studies stress a role of traumatic brain injury (TBI), that is, cognitive dysfunction and neurological difficulties following domestic violence physical injuries, as an important factor that may increase a risk for PTSS development (Albrecht et al., 2017; Kwako et al., 2011; Monahan, 2019; Valera & Kucyi, 2017; Vasterling et al., 2018). However, considering the studies that focus on protective role of TBI against PTSS or those that emphasize the difficulties in differential diagnosis, the literature review in the area of TBI becomes ambiguous (Bryant, 2011; Sbordone & Liter, 1995).

The experience of a traumatic event is often initially associated with distress, negative emotions, and the depletion or loss of personal resources, especially in the initial stage of coping. Nevertheless, recent findings indicate that long-term consequences resulting from a traumatic experience may also be positive and find expression in the form of posttraumatic growth (PTG). They concern changes in the perception of oneself, relationships with others, and the philosophy of life, including appreciation of life and spiritual changes (Ogińska-Bulik, 2015; Tedeschi & Calhoun, 1996, 2004). However, it should be emphasized that the occurrence of PTG does not suggest that trauma itself is something good, desirable, or necessary for change. It is not related to a pleasant mood or a sense of happiness, and does not entail feeling carefree. Tedeschi and Calhoun (2004) indicate that besides loss, pain, and suffering, it is also possible to gain certain benefits from a traumatic event, thus transforming trauma into an important value. In addition, the experience of such changes allows a traumatized person to deal more effectively with adversity in the future (Tedeschi & Calhoun, 2004). Studies in this area have confirmed the occurrence of PTG among victims of violence, albeit to a lesser extent than in people who experienced other types of trauma. The studies of women who have experienced various types of violence, although mainly physical, emotional, and sexual forms, have also revealed the occurrence of positive changes after trauma (Cobb et al., 2006; Draucker, 2001; Elderton et al., 2015; Lev-Wiesel et al., 2005; Senter & Caldwell, 2002; Ulloa et al., 2016). A literature review by Elderton et al. (2015) found that, on average, 71% of respondents demonstrated positive changes following trauma associated with interpersonal violence, with the highest occurrence of positive posttraumatic change reported in the area of appreciation of life. Research conducted in Poland (Ogińska-Bulik, 2013) confirms the occurrence of growth after trauma among female victims of domestic violence, but indicated that only 7.6% of respondents experienced it to a high level. The majority of respondents (56.6%) displayed low intensity of PTG and the rest of the group (35.8%) moderate intensity.

Current studies on the relationship between PTSS severity and PTG are ambiguous. Most indicate the presence of positive links between the variables, including those performed on people who had experienced interpersonal violence (Cobb et al., 2006; Lev-Wiesel et al., 2005), whereas other studies, among individuals who had sustained various traumatic events, report negative links between PTSS severity and PTG (Hall et al., 2008; Johnson et al., 2007; Meng et al., 2018). In addition, some data fail to confirm any association between PTSS severity and PTG (Hagenaars & van Minnen, 2010; Solomon et al., 1999), and others suggest the presence of a curvilinear relationship (Kunst, 2010; Levine et al., 2008). Such ambiguity in the links between symptoms of pathology and positive changes after trauma reinforce the need for further research in this area. It also raises the need to identify the mechanism underlying this relationship, which may be associated with the cognitive processing of trauma.

Relationships Between Cognitive Processing of Trauma, PTSS, and PTG

The nature of the cognitive processing of trauma may have a strong influence on the development of PTSS and PTG (Calhoun et al., 2010; Ehlers & Clark, 2000; Foa et al., 1999; Horowitz, 1976; Nalipay et al., 2015; Stockton et al., 2011; Williams et al., 2002). It is reflected in the revised model of PTG (Calhoun et al., 2010) that defines trauma as a state that causes severe distress and violates cognitive patterns and beliefs. If the experienced traumatic event is a significant challenge for the individual, it is also thought to activate cognitive processes (cognitive processing) which may influence existing patterns. However, the event must be strong enough to force the individual to revise certain assumptions he or she holds about himself or herself, and the world. By processing the trauma cognitively, the individual hopes to gain sense and meaning from the experienced event and, consequently, adapt to the new, changed reality.

Williams et al. (2002) list several factors as indicators of effective trauma processing. These include a decrease in the level of negative emotions (especially feelings of guilt or shame), the assimilation of information about the traumatic event, the acceptance of the event, the perception of its positive aspects, and desensitization, manifested as a gradual reduction of the perceived stress and negative emotions associated with ruminating on the event. Such cognitive trauma processing is often realized through cognitive coping strategies, as indicated by Taylor’s (1989) cognitive adaptation theory. Moreover, the processing of cognitive trauma is related to a certain extent to the cognitive distortion of reality. Williams et al. (2002) highlight three positive cognitive coping strategies, these being positive cognitive restructuring, resolution/acceptance, and downward comparison, and two negative strategies: denial and regret. Effective cognitive trauma processing, expressed in the use of positive (adaptive) coping strategies, usually allows the individual to adapt to the situation and undergo positive changes (Arandia et al., 2018). In turn, inefficient cognitive trauma processing associated with negative (non-adaptive) coping strategies usually promotes the occurrence and maintenance of PTSSs (Williams et al., 2002). Cognitive trauma processing may also act as a mediator in the relationship between the negative and positive consequences of trauma. It may also serve as the mechanism underlying the associations between PTSS severity and PTG.

The aim of the study was to identify the explanatory role of multiple patterns of cognitive processing, expressed in the form of cognitive coping strategies with regard to relationships between the negative consequences of trauma (PTSS severity), and its positive consequences (PTG) among women following domestic violence, and establish the associations between variables.

The adopted research model refers to the cognitive theory of trauma proposed by Ehlers and Clark (2000) and the Calhoun et al. (2010) concept of PTG, both of which stress that cognitive activity plays a significant role in the positive and negative consequences of trauma. Calhoun et al. (2010) indicate that while PTSS typically manifests before PTG, the occurrence of positive or negative trauma depends on the nature of the accompanying cognitive activity. The study also adopts the classification of cognitive coping strategies proposed by Williams et al. (2002), which imply negative and positive trauma processing.

It is assumed that negative coping strategies will be related positively with the occurrence of PTSS and negatively with that of PTG; in contrast, the positive strategies will be associated negatively with PTSS severity and positively with PTG. In addition, PTSSs will be assumed to be associated with PTG; however, due to the ambiguity of the results presented in the literature, the nature of this relationship remains unclear. In addition, it is assumed that the identified positive cognitive coping strategies will serve as mediators in the relationship between PTSS severity and PTG.

Method

Procedure and Sample

The study included 65 White women who were victims of domestic violence. All were currently residents of shelters for those who have experienced domestic violence, located in a single city in central Poland. Data were collected between October 2017 and May 2018. The inclusion criteria comprised age above 18 years and prior experience of at least one act of domestic violence. Age below 18 years was main exclusion criterion. Moreover, homogeneity of the group was maintained by including only White women (Figure 1). The research was voluntary, anonymous, and conducted collectively on the premises of the shelters in direct contact with respondents. The study was approved by the Committee on the Bioethics of Scientific Research, University of Lodz. As two respondents did not complete the questionnaires, the final analysis included complete results obtained from 63 women aged 19 to 71 (M = 42.25, SD = 14.81). The duration of domestic violence ranged from 1 month to 50 years (M = 12.50, SD = 13. 60). The time that had elapsed since the last act of violence ranged from 1 to 58 months (M = 15.94, SD = 17.68). The participants’ demographics are presented in Table 1.

Figure 1.

Consort diagram of analyzed group.

Table 1.

Demographic Variables of Examined Group.

Demographic variable	Frequency (n = 63)	%
Level of education
Secondary education	26	41.3
Higher education	13	20.6
Vocational or primary education	24	38.1
Marital status
In relationship (married, cohabitation)	25	39.7
Single (also divorced, widowed)	38	60.3
Children
Yes	53	84.1
No	10	15.9
Type of violence^a
Psychological	62	98.4
Physical	51	81.0
Economic	47	68.3
Sexual	25	39.7
Perpetrator^b
Husband	39	61.9
Partner	17	27.0
Father	10	15.9
Mother	8	12.7
Child	6	9.5
Other family member	3	4.8

The respondents could point to several types of violence at the same time.

The respondents could point to more than one perpetrator.

One survey was used to collect data regarding age, level of education, marital status, children, type of violence, and the perpetrators and duration of domestic violence. In addition, the Posttraumatic Stress Disorder Checklist (PCL-5) was also used to gain an insight into the occurrence of PTSS, the Posttraumatic Growth Inventory (PTGI) was used for PTG, and the Cognitive Processing of Trauma Scale (CPOTS) was used to survey cognitive processing.

Measures

PCL-5 by Weathers et al. (2013) was administered as the Polish adaptation by Ogińska-Bulik et al. (2018). The PCL-5 contains descriptions of 20 PTSSs, such as “How many times have you been annoyed by repetitive, unpleasant, and unwanted memories of a stressful event,” assigned to four categories: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Responses are given on a 5-point scale ranging from 0 (not at all) to 4 (very strongly), with the severity of symptoms calculated as the sum of all results for all 20 items. The tool is characterized by very good psychometric properties. The internal consistency (Cronbach’s α) was .96.

PTGI, developed by Tedeschi and Calhoun (1996), was administered as the Polish adaptation by Ogińska-Bulik and Juczyński (2010). The PTGI comprises 21 items that describe various positive changes that may occur as a result of a traumatic event (e.g., “I changed my priorities regarding what is important in life”). The respondent indicates a response on a 6-point scale ranging from not having experienced this change (0 points) to having experienced it to a very large extent (5 points). In the Polish version, the scale measures the general PTG intensity index and scores four factors contributing to posttraumatic development: (a) changes in self-perception, (b) changes in relationships, (c) greater appreciation of life, and (d) spiritual changes. The overall result is the sum of the four factors mentioned above. The reliability indicators are comparable with the original version (Cronbach’s α = .93).

CPOTS, developed by Williams et al. (2002), was administered as the Polish version by Ogińska-Bulik and Juczyński (2018). The scale comprises 17 items (e.g., “Ultimately, there is more good than bad in this experience”) and measures five aspects of cognitive processing: positive cognitive restructuring, downward comparison, resolution/acceptance, denial, and regret. The individuals respond to each statement on a 7-point scale from –3 (I strongly disagree) to +3 (I strongly agree). The result for each subscale is calculated separately. Positive cognitive processing of trauma is calculated as the sum of the results of three strategies, that is, positive cognitive restructuring, resolution/acceptance, and downward comparison, while negative cognitive processing is given as the sum of the regret and denial strategies. The reliability for the Polish version of CPOTS was satisfactory, with the obtained Cronbach’s alpha coefficients ranging from .89 to .56: Higher values were obtained for the positive trauma processing strategies (.90) than the negative strategies (.73).

Analyses

In the next steps, SPSS version 25 was used to determine the means of the analyzed variables, as well as the relationships between variables and cognitive trauma processing believed to act as statistical mediators between PTSS severity and PTG. Mediation analysis was performed using the PROCESS macro based on the bootstrapping procedure proposed by Preacher and Hayes (2008). This method allows a more complex structure to be determined for the model, in which an independent variable, acting as a predictor (in this case, PTSS severity), is associated with a dependent variable (PTG) through a third variable, acting as a mediator (cognitive strategies for coping with trauma). A mediating effect occurs when the intermediate variable reduces the predictive values of the independent variable for the dependent variable. A confidence interval of 95% was assumed.

Results

The overall PTSS severity score obtained by women following domestic violence was found to be similar to data from standardization studies (Ogińska-Bulik et al., 2018). Assuming a total score of 33 points as the cut-off point for the PCL-5, 39 respondents presented a high probability of developing PTSS (61.9%) while 24 displayed a low probability (38.1%). The mean PTG score (59.90) corresponds to a moderate intensity of positive posttraumatic changes. Twenty-four women (38.1%) demonstrated a low level of PTG, 15 (23.8%) revealed an intermediate level, and 24 (38.1%) a high level. The means obtained for each trauma coping strategy (Table 2) are similar to those obtained in the Polish adaptation of the CPOTS (positive cognitive restructuring—M = 8.04; resolution/acceptance—M = 14.52; downward comparison—M = 11.94; denial—M = 9.00; regret—M = 9.87; Ogińska-Bulik & Juczyński, 2018).

Table 2.

Correlation Coefficients, Means, and Standard Deviations Among Analyzed Variables.

Variable	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17
1. PTSD total	—
2. PTSD.1	.90***	—
3. PTSD.2	.56***	.34**	—
4. PTSD.3	.94***	.79***	.50**	—
5. PTSD.4	.91***	.78**	.40**	.78***	—
6. CPOT.positive	−.40***	−.44***	−.23	−.35**	−.34**	—
7. CPOT.1	−.11	−.09	.03	−.11	−.13	.73***	—
8. CPOT.2	−.43***	−.51***	−.37**	−.35**	−.31*	.84***	.44***	—
9. CPOT.3	−.38***	−.40***	−.16	−.34**	−.34**	.79***	.37**	.49***	—
10. CPOT.negative	.36**	.27*	.30*	.43***	.21	.07	.16	−.06	.09	—
11. CPOT.4	.19	.13	.19	.25*	.07	.15	.17	.08	.11	.84***	—
12. CPOT.5	.41***	.32**	.32**	.48***	.28*	−.01	.11	−.17	.05	.86***	.46***	—
13. PTG total	−.35**	−.25*	−.27*	−.38***	−.27*	.51***	.38***	.44***	.37**	−.31*	−.16	−.36**	—
14. PTG.1	−.36**	−.29*	−.30*	−.38***	−.28*	.45***	.35**	.44***	.28*	−.30*	−.14	−.36**	.93***	—
15. PTG.2	−.29*	−.16	−.21	−.34**	−.23	.45***	.36**	.33**	.39***	−.29	−.19	−.31*	.92***	.74***	—
16. PTG.3	−.24	−.21	−.13	−.28*	−.17	.53***	.41***	.47***	.36**	−.22	−.08	−.29*	.90***	.81***	.79***	—
17. PTG.4	−.31*	−.22	−.31*	−.29*	−.27*	.35**	.18	.32**	.32**	−.21	−.11	−.25*	.73***	.60***	.64***	.59***	—
M	35.08	8.60	3.89	12.32	10.27	31.19	6.92	13.62	10.65	15.95	7.03	8.92	59.90	27.13	20.16	9.17	3.44
SD	18.71	5.38	2.27	7.53	6.06	14.01	5.23	6.51	5.97	9.57	5.44	5.78	26.24	11.31	10.12	4.53	3.22

Note. PTSD = posttraumatic stress disorder; PTSD.1 = intrusion; PTSD.2 = avoidance; PTSD.3 = negative alterations in cognitions and mood; PTSD.4 = alterations in arousal and reactivity; CPOT.positive = positive cognitive processing of trauma; CPOT.1 = positive cognitive restructuring; CPOT.2 = resolution/acceptance; CPOT.3 = downward comparison; CPOT.negative = negative cognitive processing of trauma; CPOT.4 = denial; CPOT.5 = regret; PTG = posttraumatic growth; PTG.1 = changes in self-perception; PTG.2 = changes in relationships; PTG.3 = greater appreciation of life; PTG.4 = spiritual changes.

p < .05. **p < .01. ***p < .001.

No significant associations were found between the majority of demographic variables and the intensity of negative and positive posttraumatic changes. Only the time elapsed since the last act of violence correlated negatively with PTSS severity (r = –.40, p < .001) and positively with PTG (r = .30, p < .05). Because of the small numbers of respondents in one group, with regard to have children, or multiple type of violence and perpetrator, the influence of these variables on consequences of trauma was not analyzed.

Following this, the relationships between variables, that is, PTSS severity, PTG, and cognitive strategies of coping with trauma, were established using Pearson’s correlation coefficient (Table 2). Summary indicators were also derived in the form of negative and positive trauma processing.

Three of the five strategies included in the CPOTS (resolution/acceptance: r = –.43, p < .001; downward comparison: r = –.38, p < .001; regret: r = .41, p < .001) were found to be significantly associated with overall PTSS severity score. The strategy of resolution/acceptance (negatively) and regret (positively) correlates with all categories of PTSS severity. Positive cognitive restructuring (r = –.11, p > .05) and denial (r = .19, p > .05) strategies are not linked to PTSS severity (total). With regard to total indicators of cognitive processing, PTSS severity (total) was positively associated with negative cognitive processing (r = .36, p < .01) with the highest correlation coefficients referred to negative alterations in cognitions and mood (r = .43, p < .001) and negatively with positive cognitive processing (r = –.40, p < .001) with the highest values of correlation coefficients referred to intrusion (r = –.44, p < .001).

The data presented in the table confirm that four cognitive strategies of coping with trauma (positive cognitive restructuring: r = .38, p <.001; resolution/acceptance: r = .44, p < .001; downward comparison: r = .37, p < .01; regret: r = –.36, p < .01) are related to PTG. No links were found between denial and PTG (r = –.16, p > .05). With regard to total indicators of cognitive processing, PTG was more closely associated with positive trauma processing (r = .51, p < .001) than negative processing (r = –.31, p < .05).

There is a negative correlation between PTSS severity and all areas of PTG (r for overall scores = –.35, p < .01). Hence, in the group of women who have experienced domestic violence, the occurrence of PTSS, revealed mainly in the form of negative alterations in cognitions and mood, seems to inhibit the manifestation of positive changes.

The associations identified between the variables considered in the study, that is, cognitive processing of trauma and PTSSs and PTG changes, prompted a search for more complex relationships. In total, four models indicating that cognitive coping strategies play significant roles as mediators in the relationship between PTSS severity and PTG were obtained (Figures 2 –4 where βc indicates the predictive values of the independent variable prior to the implementation of the mediator and βc′ indicates the value of the independent variable after implementation). First, the mediating variable, in the form of summary results, that is, positive and negative trauma processing, was examined; following this, the significance of each individual coping strategy was analyzed.

Figure 2.

Model of relations between posttraumatic stress symptoms, positive and negative coping strategies, and posttraumatic growth.

Figure 3.

Model of relations between posttraumatic stress symptoms, cognitive coping strategies in the form of resolution/acceptance, downward comparison, positive cognitive restructuring, and posttraumatic growth.

Figure 4.

Model of relations between posttraumatic stress symptoms, cognitive coping strategies in the form of regret and denial, and posttraumatic growth.

Figure 2 shows that the symptoms of posttraumatic stress are predictors for PTG and positive trauma processing expressed in the use of all adaptive coping strategies, and positive trauma processing is a predictor of PTG. The implementation of positive trauma processing as a mediator results in the relationship between PTSS severity and PTG losing significance. This finding indicates full mediation. It means that the relationship between PTSS severity and PTG is fully explained by the role of positive coping strategies: positive cognitive processing is the only predictor of PTG. The introduction of non-adaptive coping strategies (total indicator) as a mediator results in the lack of mediation effect.

Similar results were obtained by using specific positive cognitive coping strategies, that is, resolution/acceptance and downward comparison as an intermediate variable (Figure 3). The introduction of these strategies resulted in the disappearance of the initial negative correlation between PTSS severity and PTG changes, which also indicates full mediation. The occurrence of PTG is more closely linked to the resolution/acceptance and downward comparison strategies than to the PTSS severity. The strategy of positive cognitive restructuring did not play the role of mediator in the relationship between PTSS severity and PTG.

Among the negative strategies of cognitive coping, only the strategy of regret proved to be a mediator in the relationship between PTSS severity and PTG: Its introduction makes the relationship between PTSS severity and PTG statistically insignificant (Figure 4). Moreover, the PTSS severity revealed by the respondents are conducive to this strategy, which also weakens the occurrence of positive posttraumatic changes. The introduction of denial strategy as a mediator results in the lack of mediation effect.

Discussion

The women who were exposed to domestic violence experienced both negative and positive posttraumatic changes. A high probability of PTSS development was demonstrated by 62% of respondents. Our obtained results, indicating a high risk of PTSS development among women experiencing domestic violence, are similar to those presented in the literature (Dąbkowska, 2009; McLean et al., 2014; Ogińska-Bulik, 2016). In addition, the respondents also reported examples of PTG, which is consistent with the majority of studies conducted in this area (Cobb et al., 2006; Draucker, 2001; Elderton et al., 2017; Lev-Wiesel et al., 2005; Ogińska-Bulik, 2013, 2016; Senter & Caldwell, 2002; Ulloa et al., 2016). It indicates that many women, despite the negative consequences of trauma, are able to see new opportunities, improve relationships with others, orient themselves to the future, and formulate new goals and life tasks. Such changes in priorities and the identification of new opportunities and life paths represent the most important aspects of PTG.

However, the study shows that the relationship between PTSS severity and PTG is negative, that is, higher severity of posttraumatic symptoms may be associated with lower intensity of positive posttraumatic changes. In other words, the occurrence of severe PTSSs seem to inhibit growth after trauma. These findings confirm those obtained from earthquake victims (Meng et al., 2018) or settlers in the Gaza Strip (Hall et al., 2008). It should also be considered that many of the women surveyed in the present study had experienced domestic violence for a long period, and some may still have been exposed to it; on one hand, this may intensify the symptoms of posttraumatic stress, on the other, it may also lessen the chance of PTG. Perhaps from a long-term perspective, the occurrence of PTG changes in women experiencing domestic violence will be associated with a greater reduction of PTSS severity.

Trauma processing, expressed in the form of cognitive coping strategies, is associated with both negative and positive consequences. As expected, negative strategies positively correlated with PTSS severity and negatively with PTG. Positive strategies, on the contrary, negatively correlated with the PTSS severity but positively with PTG. Similar relationships have been found in other studies of women who were victims of violence from a close partner (Arandia et al., 2018; Valdez & Lilly, 2015). They have also been confirmed among people experiencing other traumatic events (Oginska-Bulik & Juczyński, 2018). These findings highlight the universal character of this type of relationship, and imply that similar relationships exist regardless of the type of experienced event. This thesis, however, would require confirmation in further studies. The obtained relationships confirm the assumptions of the model formulated by Ehlers and Clark (2000), according to which, negative cognitive processing of trauma information related to trauma is associated with PTSD symptoms. They are also consistent with the assumptions of the Calhoun et al. (2010) model highlighting the importance of cognitive activity in the occurrence of PTG changes. In general, cognitive processing allows those who have experienced trauma to revise their assumptions about themselves and the world. It is also connected with the ability to give the experienced event sense and meaning and thus adapt to a new, changed reality. The obtained relationships also confirm the validity of the division of cognitive trauma coping strategies into positive (adaptive) and negative (non-adaptive) types, as presented by Williams et al. (2002).

Our findings confirm the mediating role of positive trauma processing in the relationship between PTSS severity and PTG. More detailed analysis showed that three out of the five cognitive trauma coping strategies, that is, resolution/acceptance, downward comparison, and regret, act as mediators. Hence, the use of the correct coping strategy, especially a positive strategy, offers the chance for growth following trauma, even among people displaying high PTSS severity. In addition, the cognitive processing of trauma, especially positive strategies, may serve as the mechanism explaining the relationship between the negative and positive consequences of experienced events. It is worth highlighting the mediating role of the regret strategy, an example of negative coping with trauma, in the relationship between PTSS severity and PTG. This strategy is characterized by thinking persistently about what could have been done to avoid the events surrounding the trauma. This type of repetitive thoughts and accompanying negative emotions undoubtedly hinders the process of adaptation to trauma. Regret can also be manifested as sadness associated with not dealing with the experienced situation and in feeling blame for what has happened: a common reaction observed among women who suffer violence. However, studies show that the use of this strategy by women experiencing domestic violence in fact contributes to a reduction in the negative relationship between PTSS severity and PTG. It should be stressed that while PTSS severity is a rather strong predictor of regret, regret appears to be a weak predictor of PTG. Perhaps the mediating role of regret stems from the fact that this strategy is somehow linked to acceptance of the sadness and helplessness experienced in the face of what has happened, which in turn may reduce the negative impact of PTSS severity on PTG.

It is worth noting that cognitive processing of trauma is a complex process, and that the strategy employed for coping with experienced situations by an individual may change over time. The dynamics of these changes could be captured by longitudinal studies. Moreover, the choice of coping strategy is influenced not only by the experienced situation but also by the personality of the individual and their perceived social support. In the process of cognitive processing of trauma, an important role is played by the rumination and also by readiness to change one’s beliefs (Cann et al., 2010; Gul & Karanci, 2017; Juczyński & Ogińska-Bulik, 2018; Ogińska-Bulik, 2016). In addition, cognitive processing is linked to the regulation of emotions, also known as emotional processing; Ogińska-Bulik and Michalska (2019) indicate that deficits in emotional trauma processing favor the persistence of PTSSs.

Strengths and Limitations

The study has some limitations. It applies to a relatively small group of respondents, and is limited only to White women from Poland. The occurrence of other types of traumatic events in the studied group, such as the death of someone close or a serious, life-threatening illness and some important factors such as TBI occurrence, childhood history of sexual abuse, incarcerations, drug abuse, or solicitation, were not analyzed. The coexistence of traumatic events may affect the severity of both PTSSs and PTG. The assessment of the negative and positive effects of traumatic events was performed by self-description, which is influenced by social approval. Moreover, the research was of a cross-sectional nature, which does not allow conclusions to be drawn regarding cause–effect relationships. Finally, the study assumed PTSSs to be independent variables and cognitive coping strategies to be mediation variables: It could be equally well assumed that the opposite is the case, that is, that coping strategies allow PTSS severity to be predicted.

Despite these limitations, our findings offer a new viewpoint for understanding the relationship between the negative and positive consequences of experienced traumatic events and the use of trauma cognitive processing. The obtained results confirm that the survival of even very strong trauma is associated not only with negative, but also with positive, changes in the psychosocial functioning of the individual. They also indicate that cognitive processing may be the mechanism underlying the relationship between PTSS severity and PTG. An important advantage of the conducted research is the fact that it uses new tools adapted to Polish conditions, that is, PCL-5 and the CPOTS.

Implications for Practice

The obtained results may therefore be an inspiration for further research, and may also be used in practice. It is indicated that, on average, 44% of people with diagnosed PTSD experience a clinically significant improvement in their mental state without specific treatment (Morina et al., 2014). The study showed that recovery from PTSD is faster when appropriate treatment is implemented. In this case, the most effective therapeutic approach appears to be cognitive-behavioral therapy (Monson & Shnaider, 2014). Research has found that such treatment has significantly improved the way that women who have experienced violence (sexual violence) perceive the world. This way of thinking can be treated as a form of cognitive processing, which in turn has a positive impact on their mental health (Iverson et al., 2015; Kaysen et al., 2013). Programs implemented to support PTG that focus on changing the way of thinking, reformulating basic existential principles, reducing negative emotions, and encouraging the patient to express traumatic emotions brought expected results in the form of a greater intensity of positive posttraumatic changes (Lechner & Antoni, 2004).

Conclusion

The obtained results indicate that the studied women who had experienced domestic violence revealed both negative (PTSS severity) and positive (PTG) posttraumatic changes. PTSS severity were negatively associated with PTG. Negative coping strategies were positively correlated with PTSS severity but negatively with PTG, while the opposite was true for positive strategies: They were negatively related to PTSS severity but positively related to PTG. Moreover, the mediating role in the relationship between PTSD symptoms and PTG changes is played by two positive coping strategies, that is, resolution/acceptance and downward comparison, and one negative, that is, regret. Hence, therapeutic approaches aimed at changing the way of thinking and encouraging the use of positive coping strategies by trauma victims may significantly reduce the severity of PTSSs and increase the possibility of PTG.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Patient Consent

Informed consent was obtained from all women included in the study.

ORCID iD

Paulina Michalska

Author Biographies

Nina Ogińska-Bulik is a professor and the head of the Health Psychology Department in the Institute of Psychology at University of Lodz (Poland). Her research focuses on positive and negative effects of trauma including violence trauma. She has a number of publications related to posttraumatic stress disorder and posttraumatic growth and their relationship with cognitive processing of trauma among women who experienced domestic violence.

Paulina Michalska is a MA, researcher, and doctoral candidate in psychology at the University of Lodz (Poland). She is interested in looking for predictors of complex trauma including intimate partner violence and supporting the process of adaptation and human development.

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