Open Journal of Social Sciences
Vol.06 No.08(2018), Article ID:86555,15 pages
10.4236/jss.2018.68004

The Two Faces of Spirituality in Time of Traumatic Loss: A Thematic Analysis Study

Michael Galea

University of Malta, Tal-Qroqq, Msida, Malta

Copyright © 2018 by author and Scientific Research Publishing Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

Received: June 28, 2018; Accepted: August 6, 2018; Published: August 9, 2018

ABSTRACT

Introduction: Research strongly suggests a steady relationship between important life events and one’s tendency toward spirituality. Studies view this phenomenon as both positive and negative, always depending on many contributing factors. More complex is the situation when individuals are exposed to vicarious posttraumatic exposure. This study analyzed such lived experiences vis-a-vis spirituality, from a purposive sample of relatives of victims from tragic pyrotechnics accidents in Malta. Method: Guided by Braun and Clarke [1] Thematic Analysis guidelines, we interviewed 8 relatives of individuals who tragically died in fireworks accidents, and who met the inclusion criteria. Results & Discussion: This study highlighted two key results that were noted by the thematic analysis employed: conflicting and complicated spirituality, highlighted by strong emotions and difficulty integrating the hard truth that ensues from such trauma, and protective spirituality, resulting from family cohesion, ability to move on with life, and living in the present. The relevance and implications of these results were discussed.

Keywords:

Spirituality, Well-Being, Vicarious Posttraumatic Exposure, Fireworks Accidents, Traumatic Loss

1. Introduction

The [2] Posttraumatic Growth Inventory (PTGI) posits five underlying issues: new possibilities, relating to others, personal strength, spiritual change, and appreciation of life, involving both the negative and positive reality emanating from trauma. Normally these are lumped together under posttraumatic growth. Yet, it would be wrong to assume that all these benefits reflect the same path to positive change [3] . In fact, there seems to be three distinct models of PTG, namely: strength through suffering, psychological preparedness, and existential reevaluation.

First, strength through suffering is perhaps the most evident in our culture, regularly motivated by the axiom: no pain, no gain. Two factors in the PTGI best explain this line of thought: empowerment (self-reports of self-reliance, determination and self-respect), and new horizons and possibilities. Second, psychological preparedness understood in terms of changes in the survivor’s assumptive world. Coping requires rebuilding a viable assumptive world. This eventually may equip the person for possible future trauma and for a lesser impact. Finally, the model of existential reevaluation highlights the fact that humans are meaning-making beings. Because traumatic events have the potential to shatter long-held old assumptions of life, they could make way for new ones. As a result, these three models postulate that whatever the survivor’s focus or priority in life, both negative and positive realities resulting from trauma remain ever present and close to heart.

Three of the five factors of the Posttraumatic Growth Inventory―appreciation of life, relating to others, and spiritual change―can best be understood through this third model of growth, stemming from a different yet new appreciation of one’s existence in life. Spiritual change is particularly relevant, as it is the scope of this study to investigate how this phenomenon could relate to vicarious posttraumatic growth after fireworks trauma.

Research strongly suggests a steady relationship between important life circumstances and one’s tendency toward spiritual transcendence [4] [5] [6] . Adjustment after trauma and other strenuous life events often results in seeking spiritual consolation and meaning for a number of people. Thus, spirituality can both serve as a predictor variable and an outcome variable [7] .

Three patterns along which spirituality is found acting and somehow defined are: 1) as a coping mechanism against negative life events [8] ; 2) as providing social support [9] [10] ; and 3) as a meaning-making mechanism [11] .

People vary in their response to loss just as they differ in other responses to stressful situations.

Just as grief is varied and complex for different people, the same applies to the response to it. For example, it was suggested that individuals use positive religious coping (PRC)―underlined as a secure bond to God, with a meaningful life, and a spiritual connectedness to others―and sometimes a negative religious coping (NRC), defined as spiritual and interpersonal religious discontent [12] . At times, these diverse coping mechanisms are even seen together, in answer to grief. Both PRC and NRC are subsets of coping responses.

It was found that mourners adapt to loss through many avenues, including religious coping [13] . Research point at it as providing meaning, asking God for assistance and strength, seeking support from people who share one’s religious perspectives, finding control in a highly stressful situation, and as enabling the person to change and move on with life.

Spirituality can be viewed as an empowering strength and advantage or as a source of strain, depending from which perspective it is evaluated and what are the circumstances of the case [14] . Furthermore, studies argued that people in distress often go through religious struggle, feeling at the mercy of a detached God, if not completely abandoned by him [15] . To put it more succinctly, it was suggested that for some distraught persons, enduring a spiritual crisis constitutes the end of one’s faith per se [16] .

It was found that “suffering stimulates the need for meaning” because “people analyze and question their sufferings far more than their joys” [17] . It seems that, being meaning-seekers, humans find different ways of arriving to this point in their life [18] . It could be speculated then that beliefs that counter hopelessness, such as religious beliefs, form an important part in this equation [19] [20] . It was indicated such a pattern based on their findings that religious belief related to emotional well-being [21] . To this effect, it was stressed the relevance of spirituality and posttraumatic growth for the promotion of holistic wellbeing for those affected by trauma [22] .

The objective of this study was to explore the experience of relatives who lost relatives due to fireworks tragedies in Malta. This research focused on vicarious trauma experiences and spirituality, and how they influenced and impacted the lives of relatives and significant others considering that all tragedies were related to religious feasts.

2. Method

This qualitative study employed thematic analysis to examine themes within the data. Accordingly, it emphasizes the organization and rich description of data. Eight participants were selected through purposive sampling from the island of Gozo, Malta. In the recent decade, Gozo has experienced a spate of fireworks explosions, which may give a skewed picture of related accidents in the Maltese islands in the last 50 years. Moreover, the island of Gozo had more fireworks factories at the time of the study, per capita, than Malta.

Inclusion criteria of the study were individuals related to victims of fireworks tragedies, age 18 plus, who were willing to participate freely, and who experienced their trauma at least 2 years prior the study and not earlier than 14 years.

Data was collected through deep, semi-structured and face to face interviews, over three months from June to September 2012. Interviews ranged from about 45 - 90 minutes, depending on the participant’s ability to delve deeper into own experiences. All interviews were recorded with a digital voice recorder and transcribed verbatim. The major research question focused on the participants’ view of the impact of trauma and loss they went through; how it impacted their spirituality; and what problems still linger on in their lives today. Participants were also asked probing questions during the interview to clarify their answers. Informed written consent was obtained from all participants, who were ensured of the confidentiality of their information and experiences.

Thematic Analysis was the approach chosen for this study. Braun and Clarke define thematic analysis as the process of identifying, analyzing and reporting patterns within a set given of data. It is a flexible analytic method that allows for meaningful and rich description of data. A process of coding in six phases is done to create established and meaningful patterns. These phases are 1) the familiarization with the data collected (transcribing data and noting initial ideas), 2) generation of initial codes (coding interesting features of data), 3) searching for themes among codes (collating codes into potential themes), 4) reviewing themes (gathering a thematic “map” of analysis), 5) defining and naming themes (refining specifics of each theme), and 6) production of final report.

According to recent guidelines for thematic analysis, three types of data collection and sample size of related projects were suggested, namely: small, medium or large. For small projects it was recommended 6 to 10 participants for interviews [23] . In this research, deemed to be a small project, we earmarked 8 subjects, with age ranging from 18 - 68 years old (Mean = 43.63). All were females, except one. All subjects hailed from the island of Gozo, Malta. With a population of around twenty five thousand, statistics about fireworks fatalities in Malta are skewed, considering that in just 4 years, most fatalities occurred in Gozo.

Identifying information was purposely altered to ascertain confidentiality. Participants included four parents who lost their children, one lost her father, another who lost a son and a spouse during the same accident, one who lost a sibling and one who lost a relative, all due to firework accidents. Among the victims, four were involved in pyrotechnics as their full-time employment, while the other four as their hobby. Only two of the victims died alone, while the rest died with other colleagues at the scene. Participants ranged from two students, four housewives, a self-employed and a civil servant. Demographic data is presented in Table 1.

Collected data was therefore transcribed by the principal researcher. Initial thoughts and ideas were also noted, during this critical stage of analysis. Moreover, the recordings were listened to a number of times to attain familiarisation

Table 1. Participants’ demographic information.

N = 8.

and ensure accuracy of transcription. The researcher then tried to identify key themes which integrated substantial sets of the codes indicated.

Thematic analysis is a meticulous process of data familiarization, data coding, and theme development and revision. Initially, the researcher became familiarized with the data and transcribed it. Then, codes from the data (application of short verbal descriptions to small amount of data) were extracted. Some codes are richer than others. As a result of the coding process, key themes were identified. This substantially grouped sets of codes together and cleaned up the emergent results. Each theme was defined for further clarification. Examples of themes chosen were also registered to illustrate the progress of analysis. All analysis stages required revising themes and codes and modifying analysis as new ideas surfaced through this development. Trustworthiness was ensured, as per the protocol [24] .

3. Results

Figure 1 shows the Thematic Map of key results of this study. Considering that this study focused on vicarious trauma related to fireworks accidents related to religious feasts, we sought to investigate whether such trauma resulted in protective or complicated spirituality. One’s spiritual orientation and religious commitment can either be protective after tragic trauma or lead to complicated spiritual grief. This could come about if such individuals distance themselves from a higher being or detach from their spiritual or religious community [25] .

Themes highlighted:

Two themes emerged from the results: a) complicated spirituality, and b) protective spirituality.

3.1. Complicated Spirituality

In face of trauma, spirituality can be quite tolling and challenging, and some individuals find it too taxing to them to adjust and find any benefit from it to move on with one’s life. Of the many codes found, two stand out very strongly: a truth too challenging, and experiencing hard feelings (anger, and pain with denial) that normally ensue.

3.1.1. A Truth too Demanding

The first code focused on the truth that respondents found as too demanding. Some resort to their faith to find answers. They may struggle with difficult thoughts on where their departed ones may be. As Linda explained, she always sought to know where her sons were after their lives were shattered in the blasts.

For others, admitting that one cannot control others, not even close relatives, on what to like and do in life, and what not, may result as an everyday dilemma. Marie admitted that her son died doing what he enjoyed doing best: fireworks making: “… we cannot understand their passion, it’s only logical to those immersed in it ... he used to tell me: ‘to me, my partner is pyrotechnics’”. Yet for others, the stark reality presents a challenge for certain annual events, particularly

Figure 1. Thematic Map of key results.

religious occasions. Carmen recounted how hard it is for her still, to live and remember certain anniversaries. Going through certain occasions, like her children’s first holy communion, their birthdays and others, were a challenging time to her indeed. She felt his absence, who otherwise would have been enjoying those precious moments with his family.

Living and celebrating annual events which normally bring the family together is naturally no easy feat for such individuals. This may prove as a two-edged sword to them, both in going through such hard times themselves but also when they have their dependants, who need nourishment and attention themselves.

The stark reality that one must accept and live by, day in and day out, is an experience like no other. Carmen spelled it out succinctly. She could not understand how God let the tragedy occur, when her husband was the main breadwinner. Having her children lose their father so dramatically, was not easy to understand.

For those still young, the tragic loss of loved ones may also imply ongoing pain in future family events. Pauline said that when she marries, she will miss her father’s absence―he won’t accompany her up the aisle. She missed his support.

Some participants went further with the difficult experience of the present, and tried to implore and caution other individuals who still persist in fireworks making at the huge risks involved to their own lives, and to the painstaking experience their loss could hold to their dear ones. Annah wished that all families with members involved in pyrotechnics would persuade them to quit this dangerous sport. She wished the authorities would abolish it―but acknowledge the huge lobby favoring it. She felt that time is known to heal the past, but she genuinely believed that her wound won’t be forgotten. On her part, Pamela opined: “... but experience has taught me such individuals are too passionate about it ... it is very hard for them to quit ... if only they realise the painful loss we endure ...”

The hard truth of accepting the tragic loss, trauma and its aftermath is very hard. Each person processes it differently. It is as unique as the relationship to the lost victim was unique.

3.1.2. Hard Feelings That Ensue

The stark reality of trauma, especially after a fireworks tragedy, robs a family of those assumptions and dreams for a bright future, only to leave the family coping with shattered dreams. Considering that such trauma was related directly to religious feasts, makes one’s roller-coaster of emotions much more dramatic. Such a traumatic experience naturally engulfs the person with many troubling feelings.

Anger at God. The first feeling that was clearly demonstrated was that of anger. Anger is an important emotion, and like all feelings, anger carries with it much energy that can be used positively or negatively. Carmen’s emotions were clear. She felt angry at God at first, through the shock of the news. She felt that God, somehow, was responsible, given the fact that her husband was manufacturing fireworks earmarked for a religious feast. To the end, she felt it hard to enter church at first, even to pray.

Janey narrated that it was ironic that the fireworks, through which her beloved perished, were being manufactured for a religious feast, and still the help and assistance given to her at the time left much to be desired. One would expect much more from religiously-oriented people!

Anger was also evident when relatives noted that religion may in fact reinforce pyrotechnics displays. Pamela argued along this line. She believed that the local church helped this reinforcement even by encouraging fireworks during religious feasts, because such feasts would seem lacking or not complete without fireworks displays.

Frustration at God. Some felt frustrated that despite the horror of the trauma they went through, life still had other surprises they never expected. Carmen recounted how during that year, she experienced two miscarriages. She recounted how at times she used to question herself the reason for going through that loss yet again, when it seems to her that life started recovering and gaining a steady momentum: “is there no end to this trauma …?”

Pain. Another hard feeling highlighted was that of pain. Besides not being comforted at the help offered them when they lost their son, Peter and Marie shared their pain at how events unfolded, and what had occurred since then.

Peter shared that he became so much fond of religious feasts partly because of his late son’s obsession with fireworks. However, after his death, to Peter, all religious feasts lost all the glitter and appeal they once held. He felt a pinching heart each time he heard fireworks being let off, for nearby religious feasts.

Marie said that her son’s tragic death caused her still disbelief. No matter how many times she tried to persuade him to quit his hobby, it all went on deaf ears. Worse still, he was surrounded by friends who all they cared for, was to reinforce his obsession.

An area that Marie found most complexing was the fact that as a health professional, he would always volunteer to assist individuals when hurt and injured in related fireworks tragedies, but still, that traumatic experience was not enough for him to quit from his. He persisted in his hobby nevertheless! She admitted that the silent suffering of loss that parents feel, is acknowledged by very few, if at all. She confessed that hardly anyone understands what a mother or a father go through when losing a son in such a tragedy. She could not understand how a loving God as preached could let such a tragedy occur.

This pain surrounds also the issue of shattered dreams. Linda clarified that any dreams she still could have survived in life, have since evaporated. She further explained that although she did at times share her husband’s satisfaction, when fireworks were let off to the delight of many during religious feasts, she still wished him to quit: “I learned to live in fear, telling myself: ‘today, it was that person’s turn, … maybe my husband’s would be next …!”

To Janey, her biggest dream shattered was that somehow, someday, she would reunite with her son. Pain can be very powerful experience and it can result in varied expressions. For Annah, it resulted in mere denial: “... as a family, we never mention him. He remained our greatest secret”. She emphasized that each family members dealt with their respective grief individually, ignoring the obvious. She felt this remained their weakest point as a family.

Strong feelings have the potential to destroy one’s hopes and sense for meaning in life. As much as they need to be expressed and processed, they also need to be managed well. Otherwise, they may result in more harm than good.

3.2. Protective Spirituality

The second theme elevated focuses on spirituality as a positive strength. A number of codes supported this second theme.

3.2.1. Living in the “Here and Now”

Living in the present may entail accepting oneself and others together with their behavior, even when one does not agree with it. As Peter recalled about his son, he enjoyed his hobby till the end. Although it looked folly for his family, to him it meant the world. Accepting the present reality is challenging, but surely it is the way forward. Annah stressed that initially, she turned her home into a shrine, with pictures of her loved one in each room and hallway. She even lit candles in front of some of his pictures. Later, though, she decided to remove it all. She felt that she had to move on. This approach led her to move on, thus resulting in a more cohesive family, which was of benefit to one and all.

Living the present may mean appreciating the fragility of human life as well. Carmen at first believed that life had a reason for each individual. However, after the tragedy, she started appreciating each moment, focusing more on what she had then. She felt that it took just a split of a second to have one’s world turned upside down. She believed in God’s help, but she first had to go through her desert experience, as she labelled it.

Living the present means accepting reality, that life moves on, even without our beloved departed. Some may find inner strength in their religious convictions and beliefs to be able to move on, despite the pain and void experienced. For Pamela, it took almost three months to get some normalcy in life. Still today it meant an uphill battle.

3.2.2. United as a Family

Spirituality as protection may imply cohesion among people, particularly in the aftermath of trauma. Carmen stated pointedly: “my greatest help was in my family ... the emptiness was very hard, but God did eventually bring into our lives another person, another partner to me, a second father to my children, who loves them dearly ...”

Although to some, trauma can divide a family, yet to others, it may have an opposite effect. To Peter, tragedy brought the family closer to each other. Annah agreed. She credits the strength after the void each member in her family experienced to the staunch unity they mastered together.

Clearly, individuals going through such trauma did have mixed feelings, and shared at times opposite thoughts and reflections about the value of spirituality during their challenging times. Marie credited the strength received after trauma to the fact that her family remained resiliently united. She felt that a key aspect in this equation was to hold strong to her faith, despite at times feeling abandoned by her God.

3.2.3. Accepted the Challenge to Move on and Grow

Rather than being entrapped in a vicious cycle of depression and self-pity, Pauline felt that the tragedy helped her become more independent in life: “I felt I matured ahead of my peers, in many ways …” Her journey required many sacrifices from her and her family. Factors that helped her out were her faith and also keeping herself occupied. Her faith empowered her immensely in her bumpy journey. It was responsible for assisting her to keep moving, to keep believing in a better future. With faith, she felt that work, keeping herself occupied, was also key to her healing after her trauma.

Moving on means that one has to be determined to proceed with life despite the daily struggle, with the firm belief that such is life. True, such occurrences could well mean a blow to one’s assumptions and a dramatic adjustment in life, but life had to move on, as Carmen explained.

4. Discussion

Two key themes which manifest the spiritual journey of relatives of victims of fireworks trauma were extracted: complicated spirituality and protective spirituality.

Complicated spirituality meant that spirituality was seen as a strain. Complicated spiritual grief (CSG) was described as a spiritual crisis following the loss of a loved one [25] . In this study, complicated spirituality covered two key areas: first, absorbing the stark reality of truth was found too taxing to the subjects, and secondly, going through the resultant feelings that ensue from this hard truth. Losing a loved one to a violent death has been associated with poor mental health outcomes, including depression and complicated grief. Furthermore, such trauma can precipitate a spiritual crisis following the tragedy, dubbed as complicated spiritual grief.

Viewing reality as too demanding consisted of two aspects. First, an interesting aspect that seemed shared by a number of participants dwelt on the fact that despite the huge risks involved, individuals could not control and persuade their loved ones to quit fireworks altogether. This was quite difficult to digest and comprehend. Secondly, the difficulty in adapting and adjusting with life as usual. This was mostly felt during annual events and holidays, Christmas and birthdays. For others, they felt saddened that during future family and personal life events, such as that of marriage, their beloved father would not be joining them to share the joy with them. It is good to point out also that some participants went as far as cautioning those still persisting in fireworks, to be weary of the high risks involved in this sport.

It is understandable that such a stark reality results in a number of hard feelings in those involved, which brings us to the second code elevated under the theme of complicated spirituality. Of the feelings mostly felt across the board, three were reported clearly: first, anger at God: individuals felt angry at how such tragedy could rob them of their loved ones, particularly as the fireworks involved were all related to religious feasts. Anger was directed at God in particular, having “tolerated” such tragedies occur. What meant a double edged sword to some was the dilemma of integrating their one’s held religious beliefs of a loving deity, with the fact of a religious-linked fireworks tragedy that destroyed the life of their loved ones. After all, how could such a loving God permit and allow such tragedies to occur?

Another feeling shared was that of participants’ frustration at God. As is mostly expected in similar events, those impacted would naturally expect some respite or relief. However, life is such that it may hold further surprises that may continue to trouble and challenge our innermost beliefs and convictions.

A final strong feeling experienced across the board was that of pain. Relatives felt pain when going through and living again those difficult and painful moments. Such moments became more scary and difficult to digest considering the number of instances and friends who reinforced more the love for fireworks―a fact that caused them much silent pain. As one respondent outlined succinctly, “no one understands what a mother goes through …”

Pain also surrounds the reality of shattered dreams. To have one’s own dreams and future aspirations perish instantaneously is extremely painful, particularly as this may directly challenge one’s security in life [26] . Pain is not an easy experience, obviously. Some individuals may even go to great lengths in accepting reality, which explains why they may resort to denial in order to be able to move on with life.

Protective spirituality was the second emergent theme indicated by these results. It delineated spirituality as positive strength and empowerment. In fact it was pointed that for most believers, spirituality moves further from a means of coping to a means of being, a strategy to make sense out of a very difficult situation [27] .

Spiritual inner life was described as the only location of freedom or escape from unbearable physical and emotional pain [28] . Consonant to this, other research found that spirituality and religion are important but often neglected areas of clinical exploration [29] . In fact, research documents spirituality and religion as primary mechanisms of coping with mental health issues such as depression and PTSD [30] . In synthesizing related research, while spirituality and religion can be related to guilt, neurotic and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort and forgiveness for the self and others [31] . In fact, spiritual beliefs were found to be having a significant effect during times of struggles and trials in people’s lives―an aspect that relates to protective spirituality as is being suggested in this study.

Spirituality proved to have protective features to relatives who lost loved ones during fireworks tragedies in three key areas: first, in embracing the here and now, with all reality’s hardships; second, by driving families to remain united; and thirdly, by challenging relatives, to move on with life despite the hard reality.

Living in the here and now was difficult, but it entailed relatives not to get stuck in the past. Accepting reality is always challenging, especially as this requires constant adjustment, letting go of past expectations, and stepping into the unknown. Although it may naturally be encountered by resistance and denial, it eventually asks the person to accept the real hard facts of truth and move accordingly. This often entails living with vulnerability and fragility of human life [32] . Admitting that life has to be lived and appreciated in the present, meant that one had to accept that living either in the past which is gone for good, or in the future, which may never materialise, were not credible options to move on with life. Moreover, when such tragedies strike, they have the power to dramatically change one’s life and turn things upside down in an instant, which obviously carries with it much pain of adjusting to it.

Spirituality meant also a protective force when it moved family members cohesively together in facing reality. Family unity in such times of difficulty is indeed important, in order for one and all to process the death and adjust to a new life. Having a safe base from which to operate and to which one relates to is indeed helpful and key in this process of major adjustment in life.

Finally, spirituality challenged individuals to move on with life while remaining in sync with their life’s demands. This did not mean forgetting one’s past experiences, but rather become a new person born from past lessons learned before, and able to face the present squarely. A young participant in the study felt that the trauma challenged her to become more independent and autonomous, to the point that she matured ahead of her time. Researches are increasingly pointing at spirituality as having a key value in the adaptation process particularly after trauma [33] [34] [35] .

Research continues to show the link between spirituality and posttraumatic growth. As suggested, individuals who experience post-traumatic growth may not necessarily experience less pain or more happiness in life [36] . In fact, research has emphasized that appreciation of life includes a number of necessary albeit difficult steps of the experience of pain, in the process of a person’s own transformation [37] . However, the value of spirituality in becoming protective to individuals facing trauma seems to lie in producing a meaningful perspective through which painful experiences may be more easily borne [38] .

This study has a number of limitations. First, it has a small number of participants. Although this is normal for a thematic analysis study, it still restricts its results’ generalization. Second, the nature of the purposive sampling, although one must clarify that the participant pool was limited. Finally, participants were mostly female which is understandable when males are mostly involved in pyrotechnics.

5. Conclusion

This study highlighted two key results that were noted from the thematic analysis employed: conflicting and complicated spirituality, highlighted by strong emotions and difficulty integrating the hard truth that ensues from such trauma, and protective spirituality, resulting from family cohesion, ability to move on with life, and living in the present. The relevance and implications of these results were discussed.

Acknowledgements

The author wishes to thank all participants in this study.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

Cite this paper

Galea, M. (2018) The Two Faces of Spirituality in Time of Traumatic Loss: A Thematic Analysis Study. Open Journal of Social Sciences, 6, 49-63. https://doi.org/10.4236/jss.2018.68004

References

  1. 1. Braun, V. and Clarke, V. (2006) Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3, 77-101. https://doi.org/10.1191/1478088706qp063oa

  2. 2. Tedeschi and Calhoun (1996) The Posttraumatic Growth Inventory: Measuring the Positive Legacy of Trauma. Journal of Traumatic Stress, 9, 455-471. https://doi.org/10.1002/jts.2490090305

  3. 3. Janoff-Bulman (2004) Posttraumatic Growth: Three Explanatory Models. Psychological Inquiry, 15, 30-34.

  4. 4. Young, J.S., Cashwell, C.S. and Shcherbakova, J. (2000) The Moderating Relationship of Spirituality on Negative Life Events and Psychological Adjustment. Counseling and Values, 45, 49-58. https://doi.org/10.1002/j.2161-007X.2000.tb00182.x

  5. 5. Galea, M. (2010) Does Child Maltreatment Mediate Family Environment and Psychological Well-Being? Psychology, 1, 143-150. https://doi.org/10.4236/psych.2010.12019

  6. 6. Galea, M. (2011) Healing the Healers: A Profile of Strengths and Weaknesses of Catholic Priests in Gozo, Malta. Pastoral Psychology, 60, 857-868. https://doi.org/10.1007/s11089-011-0387-y

  7. 7. Galea, M., Ciarrocchi, J.W., Piedmont, R.L. and Wicks, R.J. (2007) Child Abuse, Personality, and Spirituality as Predictors of Happiness in Maltese College Students. Research in the Social Scientific Study of Religion, 18, 141-154. https://doi.org/10.1163/ej.9789004158511.i-301.57

  8. 8. Ellison, C.G. (1991) Religious Involvement and Subjective Well-Being. Journal of Health and Social Behavior, 32, 80-99. https://doi.org/10.2307/2136801

  9. 9. Galea, M. (2009) Extraversion, Childhood Trauma and Family Environment as Predictors of Happiness and Well-Being among Maltese University Students. Advances in Psychology Research, 65, 15-19.

  10. 10. Galea, M. (2012) Studying the Incremental Validity of Family Environment among Maltese University Students with Past Mental Trauma. Pastoral Psychology, 61/1, 211-220. https://doi.org/10.1007/s11089-011-0389-9

  11. 11. Piedmont, R.L. (2001) Spiritual Transcendence and the Scientific Study of Spirituality. Journal of Rehabilitation, 67, 4-15.

  12. 12. Pargament, K.I., Smith, B.W., Koenig, H.G. and Perez, L. (1998) Patterns of Positive and Negative Religious Coping with Major Life Stressors. Journal for the Scientific Study of Religion, 374, 710-724. https://doi.org/10.2307/1388152

  13. 13. Burke, L.A. and Neimeyer, R.A. (2014) Spiritual Distress in Bereavement: Evolution of a Research Program. Religions, 5, 1087-1115. https://doi.org/10.3390/rel5041087

  14. 14. Galea, M. (2015) Burnout and Vocational Satisfaction: An Incremental Validity Study. In: Winston, T.N., Ed., Handbook on Burnout and Sleep Deprivation, NOVA Publishers, Hauppauge, New York, Vol. 13, 201-217.

  15. 15. Edmondson, C., Park, C.L., Chaudoir, S.R. and Wortmann, J.H. (2008) Death without God Religious Struggle, Death Concerns and Depression in the Terminally Ill. Psychological Science, 19, 754-758. https://doi.org/10.1111/j.1467-9280.2008.02152.x

  16. 16. Hill, P.C. and Pargament, K.I. (2008) Advances in the Conceptualization and Measurement of Religion and Spirituality: Implications for Physical and Mental Health Research. Psychology of Religion and Spirituality, 1, 2-17.

  17. 17. Baumeister, R.F. (1991) Meanings of Life. Guilford, New York, 232.

  18. 18. Wink, P. (1999) Addressing End-of-Life Issues: Spirituality and Inner Life. Generations Spring, 23, 75-81.

  19. 19. Galea, M. (2012b) A Conspiracy of Silence? Addressing Childhood Trauma in Malta: An Empirical Review. In: Turner, R.A. and Rogers, H.O., Eds., Child Abuse: Indicators, Psychological Impact and Prevention, Nova Science Publishers, Hauppauge, 5th Edition, 85-98.

  20. 20. Galea, M. (2012) Integrating Spirituality with Positive Psychology in View of Childhood Trauma. In: Stark, C.A. and Bonner, D.C., Eds., Handbook on Spirituality: Belief Systems, Societal Impact and Roles in Coping, Nova Science Publishers, Hauppauge, 4th Edition, 85-106.

  21. 21. Murphy, P.E., Ciarrocchi, J.W., Piedmont, R.L., Cheston, S., Peyrot, M. and Fitchett, G. (2000) The Relation of Religious Belief and Practices, Depression, and Hopelessness in Persons with Clinical Depression. Journal of Consulting and Clinical Psychology, 68, 1102-1106. https://doi.org/10.1037/0022-006X.68.6.1102

  22. 22. Galea, M. (2014e) The Relationship of Personality, Spirituality and Posttraumatic Growth to Subjective Wellbeing. Open Access Library Journal, 1, e1069.

  23. 23. Braun, V. and Clarke, V. (2013) Successful Qualitative Research: A Practical Guide for Beginners. Sage, London.

  24. 24. Grimes, C.E., Bowman, K.G., Dodgion, C.M. and Lavy, C.B. (2011) Systematic Review of Barriers to Surgical Care in Low-Income and Middle-Income Countries. World Journal of Surgery, 35, 941-950. https://doi.org/10.1007/s00268-011-1010-1

  25. 25. Burke, L.A. and Neimeyer, R.A. (2014) Complicated Spiritual Grief I: Relation to Complicated Grief Symptoms Following Violent Death Bereavement. Death Studies, 38, 259-267. https://doi.org/10.1080/07481187.2013.829367

  26. 26. Galea, M. (2017) Vicarious PTG after Fireworks Trauma. Psychology, 8, 2496-2515.

  27. 27. Kwilecki, S. (2004) Religion and Coping: A Contribution from Religious Studies. Journal for the Scientific Study of Religion, 43, 477-489. https://doi.org/10.1111/j.1468-5906.2004.00250.x

  28. 28. Frankl, V. (1962) Man’s Search for Meaning. Beacon Press, Boston.

  29. 29. Bryant-Davis, T., Ellis, M.U., Burke-Maynard, E., Moon, N., Counts, P.A. and Anderson, G. (2012) Religiosity, Spirituality and Trauma Recovery in the Lives of Children and Adolescents. Professional Psychology: Research and Practice, 43, 306-314. https://doi.org/10.1037/a0029282

  30. 30. Watlington, C.G. and Murphy, C.M. (2006) The Roles of Religion and Spirituality among African American Survivors of Domestic Violence. Journal of Clinical Psychology, 62, 837-857. https://doi.org/10.1002/jclp.20268

  31. 31. Brewer-Smyth, K. and Koenig, H.G. (2014) Could Spirituality and Religion Promote Stress Resilience in Survivors of Childhood Trauma? Issues in Mental Health Nursing, 35, 251-256. https://doi.org/10.3109/01612840.2013.873101

  32. 32. Galea, M. (2014) Extraversion and Burnout: An Incremental Validity Study. In: Haddock, A.D. and Rutkowski, A.P., Eds., Psychology of Extraversion, Nova Science Publishers, Hauppauge, 8th Edition, 133-144.

  33. 33. Calhoun, L., Tedeschi, R.G., Fulmer, D. and Harlan, D. (2000) Parental Bereavement, Rumination, and Posttraumatic Growth. Poster Session Presented at the Meeting of the American Psychological Association, Washington DC.

  34. 34. Overcash, W.S., Calhoun, L.G., Cann, A. and Tedeschi, R.G. (1996) Coping with Crisis: An Examination of the Impact of Traumatic Events on Personal Belief Systems. Journal of Genetic Psychology, 157, 455-464. https://doi.org/10.1080/00221325.1996.9914878

  35. 35. Galea, M. (2014) Assessing the Incremental Validity of Spirituality in Predicting Nurses Burnout. Archive for Psychology of Religion, 36, 118-136. https://doi.org/10.1163/15736121-12341276

  36. 36. Galea, M. (2014) Modeling the Relationship between Personality and Posttraumatic Growth. In: Haddock, A.D. and Rutkowski, A.P., Eds., Psychology of Extraversion, Nova Science Publishers, Hauppauge, 8th Edition, 167-176.

  37. 37. Galea, M. (2014) The Progressive Impact of Burnout on Maltese Nurses. SOP Transactions on Psychology, 2, 1-8. https://doi.org/10.15764/STP.2014.01001

  38. 38. Galea, M., Ciarrocchi, J.W., Piedmont, R.L. and Wicks, R.J. (2008) The Impact of Child Abuse on the Psycho-Spiritual and Religious Status of Maltese College Students. Pastoral Psychology, 57, 147-159. https://doi.org/10.1007/s11089-008-0159-5