Psychology
2012. Vol.3, No.12A, 1238-1242
Published Online December 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.312A183
1238
Bringing Back the Body into Positive Psychology: The Theory of
Corporeal Posttraumatic Growth in Breast Cancer Survivorship
Kate Hefferon
Department of Psychology, U niversity of East London, London, UK
Received October 1st, 2012; revised November 5th, 2012; acce pted November 29th, 2012
Objective: Posttraumatic growth (PTG) is the phenomenon of surpassing levels of functioning than which
existed before a traumatic event occurred. The objective of this study was to assess how the body may
have had an influence on the facilitation, and as an outcome, of PTG. Methods: 83 female breast cancer
survivors, 5 years post cancer diagnosis, were interviewed on their long-term experience of physical ac-
tivity engagement. Inductive thematic analysis was used in order to ascertain whether or not there were
any serendipitous expressions of posttraumatic growth. Results: 24% (n = 20) of the study mentioned ex-
periencing some form of PTG, including both generic and corporeal specific domains. Of those that re-
ported PTG, 70% were from the original physical activity intervention group indicating potential links
between activity participation during cancer treatment and long term PTG. Discussion: The results sup-
port the theoretical viewpoint that recovery from physical illness may have a unique PTG journey in
comparison to more cognitive/external sources of trauma. Conclusions: This is the first study to qualita-
tively collect longitudinal data from a large and unique sample on the experience of PTG following breast
cancer survivorship. Furthermore, the author has coined this new addition of a more embodied experience
of PTG, the theory of “Corporeal Posttraumatic Growth” and presents suggestions for future research.
Keywords: Positive Psychology; Corporeal Posttraumatic Growth; Breast Cancer; Physical Activity;
Embodiment
Introduction
Positive psychology has been criticised for its lack of em-
bodiment and focus on the body as part of human flourishing
(Resnick et al., 2001; Hefferon & Mutrie, 2012). Furthermore,
the role of the body in eudaimonic well being following adverse
life events has been largely neglected. Research has shown that
despite the suffering associated with traumatic events (e.g.
cancer diagnosis) individuals are capable of thriving and even
surpassing their previous levels of functioning than which ex-
isted before the traumatic event occurred (Calhoun, Tedeschi,
Cann, & Hanks, 2010). Research into this phenomenon falls
under the concept of Posttraumatic growth (PTG) and encom-
passes the ability to thrive in some or all of the following do-
mains including: Personal strength (or perceived changes in
self); “Relating to others”; “Appreciation for life” (or increased
existential awareness); “New possibilities” and “Spiritual
change” (Calhoun & Tedeschi, 2004, 2006).1
Traditionally, PTG has been restricted to these 5 main do-
mains which inform the current measurement tools. Despite
high levels of reliability (Weiss, 2002; Shakespeare-Finch &
Enders, 2008), recent research has argued that the measurement
tools need to take into account trauma specific progression
throughout the PTG process that are unique to different types of
traumas (e.g. external versus internal transgressors; acute ver-
sus chronic threat) (Hefferon, Mutrie, & Grealy, 2008; 2009;
2010; Hefferon, Sparkes, & Painter, 2011; Shakespeare-Finch &
Enders, 2008). More specifically, the current measurement
tools do not take into account the corporeality of traumas,
which is essential to understanding how people grow and relate
to their embodie d self after adversity.
The Body and Illness
Our body is fundamental in the process of experiencing he-
donic and eudaimonic well being (Hefferon & Boniwell, 2011).
Over the past 30 years, researchers have argued that the diag-
nosis of illness can create a heightened awareness of the body
and the physical self (Frank, 1993, 1995, 1998, 2002). The
body also has the ability to heighten our mortality awareness
(Goldenberg, 2005) and only recently has this been linked to
the concept of post-traumatic growth (Hefferon, Mutrie, &
Grealy, 2008, 2009, 2010). Trauma and transformation from
illness can create an environment in which there is a reconnec-
tion to the body (Frank, 1995; Hefferon et al., 2009), thereby
creating enhanced appreciation for the body, increased care
towards the body (listening to the body; treating it better) and
increased health behaviour changes (teachable moments, see
Demark Wahnefried et al., 2000). Despite the copious amounts
of research supporting this (see Hefferon et al., 2009 for a sys-
tematic review), there remains a dearth of literature within this
area.
Although breast cancer is one of the most researched areas in
PTG, less is known about how PTG develops over time (Joseph,
2011). For cancer survivors, the 5-year post diagnosis period
elicits several mini traumas in addition to the threat of re-oc-
currence, leading many to claim that they are never really
1It is important to note that PTG does not dismiss the negative ex
p
eriences
but recognises that PTG and distress can co-occur (Morris & Shakespeare-
Finch, 201 0 ).

K. HEFFERON
“post-trauma”. Thus, research into the long-term experiences of
PTG is essential for the development of our understandings of
the phenomenon.
In conclusion, the study aimed to supplement the longitudi-
nal literature on PTG within a unique and large breast cancer
sample. More preci sely, the ai m of the study was to understand,
from a qualitative perspective:
1) How breast cancer patients experience PTG over a 5 year
survival period and
2) What role, if any, did the body have in their experience of
PTG?
Methods
Ethical approval was obtained by the University of East
London and the University of Strathclyde.
Participants and Procedure
This study was part of the 5-year follow up of the Mutrie et
al. (2007) randomised control trial (see Mutrie et al., 2012 for
full participant information and recruitment procedure). The
original study (2007) focused on the benefits of regular aerobic
activity as a rehabilitation strategy for women receiving treat-
ment for breast cancer. The results of that study showed that the
intervention group had increased physical ability and decreased
depression at completion and the 6 months follow up. The
beneficial results remained at the 5 year follow up with the
original intervention group scoring higher levels of leisure phy-
sical activity and positive moods (Mutrie et al., 2007; Mutrie et
al., 2012).
Data was collected over a one-year period (January 2010 un-
til December 2010) at various local sports facilities across
Glasgow, Scotland. A research interview was carried out by a
trained interviewer, after a 2-hour follow up assessment set of
physical measures was taken from participants as part of the
larger study (see Mutrie et al., 2012). Individuals participated in
a time limited (15 minute) interview at the end of their assess-
ment. The brevity of time allocated was due to the time con-
straints upon this project however the interview adhered to high
quality guidelines (Yardley, 2000). The research interview
focused on the perceived benefits and barriers to exercise par-
ticipation that the women had experienced over the five-year
period. The participants were not explicitly asked about their
experience of PTG, thus all results emerged serendipitously.
Analysis
Due to the large sample size, Inductive Thematic Analysis
was deemed the most appropriate method for the design of the
study than other qualitative methods of inquiry (e.g. Interpreta-
tive Phenomenological Analysis) due to its flexibility and em-
phasis on nomothetic inquiry (Smith, 2008; Braun & Clarke,
2006).
The analysis included several readings of the transcripts (N =
83), by the autho r, so as to beco me fam iliar with the text (W illig,
2008). Individual’s who displayed examples of the main do-
mains of PTG, and the “6th domain” (New awaren ess of th e body ,
see Hefferon et al., 2009) were iso lated (N = 20). The research er
looked for m ajor themes in relatio n to PTG, beyond surface level
interpretation, organizing the text into coherent themes. The
detail of analysis included line by line coding and then moving
on to broader overarching themes to create the final master list
for both generic PTG themes and “body specific” themes (Ta-
bles 1 and 2) (Braun & Clarke, 2006).
Results
In total, 24% (n = 20) of the total study serendipitously men-
tioned experiencing some form of PTG 5 years post cancer
diagnosis. Generic PTG domains included: Stronger self (20%);
Improved relationships (10%); Changed priorities (5%);
Changed philosophy (10%) (Table 1) and a new domain
emerged, entitled Corporeal awareness (85%) (akin to the
proposed 6th domain in Hefferon et al., 2009) (Table 2). Of
those that reported some form of PTG, 70% were in the original
intervention group (IG) (n = 14), which is an intriguing result
with regards to activity participation during treatment and pos-
sible long term PTG.
Despite offering longitudinal data regarding PTG following
cancer diagnosis, due to the already well-established research
on the generic domains of PTG, this paper will focus solely on
the examples of data in support of the new proposed concept of
Corporeal PTG (Table 2) thereby progressing the literature
area. The participants expressed examples of Corporeal aware-
ness in the manor of 1) New relationship with body; and 2) In-
creased awareness of health and conscious health behaviour
changes. These findings support the synthesis findings of a
“6th” domain of PTG found in Hefferon et al.’s (2009) review
of the PTG and illness research.
New Relationship with Body
The diagnosis of cancer brought about a “Corporeal aware-
ness” which stemmed from the fact that the women were deal-
ing with and negotiating a “new body”; one that many of them
could not relate to, nor like. For example, Linda discussed how
she saw a stranger in the mirror and how this negatively af-
fected her body image and sense of identity:
“You still have a down day when you’re really feeling quite,
em, you look in the mirror and you don’t know who’s looking
back at you, you don’t like what you see. Your physical body
changes as well, body image was one of the things that kind of
upset me most after surgery.” (Linda)
Danielle also discussed the concept of 2 physical selves:
“I just feel it’s me now, I feel I’m back to me. I felt that [can-
cer physical self] was not me.” (Danielle)
The participants reported that by re-connecting with their
body, they were able to regain, and then indeed surpass, their
previous levels of physical functioning. This again highlights
that women not only go through psychological and biological
distress during cancer, but they have to also negotiate a “new
Table 1.
Posttraumatic growth 5-years post breast cancer diagnosis.
Posttraumatic Growth
Stronger selfImproved
relationships Change d priorities Changed philosophies Corporeal awareness
Table 2.
Corporeal posttraumatic growth.
Corporeal Awareness
New relationship with body Increased awareness of health and
conscious health beha viour cha nge s

K. HEFFERON
physical self’. The importance of this finding stems from the
argument that our society is becoming increasingly dis-em-
bodied (Frank, 1998) with an escalating negative relationship
with our physical selves (Orbach, 2009). Unfortunately, it is not
usually until something traumatic occurs that our “taken-for-
granted” bodies are thrust into the forefront of our conscious-
ness (Frank, 1995; Stam, 1998) and force us to take notice.
Through negotiating a new body, the participants also re-
ported being “kinder” and listening to their body when it was
telling them enough was enough. For example, Emer discussed
how she began to put her body’s needs above that of social
engagements:
“If I can’t manage it that day I’ll just phone them up and say,
‘look we’ll do it another day’.” (Emer)
This self regulation continued even further to some of the
participants work arrangements, with Melissa recounting how
she started to listen to her body when it was tiring out and in-
stead of pushing herself, she reduced her workload from full to
part-time:
“I found going full time was just too much. I was burnt out at
the end of the year. I was doing too much. And having been
where I was before, I saw the warning signs, and I thought, I’m
not doing this to myself any more. So I went part-time.”
(Melissa)
The new relationship extended to the monitoring of the
physical self, even utilising activity as a tool to measure their
internal fitness:
“I’m a walker […] I kind of knew before I was even diag-
nosed [for the second time]. They kept putting it down to some-
thing else […] you went to the doctors saying there was some-
thing wrong because you couldn’t walk as far.” (Emer)
This theme was demonstrated in previous research on the
original exercise group (Hefferon et al., 2008), thus showing
continued engagement with “barometer” like activities over the
5-year survival process.
Importance of Health and Conscious Health
Behaviour Changes
Many of the participants reflected upon a heightened impor-
tance of their health and subsequent conscious health behaviour
changes, during the 5-year process. The possibility that they
could have some form of control over their survival (and poten-
tial re-occurrence) meant that participants engaged in changes
to their diet and exercise as well as the cessation of negative
heath practices (e.g. smoking). For example, Mary discussed
how she quit smoking when she realised the gravity of her
situation and the accountability she held for own health:
“I’m very aware—very much aware [of getting healthy]. Um,
at the time, I was a smoker and I had to stop smoking after I
had had my treatment, I thought—right, once I finish all that,
that’s clear, I’m gonna stop smoking. All these people are
helping me […] so I thought you know, it’s crazy, I’m smoking
away and everybody’s trying to save me—so I made a decision
that I would give up smoking.” (Mary)
Changes in Diet
The women reported changes to their diet to reflect a more
balanced, healthy regime and also to address the issues of
weight gain from diagnosis to the 5 year follow up:
“Um, yes, I had to start eating healthily—a lot healthier than
I did. You know, for myself. I wanted to lose a bit of weight.
Because the weight… during the chemotherapy, I went up tae
eleven stone, maybe eleven and a half stone.” (Lara)
“I did change my diet in general, I just do non-dairy now…
So I just wanted to try and get back to my normal where I felt
comfortable, because I just felt bloated and, I’d put on about
two stone, over two stone. You know, just wasn’t me.” (Dan-
ielle)
The maintenance of a healthy weight and diet over the course
of the cancer journey (diagnosis, treatment and then survivor-
ship) is extremely important (Uhley & Jen, 2007). The
women’s new healthy approach to diet demonstrates positive
health behaviour changes as a result of their cancer experience.
Increased Exercise Behaviours
Of the 20 participants, over 55% (n = 11) mentioned engage-
ing in physical activity as a new benefit from their trauma and
this was the strongest of all generic and ‘corporeal’ PTG do-
mains. This is not surprising considering the fact that these
women were part of an exercise RCT that encouraged activity
participation during chemotherapy. However, what is surprising
is their continued engagement and the heightened importance of
activity over the 5 years.
“I was fairly active but I’ve upped it I would say since then. I
feel as if that I take better care of myself. I would think now, I
think more about myself […] And I think as well when you’ve
been through something like this you re-assess your life… I
think I’ve reassessed it just with everything in my life including
the activity […] Well knowing that you’re keeping your body
healthy. I think it […] you feel you’ve done a good job.”
(Joanne)
“I have been quite active [over past 5 years]. Again, it’s get-
ting me exercise, that’s the most important point. That’s what
we go for, to get a bit of exercise….I think it keeps you healthy.
[…] I wisnae really that active before that.” (Anna)
“I felt it was really important to exercise because I had been
ill and it was really important to keep myself fit. Even though I
had done it before, it had took on more significance for me.”
(Sarah)
Hefferon and Mutrie (2012) hailed exercise as a “stellar”
positive psychology intervention for not only normal but clini-
cal populations. As the importance of health and activity was
present in both the IG and CG groups, it could be argued that
activity can be a universally adopted mode of controlled activ-
ity that enhances individual’s awareness of health.
A good proportion of participants discussed moving “from
nothing to something” with regards to their activity engagement.
This shift towards exercise demonstrates the powerful impact of
physical trauma on changes to subsequent and long-term health
behaviours:
“I never, I never really went to keep fit, I didn’t know how to
do it, I learned, and like it.” (Lara)
[And had you done any of those things before your breast
cancer diagnosis?] Never. Never. Nothing. Never joined a
club…Didn’t do any exercises.”(Ethel)
[Were you quite active before you were diagnosed with
breast cancer?] Not really, no. […] I didn’t do it that often, so I
really wasn’t all that involved in exercise.” (Nell)
The importance of exercise engagement after cancer diagno-
sis has been raised as an aid to alleviation of depression, fatigue
and even survival (Humpel & Iverson, 2007; Holmes et al.,
1240

K. HEFFERON
2005). In the general population, there is copious amounts of
research linking physical activity to enhanced physical and
psychological functioning including enhanced positive emo-
tions, self esteem, body image and overall well being (Biddle &
Mutrie, 2008; Fox, 1997, 2000). This acute and chronic sense
of well-being was seen by many of the participants:
“I felt a lot, oh I don’t know? Just with doing the exercises I
felt happier. Eh, I had a bounce in my step if you like, it was, it
wasn’t woe is me, it never was, but it, it, just kinda gave me that
wee bit extra energy it gave me a wee boost kinda thing. Eh, I
just felt happier about doing things. More likely to go out and
do something, rather than just sit watching the telly.” (Ethel)
In addition to adding increased positive emotions, engaging
in exercise classes also seemed to engender a sense of purpose
and achievement in the women’s lives:
“You know, it’s, it’s… sets me off and gives me a purpose
again.” (Nell)
“[I do it] Cause its exercise. Giving me something to do, get-
ting out of the house, meeting my friend, just having a chat. I
feel nice about it. It’s both [physical] and mental as well.”
(Ellen)
Finally, some of the women felt that by building physically
stronger bodies, they were able to build psychologically
stronger minds; a perfect example of the somato-psychic prin-
ciple (Harris, 1973). Carole demonstrates this intricate rela-
tionship between activity and psychological strength, which is
the epitome of Corporeal PTG:
“I sort of felt more positive thoughts like, just healthier. You
know like healthier in that, you know this cancer’s not going to
come back […] I’m very happy and I’m very positive about the
future, and I feel that (clears throat) exercise has really, really
helped me to have a very positive focus for my health. And I feel
that, you know my attitude, and I do feel this is through exer-
cise, because I feel mentally and physically alert and mentally
positive because of the exercise. I actually now feel that, if see
it did come back, I beat it once, and I’ll, I’ll do it again.”
(Carole)
The link between exercise engagement and induced feelings
of power has been found within other clinical populations
(Hefferon et al., 2012). If activity can bring about a perceived
sense of strength in the face of adversity then perhaps treatment
options should include exercise as an adjunct to traditional
therapy.
Conclusion
This longitudinal study found evidence of the existence of
generic and corporeal PTG domains (Tedeschi & Calhoun,
2006) 5 years post cancer diagnosis. The findings support the
concept of a 6th domain of PTG in Hefferon et al.’s 2009 meta-
synthesis on life threatening illness and PTG.
This data provides further support for future research into the
theoretical view that physical illness may have a different
growth journey and PTG outcomes then cognitive/external
sources of trauma. This may be due to several reasons: 1) Ill-
ness is an attack on the body, by the body, and thus there will
be issues of trust and negotiation with the body in the aftermath
of diagnosis; 2) Illness and trauma that permanently alter the
appearance/functioning of an individual (e.g. mastectomy, am-
putee, spinal cord injury) leave the person in a mortality salient
environment with a constant reminder of the trauma. “Corpo-
real Posttraumatic Growth” is a new addition of a more em-
bodied perception of PTG, which dictates that as embodied
individuals any trauma caused unto or within the body will
entail a different reconstruction and journey to PTG than other
types of trauma (e.g. caused by external transgressor).
The large discrepancies in reported growth at the 5 year fol-
low up may have been due to the immediate support the origin-
nal intervention group received during treatment, thereby sug-
gesting that delays in support services could suppress the fa-
cilitation and maintenance of PTG over time. Furthermore, the
opportunity to engage in activity during the crucial time period
following diagnosis remained, 5 years later, a perceived ‘sav-
iour’ for some of the women. The use of activity interventions
for facilitating corporeal PTG should be considered in future
research and as a treatment option for newly diagnosed cancer
patients.
The main issues when interpreting the data is the possibility
that as the women were not explicitly asked about their experi-
ence of PTG, there may have been further examples unac-
counted for. Alternatively, the fact that the participants were all
women may have inflated the incidence of PTG, as researchers
have found a slight gender difference in PTG prevalence
(Vishnevsky et al., 2010). Future research could include the
utilisation of questionnaires to give an objective perspective,
however these were not included due to time restrictions and to
avoid the burden of participation.
Future research should employ multi-method approaches
when deciphering longitudinal accounts of PTG (e.g. objective
biomarkers, second person reports in addition to self-report
measurements). Furthermore, the author argues that scales2
should be developed for traumas that are caused by the body to
the body and where there will be a re-negotiation with the body
in order to return to some form of homeostasis.
Overall, this is the first study to qualitatively collect longitu-
dinal data from a large and unique sample on the experience of
PTG following breast cancer survivorship. Furthermore, the
paper demonstrates evidence in support of the concept of Cor-
poreal PTG, warranting further investigation into the body
within the process of growth following adversity.
Acknowledgements
K. Hefferon would like to thank Nanette Mutrie and the
Macmillan research team as well as the participants for their
support and contribution.
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