The use of “meaning in life” to monitor clinical outcomes in rehabilitation programs


By Umair Majid

Bereavement, intimate partner violence, and surviving a natural disaster are examples of traumatic experiences that may cause distress and disrupt an individual’s meaning in life (MIL). In 1963, based on his experiences witnessing tragedy and trauma in the Auschwitz concentration camp, Viktor Frankl described the “will to meaning” as a natural human tendency to search for MIL when faced with traumatic circumstances. In 1983, Monty Python aired a musical sketch comedy film called The Meaning of Life. These examples demonstrate how MIL has been used formally in theoretical works and colloquially in the media.

In the psychological literature, Haidt (1) describes MIL as one of the ten greatest psychological ideas of all time. Scholars have attempted to conceptualize and operationalize MIL by building theories and designing questionnaires that measure this concept. However, MIL remains a nebulous concept with a remarkable level of uncertainty regarding its relevance and use to monitor clinical outcomes because MIL has diverse meanings for different individuals.

To address this uncertainty, we first provide a brief description of MIL before discussing the “Meaning in Life-Adjustment (MILA) Framework” to understand how MIL may contribute to health and rehabilitation. We conclude this commentary by describing how we have integrated MIL in a chronic pain management program and discuss its implications for rehabilitation practice.

Individuals who search for and find MIL have adjusted better to their medical condition and, in some cases, may even experience improved health, well-being, and self-coherence.

What is Meaning in Life

MIL has a profound history in the empirical literature dating to the 1900s. One useful way to conceptualize MIL is to differentiate between searching for (“Search”) and having found (“Presence”) MIL (2). These are two factors/subscales of the Meaning in Life Questionnaire (MLQ), a 10-item instrument used to measure MIL. Searching for MIL is an active process in which individuals engage after a traumatic event such as a chronic pain diagnosis. Finding MIL, on the other hand, is an outcome of searching for MIL that is accompanied by an improved understanding of oneself, the traumatic experience, and life in general. Presence of MIL can help individuals modify their everyday behaviors to more closely reflect their experiences. Collectively, these changes can be referred to as “adjustment” after a traumatic experience, which are comprised of psychological, social, and physical components. Finding MIL and adjustment are similar to the concepts of resilience, post-traumatic growth, stress-related growth, and thriving, all which are characterized by positive psychological self-development after traumatic experiences (3).

In the last two decades, empirical research has suggested that MIL and related concepts may be important targets for intervention concerning medical conditions such as chronic pain, breast cancer, and stroke (4-7). Individuals who search for and find MIL have adjusted better to their medical condition and, in some cases, may even experience improved health, well-being, and self-coherence. The relationship between MIL and health outcomes is demonstrated by the MILA Framework.

02 Article (Summer 2019 Issue 7) _ In-text Article 1
Image source: Pixabay (Pexels)

Meaning in Life-Adjustment Framework

In a recent publication, we reviewed the empirical literature to map the relationship between MIL after a traumatic experience and one’s adjustment to that experience (8). We synthesized our findings into the MILA Framework: a process that outlines six steps in an individual’s search for MIL following the diagnosis of a chronic medical condition. These six steps are described below, and a depiction of the framework is available in the original publication (8).

Step 1: The diagnosis of a chronic medical condition is a traumatic experience that causes significant psychological, social, and emotional distress. This distress disrupts an individual’s MIL and prompts them either to search for a new MIL or to renew their existing MIL.

Step 2: Individuals inquire about the aspects of their lives that make it meaningful (2) as well as give them their identity and purpose of living (9). Individuals searching for MIL also contemplate the reasons for their diagnosis, compare it to past experiences of health and wellness, engage in counterfactual thinking, and consider alternative lifestyle choices that may have prevented the diagnosis (10).

Step 3: If individuals successfully navigate these existential questions, then they will adjust positively to their diagnosis resulting in an improved understanding of one’s self, diagnosis, and life, ultimately with reduced symptoms and better pain management (11-12).

Step 4: However, certain individuals may not be able to address these questions satisfactorily, which may amplify both distress and the enthusiasm to continue searching for MIL. Greater distress due to not finding MIL can lead to negative adjustment because the lack of coherence between self and circumstances persists.

Step 5: These individuals may use other sources of MIL (e.g., family, friends, professional, education, spiritual) or resources to resolve their existential challenges (13).

Step 6: However, some individuals still may not find MIL, which may be accompanied by suicidal ideation, depressive symptoms, and anxiety.

The MILA framework highlights how two outcomes–positive and negative adjustment–result from the successful or unsuccessful search for MIL. Depending on their personal, relational, and social resources, an individual may have different chances of finding a new MIL or of renewing their existing MIL after their diagnosis.

These studies, as well as others that have explored MIL in patients with other medical conditions, show that MIL may be an important factor in rehabilitation by offering a more individualized and patient-centered approach.

Implications of Meaning in Life on Rehabilitation Practice

Some individuals benefit more than others from a chronic pain management program despite having similar demographic and clinical characteristics. When these individuals complete the program, they have adjusted positively to their life circumstances and, accordingly, have better pain management and reduced symptoms. Before conducting our research to formulate the MILA framework, we hypothesized that these individuals have personal capabilities and resources enabling them to resolve the existential questions that accompany a traumatic experience. Our understanding is supported by two studies which found groups of patients with chronic pain who reported significantly lower pain intensity, medication use, and depressive symptoms, yet greater satisfaction with life due to having high MIL (11,12).

These studies, as well as others that have explored MIL in patients with other medical conditions, show that MIL may be an important factor in rehabilitation by offering a more individualized and patient-centered approach. For medical conditions such as chronic pain that are accompanied by strong emotional and cognitive dimensions, patients’ appraisal of their diagnosis (i.e., what it means to them and their everyday life) can help them better understand and handle the physical and psychological symptoms. MIL can be a concept that enhances a patient-centered approach to rehabilitation, but this construct is seldom understood and operationalized in clinical practice.

02 Article (Summer 2019 Issue 7) _ In-text Article 2
Image source: Pixabay (Pexels)

In a systematic review of instruments that measure MIL, Brandstätter and colleagues (14) found that most instruments lack ideal psychometric properties for valid and reliable measurements. Therefore, there are limitations to conceptualizing and operationalizing MIL for clinical practice, partly due to the inherent subjectivity and context-specific factors that may influence MIL. However, the MLQ described previously is a survey instrument with adequate psychometric properties.

In our chronic pain management program, we are evaluating the usefulness of the MILA Framework by having patients complete the MLQ at multiple points throughout the program. We will use the data to determine whether the MLQ can differentiate between individuals searching for MIL and those who have found MIL. This information can help rehabilitation practitioners target meaning-focused interventions, such as meaning-based group counselling, to individuals that may benefit the most (15). Ideally, individuals searching for MIL can be better supported in adjusting to their chronic medical condition.

To refer to this article, it can be cited as:

Majid U. The use of “meaning in life” to monitor clinical outcomes in rehabilitation programs. rehabINK. 2019;7. Available from:


  1. Haidt J. The happiness hypothesis: Finding modern truth in ancient wisdom.New York: Basic Books; 2006.
  1. Steger MF, Frazier P, Kaler M, Oishi S. The Meaning in Life Questionnaire: Assessing the Presence of and Search for Meaning in Life. Journal of Counselling Psychology. 2006;53(1):80–93.
  1. Lev-Wiesel R, Amir M. Posttraumatic growth among Holocaust child survivors. Journal of Loss& Trauma. 2003;8(4):229–237.
  1. Triplett KN, TedeschiRG, Cann A, Calhoun LG, Reeve CL. Posttraumatic growth, meaning in life, and life satisfaction in response to trauma. Psychological Trauma: Theory, Research, Practice, and Policy. 2012;4(4):400–410.
  1. VickbergSMJ, Bovbjerg DH, DuHamel KN, Currie V, Redd WH. Intrusive thoughts and psychological distress among breast cancer survivors: Global meaning as a possible protective factor. Behavioral Medicine. 2000;25(4):152–160.
  1. Graham J,Lobel M, Glass P, Lokshina I. Effects of written anger expression in chronic pain patients: Making meaning from pain. Journal of Behavioral Medicine. 2008;31:201–212.
  1. Kim ES, Sun JK, Park N, Peterson C. Purpose in life and reduced incidence of stroke in older adults:’The Health and Retirement Study’. Journal of Psychosomatic Research. 2013;74(5):427–432.
  1. Majid U, Ennis J. The Role of Meaning in Life in Adjustment to a Chronic Medical Condition: A review. EC Psychology and Psychiatry.2018;7(12):1023–1030.
  1. Lee V. The Existential Plight of Cancer: Meaning Making as a Concrete Approach to Intangible Search for Meaning. Support Care Cancer.2008;16:779–785.
  1. Taylor SE. Adjustment to threatening events: A theory of cognitive adaptation. AmericanPsychologist. 1983;38(11):1161–1173.
  1. DezutterJ, Casalin S, Wachholtz A, Luyckx K, Hekking J, Vandewiele W. Meaning in Life: An Important Factor for Psychological Well-Being in Chronically Ill Patients? Rehabilitation Psychology. 2013;58(4):334–341.
  1. DezutterJ, Luyckx K, Wachholtz A. Meaning in life in chronic pain patients over time: associations with pain experience and psychological well-being. Journal of Behavioral Medicine. 2015;38(2):384–396.
  1. Emmons RA. Striving for the sacred: Personal goals, life meaning, and religion. Journal of Social Issues. 2005;61(4):731–745.
  1. BrandstätterM, Baumann U, Borasio GD, Fegg MJ. Systematic review of meaning in life assessment instruments. Psycho‐Oncology. 2012;21(10):1034–1052.
  1. MacKinnon CJ, Smith NG, Henry M,Berish M, Milman E, Körner A, et al. Meaning-based group counseling for bereavement: Bridging theory with emerging trends in intervention research. Death Studies. 2014;38(3):137–144.