Narrative centrality and negative affectivity: independent and interactive contributors to stress reactions

A multilevel factor analysis of the short form of the Centrality of Event Scale

Introduction

The Centrality of Event Scale (CES) has frequently been used to measure the degree to which positive and negative life events are perceived central to a person's identity and life story; and previous research suggests that individuals rate their most positive memory as more central compared to their most negative one. When comparing the centrality of two (or more) memories within individuals, one needs to ensure that the CES (or its short form) is equally valid for different types of events (i.e., positive and negative) as well as on different levels of analyses (i.e., on the between-person and the within-person level), pointing to the issue of measurement invariance.

Methods

Three-hundred sixty-five adults (18-89 years of age) reported up to ten positive and up to ten negative autobiographical memories. For each memory reported, participants completed the seven-item short form of the CES, which measures three different components of centrality: Events can form a central component of identity (two items), a turning point in the life story (three items), and a reference point for everyday inferences (two items).

Results

Based on exploratory and confirmatory factor analyses, we found a two-factor structure (Self-Perception and Life-Course) to fit the data best at both levels of analyses and for both positive and negative events. Strict measurement invariance could be applied for positive and negative events at between-person level and at within-person level. The two factors, which measure the impact of an event on either a person's self-perception or their (future) life course, were rated higher for positive compared to negative memories. This difference, however, was stronger for the self-perception factor.

Discussion

The present study provides a first examination of the factorial structure of the CES short form on two levels (within and between persons) as well as for two types of life events (positive and negative). Whereas, a unidimensional scale might be sufficient to measure the centrality of stressful or traumatic life events, a more fine-graded measure seems better suited to understand the different roles of positive and negative life events for a person's identity and life story.

Characteristics of positive and negative autobiographical memories central to identity: emotionality, vividness, rehearsal, rumination, and reflection

Introduction

Some events are remembered as more central to a person's identity than others. However, it is not entirely clear what characterizes these autobiographical memories central to one's identity. In this study, we examined the effects of various characteristics on centrality to identity of positive and negative memories. Characteristics such as emotionality, vividness, and how frequently a memory is retrieved and shared with others as well as ruminative and reflective self-foci were studied.

Methods

The sample included 356 participants (18-92 years of age). First, participants responded to demographic questions and individual difference questionnaires. Next, they recalled memories in response to 12 emotional cue words. The cue words were balanced for emotional valence (i.e., six positive and six negative) and presented in a random order. After retrieving all memories, participants rated them regarding centrality, using the short seven-item Centrality of Event Scale and other memory characteristics, on a seven-point Likert scale. Multivariate multilevel regression was used for data analyzes, to consider multiple characteristics at the same time and account for data dependency within individual.

Results

The results showed that emotionality, vividness, and frequency of memory retrieval contributed to higher centrality of memories, and employing a reflective self-focus resulted in rating memories as more central. In specific cases, these characteristics were associated differently with centrality of positive and negative memories.

Discussion

Central memories can be perceived as markers in a person's life story. The findings of this study suggest that these marker events are also highly available in a person's memory system, by being actively emotional, visually rich, and frequently retrieved. Moreover, not only memory characteristics but also individual's features are important to fully understand the autobiographical memory centrality.

Psychometric properties of the Chinese version of the Centrality of Event Scale across multiple trauma-exposed Taiwanese samples

The widely used Centrality of Event Scale (CES) measures the extent that a traumatic event serves as a central component of self-identity, a reference point, and a turning point in an individual's life story. The present study aimed to develop a Chinese version of the CES and assess its reliability, criterion validity, and factor structure. Data were collected from three samples of trauma-exposed Taiwanese individuals (N = 939), including 420 earthquake survivors, 300 trauma-exposed community adults, and 219 trauma-exposed undergraduate students. We conducted an exploratory factor analysis and confirmatory factor analysis and compared the resulting models with a one-factor model and the originally proposed model. The results indicated that a new three-factor model, S-Bχ² (167, N = 519) = 687.01, p < .001, CFI = .95, IFI = .95, NNFI = .94, RMSEA = .078, SRMR = .047, might better represent the construct compared to the one-factor or originally proposed model. Furthermore, the Chinese CES demonstrated excellent internal consistency, Cronbach's αs = .89-.94; adequate 1-month reliability, rs = .54-.64, and 6-month temporal stability, rs = .52-.67; and good concurrent and predictive validity. The findings indicate that the Chinese version of the CES demonstrates good psychometric properties with a three-factor structure, and it could be used to assess event centrality among nonclinical trauma-exposed Taiwanese adults.

PTSD Symptoms and Coping with COVID-19 Pandemic among Treatment-Seeking Veterans: Prospective Cohort Study

Background: The aim of this study was to examine post-traumatic stress disorder (PTSD) symptom levels and coping strategies during the COVID-19 pandemic among treatment-seeking veterans with pre-existing PTSD. Method: A cohort of 176 male treatment-seeking veterans with pre-existing PTSD during the first COVID-19 pandemic lockdown (T1) and 132 participants from the same cohort one year after the onset of the pandemic (T2) participated in a longitudinal study. All participants responded to a COVID-19-related questionnaire and the following measures: the Life Events Checklist for DSM-5 (LEC-5), PTSD Checklist for DSM-5 (PCL-5) and the Brief COPE. Results: The intensity of overall PTSD symptoms, avoidance symptoms and negative alterations in cognitions and mood was lower at T2. PTSD symptoms were not significantly correlated with SARS-CoV-2 potentially traumatic events (PTE) at T2. Veterans scored higher on emotion-focused and problem-focused coping than on dysfunctional coping. Conclusions: Veterans with pre-existing PTSD who were receiving long-term treatment coped with COVID-19 stressors without the effects of retraumatization and a consequent worsening of PTSD symptoms.

Psychological adjustment following mechanical restraint in individuals with schizophrenia

AIM

While it is known that being mechanically restrained during hospitalization can, in severe cases, lead to PTSD in individuals with mental illness, less is known about why some develop posttraumatic stress reactions following restraint while others do not. This study examined whether the amount of exposure to mechanical restraint and patients' interpretations of the episodes' centrality to their identity were related to symptoms of PTSD in individuals with schizophrenia.

METHODS

We asked 20 individuals to recall mechanical restraint episodes and rate them on centrality to identity. They also completed scales measuring symptoms of posttraumatic stress, depression, trauma history, and were rated on positive and negative symptoms. Objective information about the number of times they had been restrained was obtained through Danish health registries.

RESULTS

Amount of exposure to mechanical restraint was not significantly related to PTSD symptoms, potentially due to limitations of our small sample. However, interpreting episodes as more central to identity was. This relationship remained significant when controlling for trauma history, positive symptoms, and depression.

CONCLUSION

The results suggest that clinically significant levels of PTSD are common in this population, and that considering patients' subjective interpretations of restraint episodes, and not merely the objective facts surrounding them is important for patients' psychological adjustment.

Validierung der deutschen Übersetzung der Centrality of Event Scale (CES-G)

Zusammenfassung. Theoretischer Hintergrund: Eine wachsende Zahl von Forschungsarbeiten weist auf die Bedeutung der wahrgenommenen Zentralität eines traumatischen Ereignisses in der eigenen Lebensgeschichte für das Verständnis von Symptomen der Posttraumatischen Belastungsstörung (PTBS) hin. Zur Untersuchung dieser Beziehung exisitert bislang noch kein Messinstrument, das die Ereigniszentralität auf Deutsch erfasst. Fragestellung: Um die Forschung auf diesem Gebiet im deutschsprachigen Raum zu ermöglichen, wird die Centrality of Event Scale (CES; Berntsen & Rubin, 2006 ) in einer deutschen Übersetzung (CES-G) vorgestellt und hinsichtlich ihrer psychometrischen Eigenschaften untersucht. Methode: Zur psychometrischen Auswertung wurde die CES-G 322 Student_innen sowie 115 ambulanten Patient_innen mit ausgeprägter PTBS-Symptomatik vorgelegt. Ergebnisse: Die CES-G zeigt eine hervorragende interne Konsistenz, substanzielle Korrelationen mit Maßen von PTBS Symptomen, allgemeiner Psychopathologie, Depressivität und maladaptiven kognitiven Prozessen sowie eine kriterienbezogene Validität bezüglich PTBS Symptomen in einer klinischen Stichprobe. Schlussfolgerungen: Die deutsche Übersetzung der CES ist ein verlässliches und valides Messinstrument für Ereigniszentralität.

Posttraumatic stress disorder symptoms and coping with the lockdown among help-seeking veterans before and during the COVID-19 pandemic

AIM

To compare the severity of posttraumatic stress disorder (PTSD) symptoms and of particular PTSD clusters among help-seeking veterans before and during the COVID-19 lockdown. The second aim was to identify the main coping strategies used.

METHODS

Male war veterans (N=176) receiving outpatient treatment at the Referral Center for PTSD were assessed at baseline (12-18 months before the pandemic declaration in March 2020) and during the COVID-19 pandemic lockdown (March-June 2020). The Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, and The Brief COPE were used.

RESULTS

Direct exposure to the virus in our sample was low, and the majority of participants followed the preventive measures. The severity of the overall PTSD symptoms and of clusters of symptoms significantly decreased compared with the first assessment. At the second assessment, all participants still fulfilled the PTSD diagnosis criteria. During the lockdown, the participants used emotion-focused and problem-focused coping rather than dysfunctional coping.

CONCLUSION

The severity of PTSD symptoms decreased during the lockdown. Further research is needed to study the trajectories of long-term psychopathology.

Does neuroticism disrupt the psychological benefits of nostalgia? a meta-analytic test

Nostalgia, a sentimental longing or wistful affection for the past, confers self-oriented, existential, and social benefits. We examined whether nostalgic engagement is less beneficial for individuals who are high in neuroticism (i.e. emotionally unstable and prone to negative affect). Specifically, we tested whether the benefits of experimentally induced nostalgia are moderated by trait-level neuroticism. To address this issue, we conducted a high-powered individual participant data meta-analysis ( N = 3556, k = 19). We found that the benefits of nostalgia were not significantly moderated by neuroticism, as they emerged for both high and low neurotics. This finding upheld when the self-oriented, existential, and social benefits of nostalgia were analysed jointly and when they were analysed separately. Taken together, individuals high and low in neuroticism are equally likely to benefit psychologically from engagement in nostalgic reverie.

Does event centrality mediate the effect of peritraumatic reactions on post-traumatic growth in survivors of a terrorist attack?

BACKGROUND

While self-reported post-traumatic growth (PTG) has been documented after a wide variety of potentially traumatic experiences, we need more knowledge on the mechanisms behind PTG to gain a better understanding of this phenomenon.

OBJECTIVE

We aimed to investigate the hypothesized mechanism of perceived event centrality as a mediator on the pathway between peritraumatic reactions and later PTG.

METHOD

In total, 204 survivors of the 2011 massacre on Utøya island, participated 4-5 months (T1), 14-15 months (T2), and 30-32 months (T3) post-terror. We applied counterfactually based causal mediation analysis to explore the potential mediating role of survivors' perceived centrality (T2) in linking their peritraumatic reactions (T1) and self-reported PTG (T3).

RESULTS

The vast majority of the survivors reported experiencing some positive changes post-terror, and we found a positive, significant association between survivor's peritraumatic reactions, perceived event centrality and self-reported growth. However, we did not find that centrality significantly mediated the longitudinal association between peritraumatic reactions and later PTG.

CONCLUSION

Reports of PTG are common post-terror, and peritraumatic reactions and perceptions of centrality may help explain individual differences in trauma survivors' level of PTG. Perceived event centrality about one year post-trauma does not appear to explain the relationship between initial reactions to trauma and subsequent PTG.

Pain centrality mediates pain self-efficacy and symptom severity among individuals reporting chronic pain

Chronic pain is consistently associated with the presence of mental health disorders. Although previous research has shown relations between low levels of self-efficacy with chronic pain severity as well as comorbid mental health symptoms, the link between self-efficacy and mental health symptoms in chronic pain is not well understood. This study examined whether pain centrality, the extent to which pain is viewed as central to self-identity, may underlie these associations. Individuals with a diagnosis of chronic pain (N = 89) recruited through MTurkcompleted self-report measures including demographics, self-efficacy, pain centrality, pain severity, depression, and anxiety. Pain severity was associated with higher levels of pain centrality, depression, anxiety, and lower levels of self-efficacy. Path analysis demonstrated pain centrality significantly mediated the relationship between self-efficacy and pain severity, depression, and anxiety. Future studies would benefit from testing whether modifying pain centrality beliefs shift perceptions of control as well as pain and psychological outcomes.

The utility of college student samples in research on trauma and posttraumatic stress disorder: A critical review

There is a widespread notion of the 'college sophomore problem' in social science research that posits that college student samples are samples of convenience with little generalizability to the general population. To address this concern, we conducted a critical review of the literature on college student samples in trauma research. Specifically, we reviewed how college student samples differ from non-college samples in four key areas of trauma research: (1) exposure rates to potentially traumatic events (PTEs), (2) prevalence of posttraumatic stress disorder (PTSD) symptoms, (3) factor structure of PTSD symptoms, and (4) PTSD's relation with common markers, correlates, and consequences. Lastly, we discussed the value and advantages of using college student samples in trauma research. Results of the critical review indicated similar trends of trauma-related findings (Points 1-4) between college student samples and both U.S. nationally collected and treatment-seeking samples; specifically, we identified a comparable lifetime PTE exposure rate, comparable rates of PTSD, a comparable factor structure of PTSD symptoms, and a comparable pattern of associations between PTSD symptoms and post-trauma markers/correlates/consequences. Although trauma-exposed college student samples are biased in some key areas, they may be no more biased than other commonly used trauma samples (e.g. epidemiological, treatment-seeking). Results of this critical review highlight the need to re-examine potentially unfounded biases on the part of the trauma research community, as well as the need to consider advantages of using college student samples in trauma research.

Medical Stress Reactions and Personal Growth in Parents of Children With a Rare Craniofacial Condition

BACKGROUND

The birth of a child with a congenital craniofacial anomaly (CFA) can have a profound psychological impact on the family. Despite the complexity and variability in treatment for these rare conditions, few studies have been conducted into parents' emotional responses to health-care experiences. The aim of the present study was to investigate parents' subjective experiences of their child's condition and treatment using an in-depth qualitative approach.

METHODS

Individual semistructured interviews were conducted in person or over the telephone with 48 parents of children with a range of rare CFAs. Interviews were transcribed verbatim, translated into English, and analyzed using inductive thematic analysis.

RESULTS

Participants reported physical and psychological symptoms that could be indicative of medical traumatic stress in relation to their child's diagnosis and treatment. Participants described feelings of powerlessness and the weight of being responsible for their child's care. Yet, participants also reported that as a result of their experiences, their perspective on life had changed and they had grown in self-confidence.

CONCLUSIONS

The findings provide insight into the complex physical and psychological effects experienced by parents in response to their child's diagnosis and medical treatment, as well as an understanding of how these experiences may also result in personal growth over time. Implementation of trauma-informed evidence-based resources should be considered in craniofacial care and future research, particularly in regard to prevention and treatment of psychological distress.

Mental health and imprisonment: Measuring cross-cutting symptoms among convicts in Punjab, Pakistan

BACKGROUND

DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult (APA, 2013) is a self-reported instrument to measure comorbidity of psychiatric symptomology. Translation and validation of this instrument contribute to the literature, both in terms of its availability in native language Urdu and its usefulness in the prison settings of Pakistan.

AIM

The purpose of the present study is to translate DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult (APA, 2013) and to measure comorbid psychiatric symptomology among convicted criminals of Central Jail Bahawalpur (CJB) and Central Jail Sahiwal (CJS).

MATERIALS AND METHOD

Cross-sectional design was used and guideline proposed by Mapi Institute (Acquadro et al., 2012) was used for the translation and adaptation process. Data were collected from 362 imprisoned convicts.

STATISTICAL ANALYSIS

For construct validity, Confirmatory Factor Analysis (CFA) was done by taking domains as continuous variables. The analysis was conducted using AMOS. Cross-tabulation analysis was conducted to see the association of comorbid psychiatric symptomology with respect to crime-related variables by using SPSS.

RESULTS AND CONCLUSION

Goodness of fit showed that the translated version of the instrument has a satisfactory to good construct validity. For domains with more than one items, Guttmann and Alpha reliability analysis showed satisfactory reliability of domains (.52-.71) and Alpha reliability of .89 for the overall instrument. Sleep disturbance and anger related symptoms showed a high prevalence in the current sample. Current and previous crime-related variables do associate significantly with comorbid psychiatric symptomology.

A proposal for augmenting the measurement of index events in PTSD assessment using event centrality

BACKGROUND: Standard practice in assessing and diagnosing posttraumatic stress disorder (PTSD) entails identifying a single "worst" index event as the basis for symptom inquiry. Determining a single event can be challenging for clinicians and clients when multiple traumas are considered equally distressing. Additionally, it can be difficult to distinguish potential index events based on distress given the cumulative effect of repeated trauma exposure. This calls for the development of approaches that build on existing selection methods (e.g., worst event method). OBJECTIVE/CONCLUSIONS: In this article, we propose an innovative approach for identifying and measuring index events that utilizes the construct of event centrality to expand the parameters by which index events are selected. Event centrality assesses the degree to which traumatic events are perceived as integral to one's personal identity and worldviews. Given its role in the etiology and maintenance of PTSD symptoms, this construct also approximates the emotional impact of trauma. Incorporating validated measures of event centrality into PTSD assessments would provide an objective strategy for identifying index events in a way that may increase the reliability of diagnosis. Our proposed strategy may also have a positive impact on the therapeutic process and treatment outcomes.

Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults

OBJECTIVES

There is substantial evidence regarding the role of event centrality (EC) in posttraumatic stress disorder (PTSD) symptoms, but little research has examined the explanatory pathways linking EC with PTSD symptoms severity. The present study examined whether core beliefs (CB) mediates the relationship between EC and PTSD symptoms in internally displaced older adults.

METHOD

Internally displaced older adults (N = 279; mean age = 62 years) sheltered in two camps located in north-central Nigeria, completed Tiv language versions of self-report measures, namely, the Harvard Trauma Questionnaire, the Centrality of Event Scale, Core Beliefs Inventory, and provided relevant demographic information.

RESULTS

Analysis indicated that EC and CB were linked to greater PTSD symptoms as well as re-experiencing/intrusion, avoidance and hyperarousal symptoms severity. The mediator path was significant which implies that CB was a pathway through which EC influences PTSD symptoms clusters and overall PTSD symptomatology.

CONCLUSION

A traumatic event becoming more central in a person's identity and life story distorts entrenched beliefs about oneself, others and the world, thereby resulting in greater PTSD symptoms. Our findings suggest that considerations of disrupted world assumptions may be a salient target for prevention and treatment efforts.

Psychological and clinical correlates of the Centrality of Event Scale: A systematic review

The Centrality of Event Scale (CES) was introduced to examine the extent to which a traumatic or stressful event is perceived as central to an individual's identity and life story, and how this relates to Posttraumatic Stress Disorder (PTSD) symptoms. In addition, the CES has been examined in relation to a range of other conditions and dispositions. We present a systematic review of the correlates of the CES. Results from 92 publications resulted in 25 measurement categories in the six theoretical domains of trauma, negative affect and distress, autobiographical memory, personality, positive affect, and gender. The mean weighted correlations of the 25 measurement categories ranged from -.17 to .55, with standard errors from .01 to .02, allowing us to distinguish empirically among effects. Consistent with the theoretical motivation for the CES and predictions predating the review, the CES correlated positively with a range of measures, correlating most highly with measures related to trauma, PTSD, grief, and autobiographical memory. The findings show that the CES probes aspects of autobiographical memory of broad relevance to clinical disorders, and with specific implications for theories of PTSD.

Taking tests in the magnet: Brain mapping standardized tests

Standardized psychometric tests are sophisticated, well-developed, and consequential instruments; test outcomes are taken as facts about people that impact their lives in important ways. As part of an initial demonstration that human brain mapping techniques can add converging neural-level evidence to understanding standardized tests, our participants completed items from standardized tests during an fMRI scan. We compared tests for diagnosing posttraumatic stress disorder (PTSD) and the correlated measures of Neuroticism, Attachment, and Centrality of Event to a general-knowledge baseline test. Twenty-three trauma-exposed participants answered 20 items for each of our five tests in each of the three runs for a total of 60 items per test. The tests engaged different neural processes; which test a participant was taking was accurately predicted from other participants' brain activity. The novelty of the application precluded specific anatomical predictions; however, the interpretation of activated regions using meta-analyses produced encouraging results. For instance, items on the Attachment test engaged regions shown to be more active for tasks involving judgments of others than judgments of the self. The results are an initial demonstration of a theoretically and practically important test-taking neuroimaging paradigm and suggest specific neural processes in answering PTSD-related tests. Hum Brain Mapp 38:5706-5725, 2017. © 2017 Wiley Periodicals, Inc.

Self-Event Connections in Life Stories, Self-Concept Clarity, and Dissociation: Examining Their Relations with Symptoms of Psychopathology

Constructing a coherent life story through the formation of self-event connections may help maintain unity in the self. We examined how positive and negative self-event connections were related to symptoms of psychopathology when controlling for two other measures of self-unity: self-concept clarity and dissociation. While most studies of life stories use content coding, we used a self-report method and hence provide a rationale for this method. One hundred five young adults identified life story chapters and rated them on self-event connections, including questions of positive or negative self-change and self-stability connections. They also completed scales measuring self-concept clarity, dissociation, and symptoms. Higher ratings of positive and lower ratings of negative self-event connections in life stories were related to fewer symptoms of psychopathology. Positive self-change was related to fewer symptoms when controlling for self-concept clarity and dissociation. The results suggest that positive and negative self-event connections are differentially related to symptoms of psychopathology. In addition, the results indicate that self-report measures of life stories may be a useful supplement to coding of narratives.

Role of event centrality and emotion regulation in posttraumatic stress disorder symptoms among internally displaced persons

BACKGROUND

Event centrality and emotion regulation in relation to posttraumatic stress disorder (PTSD) have been documented in various global samples especially in Western cultures; but internally displaced persons (IDPs) still constitute an underrepresented population in psychotraumatology literature. This study tested the roles of event centrality and emotion regulation strategies (cognitive reappraisal and expressive suppression) in PTSD symptoms among IDPs in Nigeria.

DESIGN

The multi-group cross-sectional design was adopted.

METHODS

Tiv language versions of the Centrality of Events Scale, Emotion Regulation Questionnaire, and Harvard Trauma Questionnaire were completed by 859 IDPs in two camps located in Benue State, North-central region of Nigeria.

RESULTS

Hierarchical multiple linear regression results indicated that event centrality positively predicted PTSD symptoms. Cognitive reappraisal was a negative predictor of PTSD symptoms while expressive suppression was a positive predictor of PTSD symptoms. Bonferroni corrections indicated that expressive suppression was the strongest predictor of total PTSD symptoms, avoidance/numbing symptoms, and hyper-arousal symptoms; but event centrality was the most robust predictor of PTSD intrusion/re-experiencing symptoms.

CONCLUSION

The findings underscore recent developments in psychotraumatology indicating that the extent to which individual differences impact the development of PTSD is essential in clinical psychology research and practice.

Severity of traumatic injuries predicting psychological outcomes: A surprising lack of empirical evidence

Despite widespread beliefs that trauma severity is related to levels of posttraumatic stress symptoms (PTSS), the empirical evidence to support such beliefs is lacking. In the current study we examined Injury Severity Score (ISS), a medical measure of event severity for physical injuries, in a sample of 460 patients admitted to a Level 1 Trauma Center. Results revealed no significant relationship between ISS and PTSS, depression, pain, and general physical and mental health at baseline, three months, and six months post-injury. However, at 12 months post-injury, ISS significantly predicted depression, pain, and physical health, but was unrelated to PTSS. The effect sizes of these relationships were small and would not remain significant if any adjustments for multiple comparisons were employed. We conclude that the relationship between ISS and PTSS is, at best, weak and inconsistent. The results are discussed in the broader picture of event severity and psychological outcomes.

Personality traits are associated with the valence of future imagined events in individuals with schizophrenia

The relationships between the valence (positive or negative) of future imagined events and personality dimensions were examined in patients with schizophrenia. Correlational analyses showed that Extraversion was positively associated with the simulation of more positive future events whereas a statistical trend between Neuroticism and negative emotional valence was found. As in nonclinical individuals, personality is related to characteristics of mental time travel in schizophrenia patients.

Event centrality as a unique predictor of posttraumatic stress symptoms and perceived disability following spinal cord injury

STUDY DESIGN

We conducted a cross-sectional study involving completion of self-report measures.

OBJECTIVES

Individuals who acquire a spinal cord injury (SCI) face numerous physical and psychological challenges, with the former receiving considerable less attention during the rehabilitation process. In this article, we examined event centrality as a unique predictor of psychological outcomes in a sample of individuals receiving rehabilitation for SCI. Event centrality refers to the extent to which individuals construe a stressful experience as a core part of their identity. In samples of individuals exposed to psychological traumas (for example, sexual assault or military combat), event centrality has emerged as a consistent and powerful predictor of posttraumatic stress symptoms (PTSSs). This is the first study to examine event centrality in an SCI sample.

SETTING

Inpatient rehabilitation program in a large urban city in the Southwestern United States.

METHODS

A sample of 55 participants in rehabilitation for a recent SCI completed measures of event centrality, PTSS, depressed mood and perceived disability.

RESULTS

Event centrality was significantly related to perceived disability (r=0.48) and PTSS (r=0.31) and accounted for unique variance in these two outcomes after controlling for demographics and depressed mood.

CONCLUSION

Event centrality is common among individuals with SCI and may be a unique contributor to worse psychological and functional outcomes. We hope our findings will alert health-care professionals to the importance of event centrality.

SPONSORSHIP

This study was supported by a grant from the Danish National Research Foundation (DNRF89).

Self-Identity After Bereavement: Reduced Self-Clarity and Loss-Centrality in Emotional Problems After the Death of a Loved One

There is evidence that both the centrality of a loss-event as well as reduced self-concept clarity are involved in emotional problems after the death of a loved one. One issue that is still unexplored is the relative importance of these two concepts in predicting bereavement outcome. The current study examined the degree to which both concepts contribute to emotional distress after loss, both concurrently and longitudinally. Data were available from 124 individuals, all bereaved within the previous half year, who completed measures of prolonged grief, posttraumatic stress, and depression at inclusion into the study and again 6 months later. Loss-centrality and self-unclarity were associated with all three outcome measures, in cross-sectional analyses. Longitudinal analyses indicated that loss-centrality predicted symptom levels of prolonged grief, self-unclarity predicted symptom levels of depression, and both loss-centrality and self-unclarity were associated with posttraumatic stress 6 months after baseline. Implications of these findings are discussed.

Neuroticism Increases PTSD Symptom Severity by Amplifying the Emotionality, Rehearsal, and Centrality of Trauma Memories

OBJECTIVE

Although it is well established that neuroticism increases the risk of posttraumatic stress disorder (PTSD), little is known about the mechanisms that promote PTSD in individuals with elevated levels of neuroticism. Across two studies, we examined the cognitive-affective processes through which neuroticism leads to greater PTSD symptom severity.

METHOD

Community-dwelling adults with trauma histories varying widely in severity (Study 1) and clinically diagnosed individuals exposed to DSM-IV-TR A1 criterion traumas (Study 2) completed measures of neuroticism, negative affectivity, trauma memory characteristics, and PTSD symptom severity.

RESULTS

Longitudinal data in Study 1 showed that individuals with higher scores on two measures of neuroticism assessed approximately three decades apart in young adulthood and midlife reported trauma memories accompanied by more intense physiological reactions, more frequent involuntary rehearsal, and greater perceived centrality to identity in older adulthood. These properties of trauma memories were in turn associated with more severe PTSD symptoms. Study 2 replicated these findings using cross-sectional data from individuals with severe trauma histories and three additional measures of neuroticism.

CONCLUSIONS

Results suggest that neuroticism leads to PTSD symptoms by magnifying the emotionality, availability, and centrality of trauma memories as proposed in mnemonic models of PTSD.

Examining the Relationship Between Trauma Centrality and Posttraumatic Stress Disorder Symptoms: A Moderated Mediation Approach

BACKGROUND AND OBJECTIVES

The degree to which a traumatic event is seen as central to one's sense of self (trauma centrality) has been associated with posttraumatic stress disorder (PTSD) symptoms. Based on cognitive models of PTSD that highlight the role that maladaptive appraisals play in generating PTSD symptoms, we hypothesized that appraising a trauma as violating one's core beliefs and goals mediates the link between trauma centrality and PTSD symptoms. Further, we reasoned that coping ability moderates the direct and indirect link as those with better coping ability will have more adaptive appraisals.

DESIGN

Hypotheses were examined in a cross-sectional sample of 367 undergraduates who have experienced a traumatic event.

METHODS

Data were collected via an online survey.

RESULTS

Overall, results of the moderated mediation analysis were consistent with the hypothesized mediating role for appraised violations and moderating role for coping ability.

CONCLUSIONS

Findings highlight the importance of considering individual differences and trauma appraisals in understanding the relationship between trauma centrality and PTSD - trauma centrality may be related to PTSD symptoms more so among people with poorer coping ability who appraise a trauma as violating their core beliefs and goals.

The Centrality of Events Scale in Portuguese Adolescents: Validity Evidence Based on Internal Structure and on Relations to Other Variables

We explored the measurement model of the adolescent version of the Centrality of Event Scale and its invariance across community ( n = 1,079; 42.8% male), referred for foster care ( n = 205; 58.0% male), and detained ( n = 206 male) adolescent participants. Results indicated a three-factor measurement model, including all three functions that memories of significant life events may have, as a good fit to our data, particularly for male participants. This measurement model was invariant across boys taken from those different samples but not across gender. As for the short version of the instrument, a one-factor solution was the best fit to our data. It was invariant across boys taken from those different samples and across gender. Boys and girls expressed similar experiences, whereas community male adolescents reported the lowest impact of a meaningful event, in comparison with referred and with detained boys. These findings provide evidence on the validity of the scale for use with diverse adolescent samples, which may contribute for a better understanding of the impact that significant life events may have on the development of gender-specific and group-specific vulnerabilities.

Impact of new traumatic or stressful life events on pre-existing PTSD in traumatized refugees: results of a longitudinal study

BACKGROUND

A significant proportion of trauma survivors experience an additional critical life event in the aftermath. These renewed experiences of traumatic and stressful life events may lead to an increase in trauma-related mental health symptoms.

METHOD

In a longitudinal study, the effects of renewed experiences of a trauma or stressful life event were examined. For this purpose, refugees seeking asylum in Germany were assessed for posttraumatic stress symptoms (PTS), Posttraumatic Stress Diagnostic Scale (PDS), anxiety, and depression (Hopkins Symptom Checklist [HSCL-25]) before treatment start as well as after 6 and 12 months during treatment (N=46). Stressful life events and traumatic events were recorded monthly. If a new event happened, PDS and HSCL were additionally assessed directly afterwards. Mann-Whitney U-tests were performed to calculate the differences between the group that experienced an additional critical event (stressful vs. trauma) during treatment (n=23) and the group that did not (n=23), as well as differences within the critical event group between the stressful life event group (n=13) and the trauma group (n=10).

RESULTS

Refugees improved significantly during the 12-month period of our study, but remained severely distressed. In a comparison of refugees with a new stressful life event or trauma, significant increases in PTS, anxiety, and depressive symptoms were found directly after the experience, compared to the group without a renewed event during the 12 months of treatment. With regard to the different critical life events (stressful vs. trauma), no significant differences were found regarding overall PTS, anxiety, and depression symptoms. Only avoidance symptoms increased significantly in the group experiencing a stressful life event.

CONCLUSION

Although all clinicians should be aware of possible PTS symptom reactivation, especially those working with refugees and asylum seekers, who often experience new critical life events, should understand symptom fluctuation and address it in treatment.

The frequency of involuntary autobiographical memories and future thoughts in relation to daydreaming, emotional distress, and age

We introduce a new scale, the Involuntary Autobiographical Memory Inventory (IAMI), for measuring the frequency of involuntary autobiographical memories and involuntary future thoughts. Using the scale in relation to other psychometric and demographic measures provided three important, novel findings. First, the frequency of involuntary and voluntary memories and future thoughts are similarly related to general measures of emotional distress. This challenges the idea that the involuntary mode is uniquely associated with emotional distress. Second, the frequency of involuntary autobiographical remembering does not decline with age, whereas measures of daydreaming, suppression of unwanted thoughts and dissociative experiences all do. Thus, involuntary autobiographical remembering relates differently to aging than daydreaming and other forms of spontaneous and uncontrollable thoughts. Third, unlike involuntary autobiographical remembering, the frequency of future thoughts does decrease with age. This finding underscores the need for examining past and future mental time travel in relation to aging and life span development.

Accounting for Posttraumatic Stress Disorder Symptom Severity With Pre- and Posttrauma Measures: A Longitudinal Study of Older Adults

Using data from a longitudinal study of community-dwelling older adults, we analyzed the most extensive set of known correlates of PTSD symptoms obtained from a single sample to examine the measures' independent and combined utility in accounting for PTSD symptom severity. Fifteen measures identified as PTSD risk factors in published meta-analyses and 12 theoretically and empirically supported individual difference and health-related measures were included. Individual difference measures assessed after the trauma, including insecure attachment and factors related to the current trauma memory, such as self-rated severity, event centrality, frequency of involuntary recall, and physical reactions to the memory, accounted for symptom severity better than measures of pre-trauma factors. In an analysis restricted to prospective measures assessed before the trauma, the total variance explained decreased from 56% to 16%. Results support a model of PTSD in which characteristics of the current trauma memory promote the development and maintenance of PTSD symptoms.

Adverse events in emerging adulthood are associated with increases in neuroticism

Previous studies have produced mixed results when examining whether experiencing an adverse event can lead to changes in Neuroticism. We sought to examine this effect when (a) the event was relatively recent, (b) the event occurred during a relatively early development stage (i.e., emerging adulthood), and (c) the event was severely adverse. A sample of 1,108 undergraduates completed three measures of Neuroticism twice, separated by approximately 3 months, and indicated the most traumatic or adverse event they experienced during the intervening 3 months. We examined two operationalizations of adverse events: one that is more objectively defined (indicated experiencing a trauma listed on a trauma history measure) and another more subjectively defined (participant ratings of event centrality). The results revealed that high Neuroticism at Time 1 predicted future exposure to both types of adverse events. Critically, participants who experienced either type of adverse event during the semester reported significant increases in Neuroticism. Experiencing a high event centrality event was also associated with small increases in the personality traits Openness to Experience and Conscientiousness. The results are discussed in terms of the conditions necessary for adverse events to affect personality traits.