The Influences of Event Centrality in Memory Models of PTSD

A wave of COVID-19 related PTSD? Disentangling the impact of exposure to COVID-19 related events on probable posttraumatic stress disorder in the general Dutch population

INTRODUCTION

The COVID-19 pandemic highlighted a critical gap in our knowledge on the impact on mental health, especially trauma-related disorders like PTSD. With future pandemics anticipated due to global health risks, it is essential to rigorously study the prevalence of PTSD resulting from COVID-19. Such research will help us understand the psychological effects of pandemics and develop better strategies for mental health support in future crises.

METHODS

This study uses data from the Dutch Public Health Monitor Adults and Elderly 2022, consisting of 365,000 Dutch adults recruited using random sampling. Pandemic-related and non-COVID related potentially traumatic events were assessed and anchored to a validated screening instrument for PTSD, the Dutch version of the PCL-5.

RESULTS

Two-thirds of participants reported experiencing traumatic events during the pandemic. Exposure to pandemic-related traumatic events was reported more frequently than non-COVID related traumatic events. Overall probable PTSD prevalence due to these events was 2.4%, evenly split between pandemic-related and non-COVID related traumatic events. Among exposed individuals, probable PTSD prevalence was 3.7%. The risk was higher for exposure to non-COVID related events such as sexual violence, physical violence and life-threatening accidents than exposure to pandemic-related traumatic events like hospitalization or death of someone significant. Risk factors for developing probable PTSD after exposure to a traumatic event during the pandemic were younger age, financial difficulties, loneliness, low resilience, and experiencing multiple events.

DISCUSSION

Exposure to traumatic events during the pandemic influenced the prevalence of probable PTSD. Despite the lower relative impact of pandemic-related traumatic events compared to non-COVID related traumatic events, exposure to pandemic-related traumatic events accounted for 1.1% of probable PTSD in the population and is thereby comparable in impact to five commonly occurring traumatic events. This emphasizes the need to address mental health consequences and risk factors during pandemics and, potentially, other crises with population-wide exposure to events.

Pushing through: A grounded theory of undergraduate nursing students making meaning of clinical-related critical incidents

BACKGROUND

Undergraduate nursing students are at risk of exposure to clinical related critical incidents. The impact on nursing students and the use of coping mechanisms and processes to make meaning of these distressing experiences are poorly understood.

PURPOSE

The aim of this study was to provide a theoretical understanding of the processes that undergraduate nursing students use to make meaning of clinical related critical incidents.

METHOD

Following the constructivist grounded theory method, a purposive sample was used to recruit 15 students enrolled in a Canadian university baccalaureate nursing program. Data were collected using semi-structured interviews over 12 months. Interviews were transcribed and analyzed using constant comparison and concurrent data collection and coding.

RESULTS

Three theoretical categories emerged from the data to explain the processes used by nursing students to make meaning of their critical incidents: distress, identity shift, and moving forward. The processes described were characterized by an overarching category of "Pushing Through."

CONCLUSION

The resulting theory of "Pushing Through" can be used as a lens for students and nurse educators to navigate making meaning of clinical related critical incidents. This theory highlights the significance of students' self-understanding as they explore and assemble individualized strategies and coping skills. Educators who teach in the clinical setting should prioritize the development of a trauma-informed learning environment by establishing connections and transparent expectations with learners.

To mention or not to mention? The inclusion of self-reported most traumatic and most positive memories in the life story

Many theories on Posttraumatic Stress Disorder (PTSD) make assumptions on the relationship between PTSD and centrality of traumas to the life story and identity. Although the Centrality of Event Scale (CES) is a popular measure of centrality of personally experienced events to the life story, no studies have examined whether self-rated "central" events are mentioned, when individuals recount their lives. It is also unknown if mentioning specific event types in the life story is related to psychological health or life story coherence. We asked 386 adults to write their life stories, nominate their most traumatic and positive events, rate these events on the CES, and complete measures of PTSD and depression. Two-thirds of the sample mentioned at least one event, with the positive event being mentioned twice as often as the trauma. Mentioned events were more central than non-mentioned events. Participants who mentioned their trauma scored higher on symptoms of PTSD and depression than participants who only mentioned their positive event, but did not write less coherent life stories. Further, death- and illness-related traumas were mentioned more often than accidents and disasters. Findings are discussed in relation to theories on trauma memory in PTSD.

Focusing on the self in context as an emotion regulatory strategy: an evaluation of the "self-as-context" component of ACT compared to cognitive reappraisal in managing stress

BACKGROUND

Self-as-Context (SAC) is one of the six core components of the Acceptance and Commitment Therapy model (ACT).

OBJECTIVE

The aim of the current study was to investigate whether SAC is effective in reducing negative affect and maintaining positive affect in response to a personally relevant stressor relative to cognitive reappraisal (CR) and spontaneous coping strategies.

METHOD

An undergraduate sample (N = 105) completed baseline measures and were asked to discuss a recent personally relevant stressor which was audiotaped, before being randomized to one of three conditions. Participants randomized to the SAC and CR conditions received 5-minutes of training, whilst participants allocated to the control condition were asked to read a brochure for 5-minutes. All participants then listened to their recorded stressful experience before completed follow-up measures.

RESULTS

The SAC group reported significantly less negative affect than participants in the control group post-training induction; although the CR group did not differ from the SAC or control participants in reductions in negative affect post-induction. There were no significant group differences for positive affect.

CONCLUSIONS

The findings provide preliminary evidence that SAC is an effective emotion regulatory strategy in reducing acute distress in a stress-exposed young adult sample.

Change in Event Centrality and Posttraumatic Stress Disorder Symptoms During Intensive Treatment

Event centrality, defined as the extent to which a traumatic event becomes a core component of a person's identity (Berntsen & Rubin, 2006), is both a correlate and predictor of posttraumatic stress disorder (PTSD) symptoms, over and above event severity. These findings suggest that decreasing the perceived centrality of a traumatic event to one's identity might result in decreases in PTSD symptom severity. To date, few studies have examined how centrality is affected by PTSD treatment. The present study tested the hypotheses that change in centrality would be associated with both change in PTSD symptom severity and discharge PTSD symptom severity in an exposure-based PTSD partial hospitalization program (N = 132; 86.0% White; 85.2% female; M age = 36 years). At discharge (i.e., after approximately 6 weeks of treatment), both PTSD symptoms and centrality had significantly decreased, ds = .70 and .98, respectively, with large effect sizes. Decreases in Centrality of Events Scale (CES) scores at posttreatment, baseline CES scores, and baseline PTSD Checklist for DSM-5 (PCL-5) scores were associated with change (i.e., decrease) in PCL-5 scores, p < .001, as well as with posttreatment PCL-5 scores, p < .001. Decreases in CES scores over time, baseline CES scores, and baseline PCL-5 scores explained 31% of the variance in PCL-5 change and 34% of the variance in posttreatment PCL-5 scores. The results indicate the potential importance of decreasing the centrality of a traumatic event in PTSD treatment and recovery.

Heterogeneity in temporal self-appraisals following exposure to potentially traumatic life events: A latent profile analysis

BACKGROUND

People tend to believe that they continuously improve over time. In fact, Temporal Self-Appraisal Theory ("Chump to Champ") has found that people are motivated to derogate their past selves in favor of their present selves. Studies on temporal self-appraisals following trauma is less clear, with some studies showing perceived improvement whereas other studies show appraisals of decline.

METHOD

Utilizing Latent Profile Analysis (LPA), we tested for discrete patterns of temporal self-appraisals in undergraduate college students (N = 740) following trauma exposure. We then explored various trauma-related characteristics as predictors of profile membership.

RESULTS

LPA revealed three distinct profiles of appraisal styles (Profile 1: optimistic, Profile 2: chump to champ, Profile 3: pessimistic). The optimistic profile was associated with lower levels of PTSD and depression symptoms, whereas the optimistic and chump to champ profiles were associated with greater trauma centrality.

LIMITATIONS

Findings are limited in that this study utilized cross-sectional data from a sample of predominantly undergraduate females, thus conclusions regarding temporal relations among study constructs cannot be made and findings may not generalize to other populations.

CONCLUSION

Temporal self-appraisals following trauma exposure may reflect prototypical patterns in which individual appraise adaptation to potentially traumatic stress and may confer risk for psychopathology. Such findings have implications for approaches to intervention with clinical and non-clinical populations following trauma exposure.

Trauma and identity: A reciprocal relationship?

Trauma can alter the course of identity development and destabilize existing identity commitments. Trauma, whether past or current, can also impact the resources a person brings to identity work. However, identity can also be a lens through which trauma is perceived and interpreted, helping to determine whether a traumatic experience results in posttraumatic stress disorder or posttraumatic growth. Despite the apparent implications each construct has for the other, the scholarship at the intersection of trauma and identity remains sparse. This Special Issue explores how and when trauma and identity influence one another by considering their association across various adolescent populations, methodologies, traumatic event types, and facets of identity. In doing so, this Special Issue lays the groundwork necessary for exploring, proposing, and testing more complex and nuanced reciprocal relations models between identity and trauma.

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.

Centrality of Event and Mental Health Outcomes in Child and Adolescent Natural Disaster Survivors

The experience of trauma could be considered a central event in one's life, such that it could be a core component of one's identity and life story. Indeed, trauma memories are well-remembered, vivid, intense, and easily accessible (Berntsen & Rubin, 2006). The present study investigated the mediating role of sensory-based trauma memory quality in the relationship between centrality of event and mental health outcomes among child and adolescent survivors of a natural disaster (N = 225) in its immediate aftermath. Results of mediation analyses revealed that centrality of trauma event is related to symptoms of acute stress disorder and depression through sensory-based trauma memory quality (indirect effect 95% C.I. [.06, .11] and [.04, .10], respectively). These findings support the contention that centrality of event is associated to heightened accessibility and vividness of sensory-based trauma memory quality, which in turn is related to an increase in trauma-related symptoms in the immediate aftermath of a natural disaster, where the reminders of trauma are particularly salient in the survivors' environment and daily activities.

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.

Changes in perceived centrality of anxious events following cognitive behavioral therapy for social anxiety disorder and panic disorder

BACKGROUND AND OBJECTIVE

The purpose of the present study was to explore the association between reductions in symptoms of psychopathology and perceived centrality of negative autobiographical memories in participants with social anxiety disorder (SAD) or panic disorder (PD).

METHODS

Thirty-nine individuals with SAD or PD recalled and rated four negative autobiographical memories before and after ten sessions of cognitive behavioral therapy (CBT) over a three-month period. Twenty-eight healthy controls did the same before and after a three-month period.

RESULTS

As hypothesized, results showed a decrease in perceived centrality following CBT. This decrease in perceived centrality was larger, although at the trend level, for individuals who experienced reliable change on disorder-specific symptoms.

LIMITATIONS

The correlational nature of the study prevents establishing the causal relationship between changes in perceived centrality and psychopathology, and future studies should explore such mechanisms.

CONCLUSIONS

The present study adds to the emerging body of literature, investigating changes in centrality of event following psychotherapy.

Autobiographical memory functions and posttraumatic stress symptoms across adulthood

Previous research has documented robust individual differences in the functions served by autobiographical memories, and shown that different autobiographical memory functions are related to both positive and negative indicators of psychological well-being, and that their frequency varies with age. In this study, we examined the unique relationship between autobiographical memory functions and posttraumatic stress symptoms (PTSS) and whether such relationships varied with age across adulthood. A representative sample of 1040 adult Danes (20-70 years old) reported the frequency with which they recall autobiographical memories for different purposes as well as their level of posttraumatic stress disorder (PTSD) symptoms. Higher reflective and ruminative functions, as well as lower social function, predicted higher levels of PTSS. There were no moderating effects of age. The results suggest that although the frequency of various autobiographical functions varies throughout the adult years, their association with PTSS is similar across adulthood.

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.

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).

Rumination, event centrality, and perceived control as predictors of post-traumatic growth and distress: The Cognitive Growth and Stress model

OBJECTIVES

The Cognitive Growth and Stress (CGAS) model draws together cognitive processing factors previously untested into a single model. Intrusive rumination, deliberate rumination, present and future perceptions of control, and event centrality were assessed as predictors of post-traumatic growth (PTG) and post-traumatic stress (PTS).

METHOD

The CGAS model is tested on a sample of survivors (N = 250) of a diverse range of adverse events using structural equation modelling techniques.

RESULTS

Overall, the best fitting model was supportive of the theorized relations between cognitive constructs and accounted for 30% of the variance in PTG and 68% of the variance in PTS across the sample.

CONCLUSIONS

Rumination, centrality, and perceived control factors are significant determinants of positive and negative psychological change across the wide spectrum of adversarial events. In its first phase of development, the CGAS model also provides further evidence of the distinct processes of growth and distress following adversity.

PRACTITIONER POINTS

Clinical implications People can experience positive change after adversity, regardless of life background or types of events experienced. While growth and distress are possible outcomes after adversity, they occur through distinct processes. Support or intervention should consider rumination, event centrality, and perceived control factors to enhance psychological well-being. Cautions/limitations Longitudinal research would further clarify the findings found in this study. Further extension of the model is recommended to include other viable cognitive processes implicated in the development of positive and negative changes after adversity.