Thinking about trauma: the unique contributions of event centrality and posttraumatic cognitions in predicting PTSD and posttraumatic growth

The Revised Pathogenic Beliefs Scale: A Transtheoretical Measure of Maladaptive Beliefs That Are Associated with Psychological Distress

Pathogenic beliefs are maladaptive cognitive schema that may obstruct a person's ability to achieve meaningful goals in their life. This study sought to revise a previously existing measure of pathogenic beliefs (the Pathogenic Beliefs Scale) by improving the quality of items and separating the ratings of the presence of a pathogenic belief from the distress associated with it. In Study 1 (n = 272), we used item-response theory to identify 21 items from an initial pool of 44 items. In Study 2 (n = 422), we tested the items from Study 1 using confirmatory factor analysis. Study 3 used the combined samples from Study 1 and Study 2 (total n = 528) to compare the revised measure to the Experiences in Close Relationships and the Measure of Parental Style. Results indicate that the revised 21-item PBS has good reliability and convergent validity with related measures, consistent with previous studies of the longer version of the PBS. The 21-item revised PBS is included as supplemental material, and freely available to clinicians and researchers.

Stress-associated symptoms and disorders: A transdiagnostic comparison

The ICD-11 features a new group of disorders specifically associated with stress, which are interlinked by various symptoms, such as intrusive memory symptoms. Although research interest in these new ICD-11 diagnoses is growing rapidly, so far, no studies have systematically investigated the transdiagnostic distribution of stress-associated symptoms in these disorders. In the present study, 447 individuals completed a series of online questionnaires, which measured various stress-associated symptoms, e.g., flashbacks, preoccupation or yearning. Findings showed that the majority of correlations between the measured psychopathological constructs was between 0.30 and 0.60. Furthermore, with regard to specific diagnostic groups, a complex variation of stress-associated symptoms was observed, with preoccupation as a predominant symptom in all disorders. Results demonstrate that stress-associated symptoms are inherently interconnected yet possess an individual variation in different disorders. Furthermore, findings illustrate that preoccupation represents a major feature in all stress-associated disorders.

Revisiting the Factor Structure of the Centrality of Event Scale

Traumatic experiences that become self-defining impact posttraumatic outcomes, yet exact mechanisms are currently being studied. Recent research has used the Centrality of Event Scale (CES). However, the factor structure of the CES has been in question. We analyzed archival data (N = 318) split into homogenous groups of participants to examine whether the factor structure of the CES differed based on event type (bereavement vs. sexual assault) or by levels of PTSD (meeting clinical cut off score vs. group of lowest scorers). Exploratory factor analyses with subsequent confirmatory analyses revealed a single factor model in the bereavement group, sexual assault group, and the low PTSD group. A three-factor model emerged in the high PTSD group, with the factors' themes matching previous findings. Event centrality appears to be a universal theme when people endure and process a diversity of adverse events. These distinct factors may illuminate pathways in the clinical syndrome.

Event centrality and posttraumatic stress symptoms after traumatic injury: A longitudinal investigation

The development of posttraumatic stress symptoms (PTSS) can occur following a traumatic injury, which may include an increase in negative cognitions. One cognitive construct shown to be associated with the development of PTSS is event centrality, or the degree to which an individual views a traumatic experience as central to their life story. Although cross-sectional work has demonstrated a robust connection between event centrality and PTSS, the directionality of this association remains unclear. Most previous work has investigated centrality as a predictor of PTSS, although one recent study suggests that PTSS may, in fact, predict event centrality. The current longitudinal study enrolled adult civilian participants (N = 191) from a Level 1 trauma center following a traumatic injury and assessed both event centrality and PTSS at three points posttrauma (3, 12, and 18 months). A time-constrained random intercept cross-lagged panel analysis showed that PTSS predicted event centrality over the 18-month follow-up period, B = 0.16, p = .021, but event centrality did not predict PTSS, B = -0.27, p = .340. These findings suggest that the development of PTSS following trauma exposure may lead to the perception of the traumatic event as central to an individual's story over time. Further longitudinal research is necessary to determine what variables may influence the connection between PTSS and event centrality.

Locating event centrality in associations of emotion regulation with posttraumatic stress disorder symptoms and posttraumatic growth in emerging adults

Previous research suggests that cognitive reappraisal (CR) and expressive suppression (ES) strategies of emotion regulation (ER) are associated with posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). How the patterns of these associations may vary in the context of event centrality (EC) however requires investigation to help delineate groups for whom the impact of event centrality may be more salient. We examined whether EC would moderate the associations of CR and ES with PTSD symptoms clusters and PTG domains among 388 emerging adults (18-30 year-olds) of Tiv ethnic group who were survivors of armed attack by Fulani herdsmen and were temporarily sheltered in two internally displaced persons' (IDPs') camps in North-central Nigeria. They completed self-report measures of the variables. Results indicated that EC strengthened the negative associations of CR and the positive associations of ES with avoidance, hyper-arousal and total PTSD symptoms, but not intrusion symptoms. For the PTG domains, EC only strengthened the positive association between CR and personal strength and weakened the association of ES with greater appreciation of life. These findings suggest that primary intervention programs that incorporate training of armed attack survivors in cognitive reappraisal strategy centered on the traumatic event could be effective in controlling PTSD but be less critical in engendering PTG. They also show that the psychological processes that underlie PTSD and PTG are related but involve nuances even within PTSD, and do not seamlessly set into the Janoff-Bulman's "strength through suffering" model of PTG. More research is required to test the model.

The Post-Traumatic Growth Journey of Women Who Have Survived Intimate Partner Violence: A Synthesized Theory Emphasizing Obstacles and Facilitating Factors

Suffering intimate partner violence (IPV) is a devastating personal experience and post-traumatic growth (PTG) is a positive, psychological change in a person, following trauma such as IPV. There is a gap in the literature when it comes to theories on PTG after surviving IPV. The aim of this theory development was to synthesize an approach to understanding the PTG journey of female IPV survivors. According to our theory, their PTG journey includes eight main components: 1. The women’s early experience of trauma, 2. The consequences of that trauma, 3. Their experiences of IPV, 4. The consequences of IPV, 5. The facilitating factors to PTG, 6. The hindering factors to PTG, 7. Their experience of PTG, and 8. The lingering effects of IPV. According to our findings, PTG is a real possibility for female IPV survivors, and it is likely to improve their mental health, well-being, and quality of life, as well as that of their children, loved ones, and communities, thereby decreasing the damaging effects of IPV. The theory can be useful for professionals when guiding female survivors of IPV to promote their recovery and healing. Due to the lack of research in this field, additional research is needed to further develop this theory.

Disease-based traumas transform lives: A qualitative study focused on healthcare professionals

RATIONALE

Traumas occur at unexpected moments and become a turning point in life and can cause people to experience transformations. While these transformations can progress negatively, it is also possible for people to experience positive transformations after trauma (post-traumatic growth).

OBJECTIVE

This study aims to reveal how the physicians and nurses with disease-based traumas make sense of their experiences to provide better insights into the transformative power of these traumas. Both social life and work-life were evaluated from the social dimensions of trauma. Also, the advantages and disadvantages of being a health professional in this process were examined.

METHODS

Qualitative research method was used in the study and data were obtained through interviews with 23 participants who experienced the case of disease-based trauma. As a result of the interviews, 253 pages of data were obtained. The data were subjected to thematic analysis and the Maxqda Program was used.

RESULTS

The data obtained through the interviews conducted within this attempt were categorized into parent themes such as being a health worker, post-traumatic transformations, changes in business life, and changes in the role of a service provider.

CONCLUSIONS

As a result of the study, it was seen that the social relations, philosophy of life, belief systems, and self-perceptions of healthcare professionals were transformed after the disease-based trauma and innovations occurred in their lives. Also, positive and negative changes have been determined in the relationships of healthcare professionals who have experienced disease-based trauma with their colleagues and managers their sense of belonging to the organization, the way they provide health services, and their approach to patients.

Posttraumatic Growth and Posttraumatic Stress Symptoms in People with HIV

Receiving a diagnosis of HIV can be challenging. People with HIV (PWH) can experience high levels of distress, as well as some positive psychological changes associated with post-traumatic growth. However, the mechanisms which underlying the association of a highly stressful event (i.e., being diagnosed with HIV) and posttraumatic growth (PTG) and posttraumatic stress symptoms (PTSS) are under-explored, and this is the focus of the study. Cross-sectional survey data were provided by 77 PWH living in New Zealand. An analysis examined the roles of deliberate rumination and coping strategies as serial mediators of the associations between event centrality and PTG and PTSSs. The relationships between event centrality and PTG and PTSSs were found to be sequentially mediated by deliberate rumination and avoidance coping, but not by deliberate rumination and active coping. Further analyses explored active coping and deliberate rumination as parallel mediators, with avoidance coping as a subsequent mediator, between event centrality and PTG and PTSSs. However, these analyses were not supported. The findings indicate that the more participants appraised the HIV diagnosis as central, the greater PTG they perceived; however, the more they deliberately ruminated on it, and the more avoidance coping they adopted, the less PTG and greater PTSSs they perceived. Future studies need to explore the relationships of event centrality and coping and their associations with PTG and PTSSs.

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.

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.

Predictors of treatment failure among patients with gunshot wounds and post-traumatic stress disorder

BACKGROUND

The 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes.

METHODS

A total of 218 patients completed the study. The Mississippi Scale for Combat-Related PTSD (M-PTSD) was used for assessment of the treatment outcome rate. The risk relation between treatment failure and factors was assessed by a univariate or multivariate logistic regression method, with the model accuracy measured by the AUC - Area under the ROC curve. The odds ratio (OR) was considered for the qualitative factor assessment.

RESULTS

The predictors of the PTSD treatment failure among the patients with gunshot wounds to the extremities are: 1) anesthesia type: the risk of failure is higher with the general anesthesia compared to the regional (p = 0.002), OR = 0.30 (95% CI 0.13-0.69) and the regional one with sedation (p = 0.004), OR = 0.30 (95% CI 0,14-0.65); 2) severe postoperative pain: the risk of treatment failure rises with increased pain intensity assessed by the visual analogue scale (p = 0.02), OR = 3.2 (95% CI 1.2-8.3).

CONCLUSIONS

The analysis showed that administration of general anesthesia compared to the regional one (regardless of the sedation) and high postoperative pain intensity are associated with higher risk of the PTSD treatment failure among patients with gunshot wounds to the extremities. The preference of regional anesthesia and postoperative pain control may potentially improve the treatment outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov: Retrospectively registered on December 30, 2020, NCT04689022 .

The challenging journey from trauma to post-traumatic growth: Lived experiences of facilitating and hindering factors

BACKGROUND

Many people experience psychological trauma during their lifetime, often negatively affecting their mental and physical health. Post-traumatic growth is a positive psychological change that may occur in an individual after having processed and coped with trauma. This journey, however, has not been studied enough.

AIM

The purpose of this phenomenological study was to explore people's experience of suffering psychological trauma, the personal effects of the trauma and the transition from trauma to post-traumatic growth.

METHODS

A purposeful sample of seven women and five men, aged 34-52, were selected whose backgrounds and history of trauma varied, but who had all experienced post-traumatic growth. One to two interviews were conducted with each one, in all 14 interviews.

RESULTS

This study introduces a unique mapping of the challenging journey from trauma to post-traumatic growth through lived experiences of people who have experienced trauma as well as post-traumatic growth. Participants had different trauma experience, but their suffering shaped them all as persons and influenced their wellbeing, health and view of life. Participants described post-traumatic growth as a journey, rather than a destination. There was a prologue to their journey which some described as a hindering factor while others felt it was a good preparation for post-traumatic growth, i.e. to overcome difficulties at an early age. Participants described six main influencing factors on their post-traumatic growth, both facilitating and hindering ones. They also described the positive personal changes they had undergone when experiencing post-traumatic growth even though the epilogue also included heavy days. A new theoretical definition of post-traumatic growth was constructed from the findings.

CONCLUSION

The results suggest that the journey to post-traumatic growth includes a recovery process and certain influencing factors that must be considered. This information has implications for professionals treating and supporting people who have suffered traumas.

Understanding the relationship between traumatic suffering, posttraumatic growth, and prosocial variables

OBJECTIVE

We investigated facets of posttraumatic growth (PTG) theory, including the nature of the index event, the relationship between suffering and PTG, and prosocial correlates of PTG.

METHODS

Undergraduate students (N = 253) completed measures of PTG and trauma-related, psychopathology/affect, and prosocial correlates.

RESULTS

Differences emerged in PTG according to event severity, with greater PTG for those who experienced a trauma compared to a stressor. PTG was associated with nearly all trauma-related, select psychopathology/affect (e.g., anxiety, positive affect) and prosocial (e.g., empathy, volunteerism) variables. In a multivariable model, race/ethnicity, helpfulness, perceived chronicity of distress, and positive affect were associated with PTG. Curvilinear trends demonstrated that moderate chronicity of distress and current emotional distress from trauma were associated with the greatest PTG.

CONCLUSIONS

Findings highlight factors associated with growth, including a moderately distressing trauma, positive affect, and prosocial behavior. Results clarify PTG theory and contribute to understanding conflicting evidence in prior PTG literature.

Negative Posttraumatic Cognitions Color the Pathway from Event Centrality to Posttraumatic Stress Disorder Symptoms

Background

The centrality of an event indicates the extent to which it becomes a core part of identity and life story. Event centrality (EC) has been shown to have a strong relationship with PTSD symptoms, which seems to be indirectly influenced by negative posttraumatic cognitions (PTC). However, research on this potential mediation and its causal links particularly with clinical samples is limited and essential to derive treatment implications.

Methods

Pre- and posttreatment data of 103 day-unit patients with PTSD was examined using mediation analyses and structural equation modeling.

Results

Negative PTC mediated the relationship between EC and PTSD symptoms, partially pre- and completely posttreatment. Within extended longitudinal analyses causal directions of the mediation pathways were not adequately interpretable due to unexpected suppression effects.

Conclusions

The results suggest that EC may only have an indirect effect on PTSD symptoms through negative PTC. Thus, decreasing negative PTC which are connected to centralized events might be a key element for PTSD treatment. Thereby, transforming the cognitions’ valence to more positive and constructive forms could be crucial rather than mere decentralization. Although suppression effects limited causal inferences, they do not contradict the mediation and further indicate potential interactional terms and a transformation of EC.

Post-traumatic stress, personal risk and post-traumatic growth among UK journalists

Background: Journalists covering traumatic news events can develop symptoms of post-traumatic stress disorder (PTSD). However, they may also experience perceived post-traumatic growth (PTG). The outcome may be affected by whether work-related traumatic stress has a degree of personal risk. Objective: To investigate the relationship between PTSD symptoms and PTG among journalists who experienced work-related trauma and to examine whether positive associations would exist between exposure to personal risk and PTG. Method: A web-based survey measuring post-traumatic stress symptoms and post-traumatic growth was completed by print and broadcast journalists (N = 69) working for UK-based media organizations. An open-ended question asked participants how media organizations can help to promote growth after work-related trauma. Results: The findings show a significant relationship between PTSD symptoms and PTG (p = 0.04). Journalists working in war-zones had significantly more PTSD symptoms (p < .001) and PTG scores (p < .001) than those who did not. Journalists who described their worst, work-related trauma as having a degree of personal, life-threatening risk, also reported higher levels of PTG than those who did not (p < .001). This was consistent across all PTG subscales. Conclusions: This study, the first to examine PTSD symptoms, personal risk and post-traumatic growth within journalists, suggests those working in conflict areas experience significantly higher levels of post-traumatic stress and post-traumatic growth, than those who do not. Those who experience personal risk also had high PTG levels. Media companies can help develop PTG by recognizing when personal risk plays a role in covering demanding assignments. Participants suggested organizations also needed to allow sufficient time for reflection and meaning-making for all those working in hostile environments.

Posttraumatic stress or posttraumatic growth? Using network analysis to explore the relationships between coping styles and trauma outcomes

Trauma can produce posttraumatic stress disorder (PTSD), but may also foster positive outcomes, such as posttraumatic growth. Individual differences in coping styles may contribute to both positive and negative sequelae of trauma. Using network analytic methods, we investigated the structure of PTSD symptoms, elements of growth, and coping styles in bereaved survivors of a major earthquake in China. Hypervigilance and difficulty concentrating were identified as the most central symptoms in the PTSD network, whereas establishing a new path in life, feeling closer to others, and doing better things with life ranked highest on centrality in the posttraumatic growth network. Direct connections between PTSD symptoms and elements of growth were low in magnitude in our sample. Our final network, which included PTSD symptoms, growth elements, and coping styles, suggests that adaptive and active coping styles, such as positive reframing, are positively related to elements of growth, but not appreciably negatively related to PTSD symptoms. Conversely, maladaptive coping styles are positively related to PTSD symptoms, but are not negatively associated with growth. Future longitudinal studies could shed light on the direction of causality in these relationships and their clinical utility.

Written exposure therapy and app-delivered mindfulness-based meditation for PTSD and subthreshold PTSD in China: Design of a randomized controlled trial

Background

Posttraumatic stress disorder (PTSD) and subthreshold PTSD are still major global concerns, especially in developing areas short of mental health resources. Written exposure therapy (WET), a brief 5-session treatment, has been found to be effective in reducing PTSD symptoms, but no studies have examined it in an Eastern context. Mindfulness-based meditation mobile application may be a promising approach to reduce insomnia comorbid with PTSD. The current study aims to: 1) examine the effectiveness of WET for Chinese PTSD and subthreshold PTSD patients, and 2) examine the effectiveness of adding a mindfulness-based application (MBA) to WET for reducing comorbid insomnia.

Methods

The randomized controlled trial will enroll 150 adults with subthreshold/full PTSD and comorbid insomnia. Participants will be randomly assigned to written exposure therapy plus mindfulness-based application condition (WET + MBA, n = 50), written exposure therapy alone (WET, n = 50), or minimal contact control (MMC, n = 50). Clinical interview of the primary outcome (PTSD symptoms) will be administrated at baseline, posttreatment, 3- and 6- month follow-up, while self-reported PTSD symptoms and secondary outcomes (insomnia severity) will be administrated at baseline, every week and all follow-ups.

Discussion

This is the first study applying WET in Chinese PTSD patients, as well as examining a mindfulness-based mobile application as a treatment add-on for comorbid insomnia. Study findings will contribute to the knowledge of the effectiveness of WET and a mindfulness-based mobile application, and the development of a culture-adapted treatment protocol.

Trial registration

ChiCTR, ChiCTR2000034119. Registered 24 June 2020, http://www.chictr.org.cn/showproj.aspx?proj&equals;55,467.

Band of mothers: Childbirth as a female bonding experience

Does the experience of childbirth create social bonds among first-time mothers? Previous research suggests that sharing emotionally intense or painful experiences with others leads to “identity fusion,” a visceral feeling of oneness with a group that predicts strong forms of prosocial action and self-sacrifice for other group members. This study compared identity fusion with other mothers during pregnancy versus after childbirth in a sample of 164 U.S. women. Eighty-nine mothers in our sample were pregnant with their firstborn, and 75 mothers had given birth to their firstborn up to 6 months prior to the time of data collection. Results demonstrated that identity fusion with other mothers was higher for postpartum mothers than for antenatal mothers. As predicted, among postpartum mothers, those who thought that their childbirth was more painful than a typical childbirth experience reported greater identity fusion with mothers who reported having had a very difficult birth. Postpartum mothers’ ruminative thought about the birth mediated the association between level of dysphoria and identity fusion, and identity fusion moderated the association between postpartum mothers’ ruminative and reflective thought about the birth and their posttraumatic growth in complex ways. These findings provide evidence that perceived sharedness of the childbirth experience and thoughts about the birth are important to the process of identity fusion with other mothers, and highlight the importance of post-event processing for psychological health.

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.

The relationship between posttraumatic stress disorder, trauma centrality, posttraumatic growth and psychiatric co-morbidity among Chinese adolescents

This study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, psychiatric co-morbidity, trauma centrality and posttraumatic growth (PTG) among Chinese adolescents. Nine hundred and forty-eight Chinese adolescents (M = 462, F = 486) were recruited from two secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Centrality of Events Scale, the Posttraumatic Growth Inventory, the General Health Questionnaire-28, and the Educational Stress Scale for Adolescents. After controlling for demographic variables and levels of academic stress, structural equation modeling showed that PTSD was positively associated with trauma centrality and psychiatric co-morbidity but negatively associated with posttraumatic growth. Trauma centrality mediated the impacts of PTSD on posttraumatic growth and psychiatric co-morbidity. To conclude, PTSD from past trauma could impact adolescents' ways of perceiving positive aspects of their trauma and psychological well-being. Such impact, however, was influenced by the changes in their self-concept.

The Dutch Version of the Centrality of Event Scale (CES)

Abstract. Event centrality is defined as the extent to which the memory of a traumatic event forms a reference point for personal identity and the attribution of meaning to other experiences in a person’s life. The current study investigated the psychometric properties of the Dutch translation of the Centrality of Event Scale (CES; Berntsen & Rubin, 2006 ) and its relation with symptoms of Posttraumatic Stress Disorder (PTSD), depression, exposure to traumatic events as defined by DSM-5 trauma criterion A, and negative life events in a student sample ( N = 967). An underlying structure of one factor was found. This factor structure was replicated in two additional independent samples. High internal consistency was found for a 6-item CES. CES scores were positively related to symptoms of PTSD and depression, to the DSM-5 trauma criterion A, and the number of negative life events. The CES made a unique contribution to the explained variance in PTSD symptoms when controlling for depression. However, CES scores were unrelated to depression when controlling for PTSD symptoms, suggesting that event centrality might be more typically related to PTSD, and less to depression.

Cognitive mediators of the relationship between adverse childhood experiences and adult psychopathology: A systematic review

This is the first review to rigorously examine the mediating role of cognitive factors in the relationship between childhood trauma and subsequent adult psychopathology, and highlight areas for future research. A database search (Child Development & Adolescent Studies, ERIC, Global Health, PsycARTICLES, and PsycINFO) was conducted to identify empirical studies on cognitive factors, explaining the relationship between different types of adverse childhood experiences and adult psychopathology across clinical and nonclinical populations. A narrative synthesis and appraisal of the methodological quality of the studies was conducted. Ninety-eight mediation studies were identified, comprising 4,137 clinical and 28,228 nonclinical participants. Despite great variation in methodological quality of the studies, our narrative synthesis suggests that cognitive factors mediate the relationship between early trauma and later psychopathology. This finding is consistent across different measures of traumatic experiences, psychopathology, and cognitive mediators. Cognitive mediators represent potentially valuable intervention targets for (non)clinical patients who have experienced childhood adversity. Future studies are needed to (a) establish longitudinal causal connections, and (b) assess the effect of interventions that specifically target cognitive change in patients with different levels and types of pathology.

Event Centrality: Factor Structure and Links to Posttraumatic Stress Disorder Symptom Clusters

Event centrality is defined as the extent to which traumatic events are perceived to be integral to one's life. However, there are discrepancies regarding the factor structure of event centrality, as the factor structure may differ depending on the nature of the trauma. Event centrality has predicted posttraumatic stress disorder (PTSD); yet, few studies have taken into account other key cognitive predictors of PTSD, such as posttraumatic cognitions. The PTSD symptom clusters also remain largely unexamined, despite potential specificity in their ties to event centrality. The aims of the current study were to: (a) examine the factor structure of event centrality and whether the structure differs following interpersonal versus noninterpersonal trauma; (b) investigate whether event centrality predicts PTSD symptom clusters beyond posttraumatic cognitions; and (c) determine if the associations between event centrality, posttraumatic cognitions, and PTSD are equivalent between trauma types. The study aims were examined utilizing 263 college students (M_age = 24.54, SD = 6.29; 79.8% female; 58% White). Event centrality was best represented by one factor, which was consistent between groups. Structural equation models indicated that event centrality and posttraumatic cognitions regarding the self predicted each of the PTSD symptom clusters across groups, βs = .27-.58. However, event centrality was more strongly related to avoidance symptoms among individuals who experienced a noninterpersonal trauma. For both the interpersonal and noninterpersonal groups, event centrality had equivalent ties to each cluster. Even after accounting for negative trauma-related beliefs, event centrality appears to be relevant in understanding posttrauma functioning.

Psychometric properties of the Posttraumatic Growth Inventory in a sample of Brazilian university students

OBJECTIVE

To examine psychometric properties of the Brazilian version of the Posttraumatic Growth Inventory (PTGI).

METHOD

A total of 300 university students were evaluated though instruments that investigated trauma history, depression and posttraumatic symptoms, and personality traits through the Big Five model. Pearson's correlation was used to assess internal consistency, inter-item reliability and construct validity. Principal component analysis and confirmatory factor analysis were performed to investigate the factor structure of the PTGI.

RESULTS

Results confirmed the original five-factor structure. The results showed good internal consistency for the total scale (α = 0.91) and its subscales, ranging from α = 0.85 to α = 0.70. Also, evidence of construct and convergent validity was observed through correlations with posttraumatic and depression symptoms and personality measures.

CONCLUSIONS

These preliminary results suggest that the Brazilian PTGI is reliable and showed adequate evidence of validity.

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.

Driving cognitions, rumination, and posttraumatic stress disorder in road traffic accidents survivors

This study evaluated the relationships between driving cognitions (i.e., panic-related cognitions, accident-related cognitions, and social-related cognitions), rumination, and posttraumatic stress disorder (PTSD) symptoms in a sample of road traffic accidents (RTAs) survivors. We also investigated the indirect effect of driving cognitions on PTSD symptoms through rumination. The sample included 633 drivers (62% were men; Mage = 36.09; standard deviation [SD] = 11.42 years). The participants completed scales measuring driving cognitions, rumination, and PTSD symptoms, as well as providing their demographic information. The results showed that all three types of driving cognitions assessed in the present study and rumination were significantly positively associated with PTSD symptoms. Furthermore, rumination mediated the relation between social-related cognitions and PTSD symptoms. The implications for PTSD treatment and future research are discussed.

Validation of the polish version of the posttraumatic cognitions inventory

The paper presents the Polish version of the Posttraumatic Cognitions Inventory developed by Foa and colleagues Psychological Assessment, 11(3), 303–314 (Foa et al., 1999). The scale measures three types of cognitions that are typically associated with traumatic experiences: negative cognitions about the self, negative cognitions about the world, and self-blame. The scale was translated to Polish using a forward – backward translation method; it was administered to a group of adult Polish women from the general population. A total of 337 individuals participated in the project. Traumatic experiences of sexual and non-sexual type were assessed and separate analyses were conducted for cognitions related to trauma of non-sexual and sexual nature. Moreover, the cumulative trauma and the severity of symptoms of the posttraumatic stress disorder were measured. Reliability of all scales was proven to be very good, with Cronbach-α for all scales above.80. There was a positive correlation between all three types of posttraumatic cognitions and (1) severity of the PTSD symptoms, (2) number of different traumatic events. The results of the current study provided partial support for the three factor structure of the tool: three factors emerged in exploratory factor analyses, but the correlations between the subscales were very high. Also, confirmatory factor analyses did not support the original solution. Overall, the Polish version of the PTCI has good psychometric properties and can be used in research, considerable evidence to support the three factor solution was also found.

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.

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).

Correlation Between Posttraumatic Growth and Posttraumatic Stress Disorder Symptoms Based on Pearson Correlation Coefficient: A Meta-Analysis

The literature on posttraumatic growth (PTG) is burgeoning, with the inconsistencies in the literature of the relationship between PTG and posttraumatic stress disorder (PTSD) symptoms becoming a focal point of attention. Thus, this meta-analysis aims to explore the relationship between PTG and PTSD symptoms through the Pearson correlation coefficient. A systematic search of the literature from January 1996 to November 2015 was completed. We retrieved reports on 63 studies that involved 26,951 patients. The weighted correlation coefficient revealed an effect size of 0.22 with a 95% confidence interval of 0.18 to 0.25. Meta-analysis provides evidence that PTG may be positively correlated with PTSD symptoms and that this correlation may be modified by age, trauma type, and time since trauma. Accordingly, people with high levels of PTG should not be ignored, but rather, they should continue to receive help to alleviate their PTSD symptoms.

Psychological Mechanisms of PTSD and Its Treatment

Psychological mechanisms can be defined as processes or events that are responsible for specific changes in psychological outcomes. In psychotherapy research, mechanisms are the factors through which interventions produce change. In this article, we explain the importance of identifying psychological mechanisms, describe methods for identifying them, and analyze recent literature on the psychological mechanisms underlying the development and treatment of posttraumatic stress disorder (PTSD). Based on the findings of recent investigations (from 2013 to present), we focus on four putative mechanisms: emotional engagement, extinction and contextualization, distress tolerance, and negative posttraumatic cognitions. Future directions for psychological mechanism research are also outlined, including possible opportunities for capitalizing on the most promising mechanisms identified to date.

Relationships among Trait Resilience, Virtues, Post-traumatic Stress Disorder, and Post-traumatic Growth

The present study aims to examine the relationship between trait resilience and virtues in the context of trauma. A total of 537 participants who attended the preliminary investigation and completed the Life Events Checklist were screened. Of these participants, 142 suffered from personal traumatic experiences in the past year; these individuals were qualified and invited to respond to online questionnaires to assess trait resilience, virtues (i.e., Conscientiousness, Vitality, and Relationship), post-traumatic stress disorder (PTSD) symptoms, and post-traumatic growth (PTG). The following questionnaires were used: Connor-Davidson Resilience Scale-Revised, Chinese Virtues Questionnaire, PTSD Checklist-Specific, and Post-traumatic Growth Inventory-Chinese. Only 95 participants who manifested self-reported PTSD symptoms and PTG were involved in the current analyses. Trauma was positively and significantly correlated with PTSD in the current sample. Results indicated that trait resilience was positively associated with virtues and PTG; by contrast, PTSD scores were negatively but not significantly related to most of these factors. The three virtues contributed to PTG to a greater extent than trait resilience in non-PTSD and PTSD groups. However, trait resilience remained a significant predictor in the PTSD group even when the three virtues were controlled. The relationship between trait resilience and PTG was moderated by PTSD type (non-PTSD group vs. PTSD group). Our results further suggested that trait resilience and virtues were conceptually related but functionally different constructs. Trait resilience and virtues are positively related; thus, these factors contributed variances to PTG in the context of trauma; however, trait resilience is only manifested when virtues are controlled and when individuals are diagnosed as PTSD. Furthermore, implications and limitations of this study are discussed.

An Integrated Model of Posttraumatic Stress and Growth

A number of recent models have examined cognitive predictors of posttraumatic stress and posttraumatic growth (S. Barton, A. Boals, & L. Knowles, 2013; J. Groleau, L. Calhoun, A. Cann, & G. Tedeschi, 2013; K. N. Triplett, R. G. Tedeschi, A. Cann, L. G. Calhoun, & C. L. Reeve, 2012). The current study examined an integrated model of predictors of distress and perceived growth in 194 college undergraduates. Domains covered included the roles of core belief challenge, event centrality, posttrauma cognitions, and event-related rumination. Negative cognitions about the self and the centrality of the event directly predicted both growth and distress, although intrusive rumination predicted only posttraumatic stress disorder symptoms, and deliberate rumination predicted only posttraumatic growth. Future research should continue to examine the shared and unique predictors of postevent growth and distress.

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.