Centrality of Event and Symptoms of Posttraumatic Stress Disorder After the 2011 Oslo Bombing Attack

It has been proposed that a highly integrated trauma leads to more accessible and vivid memories of the traumatic event, in turn heightening symptoms of posttraumatic stress disorder. The relationship between the centrality of a traumatic event and symptoms of posttraumatic stress disorder after the 2011 Oslo bombing attack was investigated in the present study. A high degree of perceived centrality was associated with higher symptom levels of posttraumatic stress as shown in the results. This association was found after controlling for gender, age and educational background. The relationship between types and level of trauma exposure, peritraumatic reactions and centrality of event was also investigated in the present study. Higher levels of trauma exposure and peritraumatic reactions were associated with higher levels of centrality of event as shown in the results. When a traumatic event becomes a reference point in the individual's life story and central to their identity, this is associated with an increased risk of symptomatology as suggested in the findings. Copyright © 2013 John Wiley & Sons, Ltd.     

Vivid memories of distant trauma: Examining the characteristics of trauma memories and the relationship with the centrality of event and posttraumatic stress 26 years after trauma

In the present study, we investigated the phenomenological characteristics of distant trauma memories and the relationship between the vividness of trauma memories, the centrality of event and symptoms of posttraumatic stress in two groups with different types of trauma exposure, namely survivors and bereaved, from the fire on the passenger ferry, Scandinavian Star, 26 years earlier. More than two decades after the fire, the traumatic event was represented as a vivid, emotional recollection for many of the victims. For both the survivors and the bereaved, a higher degree of vividness of trauma memories and centrality of the event were associated with higher levels of posttraumatic stress. The present findings show that even very distant trauma memories can be represented as vivid recollections. Furthermore, the findings suggest that both vividness of trauma memories and event centrality may contribute to explain how posttraumatic stress reactions can remain present over a very long time.     

Latent classes of posttraumatic stress and growth

Background and Objectives: Potentially traumatic events may lead to different patterns of posttraumatic stress symptoms and posttraumatic growth. The objective of the present study was to identify subgroups with different patterns of posttraumatic reactions, and to determine whether these subgroups differed in terms of personal and social resources and indicators of adjustment. Design: This study used survey data collected 10 months after the 2011 Oslo bombing attack to investigate patterns of reactions among ministerial employees (N = 1970). Methods: We applied latent class analyses with covariates to extract subgroups of individuals. Results: Three classes of individual reactions were extracted, and these were similar among those who were and those who were not physically proximate to the bombing attack: “High stress/high growth” (27% and 11%, respectively), “Low stress/high growth” (74% and 42%, respectively), and “Low stress/low growth” (only among the not physically proximate: 47%). The classes differed in terms of gender, neuroticism, and social support as well as life satisfaction and daily functioning. Conclusions: Heterogeneous patterns of posttraumatic reactions were found. Physical proximity is not necessary to experience posttraumatic stress or growth after political violence. Among individuals with low stress, posttraumatic growth may not encompass higher life satisfaction or functioning.     

Using Event Centrality to Predict Depressive Symptoms after a Romantic Conflict: A Prospective Design

Using cross‐sectional analyses, event centrality has been shown to be related to a number of poor psychological outcomes, including depressive symptoms and posttraumatic stress disorder symptoms. In the current study, we examined the ability of event centrality of a recent conflict in or breakup of a romantic relationship to prospectively predict depressive symptoms. Replicating previous findings, ratings of event centrality to a recent romantic conflict or breakup were significantly associated with depressive symptoms and posttraumatic stress disorder symptoms at Time 1. These relationships remained significant after controlling for closure and perceived insight. In addition, Time 1 event centrality prospectively predicted Time 2 depressive symptoms, particularly for participants who were split from their romantic partners at Time 2. This prediction remained significant after controlling for Time 1 depressive symptoms. The results of the study suggest that levels of event centrality for romantic conflicts prospectively predict subsequent mental health outcomes. Copyright © 2014 John Wiley & Sons, Ltd.     

The Influences of Event Centrality in Memory Models of PTSD

The consequences of events for well‐being are influenced by individual and situational factors that are often studied in isolation. In the research reported here, a large (N = 489) nonclinical sample of college students reported their most traumatic event, posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, personality traits, and characteristics of their event memory. This study achieved three major goals. First, we identified the highest types of stress event types in this population as disruptions of interpersonal relationships, homicides/assaults on others, and assaults/accidents involving themselves. Second, we established that the effects of memory characteristics such as vividness, belief, and impact on PTSD symptoms are mediated by the centrality of the event to identity. Third, we affirmed the hypothesis that a structural model of the influence of personality factors on PTSD symptoms has a higher level of concurrent validity if event centrality is included as a mediator of those influences. Copyright © 2015 John Wiley & Sons, Ltd.     

Perception of threat and safety at work among employees in the Norwegian ministries after the 2011 Oslo bombing

Background and objectives: Terrorism can heighten fears and undermine the feeling of safety. Little is known, however, about the factors that influence threat and safety perception after terrorism. The aim of the present study was to explore how proximity to terror and posttraumatic stress reactions are associated with perceived threat and safety after a workplace terrorist attack. Design and methods: A cross-sectional questionnaire survey was administered to employees in 14 of 17 Norwegian ministries 9–10 months after the 2011 bombing of the government headquarters in Oslo (n = 3520). Results: About 198 of 1881 employees completing the survey were at work when the bomb exploded. Regression analysis showed that this high-exposed group had elevated perceived threat (β = 0.36; 95% CI = 0.19 to 0.53) and reduced perceived safety (β = ?0.42; 95% CI = ?0.62 to ?0.23) compared to a reference group of employees not at work. After adjusting for posttraumatic stress reactions, however, proximity to the explosion no longer mattered, whereas posttraumatic stress was associated with both high perceived threat (β = 0.55; 95% CI = 0.48 to 0.63) and low perceived safety (β = ?0.71; 95% CI, ?0.80 to ?0.63). Conclusion: Terror-exposed employees feel more threatened and less safe after a workplace terrorist attack, and this is closely linked to elevated levels of posttraumatic stress reactions.     

The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma

Background and Objectives: Repetitive thought (RT) strategies have been linked to a range of negative outcomes following traumatic interpersonal events but are proposed to serve an adaptive function under particular circumstances. This study examined outcomes following RT within a transdiagnostic framework, and explored the potentially adaptive nature of trait-like and event-related RT. Design: The centrality of a traumatic event to one's identity was explored as a context under which the adaptive nature of RT might change. Young adults with interpersonal violence experiences (N = 163) reported use of trait-like and event-related RT, centrality of the event, depressive, anxious, and posttraumatic stress symptoms (PTSS), posttraumatic depreciation and posttraumatic growth. Methods: Hierarchical multiple regression analyses were used to examine main and moderating effects of four types of RT and event centrality on outcome variables. Results: Centrality positively predicted depressive symptoms and PTSS, depreciation, and growth. Brooding RT positively predicted all negative outcomes. Reflecting RT positively predicted anxious symptoms and PTSS and depreciation. Only deliberate RT positively predicted growth. Centrality did not moderate any examined relationships. Conclusions: Findings highlight the importance of addressing specific types of RT in interventions with survivors and of considering centrality as a robust contributor to outcomes following interpersonal violence.     

A double‐edged sword: Event centrality,PTSD and posttraumatic growth

Previous research has demonstrated negative mental health consequences (including PTSD symptoms) of construing a potentially traumatic event as central to one's identity. In the current paper, we replicated an association between event centrality and PTSD symptoms. We also found event centrality similarly predicts posttraumatic growth (PTG) even after controlling for PTSD symptoms, depression, DSM‐IV A1 and A2 status of the event, coping styles and cognitive processing of the event. Because predictive relationships between event centrality and PTSD symptoms, as well as event centrality and PTG were positive, construing an event as central to one's identity can indeed become a double‐edged sword, allowing for both debilitation and growth. Copyright © 2010 John Wiley & Sons, Ltd.     

Anxiety sensitivity and posttraumatic stress among traumatic event-exposed youth

Total and factor scores of the Childhood Anxiety Sensitivity Index (CASI) were examined in relation to posttraumatic stress symptom levels within a community-based sample of 68 (43 females) traumatic event-exposed youth between the ages of 10 and 17 years (M_age=14.74 years). Findings were consistent with hypotheses; global anxiety sensitivity (AS) levels, as well as disease, unsteady, and mental incapacitation concerns, related positively to posttraumatic stress levels, whereas social concerns were unrelated to symptom levels. These results suggest that fears of the physical and mental consequences of anxiety are associated with relatively higher levels of posttraumatic stress subsequent to traumatic event exposure. Findings are discussed in terms of potential implications for the role of AS in developmentally sensitive etiological models of posttraumatic stress disorder (PTSD).     

Path analytic examination of a cognitive model of PTSD

Ehlers and Clark (2000) developed a cognitive model of posttraumatic stress disorder (PTSD) symptom maintenance which implicated the role of posttraumatic cognitions and aspects of the trauma memory in maintaining symptoms via an increased sense of current threat. The aim of the current study was to empirically test a variant of this model using path analysis. Participants in the current study were 514 undergraduates at a midwestern university who reported experiencing at least one traumatic event. Path analyses examined various models of the possible relationships between one’s posttraumatic cognitions and the centrality of the traumatic event to the sense of self (considered an aspect of memory integration) in predicting current level of PTSD symptoms. Results indicate that both event centrality and posttraumatic cognitions are unique and independent predictors of current symptom level. Overall, the results of this study support aspects of Ehlers and Clark’s cognitive model of PTSD; cognitive appraisals of the self and centrality of the event were highly related to levels of distress. However, the current study suggests that overly integrated trauma memories may lead to greater distress and not poorly integrated ones as suggested by Ehlers and Clark.     

Event centrality and posttraumatic outcomes in the context of pervasive violence: a study of teachers in El Salvador

It is well established that the importance assigned to a trauma can affect one's recovery and psychological health in numerous ways. Event centrality is an increasingly popular construct that captures the tendency among survivors to reevaluate and possibly accommodate their worldviews posttrauma. The centrality given to trauma appears to serve as a “double-edged sword” in that this construct might factor prominently in both posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). Focusing on 257 violence-exposed teachers from educational departments throughout El Salvador, we examined whether the centrality assigned by the teachers to stressful life events uniquely predicted both PTSD symptomatology and PTG. Results revealed that event centrality was positively related to both PTSD and PTG, even when controlling for demographic factors, violence exposure, and depression. In addition, PTSD symptomatology and PTG were not associated with one another in this sample. In summary, these findings support the role of event centrality as a contributing factor for PTSD and PTG among persons exposed to pervasive trauma.     

Personal resources of mastery–optimism,and communal support beliefs,as predictors of posttraumatic stress in uprooted Israelis

Abstract

The study aims to assess the personal resources of mastery–optimism, and communal support beliefs, as predictors of posttraumatic stress and adaptation in uprooted Israelis following Israel's disengagement from the Gaza Strip and northern Samaria in the summer of 2005. A telephone interview of a sample of 104 respondents slated to be uprooted was conducted several weeks before the disengagement (T1), and again 9 months after the event (T2). At T1, respondents answered a questionnaire which included assessments of dispositional optimism and mastery, beliefs in the availability of community–family and governmental–societal support, nation-related anxiety, and demographic data. Posttraumatic stress levels were assessed at T2. The main findings showed that high levels of mastery–optimism and low nation-related anxiety at T1 predicted a low severity of total posttraumatic stress scores at T2. A high educational level and a secular identity also predicted low posttraumatic stress. In contrast, communal support beliefs were not related to posttraumatic stress. These findings point to the importance of personal resources and education as protective factors against posttraumatic stress following an event such as forced uprooting.     

Co‐Witness Influence on Children's Memory Reports: The Difference is in the Details1

This study examined the effect of social influence on children's witness reports, with respect to a number of details varying in centrality. Children (N = 115; age = 10 years, 4 months to 13 years, 8 months) were interviewed about a personally experienced event. Half of the children were interviewed together with a confederate who answered the interview questions before the child did, while the other half were interviewed alone. Children were influenced by the confederate's answers to withhold some critical details observed (omission errors), but not to add details not observed (commission errors). When the children were asked to follow up on their reports, truthful reports contained more information than did false reports.     

Flashbulb memories and posttraumatic stress reactions across the life span: age-related effects of the German occupation of Denmark during World War II

A representative sample of older Danes were interviewed about experiences from the German occupation of Denmark in World War II. The number of participants with flashbulb memories for the German invasion (1940) and capitulation (1945) increased with participants' age at the time of the events up to age 8. Among participants under 8 years at the time of their most traumatic event, age at the time correlated positively with the current level of posttraumatic stress reactions and the vividness of stressful memories and their centrality to life story and identity. These findings were replicated in Study 2 for self-nominated stressful events sampled from the entire life span using a representative sample of Danes born after 1945. The results are discussed in relation to posttraumatic stress disorder and childhood amnesia.     

Posttraumatic Stress Symptoms and Trajectories in Child Sexual Abuse Victims: An Analysis of Sex Differences Using the National Survey of Child and Adolescent Well-Being

Very few studies have prospectively examined sex differences in posttraumatic stress symptoms and symptom trajectories in youth victimized by childhood sexual abuse. This study addresses that question in a relatively large sample of children, drawn from the National Survey of Child and Adolescent Well-Being, who were between the ages of 8–16 years and who were reported to Child Protective Services for alleged sexual abuse. Sex differences were examined using t tests, logistic regression, and latent trajectory modeling. Results revealed that there were not sex differences in victims’ posttraumatic stress symptoms or trajectories. Whereas caseworkers substantiated girls’ abuse at higher rates than boys’ abuse and rated girls significantly higher than boys on level of harm, there were not sex differences in three more objective measures of abuse severity characteristics. Overall, higher caseworker ratings of harm predicted higher initial posttraumatic stress symptom levels, and substantiation status predicted shallower decreases in trauma symptoms over time. Implications for theory and intervention are discussed.     

Personal resources of mastery-optimism, and communal support beliefs, as predictors of posttraumatic stress in uprooted Israelis

The study aims to assess the personal resources of mastery-optimism, and communal support beliefs, as predictors of posttraumatic stress and adaptation in uprooted Israelis following Israel's disengagement from the Gaza Strip and northern Samaria in the summer of 2005. A telephone interview of a sample of 104 respondents slated to be uprooted was conducted several weeks before the disengagement (TI), and again 9 months after the event (T2). At T1, respondents answered a questionnaire which included assessments of dispositional optimism and mastery, beliefs in the availability of community-family and governmental-societal support, nation-related anxiety, and demographic data. Posttraumatic stress levels were assessed at T2. The main findings showed that high levels of mastery-optimism and low nation-related anxiety at T1 predicted a low severity of total posttraumatic stress scores at T2. A high educational level and a secular identity also predicted low posttraumatic stress. In contrast, communal support beliefs were not related to posttraumatic stress. These findings point to the importance of personal resources and education as protective factors against posttraumatic stress following an event such as forced uprooting.     

Posttraumatic Growth in Children and Adolescents Exposed to the 2010 Earthquake in Chile and Its Relationship with Rumination and Posttraumatic Stress Symptoms

The aim of this study was to assess a predictive model of posttraumatic growth and posttraumatic stress symptoms in children and adolescents exposed to the earthquake in Chile in 2010. 325 children (47.4% male), aged between 10 and 15 years, were surveyed 12 months after the earthquake. The following tests were administered: the posttraumatic growth inventory for children in its brief version of Kilmer et al., the child PTSD symptom scale of Foa et al., the rumination scale for children of Crider et al., along with a scale to assess the trauma severity and a socio-demographic questionnaire. The model was assessed through a path analysis, which showed that deliberate rumination mediated the relationship between trauma severity and intrusive rumination with posttraumatic growth, that intrusive rumination mediated the relationship between the severity of the event and posttraumatic stress symptoms and that the latter mediated the relationship between intrusive rumination and posttraumatic growth. The sex was included as control variable in the path model. The final model achieved adequate fit indexes. The relevance of rumination processes for the development of the psychological consequences in children and adolescents following a natural disaster and their implications for clinical is discussed.     

Visual Feedback in Written Imaginal Exposure for Posttraumatic Stress: A Preliminary Study

This study investigated the visual feedback hypothesis, which states that visual feedback from written trauma narratives contributes to the efficacy of written imaginal exposure for posttraumatic stress via the reuptake of traumatic content during production of the narrative. We tested a college sample (n = 61) with clinically elevated posttraumatic stress as measured with the Impact of Events Scale. Participants were randomly assigned to a writing with visual feedback condition, a writing without visual feedback condition, or a control condition. The hypothesis was not supported: Writing with and without visual feedback equally reduced intrusion and avoidance symptoms. Exploratory analyses, however, showed increased intrusion symptoms immediately after writing with visual feedback, which was in contrast with decreased symptom levels in the other conditions. These findings are in line with previous findings regarding immediate symptom development following writing interventions for posttraumatic stress and call for further exploration of the visual feedback hypothesis.     

Event centrality prospectively predicts PTSD symptoms

Background: Recent evidence suggests that event centrality has a prominent association with post-traumatic stress disorder (PTSD) symptoms. However, evidence for this notion thus far has been mostly correlational. We report two studies that prospectively examined the relationship between event centrality and PTSD symptoms. Study 1 Methods: Participants (N?=?1438) reported their most stressful event (“prior event”), along with event centrality, PTSD symptoms, and neuroticism. At Time 2 participants reported their most stressful event since Time 1 (“critical event”), along with measures of event centrality and PTSD symptoms. Study 1 Results: Event centrality for the critical event predicted PTSD symptoms, after controlling for event centrality and PTSD symptoms of the prior event and neuroticism. Study 2 Methods: In the second study (N?=?161) we examined changes in event centrality and PTSD symptoms over a month. Study 2 Results: Using a cross-lagged panel design, results revealed event centrality at Time 1 significantly predicted PTSD symptoms at Time 2, but the reverse was not significant. Conclusions: In two studies, a prospective association between event centrality and PTSD symptoms, but not the reverse, emerged. This evidence implicates event centrality in the pathogenesis and/or maintenance of PTSD symptoms.     

Life outcomes influenced by war-related experiences during the Gulf crisis

This study examined the life outcomes of children exposed to the Gulf crisis in 1990–1991. We expected war-trauma exposure and psychological distress symptoms to predict poorer educational and occupational outcomes. Participants were 151 Kuwaiti citizens who were assessed during childhood (in 1993; M age = 10.6 years), and who were reassessed 10 years later in young adulthood (in 2003; M age = 21.2 years). Participants completed measures of intelligence, war-trauma exposure, posttraumatic stress symptoms, anxiety symptoms, depressive symptoms, intervening life events, and life outcomes. Results indicated that war-trauma exposure negatively impacted children's educational and occupational outcomes as young adults. Boys with higher levels of war-trauma exposure were less likely to attend University. Posttraumatic stress and anxiety symptoms also predicted poorer educational and occupational outcomes. However, this relationship was not significant when we accounted for children's intelligence. Depressive symptoms were not predictive of children's educational or occupational outcomes. Results suggest that war-trauma exposure may have life-altering effects on children. Tailored, early interventions are needed for children exposed to war traumas.