Measuring narrative identity: rater coding versus questionnaire-based approaches.

Narrative identity - how individuals narrate their lived and remembered past - is usually assessed via independent rater coding, but new methods relying on self-report have been introduced. To test the assumption that different methods assess aspects of the same underlying construct, studies measuring similar components of narrative identity with different methods are needed. However, such studies are surprisingly rare. To begin to fill this gap, the present study compared the narrative variables, temporal coherence, causal coherence, and thematic coherence, measured via rater coding of participants' self-generated narratives of the remembered past and via subscales of the self-report measure Awareness of Narrative Identity Questionnaire (ANIQ). The results showed that the ANIQ subscales did not correlate significantly with their corresponding rater-coded dimension, and that the ANIQ subscales were generally unrelated to the other rater-coded dimensions. Furthermore, an exploratory factor analysis demonstrated that the ANIQ subscales loaded together on a factor that did not include any rater-coded variables. The findings suggest that the narrative variables share little empirical overlap when assessed via the ANIQ and rater coding of self-generated narratives.

Narrative identity does not predict well-being when controlling for emotional valence.

Narrative identity refers to a person's internalized and evolving life story. It is a rapidly growing research field, motivated by studies showing a unique association with well-being. Here we show that this association disappears when controlling for the emotional valence of the stories told and individuals' general experience of autobiographical memory. Participants (N = 235) wrote their life story and completed questionnaires on their general experience of autobiographical memory and several dimensions of well-being and affect. Participants' life stories were coded for standard narrative identity variables, including agency and communion. When controlling for emotional valence of the life story, the general experience of autobiographical memory was a significant predictor of most well-being measures, whereas agency was a predictor of one variable only and communion of none. These findings contradict the claim of an incremental association between narrative identity and well-being, and have important theoretical and practical implications for narrative identity as an outcome measure in interventions.

Adverse childhood experiences in patients with severe health anxiety: No evidence for an increased frequency compared to patients with obsessive-compulsive disorder.

Theoretical models of health anxiety emphasize adverse childhood experiences in the development of the disorder, but few studies examine such events in patients with severe health anxiety and the results are difficult to compare across studies. The present study examined adult retrospective reports of illness-related and traumatic childhood experiences in 31 patients with severe health anxiety, 32 non-clinical control participants, and a clinical control group of 33 patients with obsessive-compulsive disorder. No evidence of an increased frequency of adverse childhood experiences in patients with severe health anxiety was found. However, patients with severe health anxiety who had experienced the death of a friend or family member or a major upheaval during childhood, perceived these events as having been more traumatic than the control participants. These findings suggest that biases in how adverse childhood experiences are interpreted or remembered might play a role in severe health anxiety. The findings are discussed in relation to the cognitive behavioral model of health anxiety, and some of the processes in interpretation and memory that could explain how adverse childhood experiences might play a role in the development and maintenance of severe health anxiety are outlined.

Encoding and retrieval biases for health-related scenes in patients with severe health anxiety.

Severe health anxiety is a disorder characterised by excessive worries about harbouring or having a serious illness. The present study examines cognitive biases in evaluation and memory for health-related scenes in severe health anxiety in order to provide insights into the effect of these biases and the formation of illness intrusions in severe health anxiety. Twenty patients with severe health anxiety and 20 healthy participants completed a computerised task consisting of encoding, involuntary retrieval, voluntary retrieval and recognition of health-related, negative and neutral scenes. The results demonstrated that patients with severe health anxiety reported more negative emotional valence and greater physiological arousal to health-related scenes, both during encoding (ps < .031, ηp2 > .09) and retrieval (ps < .044, ds > 0.18). Furthermore, in contrast to the comparison group, patients with severe health anxiety did not show shorter retrieval time for health-related scenes during involuntary compared with voluntary retrieval (p = .789, d = 0.08), possibly due to greater demands on emotion regulation during involuntary retrieval. The results suggest an important role for negative emotional valence and physiological arousal to health-related stimuli in severe health anxiety, and highlight how cognitive biases in evaluation and memory might be at play in this disorder.

Resting-state connectivity and neural response to emotional images in patients with severe health anxiety: An fMRI study.

BACKGROUND: Severe health anxiety is a disorder characterized by a persistent preoccupation with one's health. In behavioral studies, biases in the processing of health-related stimuli (e.g., pictures, words) are consistently associated with health anxiety symptoms. The neural correlates of the observed behavioral abnormalities remain however poorly understood. METHODS: In this functional magnetic resonance imaging study, 22 treatment-seeking patients with severe health anxiety and 22 control participants performed a resting-state and a picture matching task. Immediately after the resting-state, participants completed a questionnaire quantifying their thoughts and feelings during rest along several dimensions. The picture task included images of health-related and neutral scenes and of disgusted and neutral faces. RESULTS: Compared to controls, patients with health anxiety showed increased functional connectivity in the dorsolateral prefrontal cortex within the left fronto-parietal resting-state network, which correlated positively with the self-reported thought dimensions of Self, Health Concern, and Thought Suppression. In the picture matching task, no significant group differences were found in the hypothesised regions (amygdala and insula) or at a whole-brain level in response to either health-related versus neural scenes or disgust versus neutral faces contrasts. LIMITATIONS: A relatively small sample size and that no information about patients declining to participate was obtained. CONCLUSIONS: Our findings suggest that behavioral biases in health anxiety may be related to aberrant left dorsolateral prefrontal cortex functional connectivity at rest. In contrast, the health anxiety patients did not show significant hyperactivations of amygdala and insula during processing of emotional stimuli, contrasting findings in other anxiety disorders.

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.

The role of illness perceptions in predicting outcome after acute whiplash trauma: a multicenter 12-month follow-up study.

OBJECTIVES: To examine (1) whether the patients' perceptions of their symptoms immediately after the accident and at 3-month follow-up predict working ability and neck pain at 12-month follow-up and (2) the possible changes in patients' illness perceptions during the follow-up period. MATERIALS AND METHODS: A total of 740 consecutive patients exposed to acute whiplash trauma consulting emergency units and general practitioners in 4 Danish counties from 2001 to 2003. The patients completed questionnaires at baseline, 3-, and 12-month follow-up. Illness perceptions were measured using a condensed version of the Illness Perception Questionnaire and a 1-item question concerning return to work expectation. Neck pain was measured using an 11-point box scale, and working ability was measured by self-report at 12-month follow-up. Multiple logistic regression analyses were applied controlling for possible confounders. RESULTS: Patients with pessimistic illness perceptions at baseline and 3-month follow-up were more likely to experience neck pain and affected working ability at 12 months compared with patients with optimistic illness perceptions. Negative return-to-work expectation predicted affected working ability at 12 months. Furthermore, patients with high neck pain intensity or affected working ability report more changes in their illness perceptions during follow-up than patients with low neck pain intensity or unaffected working ability. DISCUSSION: The findings are in line with the common-sense model of illness and previous research demonstrating that patient's expectations for recovery and illness perceptions might influence the course after whiplash injury. Illness perceptions and expectations may provide a useful starting point for future interventions and be targeted in the prevention of chronicity.