Event centrality in social anxiety disorder and major depressive disorder.

Event centrality is defined by the extent to which a memory of an event has become central to an individual's identity and life story. Previous research predominantly focused on the link between event centrality and trauma-related symptomatology. Nevertheless, it can be argued that the perception of (adverse) events as central to one's self is not exclusive to Posttraumatic Stress Disorder (PTSD). Other disorders where adverse events are linked to the onset of symptoms might also be related to event centrality. This study examined the relevance of event centrality for Social Anxiety Disorder (SAD) and for Major Depressive Disorder (MDD) separately. Moreover, we examined which cognitive and emotion regulation variables (i.e., trait anxiety, rumination, worry, intrusions and avoidance, and posttraumatic cognitions) mediated these relationships. No significant correlation was found between event centrality and social anxiety. However, a significant positive correlation was found between event centrality and depression. In a combined group, this relation was mediated by all cognitive and emotion regulation variables except for worry.

Psychological adjustment following mechanical restraint in individuals with schizophrenia.

AIM: While it is known that being mechanically restrained during hospitalization can, in severe cases, lead to PTSD in individuals with mental illness, less is known about why some develop posttraumatic stress reactions following restraint while others do not. This study examined whether the amount of exposure to mechanical restraint and patients' interpretations of the episodes' centrality to their identity were related to symptoms of PTSD in individuals with schizophrenia. METHODS: We asked 20 individuals to recall mechanical restraint episodes and rate them on centrality to identity. They also completed scales measuring symptoms of posttraumatic stress, depression, trauma history, and were rated on positive and negative symptoms. Objective information about the number of times they had been restrained was obtained through Danish health registries. RESULTS: Amount of exposure to mechanical restraint was not significantly related to PTSD symptoms, potentially due to limitations of our small sample. However, interpreting episodes as more central to identity was. This relationship remained significant when controlling for trauma history, positive symptoms, and depression. CONCLUSION: The results suggest that clinically significant levels of PTSD are common in this population, and that considering patients' subjective interpretations of restraint episodes, and not merely the objective facts surrounding them is important for patients' psychological adjustment.

Exploring the potential moderating role of self-compassion on the relationships between event centrality and post-assault psychological outcomes.

OBJECTIVE: The present study examined whether post-assault internal processes (i.e., present control, event centrality, and compassionate and uncompassionate self-responding) were associated with distress and resilience among women who have experienced adult sexual assault. The authors also tested whether compassionate and uncompassionate self-responses would moderate the relationships between event centrality and outcomes. METHOD: A convenience sample of women who had experienced sexual assault during adulthood (N = 253) completed an anonymous online survey. RESULTS: Regression analyses showed that lower present control, higher event centrality, and higher uncompassionate responses to the self were associated with posttraumatic stress disorder. Additionally, higher present control and higher compassionate responses to the self were associated with resilience. Moderation analyses were not significant. CONCLUSIONS: Endorsing greater levels of uncompassionate responses was associated with greater distress while engaging in greater compassionate responses was associated with greater resilience, even when accounting for levels of present control and event centrality.

The centrality of remembered moral and immoral actions in constructing personal identity.

There is a widespread belief that morally good traits and qualities are particularly central to psychological constructions of personal identity. People have a strong tendency to believe that they truly are morally good. We suggest that autobiographical memories of past events involving moral actions may inform how we come to believe that we are morally good. In two studies, we investigated the role of remembered past events involving moral and immoral actions in constructing perceived personal identity. For morally right actions only, we found that remembered actions judged to be more morally right relative to less morally right were more central to personal identity (Study 1). We then found that remembered morally right actions were more central to personal identity than remembered morally wrong actions (Study 2). We discuss these findings in relation to recent research on morality and personal identity.

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.

Positive Developmental Changes after Transition to High School: Is Retrospective Growth Correlated with Measured Changes in Current Status of Personal Growth?

The transition to high school is generally considered as a stressful turning point in adolescent development, but some students experience personal growth (i.e., positive developmental changes) through that experience. It is important to examine the mechanism behind such positive changes to understand various developmental patterns of adolescents during the transition. However, the concept of growth in this research area remains unexplored. Some researchers have questioned whether retrospective, self-reported growth reflects actual positive changes in the perception of personal growth. We elaborated on the concept of growth after high school transition by examining whether retrospective appraisal of personal growth after transition to high school is correlated with measured change in growth. Two hundred and sixty-two Japanese adolescents (aged 14-16 years, 50% girls) participated in surveys right before and right after transition. We assessed five domains of growth, including improved relating to others, identification of new possibilities, increased sense of personal strength, spiritual growth, and greater appreciation of life. The results showed that retrospective assessment of growth and measured change during transition were positively associated, provided the adolescents reported the transition as an important turning point in their lives. Adolescents who experienced salient positive changes across the transition were more likely to engage in intrusive and deliberate rumination and social support than adolescents who reported fewer changes. In summary, retrospective growth covaried with measured change only when adolescents perceived the transition as impactful in their lives.

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.

Event centrality of positive and negative autobiographical memories to identity and life story across cultures.

The aim of this study was to investigate whether cultural differences exist in event centrality, emotional distress and well-being in a total of 565 adults above age 40 from Mexico, Greenland, China and Denmark. Participants completed questionnaires to determine their level of post-traumatic stress disorder and depression symptoms, and of life satisfaction. They also completed event centrality scales for their most positive and most negative life events. Across cultures, participants rated positive events as more central to their identity and life stories, compared with negative events. Furthermore, participants with higher levels of emotional distress rated negative events as more central to their identity and life story, compared with participants with lower scores. However, a converse pattern was not found for positive events. Finally, participants with higher scores of life satisfaction tended to rate positive events as more central and negative events as less central to their identity and life story, compared with participants with lower scores. It is concluded that across cultures, positive events are considered more central to identity and life story than negative events and that event centrality ratings tend to be affected in similar ways by higher versus lower levels of emotional distress or well-being.

Parents' Vicarious Event Centrality of Their Child's Interpersonal Trauma.

This study aimed to understand parents' process of centering their child's interpersonal traumatic event in their lives post-disclosure. Specifically, how it informed their understanding of themselves, their lives, and the world. This phenomenon of centering a traumatic event in one's life is termed event centrality and has not been previously applied to qualitative research or this population. Participants were 17 primary caregivers (14 maternal caregivers and 3 paternal caregivers) of 27 victims of child interpersonal trauma (14 males and 13 females) located in Canada. The age of participants ranged from 35 to 75 years (average = 54.5 years) and majority self-identified as Caucasian (70.6%). Grounded theory was used to analyze the data. The resulting model was labeled Vicarious Event Centralization and Decentralization, indicating that parents center their child's interpersonal trauma across many areas of their lives, which orients them to focus on protecting and healing the child. After the child's functioning improves, parents are then able to reorient to life beyond the trauma, representing decentralization. The grounded theory consists of three phases: Centralization, Decentralization Gateway, and Decentralization. These results illustrate that parents' centralization of the trauma may be an adaptive mechanism that promotes child recovery, which in turn allows parents to begin to decentralize the trauma and move toward recovery. This study supports that parents are affected by their child's trauma in a myriad of ways and require unique services to address their needs. This study can help practitioners understand the post-trauma experience for parents and target areas likely to increase recovery.

Event centrality and post-traumatic stress symptoms among college students during the COVID-19 pandemic: the roles of attention to negative information, catastrophizing, and rumination.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected college students' mental health and caused post-traumatic stress symptoms (PTSS). Event centrality is thought to play a key role in the development of PTSS, but it is not yet clear by what mechanism. Theoretically, event centrality may affect the retrieval of traumatic memories and further prompt post-traumatic cognitions to understand events, and so may in turn be associated with PTSS in college students. However, few empirical studies have examined the mediating role of post-traumatic cognitions in the relationship between event centrality and PTSS, especially among college students during the COVID-19 pandemic. Objectives: The objective of this study was to examine the mediating roles of post-traumatic cognitive factors (e.g. attention to negative information, catastrophizing, and rumination) in the relationship between event centrality and PTSS among college students during the COVID-19 pandemic. Methods: We recruited 1153 college students who completed the pandemic experiences scale, the centrality of event scale, the attention to positive and negative information scale, the cognitive emotion regulation questionnaire, and the PTSD Checklist for DSM-5 during the COVID-19 pandemic in May 2020. Results: In this sample of college students, event centrality directly predicted PTSS, and PTSS was also indirectly predicted by event centrality through attention to negative information, catastrophizing, and rumination. Conclusions: These findings support the existing literature on the relationship between event centrality, proposed cognitive variables, and PTSS, and shed light on the mechanisms underlying PTSS. Our findings also highlight the importance and applicability of targeted cognitive interventions for PTSS in college students during the COVID-19 pandemic. HIGHLIGHTS: The COVID-19 pandemic has caused post-traumatic stress symptoms among college students.Event centrality is a risk factor of post-traumatic stress symptoms among college students during the COVID-19 pandemic.Attention to negative information, catastrophizing and rumination mediate the relationship between event centrality and post-traumatic stress symptoms.

Antecedentes: La pandemia de enfermedad coronavirus 2019 (COVID-19) ha afectado la salud mental de los estudiantes universitarios y causado síntomas de estrés postraumático (PTSS por sus siglas en ingles). Se cree que la centralidad del evento juega un rol importante en el desarrollo de PTSS, pero aún no está claro por qué mecanismo. Teóricamente, la centralidad del evento podría afectar la recuperación de los recuerdos traumáticos y estimular cogniciones postraumáticas para comprender los eventos y así su vez, podría estar asociada con PTSS en estudiantes universitarios. Sin embargo, pocos estudios empíricos han examinado el rol mediador de las cogniciones postraumáticas en la relación entre centralidad del evento y PTSS, especialmente entre estudiantes universitarios durante la pandemia de COVID-19.Objetivos: El objetivo de este estudio fue examinar los roles mediadores de los factores cognitivos postraumáticos (ej.: atención a información negativa, catastrofización y rumiación) en la relación entre centralidad del evento y PTSS entre los estudiantes universitarios durante la pandemia de COVID 19. Método: Reclutamos 1.153 estudiantes universitarios que completaron la escala de experiencias pandémicas, la escala de centralidad del evento, la escala de atención a la información positiva y negativa, el cuestionario de regulación cognitiva de las emociones y la lista de chequeo de TEPT para el DSM-5 durante la pandemia de COVID-19 en mayo del 2020.Resultados: En esta muestra de estudiantes universitarios, la centralidad del evento predijo directamente PTSS, y PTSS fueron tambien predichos indirectamente tambien por la centralidad del evento través de la atención a la información negativa, catastrofización y rumiación.Conclusiones: Estos hallazgos apoyan la literatura existente en la relación entre centralidad del evento, las variables cognitivas propuestas y PTSS y arrojan luz sobre los mecanismos subyacentes a PTSS. Nuestros hallazgos destacan tambien la importancia y aplicabilidad de las intervenciones cognitivas dirigidas a los PTSS en estudiantes universitarios durante la pandemia de COVID-19.

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.

Event centrality and secondary traumatization among Holocaust survivors' offspring and grandchildren: A three-generation study.

The present study examined the intergenerational transmission of the Holocaust trauma in relation to levels of secondary traumatization and event centrality across three generations in a cross-sectional survey. Participants included 92 Holocaust survivor-offspring-grandchild triads (Holocaust G1-G2-G3) and 67 comparison triads (Comparison G1-G2-G3). Holocaust G1 reported higher levels of post-traumatic stress disorder (PTSD) symptoms relative to Comparison G1. Holocaust G2 and G3 reported significantly higher secondary traumatization relative to Comparison G2 and G3, respectively. Holocaust G3 also reported significantly higher scores in event centrality relative to Comparison G3. In survivor families, the indirect effect of PTSD symptoms in Holocaust G1 predicted Holocaust G2's secondary traumatization, which subsequently predicted Holocaust G3's secondary traumatization. Moreover, PTSD symptoms in Holocaust G1 predicted Holocaust G3's event centrality through secondary traumatization in both Holocaust G2 and G3 and event centrality in Holocaust G2. In the comparison groups, trauma transmission was not observed in three generations. Findings elucidate unique intergenerational transmission of the Holocaust trauma in survivor families, which comprise both personal and societal constituents. Moreover, the findings show that event centrality is a distinctive mechanism in intergenerational transmission in survivor families.

The centrality of a loss-event: Patterns, correlates, and predictive value.

BACKGROUND AND OBJECTIVES: Evidence shows that the centrality of a loss-event maintains emotional distress following loss. Aims of the current study were to examine (i) if subgroups of bereaved people can be distinguished based on their endorsement of different manifestations of loss-centrality, (ii) if subgroup membership was associated with socio-demographic and loss-related variables, and (iii) the linkage of subgroup membership with symptom-levels of prolonged grief (PG), posttraumatic stress (PTS), and depression assessed concurrently and 6 months later. METHODS: Three-hundred ninety-eight bereaved people completed the 7-item Centrality of Event Scale, with their loss as anchor-event and completed symptom-measures concurrently and 6 months later. Latent profile analysis (LPA) was used to identity profiles of loss-centrality. RESULTS: LPA revealed a three-profile solution representing low, average, and high centrality classes, respectively. The death of a partner and younger age increased the likelihood of membership of classes evidencing stronger centrality. Membership of the low centrality class was associated with lower concurrent PG, PTS, and depression; membership of the high centrality class predicted elevated PG 6 months later, beyond baseline PG. CONCLUSIONS: Subgroups of loss-centrality were distinguished by increasing endorsement of all (rather than some) manifestations of loss-centrality. Clinical implications are discussed.

Psychological adjustment in care providers following restraint of psychiatric patients.

Mental healthcare providers face many difficult interactions with patients that can be emotionally demanding and have adverse effects on their well-being. Recent theoretical models suggest that the interpretation of stressful episodes may be more important for psychological adjustment than the nature of the episodes. This study examined whether care providers' interpretations of mechanical restraint episodes were related to their adjustment. We asked 80 mental healthcare providers to recall mechanical restraint episodes and to rate them on centrality to identity and positive and negative influence on self-understanding. They also completed scales measuring current symptoms of post-traumatic stress, depression, life satisfaction, and well-being. The results showed that care providers who interpreted mechanical restraint episodes as having a central negative influence on their identity experienced more symptoms of post-traumatic stress. Care providers who gave higher ratings of positive self-change following episodes reported more well-being. Our findings suggest, that considering care providers' subjective interpretations of episodes and not merely the objective facts surrounding them is critical if we wish to mitigate the negative emotional impact of episodes.

Event centrality, transitional impact and symptoms of posttraumatic stress in a clinical sample.

Background and Objectives: There is growing research indicating that event centrality strongly predicts posttraumatic stress disorder (PTSD). However, there is not much research on what makes a traumatic event central to one's life story. One reason a traumatic memory becomes a reference point for one's life story is that it brings about significant changes in one's life. This study investigated the relationships between transitional impact of an event, event centrality, and PTSD symptoms. Specifically, it tested whether higher negative changes were associated with higher levels of event centrality and PTSD symptoms. It also investigated whether event centrality mediated the relationship between transitional impact and PTSD severity.Methods: 101 individuals diagnosed with PTSD completed the Transitional Impact Scale (TIS), Centrality of Event Scale, and Impact of Event Scale-Revised regarding their traumatic experiences. Furthermore, they responded to the Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Traumatic Events Checklist (TELC), and Beck Anxiety Inventory (BAI).Results and Conclusions: Results indicate that (a) the TIS had valid and reliable psychometric properties in a PTSD sample, (b) most of the traumatic events received high negative psychological and material change scores, and (c) event centrality mediated the relationship between transitional impact and PTSD severity.

Developmental trajectories of event centrality and socio-emotional well-being after transition to high school.

Although the transition from junior high or middle school to high school can be a stressful turning point for youth socio-emotional development, the role of individual differences in susceptibility to the transition in adolescents' socio-emotional well-being remains unclear. The current study examined the developmental relation between how central the high school transition is to a student's identity or life course (i.e., event centrality) and socio-emotional well-being after transition. High school students, including cohorts in tenth to twelveth grade (n = 2,265, Mage at Time 1 = 15.9 years, SDage  = 0.9 years), participated in a four-wave longitudinal survey for a year and completed questionnaires assessing event centrality and socio-emotional well-being. Latent growth curve modelling revealed individual differences in the developmental trajectory of event centrality regarding high school transition across the tenth to twelveth grades. Increase in the centrality of transition was closely associated with improvement in socio-emotional well-being for each grade progression. Findings highlight the value of examining individual differences in the degree to which the school transition becomes a turning point in a student's identity or life course. Statement of contribution What is already known on the subject? Adolescents' socio-emotional well-being decreases on average after school transition. Event centrality, how central the transition is to student identity, is related to socio-emotional well-being. No study has examined event centrality and well-being after transition longitudinally. What the present study adds? Individual differences exist in the development of event centrality across grades 10-12. Increased event centrality of transition is associated with improved socio-emotional well-being. Development researchers must consider individual differences in susceptibility to the transition.

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

BACKGROUND: While self-reported post-traumatic growth (PTG) has been documented after a wide variety of potentially traumatic experiences, we need more knowledge on the mechanisms behind PTG to gain a better understanding of this phenomenon. OBJECTIVE: We aimed to investigate the hypothesized mechanism of perceived event centrality as a mediator on the pathway between peritraumatic reactions and later PTG. METHOD: In total, 204 survivors of the 2011 massacre on Utøya island, participated 4-5 months (T1), 14-15 months (T2), and 30-32 months (T3) post-terror. We applied counterfactually based causal mediation analysis to explore the potential mediating role of survivors' perceived centrality (T2) in linking their peritraumatic reactions (T1) and self-reported PTG (T3). RESULTS: The vast majority of the survivors reported experiencing some positive changes post-terror, and we found a positive, significant association between survivor's peritraumatic reactions, perceived event centrality and self-reported growth. However, we did not find that centrality significantly mediated the longitudinal association between peritraumatic reactions and later PTG. CONCLUSION: Reports of PTG are common post-terror, and peritraumatic reactions and perceptions of centrality may help explain individual differences in trauma survivors' level of PTG. Perceived event centrality about one year post-trauma does not appear to explain the relationship between initial reactions to trauma and subsequent PTG.

Antecedentes: Si bien el crecimiento postraumático (CPT) auto-reportado se ha documentado después de una amplia variedad de experiencias potencialmente traumáticas, necesitamos más conocimiento sobre los mecanismos detrás del CPT para obtener una mejor comprensión de este fenómeno.Objetivo: Nuestro objetivo fue investigar el mecanismo hipotético de la centralidad percibida del evento como mediador en la vía entre las reacciones peritraumáticas y el CPT posterior.Método: En total, 204 sobrevivientes de la masacre de 2011 en la isla de Utoya, participaron 4-5 meses (T1), 14-15 meses (T2) y 30-32 meses (T3) después del ataque terrorista. Aplicamos un análisis de mediación causal contrafactual para explorar el posible papel mediador de la centralidad percibida (T2) de los sobrevivientes al vincular sus reacciones peritraumáticas (T1) y el CPT autoinformado (T3).Resultados: La gran mayoría de los sobrevivientes informaron haber experimentado algunos cambios positivos después del ataque terrorista, y encontramos una asociación positiva y significativa entre las reacciones peritraumáticas del sobreviviente, la centralidad del evento percibido y el crecimiento autoinformado. Sin embargo, no encontramos que la centralidad mediara significativamente la asociación longitudinal entre las reacciones peritraumáticas y el CPT posterior.Conclusión: Los reportes de CPT son comunes después del terrorismo, y las reacciones peritraumáticas y las percepciones de centralidad pueden ayudar a explicar las diferencias individuales en el nivel de CPT de los sobrevivientes de trauma. La centralidad percibida del evento aproximadamente un año después del trauma no parece explicar la relación entre las reacciones iniciales al trauma y el CPT posterior.

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

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

The Impact of Experiential Avoidance and Event Centrality in Trauma-Related Rumination and Posttraumatic Stress.

Cognitive control strategies like rumination often increase posttraumatic stress disorder (PTSD) symptoms. However, extant research has provided equivocal results when attempting to explain why this phenomenon occurs. The current study explored several mechanisms that may clarify such findings. For this study, 193 trauma-exposed community members completed measures of PTSD, rumination, experiential avoidance, and event centrality. Elevated reports of rumination were associated with greater PTSD symptomology, experiential avoidance, and event centrality. Results suggest that rumination indirectly influenced PTSD symptom severity through experiential avoidance. This pattern held true regardless of whether a trauma survivor viewed their reported trauma as central or peripheral to their personal identity. These data suggest that the link between ruminating about a traumatic experience and enhanced PTSD symptomology may be partially explained by increasingly restrictive cognitive patterns and enhanced avoidance of aversive internal stimuli. Furthermore, they provide preliminary evidence to suggest that rumination and experiential avoidance are strongly associated with one another (and subsequent PTSD symptomology) among trauma survivors, regardless of how central a traumatic event is to an individual's personal narrative. Such findings support clinical interventions like exposure, which progressively support new learning in response to feared or unwanted experiences in service of expanding an individual's cognitive and behavioral repertoires.