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

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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.
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Anxiety, Stress, & Coping: An
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Event centrality and posttraumatic
outcomes in the context of pervasive
violence: a study of teachers in El
Salvador
Ashli G. Rolanda, Joseph M. Curriera, Lisseth Rojas-Floresa & Sofia
Herreraa
a Department of Clinical Psychology, Graduate School of
Psychology, Fuller Theological Seminary, 180 N Oakland Avenue,
Pasadena, CA 91101, USA
Accepted author version posted online: 16 Aug 2013.Published
online: 16 Sep 2013.
To cite this article: Ashli G. Roland, Joseph M. Currier, Lisseth Rojas-Flores & Sofia Herrera (2014)
Event centrality and posttraumatic outcomes in the context of pervasive violence: a study of
teachers in El Salvador, Anxiety, Stress, & Coping: An International Journal, 27:3, 335-346, DOI:
10.1080/10615806.2013.835402
To link to this article: http://dx.doi.org/10.1080/10615806.2013.835402
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BRIEF REPORT
Event centrality and posttraumatic outcomes in the context of
pervasive violence: a study of teachers in El Salvador
Ashli G. Roland*, Joseph M. Currier, Lisseth Rojas-Flores and Sofia Herrera
Department of Clinical Psychology, Graduate School of Psychology, Fuller Theological Seminary,
180 N Oakland Avenue, Pasadena, CA 91101, USA
(Received 1 March 2013; accepted 2 August 2013)
It is well established that the importance assigned to a trauma can affect ones
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 swordin that this construct
might factor prominently in both posttraumatic stress disorder (PTSD) and posttrau-
matic 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.
Keywords: event centrality; posttraumatic stress disorder; posttraumatic growth;
trauma; community violence
Introduction
It has long been recognized that the importance one attributes to stress and trauma can
have a significant impact on posttraumatic adjustment. However, the topic of event
centrality has gained special empirical attention among behavioral scientists over recent
years (e.g., Berntsen & Rubin, 2006,2007; Berntsen, Rubin, & Siegler, 2011; Boals &
Schuettler, 2011; Brown, Antonius, Kramer, Root, & Hirst, 2010; Groleau, Calhoun,
Cann, & Tedeschi, 2012; Lancaster, Rodriguez, & Weston, 2011; Robinaugh & McNally,
2010,2011; Rubin, Boals, & Berntsen, 2008; Schuettler & Boals, 2011; Webb & Jobson,
2011). Although contemporary theories of posttraumatic stress disorder (PTSD) emphas-
ize the healing role of reconciling the reality of the trauma with ones preexisting meaning
structures (for review, see Dalgleish, 2004), event centrality recognizes the possibility for
too much integration in this process. This construct attempts to capture the tendency
among many survivors to over-accommodate their personal meaning systems following
exposure to violence or other potentially traumatic events, thereby allowing the stressor to
*Corresponding author. Email: ashliroland@fuller.edu
Joseph M. Currier is now at the University of South Alabama.
Anxiety, Stress, & Coping, 2014
Vol. 27, No. 3, 335346, http://dx.doi.org/10.1080/10615806.2013.835402
© 2013 Taylor & Francis
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serve as a turning point in ones life story, key feature of ones sense of identity, or
reference point for structuring autobiographical memory. Berntsen and Rubin (2006,
2007) have also emphasized the revision of cherished beliefs/values in this integrative
process and described event centrality in terms of an enhanced memory of the stressful
event and source of meaning attribution of future experiences.
Drawing on a landmark perspectiveof trauma, these theorists have also asserted
that highly emotional and distinctive events might increase risk for PTSD and other
mental health problems if they remain too salient and serve as an organizing principle for
other benign events (Berntsen, 2001; Rubin & Kozin, 1984). Others have theorized that
aspects of event centrality might serve as a double-edged sword in many cases, and
similarly promote positive psychological outcomes such as posttraumatic growth (PTG)
via the survivors attempt to revise beliefs/values and reframe the stressor in a broader
context of meaning (Boals & Schuettler, 2011; Groleau et al., 2012; Schuettler & Boals,
2011; Tedeschi & Calhoun, 2004). However, research on the psychological consequences
of event centrality has largely relied upon undergraduate samples and focused on isolated
stressors that might not be viewed as being traumatic from a clinical standpoint. As such,
there is a need for additional research on event centrality with samples of persons
exposed to a greater severity of potentially traumatic events. In addition, there are also
questions regarding the applicability of event centrality across cultures as this construct is
yet to be applied in less developed countries where existential threat and trauma can be
pervasive for many individuals. This study attempted to advance the literature in this area
by examining the role of event centrality in PTSD symptomatology and PTG among a
group of teachers from El Salvador a specific population who frequently must contend
with violence on many levels in their lives and work.
Violence in El Salvador
Despite being the smallest nation in Latin America, El Salvador has been regarded as one
of the most violent locales in the region (Chavez, 2004). The country has experienced
nearly a century of violence, with some sources tracing violence in rural areas as far back
as the colonial period (Kay, 2001). Other violent incidences include the peasant uprising
of 1932, infamously named La Matanza (The Killing) that claimed 20,000 to 40,000
lives, waves of conflict in the 1970s that were responsible for over 200,000 deaths, and
military violence and assassinations in the 1980s (Kay, 2001; Lopez-Reyes, 1997; Truth
Commission, 1992). The country also had a devastating civil war that formally ended in
1992, which was responsible for approximately 75,000 deaths. Over the past decade,
much of the community violence in El Salvador has been attributed to inadequate
reintegration of demobilized soldiers from the war and an increase in gang activity and
drug trafficking (Chavez, 2004; Kay, 2001; Lopez-Reyes, 1997; NACLA Report, 2009;
Richani, 2010). Factors contributing to this system of violence for the Salvadorian people
are complex and wide-ranging; poverty and under-employment, social exclusion/
inequality, and rapid urbanization have been key factors. Rates of violence have also
been exacerbated at points by policy changes in the USA that led to the precipitous
deportation of an estimated 43,000 Salvadorian immigrants with a criminal record in the
years after the civil war (Richani, 2010).
Given these concerns, teachers in El Salvador are not only vulnerable for direct
victimization common to all citizens but may also confront added challenges through their
profession. For example, they often focus on reducing the risk of violence and delinquency
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among troubled youth (Croninger & Lee, 2001; Garbarino, Dubrow, Kostelny, & Pardo,
1992; Springer, Parcel, Baumler, & Ross, 2006) and serve as advocates for social change
in violent communities (Watson, 1983). In acting as mentors to students and their families,
they are also likely to have indirect and vicarious exposure via witnessing the
consequences of violent events and hearing stories of their aftermath. In fact, initial
results from this sample revealed that these teachers had on average each experienced three
to four types of potentially traumatic events as adults, including a variety of war-related
stressors (e.g., witnessing fighting, injured people, and dead bodies), witnessing someone
commit suicide, being raped or sexually assaulted, stabbed or attacked with a knife, or
being in a life-threatening accident (Rojas-Flores et al., 2013). There is an established
positive relationship between violence exposure and PTSD symptomatology (i.e., Ozer &
Weinstein, 2004; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993; Scarpa, Haden, &
Hurley, 2006). As one might anticipate, Rojas-Flores et al. (2013) also found that those
teachers with higher levels of direct violence exposure reported worse PTSD sympto-
matology. This study will expand on these findings by examining the contribution of event
centrality in teachersposttraumatic adjustment while controlling for this already
established predictor of posttraumatic adjustment in the sample.
Event centrality and posttraumatic outcomes
Several studies have documented links between event centrality and PTSD symptoms
(Berntsen & Rubin, 2006,2007; Berntsen et al., 2011; Boals, Hayslip, Knowles, &
Banks, 2012; Boals & Schuettler, 2011; Brown et al., 2010; Groleau et al., 2012;
Lancaster et al., 2011; Robinaugh & McNally, 2010,2011; Rubin et al., 2008; Schuettler
& Boals, 2011; Webb & Jobson, 2011). For example, Robinaugh and McNally (2011)
investigated the relation between event centrality and PTSD in a sample of 102 female
survivors of childhood sexual abuse. When controlling for depression and several other
relevant factors, these researchers found that event centrality was uniquely linked with
greater PTSD symptoms in their sample. In another study with 46 combat veterans of the
Iraq and Afghanistan wars, Brown et al. (2010) similarly found that event centrality
predicted PTSD symptoms when controlling for depression. In general, the results of
these two studies align with research with college students on this topic and support the
relevance of the event centrality construct for trauma populations.
Other research also suggests that event centrality can figure prominently in survivors
perceptions of PTG in the context of struggling with stress and trauma (Boals &
Schuettler, 2011; Groleau et al., 2012; Schuettler & Boals, 2011). In accordance with the
complex relationship between PTSD and PTG in general (for reviews, see Tedeschi &
Calhoun, 2004; Zoellner & Maercker, 2006), these studies assessed for both PTSD and
PTG and found that event centrality was a salient predictor of each outcome. For
example, in an undergraduate sample, Boals and Schuettler (2011) found that event
centrality was one of the strongest predictors of PTG when in the presence of several
relevant control variables. Groleau et al. (2012) also examined event centrality and PTG
in a sample of 187 undergraduate students. They found that event centrality was
positively related to PTG, after controlling for several well-established predictors of
growth as well. Findings such as these bring up complex questions about the nature of
PTG in coping with stress and trauma (Frazier et al., 2009; Zoellner & Maercker, 2006),
and how event centrality might factor into both distress and constructive life changes
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following exposure to stressful life events. To our knowledge, this is the first study to
address these questions using persons residing in Latin America with histories of
pervasive violence and potentially traumatic events.
Study aims and hypotheses
The present study attempted replication of the double-edged sword effect by examining
the link between event centrality and PTSD and PTG in a sample of Salvadorian teachers
from a range of educational contexts in the country. Based on available theory and
empirical evidence, we had these two main study hypotheses:
(1) When controlling for demographic factors, severity of violence exposure, and
depressive symptoms, event centrality will uniquely predict greater PTSD
symptomatology.
(2) When controlling for demographic factors, severity of violence exposure, and
depressive symptoms, event centrality will uniquely predict greater perceptions
of PTG.
Method
Participants and procedures
Following institutional approval, 257 teachers were recruited in March 2012 through
advertisements across the country from the Ministry of Education in El Salvador.
Participants completed a 45-minute survey prior to attending a free, psycho-educational
workshop on coping with trauma and stress led by the second author (J.M.C.). Teachers
were informed from the outset that they could attend the workshop even if they declined
to participate in the research study. Persons who attended the workshop were offered a
light meal and $7.00 to defer travel costs, regardless of their involvement in the study. Of
those teachers who attended the workshop, less than 5% declined to participate in this
study. This sample was largely composed of women (68.6%) and the average age was
42.02 years (SD = 13.12). Nearly half of the participants were married (45.2%), 32.4%
were single, 11.9% were separated or divorced, 8.5% were in committed relationships and
living with a partner, and 1.9% were widowed. The majority resided in urban areas in the
country, such as San Salvador (86.9%), and the majority worked in urban schools
(79.3%). Refer to Rojas-Flores et al. (2013) for additional details of the study.
Each participant completed a questionnaire assessing his/her demographic and
professional background, history of violence exposure, depressive symptoms, event
centrality, PTSD, and PTG. Spanish language versions of measures with established
psychometric properties were implemented to assess violence exposure, depression, and
PTSD symptom severity. Graduate research assistants in clinical psychology translated
measures of event centrality and PTG into Spanish for the current study. These measures
were then checked and revised by a Salvadorian psychologist and researcher (S.H.) to
examine whether the items were appropriate and if the language actually reflected the
regionalisms of El Salvador. As a final step, these two measures were then back-
translated into English to ensure that the original meaning and intent of the questions
remained intact. Contact the corresponding author (A.G.R.) for copies of the Spanish
versions of the measures used in this study.
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Measures
Violence exposure
Drawing on items implemented by Putman et al. (2009) in another study in Central
America, a variation of the Survey of Exposure to Community Violence (SECV; Richters
& Saltzman, 1990) was used to measure exposure to 22 common violence events in El
Salvador (e.g., being mugged/beaten up, sexually assaulted, shot at with a gun, physical
abuse, war-related stressors, earthquakes). Refer to Rojas-Flores et al. (2013) for more
details regarding the specific rates of violence exposure in the sample. Items were scored
dichotomously (0 = No, 1 = Yes; range = 022), and they were summed to represent
teachersdirect exposure to violence over adulthood (since age 18) as a control variable
for the statistical analyses.
Depressive symptoms
A four-item depression subscale of the Los Angeles Symptoms Checklist (LASC; King,
King, Leskin, & Foy, 1995) was used to measure depressive symptoms (e.g., easily
fatigued, suicidal ideation). Putman et al. (2009) had also successfully implemented these
items in Central America with indigenous individuals. Teachers reported how much of a
problem each symptom had been during the previous month with responses ranging from
0 = not a problem to 4 = an extreme problem (possible range = 016). Cronbachs alpha
for the four depression items was 0.92 in the present study.
Event centrality
We translated the 7-item Centrality of Event Scale (CES; Berntsen & Rubin, 2006) into
Spanish for assessing the degree to which a specified stressor had become a central
organizing feature in the teacherslives. Example items include This event colored the
way I think and feel about other experiencesand This event was a turning point in my
life.Participants were asked to rate the extent to which they agreed or disagreed with
each statement, with responses ranging from 0 = strongly disagree to 4 = strongly agree
(possible range = 028). Participants completed the CES with respect to the most stressful
life event over the entirety of their life, which was used as the focal stressor for assessing
PTG as well. Among the teachers in this study, the top reported index stressors on the
CES included the death of a close family member (21.2%), surviving a natural disaster
(8.0%), domestic violence or sexual abuse (5.7%), being a victim of a crime (5.2%),
witnessing/surviving another type of violent event (4.7%), and major illness/injury of a
close family member (4.7%). Stressful events that would likely not be considered
traumatic in a diagnostic sense include separation/divorce (8.0%) and a variety of life
transitions (6.6%; e.g., beginning or ending formal education). Cronbachs alpha for the
CES in the present study was 0.91.
Posttraumatic stress symptomatology
We utilized a 17-item subscale assessing PTSD symptomatology from the LASC (King
et al., 1995). This measure had also been implemented previously in Guatemala by
Putman et al. (2009). The measure assesses the three symptom domains of PTSD:
reexperiencing (three items; e.g., nightmares, intrusive memories), avoidance (six items;
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e.g., emotional numbness, avoidance of reminders of the event), and hyperarousal (eight
items; e.g., irritability, excessive jumpiness). Similar to the depression items from the
LASC, participants reported how much of a problem each symptom had been during the
past month. Responses ranged from 0 = not a problem to 4 = an extreme problem
(possible range = 068). So as to obtain as full a picture as possible of PTSD, we focused
on the overall score for study analyses. Cronbachs alpha for this PTSD scale was 0.92 in
the present study.
PTG
The 10-item Posttraumatic Growth Inventory Short Form (PTGI-SF; Tedeschi &
Calhoun, 1996) was translated to examine the occurrence of perceived positive changes
that resulted from teachersefforts to cope with the same events identified for the CES.
Cann et al. (2010) found this condensed version of the PTGI to be equivalent to the
original instrument and reported alphas ranging from 0.86 to 0.89. The PTGI-SF included
items such as I am able to do better things with my lifeand I discovered that Im
stronger than I thought I was.Participants were asked to rate the degree to which they
had experienced each positive change with responses ranging from 0 = I did not
experience this change at all to 5 = I experienced this change to a very great degree
(possible range = 050). Cronbachs alpha was 0.93 in this study.
Results
Table 1 presents descriptive statistics and bivariate correlations between the study
variables. As expected, greater event centrality was associated with higher violence
exposure, depression, PTSD symptomatology, and PTG. Violence exposure was also
positively associated with PTSD symptomatology and depression, but was not linked
with PTG in these analyses.
We next conducted two hierarchical regressions to examine the effects of event
centrality on PTSD and PTG. For the first step in each analysis, age, gender, marital
status (married or unmarried), residence (rural or urban), violence exposure, and
depression were entered into the statistical model. For the second step, we entered
participantsscores on the CES. This analytic procedure allowed us to assess the degree
to which event centrality explained unique variance in the two posttraumatic outcomes
assessed in the study.
Table 1. Descriptive statistics and bivariate correlations between study variables.
Variables MSDRange 1 2 3 4 5
(1) Violence 3.39 2.67 012
(2) Depression 2.88 2.41 013 0.20**
(3) Event centrality 14.53 7.53 028 0.16** 0.19**
(4) PTSD 14.85 10.64 056 0.22*** 0.80*** 0.24***
(5) PTG 34.61 11.85 050 0.01 0.02 0.39*** 0.01
PTSD, posttraumatic stress disorder; PTG, posttraumatic growth.
*p< 0.05; **p< 0.01; ***p< 0.001.
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The first analysis focused on PTSD as the outcome. In Model 1, the entry of the
control variables yielded a statistically significant model, F(6, 247) = 73.37, p< 0.001,
which explained 64% of the variance (see Table 2). On the next step, the addition of event
centrality increased the explained variance in PTSD symptomatology in this sample,
ΔR
2
= 0.01, F
change
(1, 246) = 4.88, p= 0.028. Both depression, p< 0.001, and teachers
with higher event centrality scores, p= 0.028, were significantly related to PTSD in the
final model.
To assess the effects of event centrality on PTG, we followed the same two-step
hierarchical regression procedure (see Table 2). In Model 1, the six control variables did
not yield a statistically significant model, F(6, 247) = 1.37, p= 0.23. However, on the
next step, event centrality again increased the explained variance, ΔR
2
= 0.14, F
change
(1, 246) = 43.17, p< 0.001, and was the only significant predictor of PTG in the overall
regression equation.
Discussion
Event centrality has been gaining recognition as an important factor in psychological
adjustment to stress and trauma. There is an emerging consensus that survivorsattempts
to redefine their lives in terms of stressful life events can figure prominently in shaping
both mental health problems and constructive changes that can also emerge from
struggling with these events. However, much of this research focused on undergraduate
samples and the construct of event centrality is yet to be applied in Latin America (to our
knowledge). This study attempted to advance the literature by examining the contribution
of event centrality in PTSD symptoms and perceptions of PTG among teachers in El
Table 2. Results of multivariate regression analyses with event centrality predicting outcomes.
Posttraumatic stress Posttraumatic growth
BSEBβΔR
2
BSEBβΔR
2
Model 1 0.64*** 0.03
Age 0.00 0.00 0.05 0.02 0.01 0.02
Gender 0.04 0.05 0.03 0.31 0.16 0.12
Marital 0.00 0.05 0.00 0.28 0.15 0.12
Residence 0.04 0.07 0.02 0.03 0.22 0.01
Violence 0.26 0.17 0.06 0.12 0.53 0.01
Depression 0.81*** 0.04 0.78 0.01 0.13 0.00
Model 2 0.01*0.14***
Age 0.00 0.00 0.04 0.00 0.01 0.02
Gender 0.03 0.05 0.03 0.29 0.15 0.11
Marital 0.02 0.05 0.01 0.16 0.14 0.07
Residence 0.06 0.07 0.03 0.14 0.21 0.04
Violence 0.22 0.17 0.05 0.29 0.50 0.04
Depression 0.79*** 0.04 0.77 0.13 0.12 0.07
Event Cent. 0.05*0.02 0.09 0.44*** 0.07 0.40
Note: Gender was coded such that 0 = female and 1 = male. Marital status was coded such that 0 = unmarried
and 1 = married. Violence = lifetime direct exposure to violence. Event Cent. = Event centrality as measured by
the CES.
*p< 0.05; **p< 0.01; ***p< 0.001.
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Salvador who had reported exposure to multiple potentially traumatic events during
adulthood (Rojas-Flores et al., 2013).
Our first hypothesis was supported; event centrality was uniquely related to PTSD
symptoms in the presence of control variables. This finding aligns with other research
(Berntsen & Rubin, 2006,2007; Berntsen et al., 2011; Boals et al., 2012; Boals &
Schuettler, 2011; Brown et al., 2010; Groleau et al., 2012; Lancaster et al., 2011;
Robinaugh & McNally, 2011; Rubin et al., 2008; Schuettler & Boals, 2011; Webb &
Jobson, 2011). In keeping with results for other trauma populations in particular (Brown
et al., 2010; Robinaugh & McNally, 2011), teachers in this study who had accommodated
their beliefs and identity in greater accordance with their identified stressors (as assessed
by the CES) indicated worse PTSD symptoms. Although the cross-sectional nature of this
study restricts causal inferences, this finding could suggest that allowing ones identity to
become more influenced by a focal stressor could place survivors at risk for PTSD.
However, it might also suggest that those teachers who struggled with higher distress-
related sequelae might have been more preoccupied with the impact of the event, which
could contribute to more extensive accommodative processes related to coping with
stressors as well. Whatever the case, it certainly appears that those teachers who placed
stressful life events at the center of their identity were most susceptible to PTSD
symptomatology at the time of the study.
Our second hypothesis was also supported; event centrality was related to greater
PTG among the teachers in the presence of demographic factors, history of violence
exposure, and depressive symptoms. These results also accord with prior research (Boals
& Schuettler, 2011; Groleau et al., 2012; Schuettler & Boals, 2011). In particular, it
appears that those teachers in the sample who reframed their lives in light of the stressors
also reported higher perceived growth. Although we are again unable to make causal
statements due to methodological limitations, this finding could suggest that reevaluating
ones belief/value system after a life stressor may lead to greater engagement with
growth-inducing processes and activities. In keeping with contemporary models of PTSD
(Dalgleish, 2004), Tedeschi and Calhoun (2004) suggest that PTG emerges from a crisis
in global meaning and subsequent attempts to reexamine/revise ones assumptive
worldviews in light of the posttrauma reality. This pattern of results further supports
Boal and Schuettlers(2011) notion of event centrality as a double-edged sword in again
highlighting the possibility that construing stress and trauma in these terms can contribute
to both debilitation and perceived personal growth in the adjustment process. However,
the strength of the association between event centrality and PTG was considerably greater
than for PTSD in this particular sample, which may indicate that this construct was a
better predictor of personal growth than possible trauma-related distress. As more
empirical knowledge is garnered on the double-edged sword effect, other researchers may
also do well to compare/contrast the effect sizes between event centrality and these
outcomes.
Although event centrality was significantly linked with both PTSD and PTG, it was
notable that these outcomes were again not related with one another. In addition, we
found positive associations between PTSD symptoms and both violence exposure and
depression, whereas PTG only correlated with event centrality among the variables
assessed in this study. Several explanations might be offered for this pattern of results.
For example, Schuettler and Boals (2011) suggest that there could be distinct pathways to
PTSD and PTG in the aftermath of stress and trauma. In addition, Groleau et al. (2012)
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suggest that although PTSD and PTG often coexist in these contexts, the lack of
consistent concurrent relations between these two outcomes might suggest their
uniqueness among many survivors. Although the same event might engender both
distress and processes that facilitate PTG, these results suggest that different factors are
likely involved for these two types of posttraumatic outcomes. Perhaps for the teachers in
this study, a helpful distinction could pertain to whether their identified stressors were
appraised in more of a negative or positive manner. If the events were viewed strictly
negatively, teachers would be in danger of constructing meanings that can impede
recovery (e.g., world is a completely unsafe, other people cannot be trusted). In contrast,
if the event had a centrally defining impact but was also viewed as an opportunity for
making constructive life changes, teachers might have been more likely to experience
PTG (e.g., greater appreciation of life, higher value on remaining relationships, and
deepened sense of spirituality).
The results of this study should be considered in conjunction with several notable
limitations. We have already noted reliance on a cross-sectional design. Second,
information was based on self-report assessments and it is unclear whether factors such
as social desirability or biases in retrospective recall may have affected results. For
example, diagnostic interviews are the gold standard for assessing PTSD and we might
have missed critical information by relying exclusively on self-report. There was also an
overrepresentation of women and teachers with more years of experience in this sample,
such that findings might not generalize as well to men and/or less experienced teachers.
The lack of random sampling over the full population of Salvadorian teachers also limits
our ability to make strong statements about this population or helping professionals in
Central America as a whole. Given that the current set of participants were self-selected
via a psycho-educational workshop on coping with stress and trauma, we also could have
had an overrepresentation of highly distressed or high functioning teachers. Future
research will do well to incorporate more sophisticated methods of assessing and
sampling from this important population.
In keeping with the notion that ones subjective appraisal of stress and trauma can
frequently contribute to adjustment more than objective circumstance of the events (e.g.,
Boals & Schuettler, 2011), participants were able to complete the CES with respect to
stressors that they deemed to be the most distressing for them. As such, many of the
teachers who rated high levels of victimization on the violence assessment opted to
complete the CES with respect to other stressors that might not meet diagnostic
definitions of trauma. So as to reduce burden in the study questionnaire, we also did not
assess for time elapsed since these events. On a related note, assessment of PTG was
based on the teachersperceptions of positive changes related to their identified stressors.
Consistent with suggestions that PTG can entail both constructive and illusory elements
(Zoellner & Maercker, 2006), Frazier et al. (2009) have distinguished between actual and
perceived growth, and demonstrated that retrospective assessments of PTG do not always
align with corresponding changes in individualsbeliefs and behaviors. Thus, it is
possible that the more severely distressed teachers had greater difficulty in discerning the
degree to which they had experienced and engaged in the positive changes assessed by
the PTGI. Future research on this topic might address these measurement concerns by
narrowing the foci to predetermined traumas for assessing event centrality and relying on
better ways to gauge actual growth in the aftermath of these stressors
Anxiety, Stress, & Coping 343
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Notwithstanding these limitations, the present study contributes to the field of stress
and trauma research in several ways. Of note, this study addresses the general research
gap regarding Central American samples and bolsters the limited research on event
centrality with trauma-exposed populations. This study is also the first to examine event
centrality and PTSD/PTG in a Latin American setting and among a population with
pervasive violence exposure. In general, study findings support the double-edged sword
effect and suggest the applicability of the event centrality construct across cultures and
with persons who may contend with greater severity of stress and trauma than often
studied to this point. It appears that event centrality factors prominently in both PTSD and
PTG, though there are likely other factors for these outcomes as well. It is hoped that this
study will prompt further research on this construct among other types of trauma
populations and help to inform mental health professionals to better support other helping
professionals who are living and working in violent communities around the world.
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... To date, in line with Tedeschi et al.'s (2018) model, several cross-sectional studies have found a positive association between level of event centrality and PTG, both in student samples (e.g. Groleau, Calhoun, Cann, & Tedeschi, 2013;Lancaster, Klein, Nadia, Szabo, & Mogerman, 2015; and among trauma survivors (Allbaugh, Wright, & Folger, 2015;Kuenemund, Zwick, Rief, & Exner, 2016;Roland, Currier, Rojas-Flores, & Herrera, 2013;Rubin, Boals, & Hoyle, 2014). This positive association persists even when controlling for other known correlates, including rumination, meaning making, depression, posttraumatic stress symptoms, and violence exposure Groleau et al., 2013;Roland et al., 2013), which indicates that event centrality may be a unique predictor of PTG. ...
... Groleau, Calhoun, Cann, & Tedeschi, 2013;Lancaster, Klein, Nadia, Szabo, & Mogerman, 2015; and among trauma survivors (Allbaugh, Wright, & Folger, 2015;Kuenemund, Zwick, Rief, & Exner, 2016;Roland, Currier, Rojas-Flores, & Herrera, 2013;Rubin, Boals, & Hoyle, 2014). This positive association persists even when controlling for other known correlates, including rumination, meaning making, depression, posttraumatic stress symptoms, and violence exposure Groleau et al., 2013;Roland et al., 2013), which indicates that event centrality may be a unique predictor of PTG. However, to the best of our knowledge, only two studies have explored the longitudinal association between event centrality and PTG. ...
... Furthermore, in line with findings from several cross-sectional studies (e.g. Allbaugh et al., 2015;Kuenemund et al., 2016;Roland et al., 2013), we found a positive association between event centrality and PTG. These findings suggest that both peritraumatic reactions and perceptions of centrality may help explain individual differences in trauma survivors' level of self-reported growth. ...
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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.
... It has been found that event centrality is positively correlated with PTSD symptoms (e.g., Berntsen & Rubin, 2007;Blix, Solberg, & Heir, 2014;Brown, Antonius, Kramer, Root, & Hirst, 2010;Roland, Currier, Rojas-Flores, & Herrera, 2014), posttraumatic growth (Boals & Schuettler, 2011;Boals, Steward, & Schuettler, 2010), symptoms of depression (Boals, 2014;Newby & Moulds, 2011), social anxiety (Matos, Pinto-Gouveia, & Gilbert, 2013), neuroticism (Ogle, Rubin, & Siegler, 2014;Rasmussen & Berntsen, 2010), disturbed grief (Boelen, 2009(Boelen, , 2012a(Boelen, , 2012b, and persistent pain (Perri & Keefe, 2008), and negatively correlated with physical health and general psychological well-being (Waters, 2014; for a recent review of correlates of event centrality see Gehrt, Berntsen, Hoyle, & Rubin, 2018). Although research has been conducted with a Dutch translation of the CES (Boelen, 2009(Boelen, , 2012a(Boelen, , 2012bSmeets, Giesbrecht, Raymaekers, Shaw, & Merckelbach, 2010;Wessel et al., 2014) no studies systematically evaluated the psychometric properties of the Dutch CES. ...
... Moreover, participants with probable PTSD according to the PCL cut-off score reported higher CES scores (Hypothesis 3). These results suggest that there is a reliable relation between event centrality of a negative life event and symptoms of PTSD (Barton, Boals, & Knowles, 2013;Berntsen & Rubin, 2006, 2007Boals, 2010;Brown et al., 2010;Roland et al., 2014). ...
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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.
... The findings can also not be generalized to other ethnic groups. Third, this study did not assess the duration of each traumatic life event and event centrality [39], which may also influence trauma responses. Fourth, the severity of traumatic events was reported at the time of interview, not at the time when the traumatic event took place. ...
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Existing studies on traumatic events focused on children, while it has been understudied in older adults. This study aims to examine prevalence, frequency, and severity of life events in older Chinese Americans. The data were drawn from the Population Study of Chinese Elderly (PINE) in 2017–2019. Twenty life events were evaluated, including natural disasters, personal traumatic events, and historical events. Among 3125 participants, the mean age was 75.33 (standard deviation (SD) = 8.22) with 61.06% female. Cultural Revolution (73.27%) has the highest prevalence. A total of 1819 (58.39%) participants reported typhoon and experienced multiple times. Falsely accused of crime was reported as the most severe event. Women were more likely to report family-related life events. Those with higher education were more likely to report personal traumatic events. This study is among the first to profile life events in older Chinese Americans. Age cohorts, gender roles, and socioeconomic status shape individuals’ exposure to life events. This study could help identify which vulnerable groups have high risks of exposure to traumatic events.
... Indeed, high EC may cause individuals to overestimate or emphasize the negative effects of the endured trauma which, in turn, will foster post-traumatic stress. However, EC may also be associ ated with posttraumatic growth in survivors of different traumatic events (Allbaugh, Wright, & Folger, 2016;Barton, Boals, & Knowles, 2013;Roland, Currier, Rojas-Flores, & Herrera, 2014;Staugaard, Johannessen, Thomsen, Bertelsen, & Berntsen, 2015). This positive link could be explained by the fact that construing a traumatic experience as central to one's identity may result in more posttraumatic cognitions (deliberate and intrusive rumination) which, as demonstrated previously, is highly associated with PTG. ...
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People who experience major life crises often report post-traumatic stress. However, the literature suggests that traumatic experiences can also be "catalysts" for positive change (i.e., posttraumatic growth; PTG). PTG (Calhoun & Tedeschi, 2006) can include improved relationships, new possibilities for one’s life, a greater appreciation for life, a greater sense of personal strength, and spiritual development. While the general population isn’t confronted with traumatic events regularly, individuals such as firefighters, policemen, and EMTs are. But what factors foster the emergence of PTG? To answer this question, a systematic search of four major database (Psychology and Behavioral Sciences Collection, PsycARTICLES, PsycINFO, and ScienceDirect) was conducted. Some of the factors that promoted PTG included sharing negative emotions, cognitive processing or rumination, positive coping strategies (e.g. positive reappraisal), personality traits (e.g. agreeableness), experiencing multiple sources of trauma, event centrality, resilience, and growth actions. Other factors may be mediators of PTG rather than direct influencers (e.g., seeking social support coping, social support, optimism, etc.). Finally, studies show a positive correlation between PTG and support for aggressive behavior suggesting that growth may be more nuanced than originally thought. By exploring systematically the factors that foster PTG in trauma-exposed professionals, we hope this systematic review would both provide avenues for future research and help design news methods of prevention and intervention for first responders.
... Dans le cadre d'une exposition à un événement traumatique, l'émotion initiale et les troubles mnésiques peuvent fortement altérer ce processus identitaire en constante évolution. Ainsi, le TSPT peut conduire à un changement de vision du monde brutal, entraînant le sujet à redéfinir ce qui faisait ses valeurs, ses croyances personnelles et les attentes qu'il avait et qu'il aura dorénavant envers le monde extérieur [40][41][42][43][44], et ce quelle que soit l'origine de l'événement [45][46][47][48][49]. En partie à cause des altérations mnésiques, les personnes souffrant d'un TSPT sont plus susceptibles d'attribuer un rôle central à l'événement traumatique dans leur conception d'elles-mêmes, cette expérience devenant 4 ...
Article
Résumé Le trouble de stress post-traumatique (TSPT), résultant de l’exposition à un événement extrêmement stressant, a inscrit son histoire dans un contexte psychiatrique et militaire et reste, aujourd’hui encore, une pathologie contemporaine largement débattue. Les recherches des dernières décennies et la révision récente des critères diagnostiques du manuel diagnostique et statistique des troubles mentaux (en anglais Diagnostic and Statistical Manual of Mental Disorders, DSM ; 1994, 2013) ont conduit de nombreux chercheurs et cliniciens à considérer le TSPT comme une « pathologie de la mémoire ». Celle-ci est caractérisée par la présence simultanée d’une hypermnésie des éléments centraux et émotionnels de l’événement et une fragmentation des souvenirs périphériques et contextuels, rendus incohérents par leur manque d’intégration autobiographique. Ces atteintes mnésiques sont fréquemment décrites dans le cadre du TSPT, mais font toujours l’objet d’âpres débats scientifiques et cliniques. Malgré tout, la symptomatologie traumatique est classiquement définie par des atteintes mnésiques caractéristiques et supposément marquées par un manque de cohérence narrative et une fragmentation des souvenirs rappelés. Par ailleurs, l’exploration de la mémoire traumatique a, depuis plusieurs années, entretenu un vif débat contemporain concernant la récupération des souvenirs issus d’abus infantiles, réactualisant ou réinterprétant les investigations psychologiques et thérapeutiques passées de la mémoire traumatique. Ce travail propose une présentation des considérations actuelles de la mémoire traumatique développée dans le cadre du TSPT, et une discussion autour de ces deux éléments de controverse : la fragmentation et l’incohérence du souvenir traumatique mémorisé et la récupération tardive des souvenirs « réprimés » du traumatisme initial.
... We did not assess trauma severity (S. T. Scott, 2007) or event centrality (Roland, Currier, Rojas-Flores, & Herrera, 2014), two factors that may also impact responses. Moreover, whereas we accounted for cumulative number of different events experienced, we could not account for the number of times a particular event may have occurred nor its duration. ...
Article
Full-text available
Objective: The objective of the study was to explore how type and timing of prior negative life experiences (NLEs) may be linked to responses to subsequent collective trauma, such as a terrorist attack. Method: Using a longitudinal design, we examined relationships between prior NLEs and responses to the 2013 Boston Marathon bombings (BMB). Shortly after the BMB, a representative sample, compiled from metropolitan Boston (n = 846), New York (n = 941), and the rest of the United States (n = 2,888), reported BMB exposure and acute stress symptomatology. Six months later, we assessed prior NLEs, BMB-related posttraumatic stress symptoms, ongoing fear about future terrorism, and functioning. NLEs were classified by Diagnostic and Statistical Manual of Mental Disorders, fifth edition, criteria for traumatic events and other stressful experiences and by occurrence in childhood, adulthood (pre-BMB), and recent (past 6 months). Results: Cumulative exposure to events, delineated by type and timing of occurrence, were contrasted; analyses adjusted for demographics, BMB-related exposure, and residential region. Post-BMB acute stress was associated with childhood (b = 0.88, 95% confidence interval [CI: 0.14, 1.61]) and adulthood (b = 0.83, 95% CI [0.21, 1.45]) trauma exposure. Exposure to childhood, adulthood, and recent traumatic events, as well as recent stressful events, was associated with higher BMB-related posttraumatic stress (ps < .05). Greater exposure to adulthood (b = 0.06, 95% CI [0.01, 0.11]) and recent (b = 0.30, 95% CI [0.01, 0.58]) trauma was associated with higher fear about future terrorism. Exposure to childhood (b = 0.17, 95% CI [0.07, 0.27]) and adulthood (b = 0.15, 95% CI [0.05, 0.25]) trauma and recent stressful events (b = 0.45, 95% CI [0.24, 0.66]) was associated with poorer functioning. Conclusion: Prior trauma may sensitize negative responses to collective trauma; recent stressors may exacerbate effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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While research suggests that the war in Syria has led to a drastic re-evaluation of oneself and elevated psychiatric symptoms among Syrian refugees, little is known whether these psychological reactions might be influenced by maladaptive beliefs about oneself and the world and their ability to cope with the effect of the trauma. This study aimed to provide further evidence on the association between trauma centrality, posttraumatic stress, and psychiatric comorbidity, and examine whether cognitive distortions and trauma-coping self-efficacy would mediate the impact of trauma centrality on distress among Syrian refugees residing in Sweden. Four-hundred seventy-five Syrian refugees completed a demographic page, the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Cognitive Distortion Scales, and trauma-coping self-efficacy. Results showed that trauma centrality was significantly correlated with posttraumatic stress disorder (PTSD) and psychiatric comorbidity after adjusting the effects of trauma exposure characteristics. Cognitive distortions mediated the impact of trauma centrality on the two distress outcomes; trauma-coping self-efficacy did not but was negatively correlated with outcomes. To conclude, the war in Syria changed self-perception, outlook on life, and identity among Syrian refugees. These changes were related to increased psychological symptoms especially for those who had distorted beliefs about themselves and the world. Refugees’ belief in the lack of ability to cope with the effect of the trauma impacted psychological distress independently of changes in self-perception.
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Background: The devastation of the Syrian war can lead to a drastic re-evaluation of oneself and alteration in self-capacities. Yet, little is known regarding its impact on these domains among Syrian refugees. Aims: To investigate the inter-relationship between trauma characteristics, trauma centrality, self-efficacy, emotional suppression, PTSD and psychiatric co-morbidity among Syrian refugees. Methods: 1197 refugees from Turkey and Sweden completed the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Generalized Self-Efficacy Scale and Courtauld Emotional Control Scale. Results: Using the DSM-IV criteria for PTSD from the Harvard Trauma Questionnaire, 43% met the criteria. The PTSD group reported significantly higher levels of trauma characteristics, trauma centrality and psychiatric co-morbidity but a lower level of self-efficacy than the non-PTSD group. Trauma characteristics were positively associated with trauma centrality; trauma centrality was negatively correlated with self-efficacy. Contrary to hypothesis, self-efficacy was positively correlated with emotional suppression which was positively correlated with psychiatric co-morbidity but not PTSD. Conclusions: The experience of war can lead to the emergence of PTSD among Syrian refugees. Exposure to war can alter self-perception, belief of personal mastery over one’s future and the way emotion is expressed, all of which can have specific effects on general psychological symptoms.
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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 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. This article is protected by copyright. All rights reserved.
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