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RESEARCH ARTICLE
Vivid memories of distant trauma: Examining the
characteristics of trauma memories and the relationship with
the centrality of event and posttraumatic stress 26 years
after trauma
Ines Blix | Marianne S. Birkeland | Siri Thoresen
Norwegian Centre for Violence and Traumatic
Stress Studies, Oslo, Norway
Correspondence
Ines Blix, Norwegian Centre for Violence and
Traumatic Stress Studies, NKVTS,
Pb. 181 Nydalen, Oslo 0409, Norway.
Email: ines.blix@nkvts.no
Funding information
The independent commission for the
Scandinavian Star case
Summary
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 dif-
ferent types of trauma exposure, namely survivors and bereaved, from the fire on the
passenger ferry, Scandinavian Star, 26 years earlier. More than two decades after the
fire, the traumatic event was represented as a vivid, emotional recollection for many
of the victims. For both the survivors and the bereaved, a higher degree of vividness
of trauma memories and centrality of the event were associated with higher levels of
posttraumatic stress. The present findings show that even very distant trauma mem-
ories 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.
KEYWORDS
centrality of event, memory, posttraumatic stress
1|INTRODUCTION
Memories of traumatic experiences are often described as vivid repre-
sentations involving sensory impressions and a sense of reliving.
According to cognitive theories of posttraumatic stress disorder
(PTSD), trauma memories play a key role in the development and
maintenance of posttraumatic stress reactions (Brewin, Dalgleish, &
Joseph, 1996; Ehlers & Clark, 2000; Rubin, Berntsen, & Bohni, 2008).
Memory is also central in the DSM-5 diagnostic criteria for post-
traumatic stress disorder (PTSD). According to DSM-5, PTSD can
involve disturbances in voluntary retrieval of autobiographical mem-
ory defined as ‘inability to recall key features of the trauma’, and
difficulties in involuntary retrieval of autobiographical memories
defined as ‘unwanted upsetting memories’and ‘flashbacks’.
While there is a consensus about the important role of trauma
memory in PTSD, there are divergent views concerning how trauma
memories are processed and how they produce symptoms. According
to some scholars, the integration of traumatic experiences in autobio-
graphical memory is prevented by maladaptive strategies like avoid-
ance and suppression of disturbing thoughts (Brewin et al., 1996;
Ehlers & Clark, 2000). This lack of integration of trauma memories is
proposed not only to result in difficulties in voluntary retrieval of
trauma memories but also repeated recall of vivid involuntary memo-
ries of the traumatic event (for a review see Dalgleish, 2004).
Received: 24 September 2019 Revised: 29 February 2020 Accepted: 2 March 2020
DOI: 10.1002/acp.3650
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2020 The Authors. Applied Cognitive Psychology published by John Wiley & Sons Ltd.
Appl Cognit Psychol. 2020;1–7. wileyonlinelibrary.com/journal/acp 1
However, according to a different perspective, trauma memories, like
memories from other emotional and distinct experiences, tend to be
highly integrated with our self-concept, interconnected with other
autobiographical memories, and characterized by enhanced memory,
in the form of highly accessible and vivid memories (Rubin, Berntsen, &
Bohni, 2008; Rubin, Boals, & Berntsen, 2008). Furthermore, difficul-
ties in voluntary retrieval of trauma memories are not well docu-
mented; on the contrary, enhancement for emotional stressful or
traumatic experiences is found for both voluntary and involuntary
recall (Berntsen & Rubin, 2014; Hall & Berntsen, 2008). In line with
this, in a literature review on studies of trauma narratives, Crespo and
Fernández-Lansac (2016) reported that trauma memories are charac-
terized by sensory and emotional details, and the degree of sensory
detail was associated with posttraumatic stress.
To explain how trauma memories tend to be highly integrated
with autobiographical memory, the concept ‘centrality of event’was
introduced (Berntsen & Rubin, 2006a). According to this perspective,
when a traumatic experience is construed as central to one's identity
and represented as a reference point in autobiographical memory,
this leads to more accessible and vivid memories of the traumatic
event, and this can, in turn, lead to posttraumatic stress symptoms
(Berntsen and Rubin (2006a, 2006b). In line with this, studies with
student samples (Berntsen & Rubin, 2006a, 2007; Boals & Schuettler,
2011, Boals, Steward, & Schuettler, 2010; Webb & Jobson, 2011)
and trauma-exposed individuals (Blix, Birkeland, Solberg, Hansen &
Heir, 2016; Brown, Antonius, Kramer, Root, & Hirst, 2010;
Robinaugh & McNally, 2011; Roland, Currier, Rojas-Flores, & Herrera,
2013) have shown that the degree of centrality for highly stressful
events is indeed associated with higher levels of post-traumatic
stress symptoms. Similarly, in a prospective study with bereaved indi-
viduals, Boelen (2012) found that the centrality of a loss was associ-
ated with concurrent symptom levels and severity of symptoms one
year after the loss for prolonged grief disorder, depression and PTSD.
Furthermore, several studies have reported a relationship
between the centrality of event, the vividness of trauma memories
and posttraumatic stress (Berntsen & Rubin, 2006a, 2006b; Fitzgerald,
Berntsen, & Broadbridge, 2016; for a systematic review, see Gehrt,
Berntsen, Hoyle, & Rubin, 2018). Two cross-sectional studies explored
these relationships using mediation analyses. In one study, centrality
was found to mediate the relationship between reliving and post-
traumatic stress (Fitzgerald et al., 2016). In another study, the vivid-
ness of trauma memories was found to mediate the relationship
between the centrality of event, and acute stress reactions and
depression symptoms (Mordeno, Galela, Nalipay, & Cue, 2018).
The role of the vividness of trauma memories and the centrality
of an event might be particularly relevant to consider when post-
traumatic stress reactions endure over a very long time. In general,
memories of personal experiences fade and become less vivid as time
passes by (Schacter, 2002). However, some research suggests that
trauma memories might not fade over time to the same extent as
other personal memories. In a prospective longitudinal study compar-
ing positive and traumatic autobiographical memories, Porter and
Peace (2007) reported that while ratings of vividness, overall quality
and sensory components declined for positive memories, these ratings
remained nearly unchanged for memories of traumatic events.
Most studies investigating the relationship between trauma
memory and posttraumatic stress have focused on fairly recent
trauma, or in samples with variation in how much time has passed
since the traumatic experience. Only a few studies have investigated
the phenomenological characteristics of very distant trauma memo-
ries. Hiskey, Luckie, Davies, and Brewin (2008) reported that elderly
people with intrusive memories from a distant traumatic event expe-
rienced these memories as intense and with vivid sensory compo-
nents. Furthermore, in a study with individuals who reported
traumatic experiences during World War II, the vividness of trauma
memories and centrality of the event was associated with post-
traumatic stress reactions decades after the traumatic experience
(Berntsen & Rubin, 2006b). This suggests that the degree to which
an event is vividly recalled and construed as central to identity and
life story might be factors that contribute to maintaining post-
traumatic stress reactions in the very long term. In the present study,
we investigate the role of vividness and centrality 26 years after a
disaster and thereby add to the very scarce literature on long-term
adjustment after trauma.
A pertinent question, that has not been of focus in the litera-
ture so far, is whether different types of exposure are associated
with differences in characteristics and degree of vividness of
trauma memories. The first aim in this cross-sectional study was to
explore the phenomenological characteristics of voluntarily
retrieved memories (memories recalled with purpose after being
asked to recall what happened) of a distant traumatic experience
in two groups with different types of trauma exposure. The partici-
pants in the present study were all affected by the fire on the pas-
senger ferry, Scandinavian Star, 26 years earlier. Some were
survivors with a life-threatening experience and others were
bereaved who had suffered a traumatic loss. Although the survi-
vors probably experienced more distinct sensory impressions during
the fire, the experience of the bereaved was also highly emotional
and distinct, and we expected that the memories of the bereaved
would also be represented as vivid. We had no particular expecta-
tions regarding potential differences between the groups in the
overall level of vividness. However, based on their very different
traumatic exposures, we wanted to explore potential differences in
phenomenological characteristics between the two groups.
The second aim was to investigate the relationship between the
vividness of trauma memories, the centrality of event and post-
traumatic stress reactions. We expected that the bereaved would
report higher centrality ratings compared to the survivors. While the
traumatic event itself can be a turning point and become central in
one's life story, we hypothesized that losing someone close would
remain more central after decades. Furthermore, we hypothesized
that a higher level of vividness of trauma memories and a higher level
of event centrality would be associated with posttraumatic stress
reactions for both survivors and bereaved.
2BLIX ET AL.
2|METHODS
2.1 |Participants and procedure
The present cross-sectional study was a part of a systematic investiga-
tion of the current mental health status of Norwegian survivors and
bereaved from the passenger ferry, Scandinavian Star, requested by
the Norwegian Parliament in 2016 (Thoresen et al., 2017). At the time
of the fire, 482 persons were on board the ship, of which 159 (33%)
died. The majority of the bereaved (86%) lost a close family member
(58% of the sample lost one and 27% lost more than one close family
member).
Based on lists over survivors and bereaved that we received from
an independent commission appointed by the Norwegian Parliament
with the mandate to evaluate the case of the Scandinavian Star ferry
disaster, we contacted 163 Norwegian survivors and 158 bereaved
during the autumn of 2016, 26 years after the fire. Information about
the study and an invitation to participate were sent by post, and those
who did not want to participate were given the possibility to notify us
if they did not wish to be contacted on the telephone. The inter-
viewers made contact by phone and asked if they wished to
participate.
We had limited information for comparing responders and non-
responders. However, women (98 out of 145 = 68%) were more likely
than men (95 out of 176 = 54%) to participate. Among the survivors,
23% reported having been located in the deadliest parts of the ship
(pre-defined according to certain corridors on certain decks) at the
time the fire started, compared to the original police investigation
placing 28% in these areas. Among the bereaved participants, 70%
had lost a partner, child, parent, and/or a sibling in the fire, compared
to 62% among the bereaved who did not participate in the study.
Informed consent was a two-step process. Before the interview,
the participants (N= 193) consented in writing that the information
could be included in our report to the Norwegian Government. After
completing the interview, most participants (96%, N= 185) gave addi-
tional written consent to use the information for research purposes.
In total, 185 individuals participated in the present study, including
94 survivors and 91 bereaved, resulting in response rates of 57 and
58%, respectively.
The traumatic exposure was severe for many of the survivors, as
76% were in areas of the ship with heavy smoke, 42% heard people
screaming or calling for help, 36% saw injured persons or bodies of
deceased persons, and 62% experienced a dangerous situation during
the evacuation of the ship (authors own). Among the survivors, a small
minority lost a close family member (7%). Of the bereaved, 86%
(n= 78) lost one, two or three close family members in the fire, that is,
partners, children, siblings, parents, grandchildren, or grandparents,
and of the remaining 13 individuals, 10 lost other relatives and 3 lost
ex-partners or others. The bereaved included individuals who were
not present on the ship, but who lost someone close. Among the
bereaved 19% (17 out of 91) of the participants scored above cut-off
for a probable PTSD diagnosis, according to their responses on the
PCL. Using a cut-off score of 31 on the PCL (Blevins, Weathers, Davis,
Witte, & Domino, 2015), 16% (15 out of 94) of the survivors scored
above the cut-off for PTSD.
Data collection took the form of face-to-face interviews, com-
bined with questionnaires filled out by the participants on a tablet
with the interviewer available. The responses were transferred
encrypted to storage within the University of Oslo's services for sensi-
tive data (TSD). To ensure confidentiality, no data were stored on the
tablet. The data used in the current study were part of the self-report
section of the interview. Strict procedures were followed to ensure
confidentiality, and the study was approved by the Regional Commit-
tee for medical and health research ethics. The study also included a
follow-up service for participants in distress.
2.2 |Measures
2.2.1 |Demographics
Demographic information included gender, age and education. For
education, the participants were asked about the number of years of
education after mandatory school. Mandatory school in (Norway) was
9 years at the time of the disaster.
2.2.2 |Memory characteristics
To measure memory characteristics, we used a set of rating scales
from the Autobiographical memory questionnaire (Rubin, Dennis, &
Beckham, 2011; Rubin, Schrauf, & Greenberg, 2003). Participants
were asked to take a moment and think about what happened during
the fire on the Scandinavian Star and asked to indicate on a 7-point
scale [from 1 (not at all) to 7 (to a very large extent)] how they cur-
rently experienced these memories in terms of sensory vividness (it is
like I can hear what is happening, it is like I can see what is happening,
it is like I can feel the smell), emotional experience (I can feel intense
emotions) and sense of reliving (it is like I re-experience what hap-
pened, it is like travelling back in time). A total vividness score was cal-
culated as the mean of all items. Cronbach's alpha was .90.
2.2.3 |The centrality of event
The Centrality of event scale (CES) (Berntsen & Rubin, 2006a) mea-
sures the degree to which an event is integrated into an individual's
life story and identity. The short version is a seven-item questionnaire
with items representing the three factors of reference point, identity,
and turning point: (1) ‘I feel that the event has become part of my
identity’; (2) ‘This event has become a reference point for the way I
understand myself and the world’; (3) ‘I feel that this event has
become a central part of my life story’; (4) ‘This event has coloured
the way I think and feel about other experiences’; (5) ‘This event per-
manently changed my life’; (6) ‘I often think about the effects this
event will have on my future’; and (7) ‘This event is a turning point in
BLIX ET AL.3
my life’. Due to a technical error, Item No. 7 of the CES was omitted
from our questionnaire, and the data are based on Item 1–6 of the
CES. The six questions were rated on a scale from 1 (strongly dis-
agree) to 5 (strongly agree). The scores were calculated as the mean
of all items. Cronbach's alpha was .91.
2.2.4 |Posttraumatic stress
The Posttraumatic Check List (PCL) is a 20-item self-administered
questionnaire that assesses the DSM-5 PTSD symptoms (Blevins
et al., 2015). We used the PCL-S (specific), and the items were specifi-
cally linked to the fire on Scandinavian Star. The participants were
asked to indicate on a 5-point scale (ranging from 0 to 4) the extent to
which extent they had been bothered by each symptom during the
last month. The PCL symptoms score was calculated as the mean of
all items. Cronbach's alpha for the total scale was .94.
3|RESULTS
Distribution of gender, mean age, mean years of education after man-
datory school, mean PCL and mean centrality of event scores are
presented separately for survivors and bereaved (Table 1). While the
groups did not differ in mean age, years of education or gender, the
bereaved group reported higher mean levels of the centrality of event
and posttraumatic stress reactions.
To test mean differences in trauma memory characteristics
between survivors and bereaved, independent sample t-tests were
performed (Table 1). Overall, we did not find evidence that the total
mean vividness scores differed between survivors and bereaved.
When looking at the individual items, the survivors to a larger extent
reported that they can feel the smell, compared to the bereaved. The
bereaved to a larger extent reported experiencing intense feelings and
re-experiencing, compared to the survivors.
Pearson correlations were performed separately for survivors and
bereaved to investigate the relationships between the vividness of
trauma memories, the centrality of event and posttraumatic stress
reactions (Table 2). The results showed significant associations of a
similar magnitude between all these variables, both for survivors and
bereaved.
To investigate the relationship between vividness, the centrality
of event and levels of posttraumatic stress reactions linear regression
analyses were performed separately in the two groups (Survivors,
Bereaved) with PCL scores as the dependent variable. First, memory
vividness and centrality were entered as independent variables in two
TABLE 1 Sample characteristics, mean total scores for posttraumatic stress reactions (PCL), centrality of event (CES), memory vividness
(AMQ), and mean score for each item on AMQ for survivors (n= 94) and bereaved (n= 91) (standard deviations in parentheses)
Survivors (n= 94) Bereaved (n= 91)
Mean (SD) Mean (SD)χ
2
or t,pCohen's d
Gender
Female 43 (45.7) 51 (56.0) χ
2
(1) = 1.96, p= 0.187
Male 51 (54.3) 40 (44.0)
Age in years 53.4 (14.4) 57.4 (14.5) 1.85, p=.066
Years of education
a
3.3 (1.4) 3.4 (1.4) .76, p=.464
Posttraumatic stress (PCL) .70 (.71) .95 (.83) 2.17, p=.031 .32
Centrality of event (CES) 2.74 (1.24) 3.57 (1.02) 4.97, p> .001 .73
Memory vividness (AMQ) 3.67 (1.85) 3.64 (1.66) .12, p= .906
It is like I can hear what is happening 3.17 (2.08) 3.01 (2.06) −.52, p=.605
It is like I can see what is happening 4.33 (2.10) 4.19 (2.12) −.45, p=.641
It is like I can feel the smell 3.90 (2.40) 2.22 (1.86) −5.25, p<.001
I can feel intense emotions 3.65 (2.21) 4.29 (2.11) 1.99, p=.048
It is like I re-experience what happened 3.78 (2.21) 4.49 (2.02) 2.26, p=0.25
It is like travelling back in time 3.20 (2.16) 3.56 (2.09) 1.12, p=.266
Note: Group comparisons are reported as Chi-Square and t-tests with associated p-values, effect sizes are reported as Cohen's d.
a
For education, the participants were asked about the number of years of education after mandatory school. Mandatory school in (country) was 9 years at
the time of the disaster.
TABLE 2 Correlations between centrality of event (CES),
posttraumatic stress (PCL), and memory vividness (AMQ) for survivors
and bereaved
Survivors Bereaved
2323
1. Posttraumatic stress (PCL) .64*** .55*** .46*** .43***
2. Centrality of event (CES) .53*** .51***
3. Memory vividness (AMQ)
***p<.001.
4BLIX ET AL.
separate regression analyses, while adjusting for age and gender
(Model 1). In the mutually adjusted model (Model 2), memory vivid-
ness and centrality of event were both included simultaneously while
adjusting for age and gender. The results showed that both centrality
of event and memory vividness were uniquely associated with the
level of posttraumatic stress reactions in both groups (Table 3).
4|DISCUSSION
More than 26 years after the fire on the Scandinavian Star, the trau-
matic event was still represented as a vivid, emotional recollection for
many of the victims. This was true for both the survivors and the
bereaved in this study, even though the quality of their traumatic
experiences were highly different. The mean scores for both survivors
and bereaved were around the midpoint of the AMQ scale and may
be considered high, given the 26 years that have passed since the
traumatic event. The present study involved trauma memories that
were voluntarily retrieved, and the results showed that a considerable
proportion of the survivors and bereaved experienced sensory
impressions, intense emotions and a sense of reliving when asked to
recall the event. The survivors, who experienced the fire and the risky
evacuation from the ship first hand, were probably exposed to highly
distinct sensory impressions at the time of the disaster. Although they
reported more olfactory vividness, they did not differ from the
bereaved group, on the other types of sensory vividness. The
bereaved individuals reported a higher level of re-experiencing and
emotional activation when remembering what happened, and in sum,
we found no notable mean difference in vividness between the two
groups. Hence, 26 years after the disaster, the survivors who at the
time of the disaster had been exposed to extraordinary sensory
impressions (e.g., corridors full of smoke, fire, the sight of dead and
injured people, being evacuated from the ship under very dramatic cir-
cumstances) reported similar levels of vividness of their memories as
the bereaved, which had been surrounded by a more everyday con-
text when they learned what happened. Thus, the particular sensory
impressions at the time of the trauma do not necessarily impact the
overall level of vividness of trauma memories in a long-term perspec-
tive. These results show that traumatic experiences can be experi-
enced as vivid recollections decades later both for individuals who
were exposed to a highly life-threatening event and for individuals
who experienced a traumatic loss. This is in line with Porter and Peace
(2007) and Hiskey et al. (2008) who reported that even distant trauma
memories can be experienced as intense and with vivid sensory
components.
For some people, the fire on the Scandinavian Star has become a
reference point in their life story and was perceived as central to iden-
tity. Consistent with previous findings (Berntsen & Rubin, 2006a,
2006b; Fitzgerald et al., 2016), a higher degree of centrality was asso-
ciated with higher levels of vividness. Thus, in line with Berntsen and
Rubin's (2007) perspective, the present results suggest that construing
the event as central in one's life story and to one's identity, can be
one important factor that contributes to keeping the memories alive
TABLE 3 Linear regression analysis for centrality of event (CES) and memory vividness (AMQ) predicting posttraumatic stress symptoms (PCL), in survivors (n= 91) and bereaved (n= 94),
adjusted for gender and age
Survivors Bereaved
Model 1 Model 2 Model 1 Model 2
B95% CI βpB95% CI βpB95% CI βpB95% βp
Age −.01 −.01–.01 −.03 .755 .01 −.01–.01 .05 .568 −.01 −.11–1.03 −.16 .109 −.01 −.01–.01 −.05 .663
Gender .02 −.24–.27 .01 .910 −.02 −.25–.20 −.01 .839 .03 −.29–.36 .02 .837 −.06 −.48–.26 −.04 .720
Memory vividness (AMQ) .22 .14–.29 .55 <.001 .11 .04–.19 .29 .003 .21 .11–.31 .42 <.001 .14 .03–.25 .27 .015
Centrality of event (CES) .37 .28–.47 .64 <.001 .29 .19–.40 .49 <.001 .38 .21–.55 .47 <.001 .32 .07–.46 .32 .008
R
2
.48 .28
Adjusted R
2
.45 .24
Note: Model 1: memory vividness and centrality were entered separately while adjusting for age and gender. Model 2: vividness and centrality of event were included simultaneously while adjusting for age and
gender.
BLIX ET AL.5
over such a long time. In the present study, the centrality of the trau-
matic event was higher in the bereaved group compared to the survi-
vors. Previous studies have shown that for many bereaved, the loss is
construed as a central event in their life story (Boelen, 2012). How-
ever, this study was the first to compare the level of centrality in two
groups who were afflicted by the same disaster, some as trauma survi-
vors and some as bereaved. The higher level of centrality in the
bereaved group might be explained by the nature of the loss. Loss is
definite and unrepairable, and new life experiences can be bitter
reminders that these cannot be shared with the deceased.
For both survivors and bereaved, more vivid trauma memories and a
higher level of event centrality were associated with higher levels of
posttraumatic stress reactions. For both factors, their associations with
posttraumatic stress reactions were largely reduced when considered
together. This indicates that vividness and centrality are interdependent
factors. Two previous studies have investigated the potential mediating
effect of vividness on the association between centrality and post-
traumatic stress reactionsand the potential mediating effect of centrality
on the association between vividness and posttraumatic stress reactions
(Fitzgerald et al., 2016; Mordeno et al., 2018). However, future longitudi-
nal studies are needed to disentangle the temporal relationships
between these factors and to further reveal how these processes
develop over time.
Our results also suggest that vividness and centrality contribute
uniquely to the maintenance of posttraumatic stress symptoms in the
long run, indicating that these factors may represent distinct pathways.
In other words, there seems to be more to vividness than what can be
explained by centrality, and vice versa. Vivid representations of traumatic
memories may thus feed into posttraumatic stress symptoms indepen-
dently of the degree of centrality of the event. Future research could
investigate whether vividness and centrality impact differentially on the
symptom clustersof posttraumatic stress disorder, or if particular aspects
of vivid trauma memories contribute more to symptom maintenance. A
better understanding of the mechanisms involved is necessaryto prevent
long-term suffering in bereaved andtrauma-exposed individuals.
The present results are in contrast to the view proposing that
posttraumatic stress is associated with difficulties in voluntary recol-
lection of trauma memories. On the contrary, these results suggest
that both vividness and integration of trauma memories in autobio-
graphical memory may contribute to the maintenance of post-
traumatic stress reactions. It is important to note however that the
design of the present study does not allow us to disentangle the
dynamic of the relationship between the centrality of event, the vivid-
ness of trauma memories and posttraumatic stress reactions. One
possibility is that the dynamic between these concepts resembles sev-
eral feedback loops where vivid memories contribute to keeping the
event central, and centrality contributes to keeping the memories
vivid. Similarly, posttraumatic stress reactions contribute to keeping
the memory vivid and central, and centrality and vividness contribute
to the maintenance of posttraumatic stress reactions. Future prospec-
tive studies should look closer at the temporal relationship between
how trauma memories are represented, the centrality of event and
posttraumatic stress reactions.
Although both groups in the present study qualify for the stressor cri-
terion in the DSM-5 PTSD diagnosis (American Psychiatric Association,
2013), life threat and traumatic loss are highly different experiences.
However, little is known about the long-term course of posttraumatic
stress reactions after different types of exposure. In our study, the
bereaved, compared with survivors reported significantly higher levels of
posttraumatic stress. This shows that very long-lasting distress after
trauma can also occur for individuals that were not exposed to a trauma
that involved a threat to own health or life.
The present study has some limitations that need to be
addressed. The memories were constructed and evaluated in an inter-
view setting, and we cannot be sure to what extent these reports
resemble memories constructed in daily life. Furthermore, although
this cross-sectional study had a good response rate, we cannot
exclude that self-selection biases may have affected the result. Self-
selection bias can contribute to both underestimation and over-
estimation of levels of posttraumatic stress. Some individuals with a
low level of current distress may have considered the study irrelevant
for them, whereas individuals with excessive symptoms may have
found participation too distressing. However, even though non-
participation might have affected the observed levels of the vividness
of the trauma memories, the centrality of the traumatic event and
posttraumatic stress reactions, the associations between the variables
are probably more robust against selection bias.
The long time that has passed since the fire on the Scandina-
vian Star needs to be considered when interpreting the results.
Because the only data collection with this sample was performed
26 years after the traumatic event occurred, we cannot determine
how the relationships between memory, the centrality of event
and posttraumatic stress have developed over time. Nonetheless,
the present results are important for showing that even after a
very long time has passed since the traumatic event, the memories
can be represented as vivid recollections. Furthermore, vividness
and event centrality may contribute to explain how posttraumatic
stress symptoms can remain present over a very long time. Future
prospective studies should look closer at the temporal relationship
between how trauma memories are represented, centrality and
posttraumatic stress reactions.
CONFLICT OF INTEREST
The authors have no conflict of interest to declare.
DATA AVAILABILITY STATEMENT
Research data are not shared, due to sensitive data.
ORCID
Ines Blix https://orcid.org/0000-0002-1603-6281
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual
of mental disorders (5th ed.). Arlington, VA: Author.
Berntsen, D., & Rubin, D. C. (2006a). The centrality of event scale: A mea-
sure of integrating a trauma into one's identity and its relation to post-
6BLIX ET AL.
traumatic stress disorder symptoms. Behaviour Research and Therapy,
44(2), 219–231. https://doi.org/10.1016/j.brat.2005.01.009
Berntsen, D., & Rubin, D. C. (2006b). Flashbulb memories and post-
traumatic stress reactions across the life span: Age-related effects of
the German occupation of Denmark during World War II. Psychology and
Aging,21(1), 127–139. https://doi.org/10.1037/0882-7974.21.1.127
Berntsen, D., & Rubin, D. C. (2007). When a trauma becomes a key to
identity: Enhanced integration of trauma memories predicts post-
traumatic stress disorder symptoms. Applied Cognitive Psychology,21
(4), 417–431. https://doi.org/10.1002/acp.3160
Berntsen, D., & Rubin, D. C. (2014). Involuntary memories and dissociative
amnesia: Assessing key assumptions in posttraumatic stress disorder
research. Clinical Psychological Science,2(2), 174–186. https://doi.org/
10.1177/2167702613496241
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L.
(2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5):
Development and initial psychometric evaluation. Journal of Traumatic
Stress,28(6), 489–498. https://doi.org/10.1002/jts.22059
Blix, I., Birkeland, M. S., Solberg, Ø., Hansen, M. B., & Heir, T. (2016). The
launching and ensnaring effects of construing a traumatic event as
central to one's identity and life story. Applied Cognitive Psychology.,30
(4), 526–531. https://doi.org/10.1002/acp.3224
Boals, A., & Schuettler, D. (2011). A double-edged sword: Event centrality,
PTSD and posttraumatic growth. Applied Cognitive Psychology,25(5),
817–822. https://doi.org/10.1002/acp.1753
Boals, A., Steward, J. M., & Schuettler, D. (2010). Advancing our under-
standing of posttraumatic growth by considering event centrality.
Journal of Loss and Trauma,15(6), 518–533. https://doi.org/10.1080/
15325024.2010.519271
Boelen, P. A. (2012). A prospective examination of the association between
the centrality of a loss and post-loss psychopathology. Journal of Affective
Disorders,137(1), 117–124. https://doi.org/10.1016/j.jad.2011.12.004
Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation the-
ory of posttraumatic stress disorder. Psychological Review,103(4), 670.
https://doi.org/10.1037/0033-295x.103.4.670
Brown, A. D., Antonius, D., Kramer, M., Root, J. C., & Hirst, W. (2010).
Trauma centrality and PTSD in veterans returning from Iraq and
Afghanistan. Journal of Traumatic Stress,23(4), 496–499. https://doi.
org/10.1002/jts.20547
Crespo, M., & Fernández-Lansac, V. (2016). Memory and narrative of trau-
matic events: A literature review. Psychological Trauma: Theory, Research,
Practice, and Policy,8(2), 149. https://doi.org/10.1037/tra0000041
Dalgleish, T. (2004). Cognitive approaches to posttraumatic stress disor-
der: The evolution of multirepresentational theorizing. Psychological
Bulletin,130(2), 228. https://doi.org/10.1037/0033-2909.130.2.228
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress
disorder. Behaviour Research and Therapy,38(4), 319–345. https://doi.
org/10.1016/s0005-7967(99)00123-0
Fitzgerald, J. M., Berntsen, D., & Broadbridge, C. L. (2016). The influences
of event centrality in memory models of PTSD. Applied Cognitive Psy-
chology,30(1), 10–21. https://doi.org/10.1002/acp.3160
Gehrt, T. B., Berntsen, D., Hoyle, R. H., & Rubin, D. C. (2018). Psychological
and clinicalcorrelates of the centrality of eventscale: A systematic review.
Clinical Psychology Review,65,57–80. https://doi.org/10.1016/j.cpr.
2018.07.006
Hall, M. N., & Berntsen, D. (2008). The effect of emotional stress on invol-
untary and voluntary conscious memories. Memory,16(1), 48–57.
https://doi.org/10.1080/09658210701333271
Hiskey, S., Luckie, M., Davies, S., & Brewin, C. R. (2008). The phenomenol-
ogy of reactivated trauma memories in older adults: A preliminary
study. Aging and Mental Health,12(4), 494–498. https://doi.org/10.
1080/13607860802224367
Mordeno, I. G., Galela, D. S., Nalipay, M. J. N., & Cue, M. P. (2018). Central-
ity of event and mental health outcomes in child and adolescent natu-
ral disaster survivors. The Spanish Journal of Psychology,21. https://
doi.org/10.1017/sjp.2018.58
Porter, S., & Peace, K. A. (2007). The scars of memory a prospective, longi-
tudinal investigation of the consistency of traumatic and positive emo-
tional memories in adulthood. Psychological Science,18(5), 435–441.
https://doi.org/10.1111/j.1467-9280.2007.01918
Robinaugh, D. J., & McNally, R. J. (2011). Trauma centrality and PTSD symp-
tom severity in adult survivors of childhood sexual abuse. Journal of
Traumatic Stress,24(4), 483–486. https://doi.org/10.1002/jts.20656
Roland, A. G., Currier, J. M., Rojas-Flores, L., & Herrera, S. (2013).
Event centrality and posttraumatic outcomes in the context of per-
vasive violence: A study of teachers in El Salvador. Anxiety, Stress &
Coping,27(3), 335–346. https://doi.org/10.1080/10615806.2013.
835402
Rubin, D. C., Berntsen, D., & Bohni, M. K. (2008). A memory-based model
of posttraumatic stress disorder: Evaluating basic assumptions under-
lying the PTSD diagnosis. Psychological Review,115(4), 985. https://
doi.org/10.1037/a0013397
Rubin, D. C., Boals, A., & Berntsen, D. (2008). Memory in posttraumatic
stress disorder: Properties of voluntary and involuntary, traumatic and
nontraumatic autobiographical memories in people with and without
posttraumatic stress disorder symptoms. Journal of Experimental Psy-
chology: General,137(4), 591. https://doi.org/10.1037/a0013165
Rubin, D. C., Dennis, M. F., & Beckham, J. C. (2011). Autobiographical
memory for stressful events: The role of autobiographical memory in
posttraumatic stress disorder. Consciousness and Cognition,20(3),
840–856. https://doi.org/10.1016/j.concog.2011.03.015
Rubin, D. C., Schrauf, R. W., & Greenberg, D. L. (2003). Belief and recollec-
tion of autobiographical memories. Memory & Cognition,31(6),
887–901. https://doi.org/10.3758/bf03196443
Schacter, D. L. (2002). The seven sins of memory: How the mind forgets and
remembers. New York, NY: Houghton Mifflin Company.
Thoresen, S., Andreassen, A., Arnberg, F. K., Birkeland, M. S., Blix, I., &
Hjorthol, T. (2017). Scandinavian Star. Erfaringer og helse hos over-
levende og etterlatte etter 26 år. Oslo: Norwegian Centre for Violence
and Traumatic Stress Studies.
Webb, H., & Jobson, L. (2011). Relationships between self-consistency,
trauma-centred identity, and post-traumatic adjustment. Clinical Psy-
chologist,15(3), 103–111. https://doi.org/10.1111/j.1742-9552.2011.
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How to cite this article: Blix I, Birkeland MS, Thoresen S. Vivid
memories of distant trauma: Examining the characteristics of
trauma memories and the relationship with the centrality of
event and posttraumatic stress 26 years after trauma. Appl
Cognit Psychol. 2020;1–7. https://doi.org/10.1002/acp.3650
BLIX ET AL.7