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Is Change in the Centrality of a Traumatic Event Associated with PTSD Symptom Reduction During Intensive Treatment?

Peter Grau, M.S., Sadie Larsen, Ph.D., & Mauricio Garnier-Villarreal, Ph.D.

June 26, 2020

What is it about certain events that makes them really stick with people years later? Some have argued that an event is more likely to be traumatic if it is seen as “central”. The centrality of a traumatic event is the extent to which the trauma becomes fundamental to one’s identity and life story (Berntsen & Rubin, 2006). For instance, that could mean thinking of an event like “I’ve never been the same since” or “My life was ruined by that event”. When a traumatic event becomes a central reference point, it becomes even more distressing to a person, can change how they see themselves (e.g. “There’s something wrong with me that brought this on”), and because of this can lead to both more rumination and more avoidance of thinking about the event (Berntsen & Rubin, 2006, 2007).

Prior research has found that event centrality is correlated with PTSD symptoms, and that it even predicts the later development of symptoms, moreso than other measures of severity or exposure to an event (Boals & Schuettler, 2011). Results have been consistent across multiple populations from veterans and refugees to college students (Brown et al., 2010; Vermeulen et al., 208; Wright, 2015). These findings suggest an intriguing clinical question – if we could decrease how central an event seems to someone, would that help to decrease PTSD symptoms? Does current evidence-based treatment in fact change a sense of centrality?

Despite the growing evidence discussed above, to date, few studies have examined how centrality is affected by PTSD treatment. In our recent study published in The Journal of Traumatic Stress, we tested the hypothesis that change in centrality would be associated with both change in PTSD symptom severity and with discharge PTSD symptom severity in an exposure-based PTSD partial hospitalization program. Overwhelmingly, participants in our study reported histories of childhood trauma (96%), experiencing multiple traumas (98%, average of 11 traumatic events experienced per person). Participants completed a full course of PTSD partial hospitalization programming, which lasted approximately 5-7 weeks. The program is based primarily in Prolonged Exposure (PE) and augmented by psychoeducation and contextual behavioral interventions (i.e. Dialectical Behavior Therapy, Acceptance and Commitment Therapy, mindfulness). The program focuses partially on symptom reduction and partially on defining and pursuing meaning and values.

Results

  1.  At discharge, both PTSD symptoms and centrality had significantly decreased (Cohen’s d = .7 and .98, respectively)
  2. Our centrality change model explained a significant percentage of the variance in PTSD symptom change and the variance in posttreatment PTSD symptoms.

Takeaways

  1. Results indicate that event centrality may contribute to the development and maintenance of PTSD.
  2. Results indicate the potential importance of decreasing the centrality of a traumatic event in PTSD treatment and recovery. These results are intriguing because they show that even an intervention that is not explicitly aimed at decreasing event centrality can still help patients decrease centrality.
  3. Treatment may be most successful when it can help patients to not only decrease symptoms, but to increase the breadth of their self-identity. Consider talking with patients about who they are beyond the trauma, in what other ways they define themselves, and helping them to see that the traumatic event may not have happened to them because they are uniquely bad.

References

Berntsen, D., & Rubin, D. C. (2006). The centrality of event scale: A measure of integrating a trauma into one’s identity and its relation to post-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. (2007). When a trauma becomes a key to identity: enhanced integration of trauma memories predicts posttraumatic stress disorder symptoms. Applied Cognitive Psychology, 21(4), 417–431. https://doi.org/10.1002/acp.1290

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

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

Robinaugh, D. J., & McNally, R. J. (2011). Trauma centrality and PTSD symptom severity in adult survivors of childhood sexual abuse. Journal of Traumatic Stress, 24(4), 483–486. https://doi.org/10.1002/jts.20656

Vermeulen, M., Brown, A. D., Raes, F., & Krans, J. (2018). Decreasing Event Centrality in Undergraduates Using Cognitive Bias Modification of Appraisals. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-018-9936-3

Wright, A. M. (2015). Event centrality after trauma: Stability, trauma type, and posttraumatic
stress disorder.

Reference Article

Grau, P.P., Larsen, S.E., Lancaster, S., Garnier-Villarreal, M., & Wetterneck, C.T. (In Press).
Is Change in the Centrality of a Traumatic Event Associated with PTSD Symptom Reduction During Intensive Treatment? Journal of Traumatic Stress.

Discussion Questions

  1. How might these findings be integrated into evidence-based PTSD treatment?
  2. How can we continue to use clinical outcomes data to inform effective PTSD treatment and research?

About the Authors

Peter Grau, M.S. is a doctoral student and instructor in the department of Counselor Education and Counseling Psychology at Marquette University, as well as an incoming intern for the Clinical Psychology Internship Program of 2020-2021 at the Ann Arbor VA. His interests include evidence-based PTSD treatment and research, acceptance-based interventions, and transdiagnostic processes of change in evidence-based treatments.

Sadie Larsen, Ph.D. is a psychologist (Milwaukee VA) and Associate Professor (Medical College of Wisconsin), who also works for the National Center for PTSD Consultation Program. Her research and clinical interests are around recovery from PTSD and how we can best utilize evidence-based treatments.

Mauricio Garnier-Villarreal, Ph.D. is a quantitative psychologist and Research Assistant Professor at Marquette University. His research cover two overall areas: First, the development and testing of advance data analysis techniques to provide best practices guidelines for applied research. Second, the use of advance data analysis techniques in applied health research.