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Abstract

This study sought to investigate event centrality and posttraumatic growth (PTG) as mediators between retrospectively reported trauma symptoms (RTS) shortly after the sexual assault occurred and self-reported trauma symptoms at the current time (CTS). College students who experienced sexual assault completed an online questionnaire. Results found that event centrality, and not PTG, mediated the relationship between RTS and CTS. This suggests that sexual assault survivors who viewed the traumatic event as central to their life and identity tended to have current trauma symptoms more closely corresponding to their trauma symptoms (rated retrospectively) at the time of the assault.

Keywords

event centrality posttraumatic growth trauma symptom course sexual assault

Sexual violence is a globally pervasive problem, with 1 in 5 women and 1 in 38 men, experiencing attempted or completed rape during their lifetime (Center for Disease Control, 2022). On college campuses alone, approximately 26% of undergraduate women and 7% of undergraduate men experience rape or sexual assault (Cantor et al., 2020; Smith et al., 2018). Sexual violence is associated with negative mental health outcomes, including anxiety, depression, and posttraumatic stress disorder (Frazier et al., 2001; Mason & Lodrick, 2013; Overstreet et al., 2017). Trauma stemming from sexual violence can have profound impacts on individuals’ lives and identity. Researchers have developed two constructs—posttraumatic growth and event centrality—that tap into identity-related responses to sexual violence. In this study, we investigated these constructs as mediators between retrospectively reported trauma symptoms at the time of sexual violence and self-reported trauma symptoms at the current time.

Retrospective Trauma Reporting

Most trauma research relies on retrospective assessments of trauma experiences (Frissa et al., 2016). Researchers have noted the challenges this poses to accuracy in memory recall and potential inflation of symptom severity and average number of traumas reported (Krinsley et al., 2003). Despite these concerns, previous research has demonstrated that people are generally consistent in their reporting of trauma experiences over time (Krinsley et al., 2003). Furthermore, there appears to be good correspondence between retrospective reports and daily reports of trauma-related symptoms one month after trauma exposure (Naragon-Gainey et al., 2012).

In addition, sexual traumas may be processed and recalled differently than other traumatic experiences (Porter & Birt, 2001). Rather than increased fragmentation and impairment in recall, as some currents in the debate suggest, memories for sexual trauma were associated with greater clarity, vividness, and details recalled (Bernsten & Rubin, 2006; Peace et al., 2008; Porter & Birt, 2001). Altogether, these findings provide some reassurance regarding the temporal stability and reliability of retrospectively recalled trauma exposure.

Posttraumatic Growth

While sexual violence clearly has negative impacts, some trauma survivors also report positive life changes in the aftermath of a traumatic experience (Tedeschi & Calhoun, 1996; Tedeschi et al., 1998). Posttraumatic growth is believed to occur when a traumatic event challenges or violates a person's beliefs about the world (Tedeschi et al., 2015). Researchers have identified five specific areas of posttraumatic growth: perception of the self, relationships with others, philosophy of life, identification of new possibilities, and spirituality (Tedeschi & Calhoun, 2004). Posttraumatic growth represents a transformative shift that is both important to the individual and an improvement from the previous status quo (Tedeschi & Calhoun, 2004).

Although posttraumatic growth has received a considerable degree of attention and has been studied in numerous empirical papers, researchers have raised concerns about the scientific validity of the construct (Frazier et al., 2009; Nolen-Hoeksema & Davis, 2004; Zoellner & Maercker, 2006). Some researchers have criticized the construct of posttraumatic growth, raising concerns about whether the reported growth experienced after a traumatic event represents a significant personal improvement or whether it represents an attempt to protect the self (Boals & Schuler, 2018; Frazier et al., 2009). When some individuals experience a highly negative event, they may be more likely to engage in self-enhancing comparisons of the present self to the past self (Taylor & Armor, 1996). In other words, individuals may be more likely to perceive positive changes in their personal attributes as a result of the traumatic experience (McFarland & Alvaro, 2000). Researchers argue that these perceptions, or “motivated illusions,” of growth can function as an attempt to deal with distressing thoughts and feelings associated with the traumatic event (McFarland & Alvaro, 2000).

Another criticism concerns whether measures of posttraumatic growth are measuring perceived growth rather than actual growth and whether perceived change represents actual change (Boals et al., 2019). Perceived change may be a weak predictor of actual change (Robins et al., 2005). Perceived growth did not relate to actual growth from pre-to-posttrauma and was strongly related to positive reinterpretation coping (Frazier et al., 2009). Furthermore, researchers found that perceived growth was associated with increases in distress pre-to-posttrauma, while actual growth was associated with decreases in distress (Frazier et al., 2009). Researchers suggest that this pattern of results suggests that perceived posttraumatic growth may be a separate construct from actual growth (Boals et al., 2019).

Event Centrality

Event centrality is a relatively new construct in trauma research that refers to the extent to which a traumatic memory is central to a person's sense of self and life narrative (Bernsten & Rubin, 2006). In recent decades, event centrality has received considerable attention for its role in predicting posttraumatic stress and posttraumatic growth. Event centrality is a cognitive attribution about the extent to which a particular event was meaningful and impactful in their life (Bernsten & Rubin, 2006). Like posttraumatic growth, event centrality is interested in the role of narrative and identity; however, whereas posttraumatic growth (PTG) attempts to measure positive responses to a troubling event, event centrality simply looks at the relative importance a person assigns to a given event in their life. Event centrality for traumatic events is associated with more psychological distress, including depression, anxiety, and posttraumatic stress (Bernsten & Rubin, 2006, 2007; Boals & Ruggero, 2016). In addition, higher event centrality has been found to predict intrusion and avoidance symptoms (Boals, 2010). These findings suggest that the degree to which someone perceives a traumatic event as a pivotal experience in their life and a core part of their identity can be an important contributor to negative psychological outcomes. Even when accounting for other variables related to posttraumatic stress including dissociation, anxiety, and self-consciousness, event centrality is independently related to PTSD symptoms (Bernsten & Rubin, 2007). In addition to its role in posttraumatic stress, some researchers have investigated the role of event centrality in predicting positive psychological changes in the aftermath of a traumatic event (Barton et al., 2013; Boals & Schuettler, 2011). Several studies have supported this idea and found event centrality to play a critical role in posttraumatic growth (Barton et al., 2013; Boals & Schuettler, 2011; Boals et al., 2010; Brooks et al., 2017; Groleau et al., 2013). Research examining the role of event centrality in negative and positive reactions to trauma has found, although somewhat counterintuitively, that event centrality positively predicts both posttraumatic stress and posttraumatic growth. This suggests that the centrality of a traumatic experience can be like a “double-edged sword,” having both negative and positive psychological consequences (Boals & Schuettler, 2011).

The Current Study

In this cross-sectional study, we asked participants to estimate their trauma symptoms at the time of the assault, which we refer to as retrospective trauma symptoms, and their trauma symptoms at the present time, which we refer to as current trauma symptoms. Posttraumatic growth and event centrality have both demonstrated relationships with trauma symptoms (Barton et al., 2013; Boals & Schuettler, 2011; Groleau et al., 2013). However, little extant research has investigated how they may relate to perceptions of change between current and past symptoms of subjective distress following exposure to a potentially traumatic event.

Both posttraumatic growth and event centrality are concerned with identity and responses to negative events; however, whereas posttraumatic growth examines the vector of positive responses to negative events, event centrality examines the extent to which a person's identity and life become defined by a negative event, whether positively or negatively. Event centrality and posttraumatic growth have received considerable attention for their relationship with posttraumatic stress. However, additional research is needed in examining the relationship between event centrality and posttraumatic growth in relation to retrospective and current trauma symptoms, as this can illuminate the processes involved in trauma recovery.

The purpose of this study was to investigate relationships between trauma symptoms, event centrality, and posttraumatic growth. Specifically, we were interested in whether trauma survivors’ reported trajectory of recovery (i.e., trauma symptoms after the traumatic event in relation to current trauma symptoms) was mediated by event centrality or posttraumatic growth. In short, we were interested in whether an individual's trauma symptoms increased or subsided due to a sense of having grown from the experience or in accordance with the amount of cognitive weight they assign to the event. We hypothesized that positive changes between retrospective and current trauma distress levels would be explained by event centrality and not posttraumatic growth.

Methods

Participants

The sample for this study came from a larger prospective study of 1,430 students at a public university enrolled in a psychology class who agreed to participate in a study about sexuality. These participants were recruited through the department's SONA system and completed the survey online. The SONA system is an online platform where university research laboratories can register studies for students to participate, in exchange for research and/or course credit. The survey included two items: (a) “Have you ever been raped?” and (b) “Have you ever been sexually assaulted?” both of which had yes/no answers. Individuals who endorsed yes on either item were included in this study. Approximately 41% of participants indicated that the sexual trauma occurred within the past 5 years (10% [6–11 years]; 8% [12–17 years]; 9% [18–26 years]; 32% [unspecified]). The sample consisted of 247 individuals, ages 18–41 (M = 21.26, SD = 4.12); 89.1% identified as female, and 10.9% identified as male. Regarding race/ethnicity, 55.9% identified White/Caucasian, 15.7% identified Black/African American, 18.9% identified Hispanic, and 9.4% other.

Procedure

This study was approved by the university committee for the protection of human subjects. Participants agreed to participate in a survey about human sexuality. An informed consent notice appeared at the beginning of the survey, and this contained language notifying individuals that the survey would include items about sexual violence. Additionally, mental health resources were provided at the end of the survey. Participants received course credit for taking part in the study and an alternative assignment for credit was available.

Measures

Covariates

Three covariates were included. Gender was dummy coded so that 0 = male and 1 = female. The age at which someone first experienced rape/sexual assault (“How old were you when you were raped/sexually assaulted for the first time?”) had a response option of “I don’t remember” or a numerical value between 1–40 or 40+, and the age at the time of the most recent rape/sexual assault (“How old were you when you were most recently raped/sexually assaulted?”) had a response option of “I don’t remember,” “I was only raped/sexually assaulted on one occasion,” or a numerical value between 1–40 or 40+.

Retrospective and current trauma symptoms

The Impact of Event Scale-6 (Thoresen et al., 2010) is a brief 6-item measure assessing subjective distress in the aftermath of a traumatic event, specifically intrusion, hyperarousal, and avoidance. For the retrospective trauma symptoms, participants were instructed: “Please take a moment to think about when you were raped/sexually assaulted. Respond how you recall feeling during the seven days after the rape/sexual assault occurred.” For the current trauma symptoms, participants were instructed: “Keeping that same event in mind, respond how you have felt during the past seven days.” Items are rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). The scale includes statements such as “I tried not to think about it.” and “I had trouble concentrating.” The total score is obtained by summing all the responses (retrospective Cronbach's α = .95; current α = .94).

Event centrality

The Centrality of Event Scale (CES; Bernsten & Rubin, 2006) is a brief 7-item scale measuring the extent to which the memory of a stressful event is central to a person's sense of self and life narrative (“This event has become a reference point for how I understand my experiences”). Participants responded on a 5-point Likert-type scale, ranging from 1 (totally disagree) to 5 (totally agree). In this study, we averaged the responses for the total scale, with a higher score indicating that individuals assign greater meaning to the event (Cronbach's α = .94).

Posttraumatic growth

The Posttraumatic Growth Inventory—Short Form (PTGI-SF; Cann et al., 2010) is a brief 10-item measure of the extent to which individuals experience positive growth following a traumatic event. The PTGI consists of five subscales: new possibilities (“I established a new path for my life.”), relating to others (“I have a greater sense of closeness with others.”), personal strength (“I know that I can better handle difficulties.”), spiritual enhancement (“I have a better understanding of spiritual matters.”), and appreciation for life (“I changed my priorities about what is important in life.”). Items are rated on a scale of 0 (I did not experience this change as a result of the event) to 5 (I experienced this change to a very great degree as a result of the event). The total score is calculated by summing all the responses (Cronbach's α = .95).

Results

Preliminary analyses were conducted to ensure there were no violations of assumptions (extreme outliers, multicollinearity, independent errors). Bivariate correlations between and descriptive statistics for all variables of interest are displayed in Table 1. There was a moderate correlation between retrospective and current trauma symptom levels, as well as trauma symptom levels (retrospective and current) with event centrality. On the other hand, posttraumatic growth showed a small correlation with both retrospective and current trauma symptom levels.

Table 1.
Bivariate Correlations and Descriptive Statistics (N = 247).

Retrospective trauma Current trauma Posttraumatic growth Event centrality

Retrospective Trauma – 0.40* 0.33* 0.43*

Current trauma – 0.28* 0.42*

Posttraumatic Growth – 0.47*

Event centrality –

M (SD) 3.58 (1.30) 1.30 (1.22) 2.00 (1.40) 3.06 (1.05)

Possible range 0–4 0–4 0–5 1–5

p < .001

Mediation analysis was performed with PROCESS using 5,000 bootstrapping resampling procedures. Bootstrapping is a nonparametric method that utilizes random resampling to estimate confidence intervals, standard errors, and hypothesis testing. We specified a model in which retrospective trauma symptoms were the independent variable and current trauma symptoms were the dependent variable. Event centrality and posttraumatic growth were mediators, entered in parallel. Gender (dummy coded so that 0 = male and 1 = female), the age at which someone first experienced rape/sexual assault, and the age at the time of the most recent rape/sexual assault were entered as covariates.

Retrospective trauma symptoms were associated with current trauma symptoms (β = 0.40, p = <.001). This relationship remained significant when event centrality and posttraumatic growth were included as mediators in the model (β = 0.25, p = <.001). Retrospective trauma symptoms had an indirect effect on current trauma symptoms through event centrality (β = 0.12, SE = .04, 95% CI [0.06, 0.19]) but not through posttraumatic growth. The mediation model is displayed in Figure 1.

Figure 1.
Conceptual Model of the Relationship Between Retrospective and Current Trauma Symptoms as Mediated by Post-Traumatic Growth and Event Centrality. p < .001.

Discussion

The study investigated event centrality and posttraumatic growth as mediators between retrospectively reported trauma symptoms at the time of the rape/sexual assault and self-reported trauma symptoms at the current time. It should be noted that retrospective trauma symptoms demonstrated a moderate correlation with current trauma symptoms. This suggests that individuals’ reporting of trauma distress levels at one time was consistent with their distress levels at a later time. We had hypothesized that lower event centrality, and not posttraumatic growth, would be associated with positive changes in trauma distress levels from retrospective and current reportings. Results generally supported this hypothesis in a diverse, college-educated Western sample. We found that individuals who perceived the sexual trauma to be integral to their life tended to have current trauma symptoms more closely corresponding to their trauma symptoms (rated retrospectively) at the time of the assault. In other words, the greater the centrality of the traumatic experience, the more likely it was that one's trauma distress levels remained relatively consistent over time. By contrast, individuals who reported lower levels of trauma centrality showed greater symptom recovery between current and retrospective reports of trauma distress. These findings are consistent with previous research which has shown event centrality to be a valuable predictor of posttraumatic distress (Bernsten & Rubin, 2006, 2007). Furthermore, they support the notion that event centrality could be a mechanism through which trauma distress symptoms are maintained (Boals & Ruggero, 2016). In contrast to event centrality, perceived posttraumatic growth did not mediate the relationship between retrospective and current trauma distress levels.

Posttraumatic growth and posttraumatic stress are not necessarily mutually exclusive. It is possible that one may report perceived posttraumatic growth while also continuing to experience posttraumatic stress symptoms (Wu et al., 2015). Therefore, even when someone is reporting perceived posttraumatic growth, we may not necessarily see positive changes in their posttraumatic stress symptomatology. Both event centrality and posttraumatic growth deal with the impact of trauma on identity and the response to the trauma event. Event centrality deals with the relative weight a person assigns to a traumatic event as it relates to their identity and life story (Bernsten & Rubin, 2007). However, unlike posttraumatic growth, event centrality is not necessarily concerned with the positive or negative valence in trauma response. Our findings suggest that changes in trauma symptoms are more attributable to the degree to which the event is deemed central to a person's identity and life story than to how much perceived personal improvement was experienced. Irrespective of whether there are associated positive or negative outcomes, it is the centrality of the experience itself that can play a valuable role in trauma symptom change and/or recovery.

Although this study provides insights into relationships between trauma symptom course, event centrality, and posttraumatic growth, it was limited in several ways. The use of a convenience sample limits the generalizability of the results. Furthermore, women were overrepresented in the present sample. This could be explained by women being more likely to experience some form of sexual violence compared to men. The predominantly female sample may limit the generalizability of the results. Prior research has found gender differences in levels of event centrality, in which women were more likely to internalize negative events and integrate them into their identity than men (Boals, 2010). Therefore, the degree to which conclusions can be drawn regarding the role of event centrality in mediating trauma symptom courses for men is limited. Future research should examine potential gender differences in the role of event centrality in mediating trauma symptom course and facilitating recovery. Another potential limitation in this study is that gender, in this study, was considered as a binary construct (i.e., male, female), which limits understanding of gender and can result in misclassification. Some research has shown that trauma event type also plays a role in the centrality of a traumatic experience, with interpersonal events (e.g., sexual assault) being perceived as more important and salient, thus having higher levels of event centrality related to the traumatic event (Reiland & Clark, 2017). This means that levels of event centrality may differ based on trauma event type; however, all participants in this study completed the questionnaires about experienced sexual trauma, in particular. Furthermore, an additional related factor that may limit the results is that participants may have experienced a number of traumatic events of varying types, which may have factored into their trauma distress levels. Moreover, participants were asked to report on retrospective and current levels of distress within the same time point, which could have impacted the severity of their trauma distress levels. The cross-sectional nature of the data limits conclusions that can be drawn about causality. The retrospective nature of the measures introduces the possibility of memory bias in recalling the traumatic experience. Retrospective trauma symptoms demonstrated a moderate correlation with current trauma symptoms. This is particularly meaningful since most participants indicated that they had not experienced the trauma in the recent past. There was variability in the length of time passed since the sexual trauma and the number of traumas experienced. Moreover, this study did not account for whether participants received psychological care for their posttraumatic stress. It is possible that these factors individually or in combination could have impacted participants’ level of trauma distress. Future longitudinal research could examine the relationship between these variables over repeated measures. More research is needed to better understand the independent role of event centrality and posttraumatic growth on trauma distress levels, as well as the relationship between the two constructs. Furthermore, further exploration of the relationship between event centrality and other variables that may be unique to sexual assault can have important clinical implications. Although the present study provided a list of mental health resources to participants endorsing a trauma and reporting traumatic stress, additional information was not provided regarding potential steps for reporting the trauma experience. Additionally, this study did not account for potential acute stress at the time of taking the survey. It is therefore important that future studies examining trauma distress incorporate procedures for assessing acute traumatic stress and implementing steps and resources for ensuring participant safety.

Altogether, the results of this study suggest that sexual assault survivors may internalize and integrate traumatic events into their identity and life narrative and that this can be of considerable importance in trauma distress levels and recovery. The finding that event centrality mediates the relationship between retrospective and current trauma symptoms does suggest that the centrality of a traumatic experience can play a critical role in trauma course and/or recovery, where higher event centrality is related to greater trauma-related distress and lower event centrality is related to less trauma-related distress and greater recovery. The present study included an ethnically diverse sample of college-educated individuals. The extent to which cultural variations play a role in event centrality and trauma processing may be an important area of further investigation for future research. However, our findings are generally consistent with prior research which has found higher event centrality to be associated with greater emotional distress across various cultures. Furthermore, results suggest that event centrality can be a critical point of intervention in trauma-informed treatment. They provide additional support for the importance of trauma processing interventions that are central to many evidence-based trauma-informed therapies, as these interventions explore trauma reactions and impacts as they relate to beliefs about the self, others, and the world and narrating of trauma experience, which relates to the construct of event centrality (Boals et al., 2020). Future research should investigate the relationship between event centrality, trauma-distress levels, and trauma-informed treatment to further evaluate the role that event centrality can play in symptom reduction and recovery.

Clinicians working with survivors of sexual assault may want to better understand and explore event centrality in relation to post-assault distress and/or resilience, as it can provide further insight into trauma reactions and help inform how survivors experience and process sexual trauma and the course of treatment. Some researchers have called for further investigation into the manipulation of event centrality in trauma treatment to better understand its role in recovery (Boals et al., 2020). Researchers may benefit from including measures like the Centrality of Event Scale in trauma intervention studies to further elucidate the degree to which existing treatments influence event centrality levels. Overall, our findings provide additional support for event centrality as a critical factor in the maintenance of posttraumatic symptoms and a point of possible intervention in treatment to help promote trauma symptom recovery.

	Retrospective trauma	Current trauma	Posttraumatic growth	Event centrality
Retrospective Trauma	–	0.40*	0.33*	0.43*
Current trauma		–	0.28*	0.42*
Posttraumatic Growth			–	0.47*
Event centrality				–
M (SD)	3.58 (1.30)	1.30 (1.22)	2.00 (1.40)	3.06 (1.05)
Possible range	0–4	0–4	0–5	1–5

Footnotes

ORCID iDs

Michael D. Barnett

Eman H. Nabulsi

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author Biographies

Michael Barnett, PhD, is an associate professor in the Department of Psychology at the University of North Texas. Barnett is a clinical neuropsychologist specializing in neurocognitive disorders among older adults. His research focuses on applying novel technologies such as virtual reality and smartphone applications to neuropsychological assessment among older adults.

Eman Nabulsi is a doctoral student in Clinical Psychology at UT Southwestern Medical Center. Her clinical and research interests include understanding the psychological impact of loss, grief, and trauma on adult populations. Eman is particularly interested in how individual and collective experiences of adversity shape mental health outcomes. Furthermore, she hopes to integrate clinical practice, research, and advocacy in her future career to support individuals coping with significant life challenges.

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Event Centrality,Not Posttraumatic Growth,Explains Trauma Symptom Course Among Sexual Assault Survivors

Abstract

Keywords

Retrospective Trauma Reporting

Posttraumatic Growth

Event Centrality

The Current Study

Methods

Participants

Procedure

Measures

Covariates

Retrospective and current trauma symptoms

Event centrality

Posttraumatic growth

Results

Discussion

Footnotes

ORCID iDs

Funding

Declaration of Conflicting Interests

Author Biographies

References