Trauma

How Do You Define Yourself After Trauma?

An interview with Dr. Derrecka Boykin on event centrality and trauma.

Posted Jun 26, 2020

Derrecka Boykin, used with permission
Source: Derrecka Boykin, used with permission

After a traumatic event, a person changes in many ways. One of those ways is how they see themselves. Event centrality is defined as "the extent to which traumatic events are perceived to be integral to one's life" (Wamser‐Nanney, 2019). How each person understands themselves in relation to the traumatic event impacts their ability to recover.

Derrecka Boykin, Ph.D., is a postdoctoral psychology fellow with the South Central Mental Illness Research, Education, and Clinical Center at Michael E. DeBakey Medical Center in Houston, Texas. Dr. Boykin is also an instructor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. She received her doctorate in clinical psychology from Northern Illinois University in 2018. Her primary research interests are related to improving access to and delivery of high quality, evidence-based care for rural, underserved, and traumatized populations.

JA: How did you first get interested in this topic?

DB: My interest in event centrality came from my experiences providing trauma-focused therapy. It is common practice to have clients with a trauma history identify a single worst traumatic experience (or index trauma) as the basis for assessment and treatment. I have always found this practice difficult to do when clients report exposure to multiple distressing traumas. Asking clarifying questions like, “Which one do you have unwanted thoughts or dreams about the most?” or “Which one do you avoid thinking or talking about the most?” are helpful in most instances. However, this was not true for all my clients.

I started looking for different ways to establish index events when I first read about event centrality. It made sense to me that, although most traumatic events are distressing, some experiences are more impactful in shaping our personality, behaviors, and beliefs. I soon learned that higher event centrality was not just associated with more posttraumatic distress, but also an indicator of greater resilience under certain circumstances. My research on event centrality has been focused on better understanding what those circumstances are and how they can inform clinical practice, such as the identification of index traumas.

JA: What was the focus of your study?

DB: Our study examined the influence of psychological flexibility on trauma reactions as the personal significance of trauma (or its centrality) increased. Psychological flexibility refers to our ability to be fully aware of the present moment and take actions that align with what matters most to us in a given situation.

We chose to include it based on research suggesting that, as psychological flexibility increased, event centrality decreased, and posttraumatic distress improved. This makes sense given that psychological flexibility is an important predictor of posttraumatic distress. Following trauma, survivors who rigidly use avoidant behaviors to escape unwanted thoughts, memories, emotions, and physical sensations (e.g., pain) experience higher distress. This is known as psychological inflexibility.

By contrast, higher psychological flexibility is associated with more positive health outcomes like lower stress and better quality of life. We believed that the combination of event centrality and psychological flexibility may play a role in determining how individuals respond to trauma. To explore this, we recruited 125 adults with a reported trauma history to complete surveys about their traumatic experiences, perceived centrality of these experiences, and associated symptoms of distress and perceived posttraumatic growth.

JA: What did you discover in your study?

DB: We found that individual differences in psychological flexibility were a better predictor of posttraumatic distress than perceived growth for traumas with increasing centrality. That is, adults who reported lower psychological flexibility indicated higher distress related to traumas with higher centrality.

Our findings did not support that differences in event centrality or psychological flexibility influenced perceived posttraumatic growth. This is not to say that these relationships do not exist but are more complicated than we anticipated. In all, our study suggests that risk for adverse trauma outcomes may be increased for individuals who are less psychologically flexible and who experience a highly central trauma.

JA: Is there anything that surprised you in your findings, or that you weren't fully expecting?

DB: We expected to find relationships between event centrality, psychological flexibility, and perceived posttraumatic growth that were not completely supported. It was surprising to find that, while event centrality and psychological flexibility were each related to perceived growth, they did not have an interactive effect on growth. In other words, the effect of event centrality on perceived growth was unchanged by how psychologically flexible a person was.

Given the novelty of this finding, more research is needed before firm conclusions can be drawn. However, we suspect that there may be conditions under which the relationship between event centrality and growth varies based on differences in psychological flexibility. For example, rumination (or excessive worrying) is related to both event centrality and posttraumatic growth and may be an important process to consider in future work.

JA: How might readers apply what you found to their lives?

DB: Trauma is often a defining moment in individuals’ lives but declaring it as a core representation of who you are has important consequences on recovery. Seeing trauma as an inherent sign of personal weakness or failure can lead to distress and suffering. Active attempts to avoid emotional pain increase the intensity and duration of suffering. Distress is not the only possible outcome following trauma. Growth can come from suffering. This may happen when trauma becomes a sign of survivorship and renewed strength.

Readers should be encouraged that neither event centrality nor psychological flexibility is permanently fixed. There are many ways to improve psychological flexibility and doing so can lessen the negative impact of trauma. Trauma-focused treatments and other cognitive-behavioral therapies can be helpful for learning effective ways to manage distress without avoidance.

JA: How can readers use what you found to help others?

DB: Understanding that trauma affects everyone differently is important. Our study highlights how traumas with high centrality are more impactful in our lives. We can tell when an event is highly central because individuals will relate everything about themselves and their lives back to that experience. For example, a survivor of a serious car accident may feel like everything he or she does will fail and view even minor mistakes as a sign of his or her overall incompetence. This is just one example of how someone might react to a trauma with high centrality. As this and other studies have shown, reactions can also be adaptive such that individuals are empowered by their survivorship. It is difficult to know exactly why reactions vary so much. However, our findings suggest that active avoidance of distress following a highly central event intensifies suffering. Therefore, it may be worth gently encouraging our loved ones who may be suffering to seek help with our support.

JA: What are you currently working on that you might like to share about?

DB: My current interests are focused on improving mental health care access and service delivery for rural, underserved, and traumatized populations. As part of this research, I am continuing to explore clinical applications of event centrality. In 2019, I published a manuscript describing the benefits of including measures of event centrality into assessments for posttraumatic stress disorder (PTSD) and presented a proposal for how to do so (Full citation below). My future plans include examining whether these applications are clinically useful and feasible recommendations for routine clinical practice.

References

Boykin, D. M., Anyanwu, J., Calvin, K., & Orcutt, H. K. (2020). The moderating effect of psychological flexibility on event centrality in determining trauma outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 12(2), 193–199. https://doi.org/10.1037/tra0000490

Boykin, DM & Teng, EJ [2019]. A proposal for augmenting the measurement of index event in PTSD assessment using event centrality. Anxiety, Stress & Coping, 32, 559-567. https://doi.org/10.1080/10615806.2019.1638682

Wamser‐Nanney, R. (2019), Event Centrality: Factor Structure and Links to Posttraumatic Stress Disorder Symptom Clusters. Journal of Traumatic Stress, 32: 516-525. doi:10.1002/jts.22413