Academic journal article European Journal of Psychotraumatology

Making Connections: Exploring the Centrality of Posttraumatic Stress Symptoms and Covariates after a Terrorist Attack

Academic journal article European Journal of Psychotraumatology

Making Connections: Exploring the Centrality of Posttraumatic Stress Symptoms and Covariates after a Terrorist Attack

Article excerpt

1.Introduction

Exposure to a traumatic event often results in psychological reactions such as re-experiencing the event, avoiding reminders of trauma, and increased anxiety and emotional arousal. Researchers have explored how factors of posttraumatic symptoms may influence each other longitudinally (Marshall, Schell, Glynn, & Shetty, 2006; Pietrzak et al., 2014; Schell, Marshall, & Jaycox, 2004; Solberg, Birkeland, Blix, Hansen, & Heir, 2016; Solomon, Horesh, & Ein-Dor, 2009). Common findings among these studies are that intrusive and hyperarousal symptoms predict further symptom development. However, symptom clusters may have effects with shorter time spans than are possible to detect in such longitudinal studies, which have months or years between measurement waves. Furthermore, other symptom constellations or single symptoms maybe central to the development or maintenance of posttraumatic stress symptoms.

The network perspective constitutes an alternative conceptualization of posttraumatic symptomatology that can offer a way to overcome these limitations. According to this perspective, disorders can be understood as networks of interacting symptoms more than as underlying disease entities that produce the symptoms (Borsboom & Cramer, 2013; Hofmann, Curtiss, & McNally, 2016; McNally, 2016; Nuijten, 2016). For example, a person who experiences a traumatic event may develop certain symptoms (e.g. intrusive memories) that activate other symptoms (e.g. insomnia), which in turn activate other symptoms (e.g. difficulty concentrating). These latter symptoms may have connections back to the first symptoms (intrusive memories), creating feedback loops of symptoms that maintain each other. By identifying which symptoms are more strongly connected to or more central than others, we can gain information about possible powerful targets for clinical interventions (Fried et al., 2016).

A small number of studies have explored networks of posttraumatic stress symptoms (Armour, Fried, Deserno, Tsai, & Pietrzak, 2017; Bryant et al., 2016; McNally, 2016; McNally et al., 2015). There were some similarities across the findings of these studies. For example, in all studies strong associations were found between hypervigilance and an exaggerated startle response, and between nightmares and flashbacks. However, different symptoms were found to be the most central in the networks; for example hypervigilance and future foreshortening (McNally et al., 2015), feeling detached (McNally, 2016), negative traumarelated emotions, flashbacks, detachment, and physiological cue reactivity (Armour et al., 2017), or intrusions and physiological reactivity (Bryant et al., 2016). The contradictory results may be due to differences in the trauma populations that were studied. The first study examined people who were grieving a lost child and dealing with practical difficulties following an earthquake (McNally et al., 2015), the second examined people with a history of childhood sexual abuse (McNally, 2016), the sample in the third study had experienced a wide range of traumas (Armour et al., 2017), and the fourth study included hospitalized patients with traumatic injuries (Bryant et al., 2016). These experiences are quite different, and they may not necessarily elicit the same network of symptoms. More studies of various trauma-affected populations are needed to determine whether networks of posttraumatic stress symptoms differ according to the type of traumatic event. Furthermore, the networks characteristics may differ in immediate phases compared to in chronic phases (Bryant, 2003).

In line with the studies that have identified factor or groups of posttraumatic stress symptoms (e.g. Armour, Műllerová, & Elhai, 2016), the network of posttraumatic stress symptoms may contain subnetworks with symptoms that are more tightly connected with each other than with other symptoms. These communities or clusters of symptoms may function as relatively independent modules of a network (Fortunato, 2010). …

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