Objective: To clarify the longitudinal, directional relationship between event centrality and post-traumatic stress symptoms (PTSS), this study examined their cross-lagged associations over time in a sample of sexual assault survivors. Method: In total, 423 participants who had experienced a sexual assault were included in this study (98% female, age M = 26.68). PTSS and event centrality were assessed 3-, 6-, and 12-months post-study inclusion. A cross-lagged panel model (CLPM) and a random intercept CLPM (RI-CLPM) were fitted to the data across the three time points to capture both between- and within-person effects. Results: Significant cross-lagged effects were observed only from PTSS to centrality and not vice versa, both in the CLPM (β = 0.12, 95% CI [0.05,0.18]) and the RI-CLPM (β = 0.23, 95% CI [0.04,0.42]). That is, higher early levels of PTSS were predictive of higher subsequent levels of event centrality both at the between- and within-person level. Exploratory findings tentatively suggest that the cross-lagged dynamics between centrality and PTSS may vary as a function of the temporal distance from the index trauma, though results were not statistically significant. Generalizability of the findings is limited by the low diversity of the sample regarding demographic characteristics. Conclusions: These findings indicate that the longitudinal association between post-traumatic stress and event centrality is predominantly symptom-driven, with centrality functioning primarily as a consequence and not a driving force of ongoing distress. Exploratory results suggest a potential temporal dependence of these dynamics, highlighting the need for research with early-recruited cohorts.

BACKGROUND:Peritraumatic reactions during sexual assault are central to societal rape stereotypes and may play a role in post-trauma mental health. Nevertheless, existing research is limited. In this cross-sectional study, we explored a broad spectrum of emotional, cognitive, and behavioural peritraumatic reactions and investigated their associations with assault characteristics, sexual assault history, and symptoms of post-traumatic stress and depression/anxiety. METHODS:Recent sexual assault victims (N = 425, 96% female, M = 26.20 years old) completed a 23-item peritraumatic reactions questionnaire developed in collaboration with lived-experience experts. Exploratory factor analysis (EFA) was employed to identify latent peritraumatic reaction factors. Associations between factor scores, various assault characteristics, history of sexual assault, and current symptoms of post-traumatic stress and depression/anxiety were assessed with t-tests, ANOVA, correlations and linear regressions. RESULTS:EFA revealed six factors: Dissociation & freeze, Cognitive strategies & thought processes, Active defense behaviour, Negative emotions, Perceived life threat, and Reactive surrender. Feelings of helplessness and non-active behavioural responses, captured by the Dissociation & freeze and the Reactive surrender factors, were much more pronounced than active resistance. Perpetrator strategies involving threats and physical violence were related to higher levels of most peritraumatic reactions, apart from Dissociation & freeze. A closer victim-perpetrator relationship was associated with lower perceived life threat, whereas a history of sexual assault was associated with higher levels of Reactive surrender. All factors except Cognitive strategies & thought processes and active defense behaviour were positively correlated with post-traumatic stress and depression/anxiety symptoms, even when controlling for assault characteristics and sexual assault history. CONCLUSIONS:These findings highlight the heterogeneity of peritraumatic responses and challenge rape stereotypes of the actively resisting victim by identifying reactive surrender as a common survival strategy. The robust associations between diverse peritraumatic reactions and post-trauma mental health propose these acute responses as vital clinical indicators for post-trauma adjustment.

Many trauma survivors mentally create alternative scenarios to the factual past (i.e., "what could have happened"), referred to as counterfactual thoughts (CFT). However, to date, research on the phenomenology of post-trauma CFT is sparse. We aimed to systematically explore the characteristics and content of CFT reported by young survivors of a terrorist attack. Approximately 8.5 years after the terrorist attack on Utøya island in 2011, 220 survivors (52.3% females, M age = 27.5, SD = 3.65) described their most common CFT related to the attack. The characteristics (e.g., direction, structure, social focus, and timing) and content of the survivors' CFT were analyzed using thematic analysis. The participants provided rich and highly detailed descriptions of their CFT. Most antecedents ("if…") were additive (action), self-referent, related to events occurring during the attack (e.g., if they had helped others, been located differently, or tried to overpower the perpetrator). The majority of the consequents ("then…") were upward and other-referent, particularly related how someone who was killed could have survived. Of note, many described CFT involving self-blame. Findings may have implications for clinicians in terms of understanding and alleviating psychological distress among survivors' post-trauma. It is important that clinicians are aware of this phenomenon, so that they better can identify and help patients cope with their CFT.

Background: After trauma, the mind often returns not only to what happened, but to what could have happened. Counterfactual thinking (CFT) has been linked to posttraumatic stress reactions (PTSR), yet its role over time remains unclear.Objective: This longitudinal study examined how frequency and vividness of CFT relate to PTSR following sexual assault, addressing a lack of longitudinal research on these associations.Method: Participants (baseline N = 452; 437 women, 15 men; M age = 26.2 years, SD = 8.4) who had experienced sexual assault within the past year and were assessed at baseline, three months (N = 216), and six months (N = 232). The participants were recruited through Sexual Assault Care Centres and social media, thereby including both survivors who had sought professional help and those who had not. PTSR were assessed with the International Trauma Questionnaire, and CFT frequency and vividness with self-report items. We used latent growth curve models to examine launch effects (higher initial symptom levels) and snare effects (time-specific elevations in symptoms over time).Results: Higher baseline frequency and vividness of CFT were associated with higher PTSR levels at the first assessment, but not with symptom change over time. Vividness of CFT showed time specific associations with elevated PTSR, whereas frequency effects were less consistent.Conclusion: These findings suggest that CFT contributes to PTSR through stable and time specific processes and may represent a clinically relevant target. Future research should examine the mechanisms underlying these longitudinal associations.

Sexual assault can lead to long-term health problems, yet many victims do not seek help from sexual assault centers. This cross-sectional observational study examined factors distinguishing help-seekers from non-help-seekers and identified factors related to concerns about help-seeking in non-help-seekers. A sample of 669 recent sexual assault victims (97.5% women; mean age 26) was recruited from sexual assault centers and social media; 251 had attended a sexual assault center and 418 had not. Multiple logistic regression was used to identify factors differentiating help-seekers and non-help-seekers. Logistic regressions identified factors associated with help-seeking, and ordinal logistic regressions examined factors related to 3 types of concerns among non-help-seekers: concerns about the incident, about the health service, and about potential negative consequences. Victims of assaults consistent with the rape stereotype (completed penetration, unknown perpetrator) were more likely to seek help. Among non-help-seekers, concerns about seeking help at a SAC were prevalent (34%-65%), while few felt they had no need (11.5%). Physical violence (OR = 0.33, 95% CI = 0.20-0.52) and higher age (OR = 0.97, 95% CI = 0.95-1.00) were linked to fewer incident-related concerns; penetration (OR = 1.73, 95% CI = 1.10-2.72) and highaer age (OR = 0.97, 95% CI = 0.94-0.99) to fewer service-related concerns; and physical violence (OR = 1.85, 95% CI = 1.18-2.90), penetration (OR = 1.95, 95% CI = 1.26-3.02), and social support (OR = 1.82, 95% CI = 0.68-0.99) to fewer concerns about negative consequences. Public information efforts highlighting the benefits of post-assault healthcare, especially for younger victims and those experiencing less stereotypical assaults, may encourage help-seeking. Support from family and friends may play an important role in victims’ decisions about seeking help.

Introduction:It is well-known that social support is related to mental health following sexual assault (SA). Recent research suggests that social reactions to disclosure may also affect mental health; however, few studies have accounted for general social support, and most have been conducted many years after the assault. This study aimed to examine whether social reactions are uniquely linked to mental health when adjusting for perceived social support in recent victims of SA. Methods:In this cross-sectional study, participants were recruited from Sexual Assault Centers (SACs) and through social media. The sample comprised 173 female participants (mean age = 26 years, SD = 8.6) who had experienced a SA within the last 6 months and had disclosed the SA to someone. We used linear regression analyses to assess associations between social reactions to disclosure, social support, and post-traumatic stress reactions (PTSR) and anxiety/depression symptoms. Results:Although positive social reactions to disclosure were most common, negative social reactions were highly prevalent even in this early phase after SA. Negative social reactions of the Unsupportive acknowledgment type were significantly associated with more PTSR (b = 0.36, 95% CI = 0.14, 0.57), while perceived social support was significantly associated with fewer symptoms of anxiety/depression (b = -0.20, 95% CI = -0.32, -0.08). Conclusions:Social reactions and social support were differentially associated with PTSR and anxiety/depression symptoms, indicating that certain aspects of social relationships may play different roles in the recovery process. Our results call for early interventions following SA to reduce negative reactions to disclosure and facilitate the provision of positive social support to victims.

According to the warning signal hypothesis, memory may be enhanced for peripheral details occurring immediately before a traumatic experience to signal potential danger if encountered again. This idea contrasts with research demonstrating a temporal memory trade-off, where central details of distressing events are prioritised over peripheral information occurring immediately before or after. This study aimed to experimentally test the warning signal hypothesis, by comparing episodic details from neutral, positive and negative/trauma-related autobiographical memories. Participants (N = 175) wrote short narratives to facilitate recall of each event and the moments leading up to it, then rated their memories on vividness and level of detail. Memories of moments preceding emotional experiences were recalled with greater vividness and detail compared to neutral experiences. Contrary to the warning signal hypothesis, the prioritisation of preceding stimuli does not appear specific to traumatic experiences and may instead reflect a general mechanism prioritising temporally proximal and emotionally significant information.

Background: Though there is substantial support for the importance of maladaptive appraisals for the development of posttraumatic stress reactions (PTSR), little is known about the long-term temporal relationship between maladaptive appraisals and PTSR beyond the first year after a traumatic event.Objective: We aimed to investigate three research questions: (1) Does the level of maladaptive appraisals change over time? (2) Are maladaptive appraisals and PTSR concurrently related to each other in the long term? (3) What is the direction of the temporal relationship between maladaptive appraisals and PTSR?Method: The participants were young survivors after the terror attack at Utøya island in Norway in 2011. We included data measured at 14-15 months, 30-32 months, and 102-108 months post trauma. The participants (N = 315) were all younger than 25 years at the time of the attack (mean age was 18.4, SD = 2.3), and 48.3% were female. The aims were investigated using correlations, paired t-tests, random intercept cross-lagged panel models (RI-CLPM), and cross-lagged panel models (CLPM).Results: We found a significant decrease in PTSR severity from 14-15 months to 30-32 months, and there was a significant increase in the mean level of maladaptive appraisals from 30-32 months to 102-108 months post trauma. Maladaptive appraisals and PTSR were highly associated across the three time points. Stable individual differences seem to account for most of the longitudinal relationship between maladaptive appraisals and PTSR, and we did not find clear indications of a direction of the temporal relationship between the variables.Conclusions: Our results indicate that the level of maladaptive appraisals can be quite stable once established, that they remain associated with PTSR, and that the long-term relationship between maladaptive appraisals and PTSR in the years following a trauma may best be explained by stable individual differences.

Background: Counterfactual thinking (CFT), involves mental simulations of alternative outcomes to past events (e.g. ‘What if … ’ or ‘If only … ’), and is commonly observed after trauma. While CFT can be adaptive, it is also linked to psychological distress, including posttraumatic stress reactions (PTSR).Objective: The present study aims to examine the relationship between the frequency and vividness of upward and downward counterfactual thoughts and PTSR, in the recent aftermath of sexual assault (SA).Method: The sample consisted of 327 women who had experienced SA within the last year. PTSR was measured using the International Trauma Questionnaire (ITQ), while CFT was assessed through self-reported frequency and vividness of upward (event could have been less severe or avoided) and downward (event could have been worse) counterfactual thoughts.Results: The results revealed a significant difference in the distribution of upward versus downward CFT. Specifically, more participants reported engaging in upward CFT ‘Very Often’ and ‘Often,’ while downward CFT was reported less frequently. Vividness was higher for downward CFT. Both frequency and vividness of upward and downward counterfactuals were significantly associated with higher levels of PTSR.Conclusion: The present findings highlight the role of counterfactual thinking in post-assault distress and emphasize the need for targeted interventions addressing CFT in the aftermath of trauma.

Background: Maladaptive appraisals, such as thoughts about experiencing a permanent and disturbing change and about being a fragile person in a scary world, are associated with posttraumatic stress reactions (PTSR) for trauma-exposed children and adolescents. Less is known about what puts young people at risk for developing such appraisals, and the differential relationship between the types of appraisals and PTSR.Objective: The primary aim was to examine the role of age, gender and exposure to potentially traumatizing events (PTEs) for the levels of maladaptive appraisals. The secondary aim was to investigate the association between the levels of maladaptive appraisals (appraisals of a permanent change and appraisals about a scary world) and PTSR.Methods: We investigated these aims in two samples: survivors after the terror attack at Ut & oslash;ya island in Norway in 2011 (N = 165, mean age 17.65, SD = 1.19) and adolescents referred to treatment after mainly interpersonal trauma (N = 152, mean age 15.08, SD = 2.18). The aims were investigated using linear regression and partial correlation.Results: In the terror-exposed sample, female gender was significantly associated with higher levels of scary-world appraisals, witnessing or learning that someone close were exposed to physical violence was significantly associated with more permanent-change appraisals, and a higher number of PTEs was significantly associated with higher levels of both types of appraisals. For the clinical sample, we found no significant associations between exposure to PTEs, gender, age, and the level of maladaptive appraisals. Both types of maladaptive appraisals were highly associated with PTSR in both samples, and there was no significant difference in the strength of the associations between the types of appraisals and PTSR.Conclusions: The results have implications for identifying adolescents at risk for developing harmful maladaptive appraisals. Both scary-world appraisals and permanent-change appraisals were strongly associated with PTSR in both groups of trauma-exposed adolescents. Factors associated with elevated levels of maladaptive appraisals, and associations between maladaptive appraisals and posttraumatic stress reactions were investigated in two samples of trauma-exposed adolescents.Both appraisals about experiencing a permanent and disturbing change and appraisals about being a fragile person in a scary world were significantly associated with posttraumatic stress reactions.Exposure to a higher number of potentially traumatizing events (PTEs), being female, and witnessing or learning that someone close was exposed to physical violence were significantly associated with a higher level of maladaptive appraisals among terror-exposed adolescents. Antecedentes: Las valoraciones desadaptativas, como pensamientos sobre experimentar un cambio permanente y perturbador y sobre ser una persona fr & aacute;gil en un mundo aterrador, est & aacute;n asociadas con las reacciones del estr & eacute;s postraum & aacute;tico (PTSR, por sus siglas en ingl & eacute;s) en ni & ntilde;os y adolescentes expuestos a trauma. Se conoce menos sobre qu & eacute; factores predisponen a los j & oacute;venes a desarrollar tales valoraciones y la relaci & oacute;n diferencial entre sus distintos tipos de valoraciones y las PTSR.Objetivo: El objetivo principal fue examinar el papel de la edad, el g & eacute;nero y la exposici & oacute;n a eventos potencialmente traumaticos (PTEs, por sus siglas en ingl & eacute;s) en los niveles de valoraciones desadaptativas. El objetivo secundario fue investigar la asociaci & oacute;n entre los niveles de valoraciones desadaptativas (valoraciones sobre un cambio permanente y sobre un mundo aterrador) y el PTSR.M & eacute;todos: Investigamos estos objetivos en dos muestras: sobrevivientes del ataque terrorista en la isla de Ut & oslash;ya en Noruega en 2011 (N = 165, edad media 17,65, DE = 1,19) y adolescentes derivados a tratamiento despu & eacute;s de un trauma principalmente interpersonal (N = 152, edad media 15,08, DE = 2,18). Los objetivos fueron investigados utilizando regresi & oacute;n lineal y correlaci & oacute;n parcial.Resultados: En la muestra expuesta al ataque terrorista, el g & eacute;nero femenino se asoci & oacute; significativamente con mayores niveles de valoraciones de un mundo aterrador; haber presenciado o enterarse que alguien cercano fue expuesto a violencia f & iacute;sica se asoci & oacute; significativamente con valoraciones de cambio permanente, y un mayor n & uacute;mero de PTEs se asoci & oacute; significativamente con niveles m & aacute;s altos de ambos tipos de valoraciones. Para la muestra cl & iacute;nica, no encontramos asociaciones significativas entre la exposici & oacute;n a PTEs, el g & eacute;nero, la edad y el nivel de valoraciones desadaptativas. Ambos tipos de valoraciones desadaptativas estuvieron altamente asociadas con PTSR en ambas muestras, y no hubo diferencias significativas en la fuerza de las asociaciones entre los tipos de valoraciones y las PTSR.Conclusiones: Los resultados tienen implicaciones para identificar a los adolescentes en riesgo de desarrollar valoraciones desadaptativas da & ntilde;inas. Tanto las valoraciones de un mundo aterrador como las de un cambio permanente estuvieron fuertemente asociadas con las PTSR en ambos grupos de adolescentes expuestos a trauma.

After traumatic experiences, it is common to think about alternative scenarios or outcomes of the event. This is often referred to as counterfactual thoughts (CFT), and CFT after trauma have been associated with posttraumatic stress reactions (PTSR). In this study, we aimed to: (1) investigate the relationship between the vividness and frequency of CFT and PTSR, and to (2) examine the associations between exposure, peri-traumatic reactions, physical injury and the loss of someone close, and the subsequent vividness and frequency of CFT. The participants (N = 289) were survivors of a terror attack in Norway. More vivid and frequent CFT were significantly and independently related to more PTSR. Exposure during trauma was significantly associated with more vivid CFT in the unadjusted regression model. No further significant relationships were found between exposure, peri-traumatic reactions, physical injury and the loss of someone close, and the vividness and frequency of CFT. As CFT are common after trauma and potentially cause distress, clinicians should identify and validate CFT, and provide coping assistance.

Background: After exposure to a potentially traumatic event, survivors may experience thoughts about 'what could have happened', referred to as counterfactual thoughts (CFTs). CFTs have been found to have a negative impact on survivors' mental health. This is the first study to investigate whether parents of trauma survivors experience CFTs and the association with psychological distress in this group.Objective: The main aim of the present study is to investigate CFTs in parents of trauma survivors and the relationship between the frequency and vividness of CFTs and psychological distress.Method: The participants (N = 310, 191 females) were parents of the youths targeted in the terror attack on Utøya island, Norway, in 2011. Frequency and vividness of CFTs, posttraumatic stress reactions (PTSR), and symptoms of anxiety and depression were measured 8.5-9 years post-terror.Results: The majority of the parents (74%) reported having experienced CFTs at some time point since the attack. For almost one-third of the parents, CFTs were still present more than eight years after the attack. Higher frequency and vividness of CFTs were uniquely associated with higher levels of PTSR, anxiety, and depression.Conclusion: The present findings suggest that frequent and vivid CFTs may contribute to mental health problems in parents of trauma survivors and should be addressed in therapy.

Background: How do we remember what happened shortly before a traumatic experience? There has been little focus on the temporal context of trauma memories, but a few studies suggest that aspects of what happened in the moments prior to a traumatic experience may be selectively enhanced and prioritized in memory. Objective: The main aim of this study was to investigate the occurrence, nature, and content of voluntary memories about what happened shortly before a disaster. The participants were individuals who had survived a fire on the passenger ferry Scandinavian Star 26 years earlier. Methods: Data collection took the form of face-to-face interviews. The analysis was carried out in two steps. First, all the narratives from participants who were aged 7 years or older at the time of the fire (N = 86) were coded in terms of the presence of detailed descriptions of what happened before the fire. Next, the narratives that included detailed descriptions of the moments before (N = 28) were included in a thematic analysis, focusing on coding the mode and the content. Results: More than one-third of the participants reported detailed accounts of what happened in the hours, minutes, or seconds before the fire. These memories included detailed descriptions of sensory impressions, dialogues, actions, and thoughts. Two themes stood out in the thematic analysis: (1) unusual observations and danger cues; and (2) counterfactual thoughts. Conclusion: The finding that specific details from the moments before a traumatic event may be vividly recalled indicates that peripheral details of traumatic events can be prioritized in memory. Such details may be interpreted as warning signals. Future research should examine whether such memories might stimulate long-standing thoughts of the world as being dangerous, and hence carry the threat forward in time.

The objective of the current study was to explore counterfactual thinking in victims of the 2011 Oslo terrorism attack. Interviews were conducted with 48 government employees present at 2011 Oslo bombing, 24 of whom had a history of posttraumatic stress disorder (PTSD) related to the attack, 24 had not. A thematic analysis of these qualitative data was conducted. The material was divided into 3 main themes: the presence of counterfactual thoughts, coincidences, and the handling of counterfactual thoughts. Across these themes, the 2 groups (PTSD/non-PTSD) demonstrated intragroup variation, but also marked intergroup variation. The PTSD group reported more counterfactual thoughts, reported perceived coincidences as spurring on "what if" thoughts (rather than as a reason to dismiss counterfactual thinking), and were more bothered by counterfactual thoughts than the non-PTSD group. Counterfactual thoughts are common among people who have experienced a terrorist event. The findings suggest that counterfactual thinking may contribute to the development and maintenance of PTSD. Clinicians should be aware of counterfactual thoughts and may focus on them in the therapy of PTSD.

Generalized trust, the belief that most other people can be trusted, has positive consequences for health and wellbeing. An increased sense of community is often seen in times of crisis or disaster, but it is unclear whether this is the case in the COVID-19 pandemic. The objectives of the current study were to assess whether generalized trust increased in an early pandemic phase compared to pre-pandemic levels, and whether trust was lower in individuals who felt particularly threatened or burdened in the pandemic. We compared levels of generalized trust in a population-representative Norwegian sample (n = 1,041) with pre-pandemic levels from the European Social Survey (ESS). Age- and gender-adjusted expected scores were compared to observed scores, using weighted data. Secondly, we tested whether indicators of pandemic-related strain, perceived health risks, or pandemic-related worry were associated with a lower level of generalized trust. This cross-sectional study was conducted in an early opening-up phase (May, 2020). The observed levels of generalized trust in an early pandemic phase did not differ significantly from expected levels based on pre-pandemic measures. Higher trust was found among individuals who reported personal experience with the COVID-19 disease (tested positive, admitted to hospital, or lost someone to the disease). Pandemic-related worry and a high perceived health threat were both associated with a lower level of generalized trust. These results indicate that personal experiences with the COVID-19 pandemic could influence trust in others, although this link may be context-dependent. Generalized trust is considered to be an important asset in society, and promote health and well-being. As the pandemic evolves, there is a risk that we may lose, or a chance that we could gain, trust, with potential consequences for our health.