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Centrality of Events
Event Centrality, or Centrality of Events, is a concept related to posttraumatic stress disorder that states traumatic memories become a central component of personal identity. The theory of Event Centrality is guided by research in cognitive psychology. The theory pulls upon availability heuristic, flashbulb memory, and autobiographical memory. The general premise is that traumatic memories are easily accessible, have extreme detail, and may be major events in people’s lives. It is theorized that having easily accessible memory of a traumatic event in extreme detail can be a turning point in a life, that memory can form a part of personal identity, and influence PTSD symptoms.

The theory of Centrality of Events is a concept utilized in the field of psychology. It was referred to as Event Centrality until the creation of the Centrality of Events Scale (CES)

Event Centrality has demonstrated promising results in the realm of PTSD, and has been shown to correlate and predict PTSD symptoms in multiple populations.

Component Description
Event Centrality states that there are three aspects of accessible personal memories that describe a traumatic memory’s role: “the traumatic memory becomes, 1) a reference point for everyday inferences, 2) a turning point in the life story, and 3) a central component of personal identity." The three concepts are multiple ways that the traumatic memory can impact an individual.

Reference Point for Everyday Inferences
Memories being a reference point for everyday inferences follows the logic of the availability heuristic, which states that humans use mental shortcuts in situations due to the ease of the shortcut. Event Centrality also draws on flashbulb memory, which states that surprising or emotionally-charged events will lead to easily accessible memories. It is important that most individuals believe their flashbulb memories as accurate, when the majority of the time they may be inaccurate. With the ease of access from the traumatic memory, a memory becomes a mental shortcut for situations, causing the memory to be a misattributed to how things are in the world. Utilizing the memory as a shortcut means the traumatic memory is easily accessible and detailed, so that an individual may misattribute safe situations as life threatening, as demonstrated by PTSD symptoms.

Turning Points in Life Stories
The idea of turning points in life stories is that certain events, or a "turning point," can affect the life course. It has been fairly accepted that there are culturally-expected transitional events that are turning points in life stories. Typically positive life events, such as: first jobs, first career, birthdays, marriage, having a child, or graduation are expected with negative events rarely expected. The theory of Event Centrality suggests that having these traumatic memories as turning points violates a shared cultural norm, and may cause the traumatic memories to “contaminate” positive events prior. It is also suggested that having the traumatic event as a turning point in the life story may cause a preoccupation with the trauma.

Components of Personal Identity
The component of personal identity is related to the turning points in life stories such that turning points become a major component of personal identity. Studies have suggested that knowledge of social roles, and changing between social roles, are incorporated into personal identities. With the knowledge of social roles, there are culturally expected behaviors, so being a trauma survivor or trauma victim as a personal identity may influence a person’s beliefs of their social norms and roles. With these components in mind, Dorthe Bernsten and David C. Rubin created the Centrality of Events Scale (CES), using evidence that traumatic events may become important to how individuals understand themselves.

The Centrality of Events Scale (CES)
The Centrality of Events Scale (CES) is a 20-item questionnaire used to rate Event Centrality in adults. The CES can be administered on an outpatient basis, with results of the CES used to assist in evaluating posttraumatic stress disorder.

History
Bernsten and Rubin originally created the CES in 2006, based upon previous research on traumatic memories and PTSD, and how trauma alters memories and outcomes for individuals. The original scale consisted of 23 items designed to measure event centrality, and was originally normed on graduate students from four major American universities. The authors decided upon the 20 final items due to scores of reliability, validity, and statistical significance.

Scale Items
The CES is a self-assessment questionnaire, consisting of 20 items. Questions on the CES ask about a participant's impression regarding a significant trauma or life stressor, and how that event has influenced their life. Participants answer questions on a Likert scale ranging from 1 to 5 (1 = Totally Disagree, to 5 = Totally Agree). The questionnaire takes approximately 10 minutes to complete.

The CES-S is a short-item version of the CES that consists of only 7 items. The authors selected the short-item questions based upon correlations and alphas relating to the three concepts of Event Centrality. The 20-item CES has demonstrated a Chronbach's alpha of α = .94, while the CES-S demonstrates α = .88. The CES also demonstrates correlations with a PTSD diagnosis, and the PTSD Checklist (PCL) (r = 0.45, p<.001). The 20-item CES has been found to correlate with the PCL (r = 0.39, beta 0.37), while the 7-item CES correlated with an r = 0.35.

Interpretation of Results
Scores on the CES help to assess how much a traumatic event is central to an individual’s life story. The different items on the questionnaire correlate to one of the three different concepts of autobiographical memory: 1) Is the event a reference point (anchor) for expectations; 2) Is it a central component to identity; and, 3) Is it a turning point in life? . The CES does not contain a cut score, but higher scores on each of the three concepts indicate varying severity, and may influence PTSD diagnosis and treatment approaches.

Application
The CES has demonstrated use by clinicians in inpatient and outpatient settings. The CES has demonstrated use in community cohorts, with older adults , for those experiencing grief , and adult survivors of child abuse. Participants with high scores on the CES have been found to also report high levels of PTSD symptoms, including Veteran cohorts. The CES has also been linked to worse physical health outcomes, worse mental health problems following a trauma , and high levels of emotional distress.