The Dynamic Relations Among Peritraumatic Posttraumatic Stress Symptoms: An Experience Sampling Study During Wartime

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The associations among peritraumatic posttraumatic stress symptoms (P-PTSS) in the immediate aftermath of trauma exposure, including those in the posttraumatic stress disorder clusters of intrusions, avoidance, negative cognitions and mood (NCM), and arousal, might indicate mechanisms through which enduring PTSD develops. During a period of war, exposed participants (N = 181) were sent twice-daily questionnaires for 30 days via smartphone. We repeatedly assessed the predictive associations between the P-PTSS clusters over time. We performed a multilevel pathway analysis built of multiple triple sequence responses (6,221 cases) on each of the four P-PTSS clusters at a mean time lag of 12 hr (Model A) and 24 hr (Model B) for 181 participants, 85 of whom had been diagnosed with a serious mental illness. Arousal predicted intrusion in Models A and B, b A = 0.08, 95% CI [0.03, 0.12], p <.001 and b B = 0.03, 95% CI [0.00, 0.07], p =.051, respectively; and NCM in Models A and B, b A = 0.09, 95% CI [0.05, 0.12], p <.001 and b B = 0.06, 95% CI [0.03, 0.09], p <.001, respectively. Intrusion predicted arousal in Model B, b B = 0.05, 95% CI [0.01, 0.08], p =.010. NCM predicted arousal, b A = 0.10, 95% CI [0.05, 0.14], p <.001, and avoidance b A = 0.05, 95% CI [0.00, 0.11], p =.052, in Model A. Avoidance did not predict any other cluster. Arousal seemed to be acting as a hub, strengthening feedback loops to and from NCM and intrusion.

Original languageEnglish
Pages (from-to)119-129
Number of pages11
JournalJournal of Traumatic Stress
Issue number1
StatePublished - 1 Feb 2019

Bibliographical note

Funding Information:
This work was supported by The Moshe Hess Foundation; The Brain and Behavior Research Foundation (Narsad Young Investigator Award, 23524); and the Israel Science Foundation, 1244/16.We would like to thank Gabriel Liberman and Amir Hefetz from Datagraph Statistical Consulting for their statistical support. We also want to thank Shulamit Grinapol for her contribution in setting this study up.

Publisher Copyright:
© 2019 International Society for Traumatic Stress Studies

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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