title: The relationship between posttraumatic stress symptoms and narrative structure among adolescent terrorist-attack survivors.
abstract: BACKGROUND
  The structure of trauma narratives is considered to be related to posttraumatic stress symptomatology and thus the capacity to make a coherent narrative after stressful events is crucial for mental health.
  
  
  OBJECTIVE
  The aim of this study is to understand more of the relationship between narrative structure and posttraumatic stress symptoms (PTSS). More specifically, we investigated whether internal and external focus, organization, fragmentation, and length differed between two groups of adolescent survivors of a mass shooting, one group with low levels of PTSS and one group with high levels of PTSS.
  
  
  METHODS
  The sample comprised 30 adolescents who survived the shooting at Utøya Island in Norway in 2011. They were interviewed 4-5 months after the shooting and provided a free narrative of the event. PTSS were assessed using the UCLA Posttraumatic Stress Disorder Reaction Index (PTSD-RI).
  
  
  RESULTS
  We found that survivors with high levels of PTSS described more external events and fewer internal events in their narratives compared with survivors with low levels of symptoms. The analysis also showed that especially narratives containing more descriptions of dialogue and fewer organized thoughts were related to higher levels of PTSS. The groups did not differ in levels of narrative fragmentation or in length of the narratives.
  
  
  CONCLUSIONS
  Specific attributes of narrative structure proved to be related to the level of PTSS. On the basis of our results, we can recommend that practitioners focus especially on two elements of the trauma narratives, namely, the amount of external events, particularly dialogues, within the narrative and the number of organized thoughts. Participants with high levels of PTSS provided trauma narratives with low amount of organized (explanatory) thoughts accompanied by detailed descriptions of dialogues and actions, which is indicative for "here and now" quality of recall and a lack of trauma processing.
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; petra.filkukova@nkvts.no.
authors.forename: Petra
authors.initials: P
authors.lastname: Filkuková
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.|Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Tine K
authors.initials: TK
authors.lastname: Jensen
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Gertrud Sofie
authors.initials: GS
authors.lastname: Hafstad
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.|Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Hanne Torvund
authors.initials: HT
authors.lastname: Minde
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Grete
authors.initials: G
authors.lastname: Dyb
keywords: Posttraumatic stress symptoms; external events; internal events; narrative fragmentation; narrative organization