The Role of Adverse Childhood Experiences and Protective Factors in the Co-Occurrence of Somatization and Post-Traumatic Stress Symptoms

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review “The Role of Adverse Childhood Experiences and Protective Factors in the Co-occurrence of Somatization and Posttraumatic Stress Symptoms.” I believe that the study examines important topics related to ACEs, including the examination of comorbid symptoms as well as potential protective factors. I have a few comments that I hope the authors will find helpful in improving the manuscript.

1. I appreciate the authors’ use of theory to guide their research questions within the literature review.
2. Is there any developmental research on why the examination of these constructs within a college/17-29-year-old sample is important? I realize that college students are a convenient sample to use; however, additional information would be helpful on why it is important to examine these associations within this age group.
3. It would be helpful if the authors provided a little bit more information in the introduction on the importance of examining comorbid somatization and PTSD beyond just citing research on the likelihood of the association. More specifically, why is it important to better understand the interdependence between these two constructs? In other words, what are some of the possible implications?
4. It wasn’t clear why the authors decided to categorize their outcome as three levels (no symptoms, single, comorbid) instead of four levels (no symptoms, somatization only, PTSD only, comorbid). Was this due to power? Although they provide the separate prevalence rates, It seems that the authors are missing out on important information regarding the associations between ACEs and somatization versus ACEs and PTSD. Is it possible to determine whether there were differential associations (ACEs --> somatization only versus ACEs --> PTSD only versus ACEs --> Comorbid symptoms)?
5. Within the discussion, I was a bit confused by the authors’ mention of the possibility that individuals are misinterpreting physical discomfort as pathological symptoms. Are they insinuating that the pain is not actually significant, and the participants are overestimating somatization?
6. Similar to the introduction, I think a bit more information in the discussion on the implications of their findings would be helpful. What are the implications for a strong connection between ACEs and comorbid somatization and PTSD? Health care costs? Importance of incorporating pain reduction within psychological services? Other implications for their findings related to the protective factors? The authors very briefly note that the findings can inform interventions without making any reference to how they could inform interventions.
7. The authors found that, contrary to expectation, psychological resilience conferred protection against isolated symptoms but not against comorbid symptoms. Since the authors did not look at somatization and PTSD separately, is it possible that the association for isolated symptoms was actually due to an association with only one type of symptom? Breaking “isolated symptoms” into somatization only and PTSD only would likely provide additional information.
8. The authors’ discussion of the limitations of the study was very brief. Some possible additions:

                  - What are the limitations of using an undergraduate/postgraduate student sample? Do the authors think the use of this sample could have possibly underestimated or overestimated the associations compared to other samples?

                  - Were there other relevant covariates that the authors could not control for that could have confounded the results? Family and/or household income? Family mental health concerns?

 

Author Response

Dear Reviewer,

Thank you for your thoughtful and constructive feedback on our manuscript, “The Role of Adverse Childhood Experiences and Protective Factors in the Co-occurrence of Somatization and Post-traumatic Stress Symptoms.” We sincerely appreciate your time and expertise in evaluating our work. Below, we provide detailed responses to each of your comments, along with a summary of revisions made to address your concerns.

Comments 1: I appreciate the authors’ use of theory to guide their research questions within the literature review.

Response 1: Thank you for your acknowledgment. We aimed to ground our hypotheses in established theoretical frameworks to ensure conceptual coherence. Your recognition of this effort is encouraging.

Comment 2: Is there any developmental research on why the examination of these constructs within a college/17-29-year-old sample is important? I realize that college students are a convenient sample to use; however, additional information would be helpful on why it is important to examine these associations within this age group.

Response 2: We agree that clarifying the rationale for focusing on this age group strengthens the manuscript. In the revised introduction (Paragraph one, p.2), we added references to developmental studies highlighting that emerging adulthood represents a critical period for both symptom consolidation and resilience-building. Specifically:The university stage represents a critical transitional period from adolescence to adulthood, marked by multifaceted challenges in academics, interpersonal relationships, and self-identity formation. Concurrently, this phase coincides with a pivotal window of neurodevelopment, where heightened neuroplasticity may allow protective factors to facilitate the remediation of adverse childhood experiences (ACEs). Specifically, ACE-induced maladaptive schemas—such as persistent negative self-perceptions or hypervigilance—could interact with this enhanced neural adaptability, creating a dual dynamic of vulnerability and remediation potential.

Comment 3: It would be helpful if the authors provided a little bit more information in the introduction on the importance of examining comorbid somatization and PTSD beyond just citing research on the likelihood of the association. More specifically, why is it important to better understand the interdependence between these two constructs? In other words, what are some of the possible implications?

Response 3: We expanded the introduction (Paragraphs three to four, pp. 2-3) to emphasize the clinical and public health implications of studying this comorbidity:

(1) Comorbid cases often exhibit poorer treatment outcomes, higher healthcare utilization, and greater functional impairment compared to single-symptom presentations;

(2) Somatic symptoms may mask underlying PTSD in clinical settings, leading to misdiagnosis and delayed trauma-focused care;

(3) Understanding shared mechanisms (e.g., hyperarousal, emotion dysregulation) could inform transdiagnostic interventions.

Comment 4: It wasn’t clear why the authors decided to categorize their outcome as three levels (no symptoms, single, comorbid) instead of four levels (no symptoms, somatization only, PTSD only, comorbid). Was this due to power? Although they provide the separate prevalence rates, It seems that the authors are missing out on important information regarding the associations between ACEs and somatization versus ACEs and PTSD. Is it possible to determine whether there were differential associations (ACEs --> somatization only versus ACEs --> PTSD only versus ACEs --> Comorbid symptoms)?

Response 4: This is a valuable insight. In our initial study design, we did not fully consider the analytical benefits of categorizing outcomes into four distinct levels. However, guided by your suggestion, we rigorously revisited our approach, optimized the study design, and reanalyzed the data using a four-level outcome classification (asymptomatic, somatization-only, PTSS-only, and comorbid symptoms). The updated statistical analysis (Section 2.3, p.5) yielded meaningful and nuanced findings, including differential associations between ACEs and symptom subtypes, as well as distinct protective effects of psychological resilience. We deeply appreciate your suggestion—it not only strengthened the methodological rigor of our work but also uncovered critical insights that were previously overlooked. This revision has significantly enhanced the depth and clinical relevance of our conclusions. The revised results (Section 3, Table 2 and Table 3) revealed distinct patterns:

(1) ACEs showed stronger associations with comorbid symptoms than with isolated PTSD or somatization;

(2) Psychological resilience buffered comorbid symptoms but had no significant effect on isolated PTSS.

Comment 5: Within the discussion, I was a bit confused by the authors’ mention of the possibility that individuals are misinterpreting physical discomfort as pathological symptoms. Are they insinuating that the pain is not actually significant, and the participants are overestimating somatization?

Response 5: Thank you for raising this important point. We sincerely apologize for the lack of clarity in our original discussion regarding the interpretation of somatic symptoms. Our intention was not to dismiss the validity of participants’ physical discomfort but rather to hypothesize that somatization in trauma-exposed individuals might reflect psychological mechanisms rather than exclusively organic pathology. Specifically, we aimed to suggest that individuals experiencing somatization may lack awareness of the trauma-related origins of their symptoms, potentially leading them to seek purely biomedical explanations. However, we recognize that this speculative interpretation risked minimizing the lived reality of somatic distress. To address this, we have removed the ambiguous phrasing and refocused the discussion on clarifying the mechanisms linking ACEs to comorbid symptoms. We also emphasized the implications of our findings for clinical assessment and treatment approaches, thereby providing a more focused discussion grounded in empirical support. This revision aligns the text more closely with the data while preserving clinical nuance.

Comment 6: Similar to the introduction, I think a bit more information in the discussion on the implications of their findings would be helpful. What are the implications for a strong connection between ACEs and comorbid somatization and PTSD? Health care costs? Importance of incorporating pain reduction within psychological services? Other implications for their findings related to the protective factors? The authors very briefly note that the findings can inform interventions without making any reference to how they could inform interventions.

Response 6: We sincerely appreciate your insightful suggestion to elaborate on the implications of our findings. In both the Introduction and Discussion sections, we have expanded on the significance of the robust link between ACEs and comorbid symptoms. Specifically, we emphasize that this connection underscores the need for comprehensive clinical assessments of co-occurring symptoms in practice, which can inform the development of integrated treatment protocols to address the root causes of symptoms and reduce long-term healthcare expenditures.

Furthermore, we have enhanced our intervention recommendations:

(1) Primary Prevention: We advocate for coordinated efforts across families, schools, and communities to prevent ACEs through initiatives such as parenting education, poverty alleviation, and trauma-informed school programs.

(2) Tiered Intervention Strategies: For individuals already affected by ACEs, we propose symptom-specific, tiered positive intervention strategies. These include: Early social support interventions (e.g., family systems therapy) for isolated symptoms; Multimodal approaches (e.g., cognitive restructuring combined with mindfulness training) for comorbid presentations.

These additions clarify how our findings bridge research, clinical practice, and public health policy to mitigate the lifelong impacts of ACEs.

Comment 7: The authors found that, contrary to expectation, psychological resilience conferred protection against isolated symptoms but not against comorbid symptoms. Since the authors did not look at somatization and PTSD separately, is it possible that the association for isolated symptoms was actually due to an association with only one type of symptom? Breaking ‘isolated symptoms’ into somatization only and PTSD only would likely provide additional information.

Response 7: Thank you very much for your constructive feedback. Based on your suggestions, we revised our research design and categorized the outcome variables into four levels: asymptomatic, somatization only, post-traumatic stress symptoms only, and comorbid symptoms. Our reanalysis of the data revealed that psychological resilience serves as a significant protective factor for comorbid symptoms, while it did not have a significant effect on either somatization only or post-traumatic stress symptoms only. We have analyzed this result in the discussion and provided relevant intervention recommendations (Section 4, Paragraphs four to five).

Comment 8: The authors’ discussion of the limitations of the study was very brief. Some possible additions:

                  - What are the limitations of using an undergraduate/postgraduate student sample? Do the authors think the use of this sample could have possibly underestimated or overestimated the associations compared to other samples?

                  - Were there other relevant covariates that the authors could not control for that could have confounded the results? Family and/or household income? Family mental health concerns?

Response 8: Thank you for your valuable feedback. As suggested, we have expanded the discussion of our study’s limitations in Section 4, Paragraph 6. Specifically, we acknowledge that the use of a university student sample—characterized by relatively higher socioeconomic status and cognitive resources compared to the general population—may underestimate the broader impact of ACEs in marginalized or less-resourced groups. Additionally, while we controlled for key demographic variables, our study did not account for critical familial factors such as household income dynamics or intergenerational mental health history, which could confound the observed associations. We recognize these limitations; however, we believe that our research still holds significant value in highlighting the connections between ACEs and comorbid symptoms. It sets the stage for future studies to explore these dynamics more comprehensively and to inform interventions in diverse populations.

 

We are grateful for your insightful critiques, which have significantly strengthened the manuscript’s rigor and clarity. All revisions are highlighted in the tracked-changes version of the manuscript. We believe that these updates have greatly improved our work and we look forward to your further feedback.

Thank you again for your valuable contribution to our work.

 

Sincerely,

Rubing Ma

On behalf of all authors

Graduate Student

Department of Psychology

Beijing Forestry University

Reviewer 2 Report

Comments and Suggestions for Authors

Thanks for the manuscript. the authors aim to explore the role of Adverse Childhood Experiences and Protective Factors in the Co-occurrence of Somatization and Posttraumatic Stress Symptoms through data analysis. To achieve this goal, the author has made some efforts, but the following issues still need further clarification.

The author's review of the relevant literature is far from comprehensive. The author merely provides a brief explanation of why it is necessary to study the role of Adverse Childhood Experiences (ACEs) and protective factors in the co-occurrence of somatization and posttraumatic stress symptoms (PTSS), while largely neglecting the research achievements in the academic field. A literature search reveals that existing studies have already identified childhood adverse experiences as a significant predictor of the co-occurrence of somatization and PTSS (Felitti, V. J., et al., 1998),. Moreover, these studies have elucidated the biological mechanisms (McEwen, 2007), psychological mechanisms (Danese, A., et al., 2007), and the buffering mechanisms of protective factors (Rutter, M., 1987; Southwick, S. M., & Charney, D. S., 2012). The author should provide a comprehensive review of these findings, then articulate the objectives of this study, and explain its contributions and significance.

references：
 Felitti, V. J., et al., 1998, "Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study," American Journal of Preventive Medicine, 14(4), 245-258
McEwen, B. S., 2007, "Physiology and Neurobiology of Stress and Adaptation: Central Role of the Brain," Physiological Reviews, 87(3), 873-904
Danese, A., et al., 2007, "Childhood Maltreatment Predicts Adult Inflammation in a Life-course Study," Proceedings of the National Academy of Sciences, 104(4), 1319-1324。
Cloitre, M., et al., 2009, "A Developmental Approach to Complex PTSD: Childhood and Adult Cumulative Trauma as Predictors of Symptom Complexity," Journal of Traumatic Stress, 22(5), 399-408
Nolen-Hoeksema, S., 2000, "The Role of Rumination in Depressive Disorders and Mixed Anxiety/Depressive Symptoms," Journal of Abnormal Psychology, 109(3), 504-511
Rutter, M., 1987, "Psychosocial Resilience and Protective Mechanisms," American Journal of Orthopsychiatry, 57(3), 316-331
Southwick, S. M., & Charney, D. S., 2012, "The Science of Resilience: Implications for the Prevention and Treatment of Depression," Science, 338(6103), 79-82

The authors did not explicitly define 'co-occurrence', but proposed a specific method for measuring co-occurrence: 'The Somatization subscale and the PCL-5 were combined to create a three-level co-occurrence outcome: (1) Somatization subscale≤24 and PCL-5 < 33 (no symptoms); (2) Somatization subscale> 24 or PCL-5≥ 33 (single symptoms); (3) Somatization subscale>24 and PCL-5≥33 (co-occurring symptoms).' What is the basis for doing this?

The current study’s findings align with previous research demonstrating a significant association between ACEs and the co-occurrence of somatization and post-traumatic stress symptoms. Building on this, the discussion should delve into the potential mechanisms underlying this association. For instance, the toxic stress model suggests that chronic exposure to ACEs can dysregulate the body's stress response system, leading to long-term physiological and psychological consequences. Furthermore, the discussion can explore how psychological resilience and social support may mitigate these effects by buffering against the negative impact of ACEs and promoting adaptive coping mechanisms.

Comments on the Quality of English Language

I am not qualified to judge the quality of the english 

Author Response

Dear Reviewer,

Thank you for your thorough and constructive feedback on our manuscript. Your insights have significantly strengthened our work. Below, we address each of your comments in detail, outlining the revisions made to improve the manuscript’s rigor and clarity.

Comment 1: The author's review of the relevant literature is far from comprehensive... Existing studies have already identified ACEs as a predictor of somatization-PTSS comorbidity and elucidated biological, psychological, and protective mechanisms.

Response 1: We sincerely appreciate your guidance and the references provided. In the revised Introduction (Section 1, pp. 2-3), we have expanded the literature review to incorporate key findings and theoretical frameworks, including:

Biological Mechanisms: Chronic ACEs dysregulate stress response systems through the toxic stress model, increasing vulnerability to somatic and PTSS comorbidity.

Psychological Mechanisms: ACEs foster maladaptive cognitive schemas (e.g., catastrophizing, emotional avoidance) that perpetuate symptom overlap.

Protective Mechanisms: The resilience compensation model and the post-traumatic growth model provide important perspectives for understanding the role of protective factors.

These additions clarify our study’s foundation and highlight its contribution: extending prior work by examining how resilience and social support differentially modulate comorbid vs. isolated symptoms—a gap identified in recent reviews.

Comment 2: The authors did not explicitly define 'co-occurrence', but proposed a specific method for measuring co-occurrence: 'The Somatization subscale and the PCL-5 were combined to create a three-level co-occurrence outcome: (1) Somatization subscale≤24 and PCL-5 < 33 (no symptoms); (2) Somatization subscale> 24 or PCL-5≥ 33 (single symptoms); (3) Somatization subscale>24 and PCL-5≥33 (co-occurring symptoms).' What is the basis for doing this?

Response 2: Thank you for prompting us to clarify this critical methodological point. Combining the Somatization subscale and the PCL-5 to define a three-level co-occurrence group of somatization and post-traumatic stress symptoms has a basis in theory. On one hand, this approach is grounded in the theory of mutually reinforcing mechanisms. On the other hand, it is informed by a study by Lensch et al. (2021), which explores adverse childhood experiences and their association with co-occurring psychological distress and substance abuse among juvenile offenders. In that study, the authors created a three-level co-occurrence outcome through a similar method of measurement. By adopting this framework, we aim to enhance the clarity and validity of our classification of co-occurring symptoms. The use of specific cut-off scores for the Somatization subscale and PCL-5 allows us to categorize individuals based on the severity and presence of symptoms, which aligns with established research on the relationship between ACEs and related psychological outcomes. This methodological choice is further supported by existing literature that reveals a nuanced understanding of the intersection between somatization and PTSD. We believe that this approach provides a more robust characterization of the interplay between these symptoms, capturing the complexities associated with their co-occurrence and enabling a better understanding of the underlying mechanisms.

In addition, we have revised the three-level co-occurrence outcome to a four-level co-occurrence outcome to provide a clearer understanding of the relationships between Adverse Childhood Experiences (ACEs), protective factors, and the distinct symptoms of somatization and post-traumatic stress symptoms.

References:

Lensch, T.; Clements-Nolle, K.; Oman, R.F.; Evans, W.P.; Lu, M.; Yang, W. Adverse childhood experiences and co-occurring psychological distress and substance abuse among juvenile offenders: the role of protective factors. Public Health. 2021, 194, 42-47. https://doi.org/10.1016/j.puhe.2021.02.014

Comment 3: "The discussion should delve into the potential mechanisms underlying this association... How do resilience and social support mitigate these effects?"

Response 3: Thank you for emphasizing the need to clarify the mechanisms underlying the ACEs-comorbidity association and the protective roles of resilience and social support. We have restructured the Discussion (Section 4, pp. 7-8) to explicitly address these pathways, as outlined below:

(1) Mechanisms Linking ACEs to Symptom Co-occurrence

The robust association between Adverse Childhood Experiences (ACEs) and comorbid symptoms can be understood through the lens of the toxic stress model, which posits that chronic childhood adversity induces multisystem dysregulation. This includes hyperactivity of the HPA axis, where prolonged cortisol elevation disrupts immune and metabolic functioning, thereby amplifying vulnerability to both somatic symptoms, such as chronic pain, and trauma-related hypervigilance. Additionally, ACEs promote the release of pro-inflammatory cytokines, exacerbating neural sensitization and interoceptive dysfunction, which ultimately fosters cross-symptom overlap. Furthermore, the observed synergism between somatization and post-traumatic stress symptoms (PTSS) corroborates the mutual maintenance framework. Chronic pain or fatigue may act as conditioned cues that reactivate PTSS-related intrusive memories and hyperarousal, while PTSS-driven behavioral avoidance—characterized by reduced physical activity and social withdrawal—can worsen somatic distress by lowering pain thresholds and limiting adaptive coping. This bidirectional reinforcement creates a self-perpetuating cycle, explaining why the risk of comorbidity escalates disproportionately with the severity of ACEs.

(2) Mechanisms of Protective Factors

Psychological resilience serves as an intrinsic resource for coping with stress, playing a crucial protective role in co-occurring symptoms often associated with severe Adverse Childhood Experiences (ACEs). These symptoms typically reflect underlying psychological trauma and allostatic overload, wherein cumulative physiological stress surpasses individual compensatory thresholds, necessitating resilient adaptation. By contrast, single symptoms may indicate lower stress levels, making resilience mechanisms less critical. Moderate ACEs can foster psychological immunization, whereas severe ACEs necessitate protective factors to mitigate mental health damage. Social support, as an external protective factor, primarily relies on environmental stability rather than individual psychological states. Effective social support mechanisms provide safety and resources that reduce threat perception and enhance individuals’ capacities to cope with trauma.

 

Your feedback has profoundly improved our manuscript’s theoretical grounding, methodological transparency, and clinical relevance. All revisions are marked in the tracked-changes document. We deeply appreciate your expertise and time and we look forward to your further feedback.

 

Thank you again for your valuable contribution to our work.

 

Sincerely,

Rubing Ma

On behalf of all authors

Graduate Student

Department of Psychology

Beijing Forestry University

Reviewer 3 Report

Comments and Suggestions for Authors

p.1.12/13 I would make a new sentence with the information after "as well as". 

p.1.24/27 The p has to be a small letter p. In addition, if you are following APA 7 rules, the p has to be placed in italics.

p.3.101 The spacing makes it difficult to read. Can you adjust the spacing. 

p.3.118 Insert a space after the number of the section. This needs to applied for more headers. Please check. 

p.3.133-135 This is difficult to read. Can you revise this?

p.5 Table 1 The n needs to be placed in italics. In the note from this table, you write a capital letter p. This has to be a small letter (again in italics). I would suggest--if you are following APA 7 guidelines--to check these. The F-value, for example, also needs to be placed in italics alongside the df. 

p.6 Table 4 The font is different for the columns. Please revise. 

 

Author Response

Dear Reviewer,

Thank you for your meticulous attention to detail and your invaluable feedback on formatting and stylistic issues. We have carefully addressed each of your comments to ensure full compliance with APA 7th edition guidelines and to enhance the manuscript’s readability. Below is a summary of the revisions made:

Comments 1: p.1.12/13 I would make a new sentence with the information after "as well as".

Response 1: The sentence has been restructured for clarity:

Original: "This study examines the association between ACEs and the co-occurrence of somatization and post-traumatic stress symptoms among Chinese college students, as well as the roles of both internal (psychological resilience) and external (social support) protective factors."

Revised: "This study examines the association between ACEs and the co-occurrence of somatization and post-traumatic stress symptoms among Chinese college students. Additionally, it explores the roles of both internal (psychological resilience) and external (social support) protective factors in this relationship."

Comments 2: p.1.24/27 The p has to be a small letter p. In addition, if you are following APA 7 rules, the p has to be placed in italics.

Response 2: All instances of p-values (e.g., p < .05) have been corrected to lowercase and italicized throughout the manuscript.

Comments 3: p.3.101 The spacing makes it difficult to read. Can you adjust the spacing.

Response 3: The spacing in the problematic paragraph of the Methods subsection has been standardized to align with the rest of the document.

Comments 4: p.3.118 Insert a space after the number of the section. This needs to applied for more headers. Please check.

Response 4: All section headers (e.g., "3.1Participants" → "3.1 Participants") now include a space after the section number. A full consistency check confirmed uniformity across the manuscript.

Comments 5: p.3.133-135 This is difficult to read. Can you revise this?

Response 5: The convoluted sentence has been split and simplified:

Original: "The Somatization subscale and the PCL-5 were combined to create a three-level co-occurrence outcome: (1) Somatization subscale≤24 and PCL-5 < 33 (no symptoms); (2) Somatization subscale> 24 or PCL-5≥ 33(single symptoms); (3) Somatization subscale>24 and PCL-5≥33(co-occurring symptoms)."

Revised: " The co-occurrence outcome variable was derived by combining scores from the Somatization subscale and the PCL-5. Participants were categorized into four mutually exclusive groups based on validated clinical cutoffs [44,45]. (1) No symptoms: Somatization subscale ≤ 24 and PCL-5 < 33; (2) somatization-only: Somatization subscale > 24 and PCL-5 < 33; (3) PTSSs-only (Post-Traumatic Stress Symptoms): Somatization subscale ≤ 24 and PCL-5 ≥ 33; and (4) co-occurring symptoms: Somatization subscale > 24 and PCL-5 ≥ 33. "

Comments 6: p.5 Table 1 The n needs to be placed in italics. In the note from this table, you write a capital letter p. This has to be a small letter (again in italics). I would suggest--if you are following APA 7 guidelines--to check these. The F-value, for example, also needs to be placed in italics alongside the df.

Response 6: The “n” in the table 1 has been placed in italics, and I corrected the capital “P” in the note to a lowercase “p”, also in italics. Additionally, I have ensured that the F-value is in italics alongside the df, as per APA 7 guidelines.

Comments 7: p.6 Table 4 The font is different for the columns. Please revise.

Response 7: The font for the columns has been standardized to resolve the discrepancies.

Your expertise has greatly improved the manuscript’s professionalism and readability. We sincerely appreciate your time and diligence in reviewing our work. All changes are highlighted in the revised manuscript with tracked changes, and we look forward to your further feedback.

Thank you again for your exceptional guidance.

 

Sincerely,

Rubing Ma

On behalf of all authors

Graduate Student

Department of Psychology

Beijing Forestry University

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I appreciate the authors' thoughtful responses to the reviews. I have no further suggestions.