Mindfulness and pathological dissociation fully mediate the association of childhood abuse and PTSD symptomatology

Severe Dissociative Experiences beyond Detachment in a Large Clinical Sample of Inpatients with Post-Traumatic Stress Disorder: Diagnostic and Treatment Implications

INTRODUCTION

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains a dissociative subtype of post-traumatic stress disorder (PTSD) characterized by depersonalization and derealization. Yet, there is evidence that dissociative symptoms in PTSD go beyond this kind of detachment dissociation and that some patients present with additional compartmentalization dissociation in the form of auditory-verbal hallucination, amnesia, and identity alteration.

METHODS

Hence, in this study, we examined latent profiles of childhood trauma (Childhood Trauma Questionnaire), PTSD (Impact-of-Event Scale-Revised), and pathological dissociation (Dissociative Experiences Scale-Taxon; DES-T) in a large sample of severely traumatized inpatients with PTSD (N = 1,360).

RESULTS

Results support a three-class solution of the latent profile analysis with a PTSD class, a dissociative subtype class, and a third class characterized by more complex and more severe dissociative symptoms. Importantly, in our inpatient sample of patients with severe PTSD, the latter class was found to be the most prevalent. Both the exploratory character of our retrospective analysis of clinical routine data and the use of the DES-T limit the generalizability of our findings, which require methodologically more rigorous replication.

CONCLUSION

In severe PTSD, dissociative symptoms beyond detachment are highly prevalent. Diagnostic and treatment implications are discussed.

Moving out of your mind and into your body: Yoga buffers the effects of childhood maltreatment on PTSD symptoms

Objective: Childhood maltreatment has been consistently linked to posttraumatic stress disorder (PTSD) symptoms among college students and yoga may buffer the effects. The current study examined the frequency of college student's yoga practice over the past year as a moderator of childhood maltreatment and PTSD symptoms in the past 30 days. Participants: A sample of 177 college students from a southern university. Methods: Participants competed an online survey in exchange for extra credit or entry into a gift card raffle. Results: Moderation analysis indicated that a more frequent yoga practice buffered the relationship between maltreatment and PTSD symptoms. Conclusion: Clinicians working with college students with a history of maltreatment are encouraged to make referrals to yoga classes. Universities are encouraged to adopt trauma-sensitive yoga programs.

Cortical volume alteration in the superior parietal region mediates the relationship between childhood abuse and PTSD avoidance symptoms: A complementary multimodal neuroimaging study

Background

Adverse childhood experiences (ACE), which can be separated into abuse and neglect, contribute to the development of post-traumatic stress symptoms (PTSS). However, which brain structures are mainly affected by ACE as well as the mediating role these brain structures play in ACE and PTSS relationship are still being investigated. The current study tested the effect of ACE on brain structure and investigated the latter's mediating role in ACE-PTSS relationship.

Methods

A total of 78 adults with self-reported ACE were included in this study. Participants completed the childhood trauma questionnaire (CTQ) and a Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) to ascertain ACE history and PTSS, respectively. T1w images and diffusion MRI scans were then acquired to assess cortical morphometry and white matter (WM) integrity in fibre tracts connecting key areas where ACE-related cortical volume alterations were observed.

Results

The combined effect of ACE was negatively associated with total grey matter volume and local cortical area in the right superior parietal region (rSP). Childhood abuse was negatively related to right superior parietal volume after controlling for neglect and overall psychological burden. The right superior parietal volume significantly mediated the relationship between childhood abuse and avoidance-related PTSS. Post-hoc analyses showed that the indirect relation was subsequently moderated by dissociative symptoms. Lastly, a complementary examination of the WM tracts connected to abuse-associated cortical GM regions shows that abuse was negatively related to the normalised fibre density of WM tracts connected to the right superior parietal region.

Conclusion

We provide multimodal structural evidence that ACE in the first years of life is related to alterations in the right superior brain region, which plays a crucial role in spatial processing and attentional functioning. Additionally, we highlight that the cortical volume alteration in this region may play a role in explaining the relationship between childhood abuse and avoidance symptoms.

Disentangling the Link Between Mindfulness and Dissociation in PTSD: The Mediating Role of Attention and Emotional Acceptance

INTRODUCTION

A number of studies have investigated the relationship between mindfulness and dissociation and suggested that mindfulness-based interventions could be effective in the treatment of dissociative symptoms. A recent study in healthy volunteers found that attention and emotional acceptance mediates this relationship. However, no study has yet been performed among a clinical sample to assess this association.

METHOD

We recruited 90 patients (76 women) suffering from Posttraumatic Stress Disorder (PTSD). They completed self-report questionnaires to measure PTSD, dissociation, emotion regulation difficulties, childhood trauma, mindfulness abilities and cognitive abilities.

RESULTS

We found that mindfulness abilities, emotional difficulties, dissociation and attention-concentration were all related to each other. Using a step-by-step approach and bootstrapping techniques, we found a significant indirect effect of mindfulness abilities on dissociation through non-acceptance (confidence interval 95%=-.14 to -.01) and attentional difficulties (confidence interval 95%=-.23 to -.05).

CONCLUSION

Patients with higher levels of dissociative symptoms have less capacity for mindfulness. Our results support Bishop et al.'s model proposing that attention and emotional acceptance are the two active components of mindfulness. To extend our findings, clinical trials are required to evaluate a causal relationship and the effectiveness of mindfulness-based interventions for patients suffering from dissociation.

Childhood Trauma and PTSD Symptoms: Disentangling the Roles of Emotion Regulation and Distress Tolerance

Research documents that a history of childhood trauma increases risk for post-traumatic stress disorder (PTSD), greater emotion regulation difficulties (ERD), and reduced distress tolerance (DT). Independent lines of research implicate ERD and DT as transdiagnostic risk factors and link them to PTSD. To elucidate how such mechanisms may influence the etiology, maintenance, and treatment of PTSD, the current study investigates the distinct mediating roles of emotion regulation and DT, exploring which explains a larger indirect effect from childhood trauma to PTSD symptom severity. Participants (N = 385, aged 18-48) who endorsed a history of childhood trauma provided retrospective report of cumulative childhood trauma exposure, and of current ERD, DT, and PTSD symptom severity. Single and dual mediation analyses were used to assess indirect effects through ERD and DT in the relation between cumulative childhood trauma exposure and current PTSD symptom severity. ERD and DT were significantly and inversely related. Higher current self-ratings of PTSD symptom severity were explained by cumulative childhood trauma through ERD (B = 0.93, p < 0.001) and DT (B = 0.50, p < 0.05). The full model explained 36% of the variance in PTSD symptom severity. Current findings provide preliminary evidence of DT and emotion regulation (with specific facets identified) as distinct mechanisms in the development of PTSD. Of clinical relevance, current findings support post-trauma processing theories that contend individuals' recovery requires accepting and learning to modulate trauma-related emotional states. Implications for methods of treatment and prevention are discussed.

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual's emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.

The Moderating Role of Resilience on Mindfulness, Experiential Avoidance, and Posttraumatic Stress Disorder (PTSD) Symptoms of College Student Veterans: A Cross-Sectional Study

The purpose of the study was to investigate the moderating effect of resilience on the relationship between mindfulness, experiential avoidance, and posttraumatic stress disorder (PTSD) symptom severity. A cross-sectional study design was used on a sample of 133 college student military veterans. We found a direct effect of mindfulness on PTSD and a significant mediating effect of experiential avoidance on the relationship between mindfulness and PTSD. Resilience also had a significant moderating effect on the relationship between mindfulness and PTSD. This study provides preliminary evidence on the usefulness of integrating resilience development in mindfulness-based interventions for trauma-related disorders.

Mindfulness and Attachment as Concurrent Mediators Linking Childhood Maltreatment to Depressive, Anxious, and Dissociative Symptoms

Childhood maltreatment has been consistently associated with adult symptoms of depression, anxiety, and dissociation, and attachment has been proposed as one mediator. Attachment, however, tends to only partially mediate the association, and mindfulness may be another explanatory pathway. The current study examined mindfulness and attachment in a multiple mediator model linking maltreatment to adult symptoms of depression, anxiety, and dissociation. A sample of 232 adults were recruited from two universities and an online sample who completed an online survey. Using structural equation modeling, childhood maltreatment was indirectly associated to symptoms of depression (ß = .104; 95% CI [.015, .193]), anxiety (ß = .090; 95% CI [.014, .166]), and dissociation (ß = .088; 95% CI [.006, .170]) through mindfulness. Additionally, childhood maltreatment was associated with symptoms of depression (ß = .062; 95% CI [.007, .118]), anxiety (ß = .074; 95% CI [.009, .139]), and dissociation (ß = .069; 95% CI [.017, .121]) through attachment avoidance. No significant indirect effects were found through attachment anxiety. These findings indicate that both mindfulness and attachment may be explanatory pathways linking childhood maltreatment. Inclusion of both attachment and mindfulness provides a more robust theoretical understanding of how maltreatment is associated with adult mental health.

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial

BACKGROUND

Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice.

OBJECTIVE

This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use.

METHODS

We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46).

RESULTS

Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=-0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice.

CONCLUSIONS

Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473.

Associations between PTSD symptoms and other psychiatric symptoms among college students exposed to childhood sexual abuse: a network analysis

Background: Childhood sexual abuse (CSA) is one of the prevalent forms of trauma experienced during childhood and adolescence. Previous research underscores its associations with depression, anxiety, post-traumatic stress disorder (PTSD), and psychosis. Objective: This study examined symptom connections between depression, anxiety, PTSD, and psychosis while simultaneously investigating whether these connections differed by gender among CSA survivors. Methods: A large-scale, cross-sectional study among 96,218 college students was conducted in China. Participants' CSA was measured by the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Participants' PTSD, psychosis, depression, and anxiety were measured by the Trauma Screening Questionnaire (TSQ), the Psychosis Screener (PS), the nine-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Network analysis was used to explore the potential associations between these symptoms and to compare the sex differences in the symptoms model. Results: Among participants who suffered from CSA, females were more likely from left-behind households, while males were more likely from households with a high annual income (P < .001, Cohen's W = 0.07). In addition, compared to male victims, female victims were more likely to report depression, anxiety, and PTSD (P < .001, Cohen's d≈0.2), while male victims were more likely to report psychosis (P < .001, Cohen's d = 0.36). Results from network estimation showed that psychosis, depression, anxiety, and PTSD symptoms were positively correlated. Moreover, psychosis had a stronger connection with PTSD symptoms, including hypervigilance, intrusive thoughts, and physiological and emotional reactivity. Conclusions: The current study explores the associations between PTSD symptoms and psychiatric symptoms among college students exposed to CSA using a network analysis approach. These crucial symptoms of PTSD may have potential connections to psychosis. Target intervention and strategy should be developed to improve mental health and quality of life among these CSA victims. Furthermore, longitudinal studies are warranted to advance our understanding of PTSD and psychosis.

Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis

BACKGROUND

Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse.

METHODS

Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization.

RESULTS

A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms.

CONCLUSIONS

Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.

Foster children's complex psychopathology in the context of cumulative childhood trauma: The interplay of ICD-11 complex PTSD, dissociation, depression, and emotion regulation

BACKGROUND

Foster children experience maltreatment at exceptionally high rates with increased risk to develop ICD-11 complex posttraumatic stress disorder (CPTSD). While rates of comorbidity between CPTSD and various disorders are high, the interplay between constituent aspects of psychopathology is not clearly understood. No study used network analysis to model the interplay between these aspects as potentially maintaining a stable condition of psychopathology, and research on the etiology and maintenance of CPTSD in children is especially scarce.

METHODS

Altogether, 208 Austrian foster children completed a set of standardized measures, resulting in a final sample of N = 122 foster children meeting the inclusion criteria. Experiences of childhood trauma, ICD-11 CPTSD, depression, dissociation, adaptive, and maladaptive emotion regulation were assessed. Following an exploratory approach, analyses were conducted using latent single indicator factor scores in two network models.

RESULTS

Domains of CPTSD, PTSD and disturbances in self-organization (DSO), evidenced as most central factors in children's complex psychopathology. Including cumulative childhood trauma did not influence the connectedness of factors in any relevant way. Shortest direct paths from cumulative childhood trauma to CPTSD included dissociation (PTSD) and adaptive emotion regulation (DSO) as mediating factors.

LIMITATIONS

Results are based on a small sample of highly-traumatized foster children, potentially limiting current findings' generalizability.

CONCLUSIONS

CPTSD identified as central in children's complex psychopathology, while the role of childhood trauma seems stronger for the onset than the maintenance of such psychopathology. The current network revealed central disorders and distinct mediating factors as important targets for treatment strategies and future research.

Cumulative Childhood Trauma and Couple Satisfaction: Examining the Mediating Role of Mindfulness

Objectives

Cumulative childhood trauma (CCT) survivors are at a higher risk of suffering from interpersonal problems including couple dissatisfaction. Dispositional mindfulness is increasingly proposed as a potential explanatory mechanism of post-traumatic symptomatology and has been documented as a predictor of couple satisfaction. Most authors operationalize mindfulness as a multidimensional disposition comprised of five facets (i.e., Describing, Observing, Non-judgment of inner experiences, Non-reactivity, and Acting with awareness), but the role of these facets in the link between CCT and couple satisfaction has yet to be understood. This study aimed to assess mindfulness as a potential mediator in the relationship between CCT and couple satisfaction and to examine the distinctive contributions of mindfulness facets in this mediation.

Methods

A sample of 330 participants from the community completed measures of couple satisfaction, mindfulness, and exposure to eight types of childhood maltreatment experiences.

Results

Path analysis results revealed that mindfulness mediated the relationship between CCT and couple satisfaction. More precisely, two mindfulness facets acted as specific mediators, namely, Describing and Non-judgment of inner experiences. The final integrative model explained 14% (p < .001) of the variance in couple satisfaction.

Conclusions

Findings suggest that mindfulness may be a meaningful mechanism in the link between CCT and couple satisfaction. They also highlight that description of inner experiences and a non-judgmental attitude of these experiences may act as key components to understand the influence of CCT on adults' lower couple satisfaction.

Modeling Patterns of Polyvictimiztion and Their Associations with Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the Israeli Population

Although evidence is accumulating for the conceptual validity of the ICD-11 proposal for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), our understanding of the specificity of trauma-related predictors is still evolving. Specifically, studies utilizing advanced statistical methods to model the association between trauma exposure and ICD-11 proposals of traumatic stress and differences in profiles of trauma exposure are lacking. Additionally, time since trauma and a clear memory of the trauma are yet to be examined as predictors of PTSD and CPTSD. We analyzed trauma exposure as reported by a general population sample of Israeli adults (N = 834), using latent class analysis, and the resultant classes were used in regression models to predict PTSD and CPTSD operationalized both dimensionally and categorically. Four distinct groups were identified: child and adult interpersonal victimization, community victimization-male, community victimization-female, and adult victimization. These groups were differentially related to PTSD and CPTSD, with only child and adult interpersonal victimization consistently predicting CPTSD and disturbances in self-organization. When modeled dimensionally, PTSD was associated with the child and adult interpersonal victimization and adult victimization groups, whereas only the child and adult interpersonal victimization group was predictive of PTSD when operationalized categorically. The roles of time since trauma and a clear memory of the trauma differed across PTSD and CPTSD. These findings support the use of trauma typologies for predicting PTSD and CPTSD and provide important insight into the distribution of trauma exposure in the Israeli population.

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid- and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems.

The mediating role of the metacognition, time perspectives and experiential avoidance on the relationship between childhood trauma and post-traumatic stress disorder symptoms

Background: The current study was designed to investigate the direct and indirect effects of the childhood trauma, metacognition, time perspectives and experiential avoidance in prediction of post-traumatic stress disorder (PTSD) symptoms. Methods: Participants included 432 adult patients referred for treatment to psychological, psychiatric disorders clinics and medical clinics of Shiraz, Iran. They were exposed to a traumatic event according to criterion A in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V). Childhood Trauma Questionnaire (CTQ), Post-traumatic Checklist for DSM-5 (PCL-5), Zimbardo Time Perspective Inventory (ZTPI), Acceptance and Action Questionnaire - II (AAQ-II) and metacognitions questionnaire-30 (MCQ-30) all were applied for data collection. Results: The results indicated that childhood trauma has a direct correlation with symptoms of PTSD, metacognition, and time perspectives, while it has an indirect correlation with experiential avoidance as well as symptoms of PTSD. Thus, metacognition and time perspectives play a mediating role between childhood trauma and experiential avoidance. In the same way, all three variables (metacognition, time perspectives, and experiential avoidance) play the same role between childhood trauma and symptoms of PTSD. Conclusions: Altogether, results of this study were consistent with the metacognitive model as well as Time Perspective Theory for PTSD and emphasizes that childhood trauma, metacognition, time perspectives and experiential Avoidance are important in explanation of PTSD symptoms.

Derealization and self-harm strategies are used to regulate disgust, fear, and sadness in adult survivors of childhood sexual abuse

Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post-traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma-related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self-harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self-harm and/or self-harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post-traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma-related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma-related emotions on PTSD severity. Three trauma-related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self-harm and via self-harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self-harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self-harm might enable the reduction of PTSD among CSA survivors.