Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity

Systematic Review of Dispositional Mindfulness and Posttraumatic Stress Disorder Symptomology: A Targeted Examination of Avoidance

High rates of nonresponse to evidence-based treatment for posttraumatic stress disorder (PTSD) have fueled the search for improved intervention. Evidence suggests that improvements in dispositional mindfulness (i.e., tendency to attend to the present with nonjudgment and nonreactivity) may help reduce PTSD symptoms. While some research suggests that transdiagnostic mindfulness-based interventions particularly target avoidance symptoms, the association between dispositional mindfulness and avoidance has yet to be systematically examined. To address this gap, we examined peer-reviewed studies that reported quantitative associations between avoidance and dispositional mindfulness among trauma-exposed adults, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. Sixteen studies were identified for final review from PsycINFO and PubMed databases. Results suggest that mindfulness has a weak relationship with effortful avoidance. This weak relationship may be obscured in studies where effortful avoidance is measured among other symptoms (e.g., anhedonia). Mindfulness appeared to have stronger associations with symptoms of hyperarousal and negative alterations in cognition and mood. An important clinical implication is that high effortful avoidance may manifest among patients who report strong mindfulness skills. It may be helpful for clinicians to carefully assess how mindfulness is being used to cope.

Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies

Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD.

Psychometric properties of the chinese version of multidimensional experiential avoidance questionnaire-30

BACKGROUND

Experiential avoidance represents the tendency to avoid negative internal experiences, which is a key concept in Acceptance and Commitment Therapy. However, existing measures of experiential avoidance (i.e., Acceptance and Action Questionnaire-II, AAQ-II) have some limitations. This study aims to assess the psychometric properties of the Chinese version of Multidimensional Experiential Avoidance Questionnaire-30 (MEAQ-30) and provide evidence for the reliability and validity of this new instrument.

METHODS

Two questionnaire surveys were conducted. The first sample (N = 546) was analyzed using classical test theory (CTT), and the second sample (N = 511) was analyzed using multidimensional item response theory (MIRT).

RESULTS

CTT supported the six-factor structure of MEAQ-30, indicating good internal consistency and measurement invariance across genders. Furthermore, the Chinese version of MEAQ-30 showed satisfactory convergent and discriminant validity. The incremental validity test showed that after controlling for the effects of neuroticism and AAQ-II, the Chinese version of MEAQ-30 could still significantly predict depression, anxiety, and stress. MIRT indicated that 30 items had good discrimination and difficulty, and the six subscales were sufficiently reliable across the continuum of experiential avoidance.

CONCLUSION

The Chinese version of MEAQ-30 has good reliability and validity and is suitable for assessing experiential avoidance among Chinese populations.

Diversity in emotion regulation strategy use: Resilience against posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with impaired emotion regulation (ER). ER diversity, the variety, prevalence, and relative abundance of ER strategy use, may provide resilience against PTSD. This study examined the prospective relation between ER diversity and PTSD, while accounting for negative and positive life events, in interpersonal violence (IPV) survivors. IPV-exposed women with PTSD onset (PTSD; n = 22), without PTSD onset (IPV; n = 37), and non-traumatized control participants (NTC; n = 41) rated their ER strategy use and experience of negative and positive life events. The ER diversity index differentiated the participant groups. Importantly, group differences in ER diversity depended on the experience of life events. When experiencing fewer positive life events and more negative life events, the IPV and NTC groups, but not the PTSD group, demonstrated higher ER diversity. Thus, greater ER diversity during periods with more negative life events and fewer positive life events may play a protective role against PTSD onset for IPV survivors.

Effectiveness and mediators of change of an online CBT intervention for students with adjustment disorder-study protocol for a randomized controlled trial

BACKGROUND

Adjustment problems and disorders are highly prevalent among university students worldwide. These problems can cause significant interference in academic and social functioning and increase vulnerability to other mental health disorders. Unfortunately, only half of students in need receive psychological help. Furthermore, few studies have evaluated psychological interventions for adjustment disorders in students. New, more scalable forms of treatment for students with an adjustment disorder need to be developed, evaluated, and implemented. The study aims to determine the effectiveness of an online transdiagnostic cognitive behavioural intervention for students experiencing adjustment disorder and to assess mediators of change.

METHOD/DESIGN

In this three-arm randomized controlled trial, we plan to recruit 214 Polish students diagnosed with an adjustment disorder. Participants who meet initial eligibility criteria will be randomly assigned to one of three 6-week conditions: (1) online cognitive behavioural therapy intervention based on an existing, empirically supported transdiagnostic protocol, the unified protocol; (2) online progressive muscle relaxation training as an active control group; or (3) waiting-list control group. Both interventions are asynchronous, interactive, and include minimal amount of therapist support. Assessments will consist of self-report questionnaires, daily diary measures, and neurocognitive tasks for evaluating cognitive functioning. These will be conducted at baseline, post-treatment, and 1-month follow-up. Daily diary measures will be taken during the first and last week of treatment (or waitlist period). Primary outcome measures will include adjustment disorder severity; secondary outcome measures will consist of other negative (psychopathology: depression, anxiety, and stress) and positive (life satisfaction) indexes of mental health as well as process measures (e.g. mindfulness, experiential avoidance, cognitive fusion).

DISCUSSION

To our knowledge, the current study is the first to evaluate the effectiveness of a psychological intervention for students with adjustment disorder. Therefore, it may have important practical implications for students with this disorder. It can potentially guide the development of a scalable, validated treatment option.

TRIAL REGISTRATION

Clinical Trials, NCT05768308, registered 14 March 2023, https://www.

CLINICALTRIALS

gov/ct2/show/NCT05768308.

Emotion regulation strategies and PTSS among children who experienced an explosion accident: the moderating role of trait mindfulness

The purpose of this study was to investigate the moderating role of trait mindfulness in the relationship between emotion regulation strategies and post-traumatic stress symptoms (PTSS) among children and adolescents who experienced an explosion accident. A total of 712 participants, aged 7-15, (Mage = 11.45, SD = 1.77; 48.9% male) who have experienced an explosion accident completed the Emotion Regulation Questionnaire, the Trauma Screening Questionnaire and the Mindful Attention Awareness Scale. The results showed that trait mindfulness significantly moderated the relationship of the expressive suppression and PTSS under the control of sex, age, trauma exposure, and cognitive reappraisal strategy (β = -0.27, p < 0.05). However, the moderating effect of trait mindfulness between cognitive reappraisal strategy and PTSS was not significant (p> 0.05). Findings suggested that traumatized children with low levels of mindfulness may report severer PTSS when they adopt expressive suppression strategy.

The Role of Coping Behaviors and Intoxication in Trauma Symptomology Subsequent to Sexual Victimization

College women are at an elevated risk for sexual victimization (SV) and secondary physical and psychological consequences. While some women experience negative outcomes such as posttraumatic stress disorder (PTSD), others experience reduced or complete absence of distress following SV. The variation in outcomes may be associated with the victim's level of intoxication, which may in turn affect their processing of and coping with the event. We examined the effects of SV severity on PTSD via coping and intoxication using a moderated mediation analysis among female college students (N = 375). Results demonstrate that coping mediates the association between SV severity and PTSD symptomology; however, intoxication did not moderate these associations. Results suggest that regardless of intoxication, SV severity influences various coping styles and plays an important role in a victim's adjustment post-victimization.

Posttraumatic Stress Symptoms and Parenting Competence among Israeli Male Veterans: The Mediating Roles of Experiential Avoidance and Parental Reflective Functioning

Although empirical studies have documented associations between posttraumatic stress symptoms (PTSS) and parenting among various high-risk populations, there is a relatively limited amount of research on paternal parenting among veterans. Moreover, the understanding of possible mechanisms which may account for this effect is severely lacking. This study examined associations between military related PTSS and parenting sense of competence (PSOC) among veteran fathers. Furthermore, we examined the mediating role of experiential avoidance (EA) and parental reflective functioning (PRF) in the association between PTSS and PSOC. Participants were 189 Israel Defense Forces (IDF) male combat veterans (mean age = 30.03) who completed a set of validated self-report questionnaires in a cross-sectional design study. Results showed negative associations between PTSS and PSOC-parental satisfaction but not parental efficacy. Furthermore, EA mediated the association between PTSS and parental satisfaction and efficacy; PRF- Pre mentalizing modes mediated the association between PTSS and parental satisfaction. Our findings imply that EA and PRF may serve as mechanisms of the association between PTSS and PSOC among veteran fathers. These findings are discussed in light of a psychological trauma perspective, and clinical implications to increase fathers' mentalization and psychological flexibility are suggested.

Experiential Avoidance in Primary Care Providers: Psychometric Properties of the Brazilian "Acceptance and Action Questionnaire" (AAQ-II) and Its Criterion Validity on Mood Disorder-Related Psychological Distress

BACKGROUND

A sizeable proportion of Brazilian Primary Care (PC) providers suffer from common mental disorders, such as anxiety and depression. In an effort to cope with job-related distress, PC workers are likely to implement maladaptive strategies such as experiential avoidance (EA). The Acceptance and Action Questionnaire (AAQ-II) is a widely used instrument that evaluates EA but has shown questionable internal consistency in specific populations. This study assesses the psychometric properties of the AAQ-II among Brazilian PC providers, evaluates its convergence and divergence with self-criticism and mindfulness skills, and explores its criterion validity on anxiety and depressive symptoms.

METHODS

A cross-sectional design was conducted in Brazilian PC services, and the sample included 407 PC workers. The measures evaluated EA, self-criticism, mindfulness, depression, and anxiety.

RESULTS

The one-factor model of the AAQ-II replicated the original version structure. The AAQ-II presented good internal consistency among Brazilian PC providers. A multiple regression model demonstrated higher relationships with self-criticism than mindfulness skills. The criterion validity of the AAQ-II on anxiety and depression was stronger in the context of more severe symptoms.

CONCLUSIONS

The AAQ-II is an appropriate questionnaire to measure the lack of psychological flexibility among Brazilian PC workers in the sense of EA.

Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility

The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale-Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.

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.

Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya

Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.

For there is nothing either good or bad: a study of the mediating effect of interpretation bias on the association between mindfulness and reduced post-traumatic stress vulnerability

BACKGROUND

Despite increasing interest in the association between mindfulness and reduced trauma vulnerability, and the use of mindfulness in the latest interventions for Post-Traumatic Stress Disorder (PTSD), few studies have examined the mechanisms through which mindfulness may influence post-trauma psychopathology. The present study aimed to determine whether negative interpretation bias, the tendency to interpret ambiguous information as negative or threatening rather than positive or safe, mediates the association between higher levels of trait mindfulness and lower levels of PTSD symptoms. Negative interpretation bias was examined due to prior evidence indicating it is associated with being less mindful and post trauma psychopathology.

METHODS

The study examined 133 undergraduate students who reported exposure to one or more potentially traumatic events in their lifetime. Participants completed self-report measures of trait mindfulness (Five Facet Mindfulness Questionnaire - Short Form; FFMQ-SF) and PTSD symptoms (Post-Traumatic Stress Disorder Checklist - Civilian version; PCL-C) as well an interpretation bias task that assessed the degree to which participants interpreted a range of everyday hypothetical scenarios to be threatening to their physical and/or psychological wellbeing.

RESULTS

Results of a mediation analysis indicated a significant negative direct effect of trait mindfulness on PTSD symptomatology (p < .001). There was no evidence that negative interpretation bias mediated this relationship [BCa CI [-0.04, 0.03)], nor was it associated with trait mindfulness (p = .90) and PTSD symptomatology (p = .37).

CONCLUSIONS

The results of the current study provide further evidence of the link between trait mindfulness and reduced post-trauma psychopathology while providing no support for the role of negative interpretation bias in this relationship.

Acting with awareness moderates the association between lifetime exposure to interpersonal traumatic events and craving via trauma symptoms: a moderated indirect effects model

BACKGROUND

History of exposure to traumatic events (ETE) is common among women in substance use disorder (SUD) treatment and is related to craving. We examined whether ETE (i.e., emotional, physical, sexual abuse) in childhood, adulthood, or both is related to craving via trauma symptoms and how trait mindfulness might attenuate this association.

METHODS

Baseline data from a larger randomized clinical trial of a mindfulness-based intervention for women (N = 245) in SUD treatment were used. Inclusion criteria were: 18-65 years of age, SUD diagnosis, English fluency, no cognitive impairment, and willingness to be audio recorded and provide consent. Demographics and validated measures of ETE, posttraumatic stress symptoms, trait mindfulness, and substance use craving were collected via in-person interviews. Descriptive statistics, correlational analysis, and relative direct, indirect, and conditional indirect effects models were run.

RESULTS

Most participants identified as Hispanic (58.5%), had at least a high school education (52.2%), with a mean age of 32.2. Women reported ETE in childhood only (20.4%), adulthood only (17.5%), both childhood and adulthood (50.0%), and never (11.4%). Compared to women with ETE in both childhood and adulthood, those with exposure in adulthood only (β = -.10, 95% CI = -.20, -.02) or no exposure (β = -.11, 95% CI = -.23, -.03; [∆R2= .347, F(8, 245) = 15.7, p < .001) had lower craving via lower trauma symptomatology but no difference when compared to those with ETE only in childhood. Acting with awareness moderated this indirect effect (∆R2 = .04, F(3, 245) = 4.66, p = .004. At low levels of awareness, women with ETE during both childhood and adulthood reported higher craving via trauma symptomatology than women with no exposure or only adulthood exposure.

CONCLUSIONS

Low levels of acting with awareness may worsen trauma symptoms after ETE, which in turn may lead to more craving for women in substance use treatment. Despite a small moderating effect size, acting with awareness may have clinical significance due to the prevalence of trauma symptoms among women in SUD treatment.

Dispositional Mindfulness and Post-traumatic Stress Symptoms in Emergency Nurses: Multiple Mediating Roles of Coping Styles and Emotional Exhaustion

Objective

To explore the relationships between dispositional mindfulness (DM) and their post-traumatic stress symptoms (PTSS) of emergency nurses, and the mediating effects of coping styles and emotional exhaustion (EE).

Methods

A cross-sectional survey study was conducted to collect data on DM, coping styles, EE, and PTSS among 571 emergency nurses from 20 hospitals in Chongqing, China. Correlation and structural equation models (SEMs) were used to evaluate the relationship among variables.

Results

Emergency nurses with lower dispositional mindfulness, higher emotional exhaustion and preference for negative coping (NC) revealed more PTSS. The effect of NC on PTSS was partially mediated by emotional exhaustion. Negative coping and emotional exhaustion played concurrent and sequential mediating roles between dispositional mindfulness and PTSS.

Conclusion

This study has made a significant contribution to existing literature. It was suggested to develop interventions aimed at enhancing mindfulness, reducing negative coping strategies, and alleviating emotional exhaustion, which may be effective at reducing or alleviating post-traumatic stress symptoms of emergency nurses.

Brain Responses to a Self-Compassion Induction in Trauma Survivors With and Without Post-traumatic Stress Disorder

Self-compassion (SC) is a mechanism of symptom improvement in post-traumatic stress disorder (PTSD), however, the underlying neurobiological processes are not well understood. High levels of self-compassion are associated with reduced activation of the threat response system. Physiological threat responses to trauma reminders and increased arousal are key symptoms which are maintained by negative appraisals of the self and self-blame. Moreover, PTSD has been consistently associated with functional changes implicated in the brain's saliency and the default mode networks. In this paper, we explore how trauma exposed individuals respond to a validated self-compassion exercise. We distinguish three groups using the PTSD checklist; those with full PTSD, those without PTSD, and those with subsyndromal PTSD. Subsyndromal PTSD is a clinically relevant subgroup in which individuals meet the criteria for reexperiencing along with one of either avoidance or hyperarousal. We use electroencephalography (EEG) alpha-asymmetry and EEG microstate analysis to characterize brain activity time series during the self-compassion exercise in the three groups. We contextualize our results with concurrently recorded autonomic measures of physiological arousal (heart rate and skin conductance), parasympathetic activation (heart rate variability) and self-reported changes in state mood and self-perception. We find that in all three groups directing self-compassion toward oneself activates the negative self and elicits a threat response during the SC exercise and that individuals with subsyndromal PTSD who have high levels of hyperarousal have the highest threat response. We find impaired activation of the EEG microstate associated with the saliency, attention and self-referential processing brain networks, distinguishes the three PTSD groups. Our findings provide evidence for potential neural biomarkers for quantitatively differentiating PTSD subgroups.

Glucocorticoid-glucocorticoid receptor-HCN1 channels reduce neuronal excitability in dorsal hippocampal CA1 neurons

While chronic stress increases hyperpolarization-activated current (I_h) in dorsal hippocampal CA1 neurons, the underlying molecular mechanisms are entirely unknown. Following chronic social defeat stress (CSDS), susceptible mice displayed social avoidance and impaired spatial working memory, which were linked to decreased neuronal excitability, increased perisomatic hyperpolarization-activated cyclic nucleotide-gated (HCN) 1 protein expression, and elevated I_h in dorsal but not ventral CA1 neurons. In control mice, bath application of corticosterone reduced neuronal excitability, increased tetratricopeptide repeat-containing Rab8b-interacting protein (TRIP8b) and HCN1 protein expression, and elevated I_h in dorsal but not ventral CA1 region/neurons. Corticosterone-induced upregulation of functional I_h was mediated by the glucocorticoid receptor (GR), HCN channels, and the protein kinase A (PKA) but not the calcium/calmodulin-dependent protein kinase II (CaMKII) pathway. Three months after the end of CSDS, susceptible mice displayed persistent social avoidance when exposed to a novel aggressor. The sustained behavioral deficit was associated with lower neuronal excitability and higher functional I_h in dorsal CA1 neurons, both of which were unaffected by corticosterone treatment. Our findings show that corticosterone treatment mimics the pathophysiological effects of dorsal CA1 neurons/region found in susceptible mice. The aberrant expression of HCN1 protein along the somatodendritic axis of the dorsal hippocampal CA1 region might be the molecular mechanism driving susceptibility to social avoidance.

The Persian version of the centrality of event scale (CES): Assessment of validity and reliability among Iranian university students

BACKGROUND

Event centrality, the extent to which an experience is perceived as a central event in one's life, has been found to be a strong correlate of posttraumatic stress disorder (PTSD). The centrality of event scale (CES) is commonly used in different conditions and cultures to measure trauma-related effects. However, the psychometric properties of this scale have not been investigated in the Iranian context.

METHODS

The present study examined the psychometric properties of the Persian translation of the 7-item CES in a sample of 525 university students with a history of a romantic breakup.

RESULTS

Confirmatory factor analysis confirmed a one-factor structure. The CES score was positively correlated with psychological inflexibility and PTSD symptoms. The measurement invariance analyses showed that the 7-item CES is gender invariant and can be used for both men and women.

FINDINGS

Findings supported the good psychometric properties of the 7-item CES for measuring event centrality in Iranian university students.

The Process of Learning Mindfulness and Acceptance through the Use of a Mobile App Based on Acceptance and Commitment Therapy: A Grounded Theory Analysis

This study aimed to explore the process of how college student military veterans with posttraumatic stress disorder (PTSD) symptoms learn mindfulness and acceptance through the use of a mobile app based on acceptance and commitment therapy (ACT). Twenty-three college student veterans with PTSD symptoms participated in the 4-week ACT mobile app-based intervention and took part in three weekly semi-structured interviews. Results of the grounded theory data analysis reveal the core category of Mindful Scaffolding, a process indicating how student veterans cope with the interruptions and intrusions associated with learning mindfulness and acceptance through the use of the ACT-based app. The grounded theory provides a foundational theoretical framework for increasing adherence with using mindfulness- and acceptance-based mobile app interventions for PTSD.

A Preliminary Evaluation of the Unified Protocol among Trauma-Exposed Adults with and without PTSD

The purpose of this study was to evaluate whether the Unified Protocol (UP)-a mechanistically transdiagnostic psychological treatment-provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis included a sample of 69 community-recruited adults seeking outpatient mental health treatment. We examined reductions in anxiety and depressive symptoms and changes in aversive and avoidant reactions to intense emotions-the UP's putative mechanism-first by comparing individuals with and without trauma histories and then specifically among participants with PTSD. Findings suggest that the UP may lead to similar improvements in clinical diagnostic severity, anxiety, and depression among patients with trauma exposure as those without trauma exposure. Roughly half of participants with PTSD demonstrated reductions in PTSD clinical severity, anxiety, depression, and distress aversion, suggesting the UP may be an efficacious treatment for people with PTSD and comorbid conditions.

The Impact of Mindfulness Training on Police Officer Stress, Mental Health, and Salivary Cortisol Levels

Unaddressed occupational stress and trauma contribute to elevated rates of mental illness and suicide in policing, and to violent and aggressive behavior that disproportionately impacts communities of color. Emerging evidence suggests mindfulness training with police may reduce stress and aggression and improve mental health, but there is limited evidence for changes in biological outcomes or the lasting benefits of mindfulness training. We conducted a randomized controlled trial (RCT) of 114 police officers from three Midwestern U.S. law enforcement agencies. We assessed stress-related physical and mental health symptoms, blood-based inflammatory markers, and hair and salivary cortisol. Participants were then randomized to an 8-week mindfulness intervention or waitlist control (WLC), and the same assessments were repeated post-intervention and at 3-month follow-up. Relative to waitlist control, the mindfulness group had greater improvements in psychological distress, mental health symptoms, and sleep quality post-training, gains that were maintained at 3-month follow-up. Intervention participants also had a significantly lower cortisol awakening response (CAR) at 3-month follow-up relative to waitlist control. Contrary to hypotheses, there were no intervention effects on hair cortisol, diurnal cortisol slope, or inflammatory markers. In summary, an 8-week mindfulness intervention for police officers led to self-reported improvements in distress, mental health, and sleep, and a lower CAR. These benefits persisted (or emerged) at 3-month follow-up, suggesting that this training may buffer against the long-term consequences of chronic stress. Future research should assess the persistence of these benefits over a longer period while expanding the scope of outcomes to consider the broader community of mindfulness training for police.

Clinical Trial Registration: ClinicalTrials.gov#NCT03488875.

Pathway Linking Different Types of Childhood Trauma to Somatic Symptoms in a Subclinical Sample of Female College Students: The Mediating Role of Experiential Avoidance

ABSTRACT

Research has shown that women are more prone to childhood trauma and this state is associated with somatic symptoms. Also, people who have been exposed to traumatic experiences use experiential avoidance to reduce negative emotions. However, the mediating role of experiential avoidance in the relationship between childhood trauma and somatic symptoms is not clear, so, the present study investigated whether the relationships among different types of childhood trauma and somatic symptoms could be explained by experiential avoidance in female college students. In a cross-sectional study, 251 Iranian female college students with somatic symptoms were recruited from the University of Tabriz. Participants completed self-report scales, including the Persian version of Child Abuse Self-Reported Scale, Acceptance and Action Questionnaire-II (AAQ-II), and the Patient-health questionnaire (PHQ-15). A path analysis was used to empirically explore the relationships. Structural equation modeling analyses confirmed a partial mediation model. Study participants who had a higher level of emotional trauma reported higher levels of somatic symptoms. Emotional and neglect trauma showed significant positive relations with experiential avoidance. Bootstrapping results showed that experiential avoidance partially mediated the relationship between emotional trauma and somatic symptoms. Moreover, the association between neglect and somatic symptoms was fully mediated by experiential avoidance. These findings suggest that experiential avoidance might be one mechanism explaining how adverse emotional and neglect experiences influence somatic symptoms. Interventions addressing experiential avoidance through methods such as emotion-focused therapy and mindfulness are discussed as potential future directions for treating somatic symptoms in females who experienced emotional and neglect trauma.

Psychometric Properties of the German Brief Experiential Avoidance Questionnaire (BEAQ)

The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item short form of the Multidimensional Experiential Avoidance Questionnaire. This study aimed to investigate psychometric properties of a German translation of the BEAQ in a student and a clinical population. The BEAQ showed high internal reliability and overall acceptable convergent and discriminant validity. The BEAQ displayed adequate 7- to 13-day test-retest reliability and captured changes in experiential avoidance when experiential avoidance was targeted in treatment. Confirmatory factor analyses indicated that a bifactor structure where the BEAQ is modeled as one general and five specific factors that correspond to the Multidimensional Experiential Avoidance Questionnaire subscales fit the data adequately. All items (except Item 1 in the clinical population) loaded on the general factor and common variance was approximately equally spread across the general and specific factors. The Distress Endurance subscale was not included in this model, since it is represented by only one item, which showed poor performances and low associations to the BEAQ's total score in both samples. We recommend further research into the BEAQ's factor structure to substantiate our preliminary findings.

Mindfulness and Posttraumatic Stress Disorder Symptom Severity in Urban African-American High School Students

OBJECTIVES

The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population.

METHOD

Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness.

RESULTS

Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03].

IMPLICATIONS

This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.

Mindfulness, Posttraumatic Stress Symptoms, and Posttraumatic Growth in Aid Workers: The Role of Self-Acceptance and Rumination

ABSTRACT

Objective: The risk for aid workers to develop posttraumatic mental problems highlights the importance of reducing the harm of posttraumatic stress symptoms (PTSS) and promoting the benefits of posttraumatic growth (PTG). This study examined the negative relationship between mindfulness and PTSS, and the positive relationship between mindfulness and PTG, and further explored the mediating roles of self-acceptance, intrusive rumination, and deliberate rumination. Methods: Aid workers from the Red Cross Organization (N = 298) were recruited in the study. They completed a series of questionnaires assessing mindfulness, self-acceptance, rumination, posttraumatic stress disorder (PTSD), and PTG. Results: Results showed that mindfulness was significantly and negatively associated with PTSD through positively predicting self-acceptance and negatively predicting intrusive rumination. Mindfulness was significantly and positively associated with PTG, although the mediating effect did not exist because the path between self-acceptance and deliberate rumination was impassable. Conclusion: The mechanisms between mindfulness, PTSD, and PTG were further explored. Limitations and implications for trauma intervention and future research were discussed.

Self-Perceived Mental Health Status, Digital Activity, and Physical Distancing in the Context of Lockdown Versus Not-in-Lockdown Measures in Italy and Croatia: Cross-Sectional Study in the Early Ascending Phase of the COVID-19 Pandemic in March 2020

The novelty of the coronavirus disease 2019 (COVID-19) pandemic is that it is occurring in a globalized society enhanced by digital capabilities. Our aim was to analyze the psychological and emotional states of participants in different pandemic-related contexts, with a focus on their digital and physical distancing behaviors. The online survey was applied during the ascending phase of the pandemic in March 2020 in two neighboring EU countries: Italy and Croatia. The study subjects involved four groups, two directly affected by epidemiological measures and two serving as controls—(1) participants from Italy who were in lockdown (Italy group), (2) participants from Croatia who were not in lockdown but who were in direct contact with an infected person and underwent epidemiological measures (CRO-contact group), (3) participants from Croatia who were in an analogous situation but not near the same infected person (CRO-no contact group), and (4) participants from Croatia who were not aware of any infected person (CRO-unrelated group). The survey consisted of validated scales of psychological and emotional states, and custom-made questionnaires on the digital (online) and physical (off-line) behavior of the participants. The Italy group in lockdown had higher self-perceived scores for depression, stress, post-traumatic intrusion, and avoidance, as well as the highest digital activity and physical distancing than the not-in-lockdown Croatian groups. The insight into the extent of online activities and off-line isolation allowed for the introduction of Digital Activity and Physical Distancing Scores. Self-perceived post-traumatic avoidance was higher in both the Italy and CRO-contact groups than the control CRO-no contact and CRO-unrelated groups, and higher avoidance correlated with higher Digital Activity and Physical Distancing Scores. Being in direct contact with the infected person, the CRO-contact group had no other alterations than unexpectedly lower post-traumatic hyperarousal when compared with the Italy group. The Italy group in lockdown demonstrated higher self-perceived psychological toll together with higher digital activity and physical distancing than Croatian groups not in lockdown, even when compared with the affected CRO-contact group. The study outcomes suggest that the general emergency measures influenced citizens in lockdown more than exposure to the virus through direct contact with an infected person.

Mindfulness as a mediator between trauma exposure and mental health outcomes: Results from the National Health and Resilience in Veterans Study

OBJECTIVE

Exposure to traumatic life events is associated with increased risk of posttraumatic stress disorder (PTSD) and other mental health problems such as suicidal ideation (SI), alcohol use disorder (AUD), and decreased quality of life (QOL). Mindfulness, which involves attending to the present moment, may help individuals cope with traumatic events by increasing acceptance of trauma-related experiences and decreasing trauma-related negative affect and avoidance of trauma reminders. The current study evaluated whether mindful attention to the present moment mediated the association between number of lifetime traumas and mental health.

METHOD

The sample consisted of 1,268 trauma-exposed U.S. veterans who participated in the National Health and Resilience in Veterans Study, a nationally representative study of U.S. veterans. On average, the sample was 60.6 years of age (SD = 15.2, range = 20-94), predominantly male (89.8%), Caucasian (75.0%), and noncombat veterans (59.2%).

RESULTS

Path analyses revealed that mindfulness partially mediated the relation between number of lifetime traumas and PTSD symptoms (β = -.55), AUD (β = -.17), and QOL (β = .38), and fully mediated the relation between number of lifetime traumas and SI (β = -.36).

CONCLUSIONS

The relationship between lifetime trauma burden and various mental health issues of relevance to U.S. veterans may be mediated by mindfulness, or the ability to pay attention to the present moment. Interventions that bolster mindfulness may help mitigate the negative impact of cumulative traumas in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Taxometric Analysis of Experiential Avoidance

Experiential avoidance, a trait-like construct referring to the tendency to rigidly avoid or change unpleasant internal experiences stemming from an unwillingness to experience them, is believed to contribute to the development and maintenance of various forms of psychopathology. Despite significant research on this construct, it remains unclear whether experiential avoidance is dimensional or categorical at the latent level. The current study examined the latent structure of experiential avoidance using three taxometric analytic approaches (MAXimum Eigenvalue, Mean Above Minus Below A Curve, Latent-Mode Factor Analysis) applied to data from two independent samples and using three widely used measures of experiential avoidance. The first sample (n = 922) completed the Multidimensional Experiential Avoidance Questionnaire (Gámez, Chmielewski, Kotov, Ruggero, & Watson, 2011), while the second sample (n = 615) completed the Brief Experiential Avoidance Questionnaire (Gámez et al., 2014) and Acceptance and Action Questionnaire-II (Bond et al., 2011). Across both samples and all three measures, experiential avoidance exhibited a dimensional structure. The clinical and research implications of this finding for experiential avoidance are discussed.

The Relationship between Mindfulness and Sleep Quality is Mediated by Emotion Regulation

Background: Sleep is critical to a person’s overall physical and mental health. The current study investigated the relationship between mindfulness and sleep quality, to determine if this relationship is influenced by emotion regulation and perceived stress. Method: Three hundred sixty-seven undergraduate students responded to five self-report measures, (1) The Cognitive and Affective Mindfulness Scale (CAMS-R), (2) The Impact of Event Scale (IES-R), (3) The Five Facet Mindfulness Questionnaire (FFMQ), (4) The Emotion Regulation Questionnaire (ERQ), and (5) The Pittsburgh Sleep Quality Index (PSQI). Results: Results revealed (1) sleep quality was predicted by the presence of hyperarousal, acting with awareness, and the CAMS-R, (2) the Impact of Event Scale was moderately positively correlated with a person’s global score on the Pittsburgh Sleep Quality Index, and (3) the relationship between mindfulness and sleep quality was mediated by hyperarousal. Conclusions: Together, our findings suggest that higher levels of intrusive thoughts, avoidance, and hyperarousal are correlated with lower overall sleep quality, and the use of mindfulness techniques such as acting with awareness and being non-reacting to negative thoughts or hyperarousal may help predict an individual’s sleep quality.

Promoting Resilience Among College Student Veterans Through an Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study

Military veterans' stigmatized views on mental disorders and traditional mental health care considerably reduce veterans' access to mental health services. The present study aimed to refine a previously developed non-stigmatizing smartphone-app intervention based on the principles of acceptance and commitment therapy for college student veterans with posttraumatic stress disorder (PTSD). To this end, we tested the acceptability of the developed prototype using a mixed-method study design. A total of nine student veterans participated in the study by using the app intervention and completing pre-post study measures and a post-intervention qualitative interview. The results showed that the intervention was highly acceptable. The results of the qualitative data analysis highlighted relevant themes related to strategies for improving the content, delivery, and structure of the intervention. The results also showed that, despite a decrease in the participants' adherence as the intervention progressed, there was a consistent improvement in the participants' resilience, PTSD, and rumination. Based on the results, the intervention was revised for prospective feasibility and efficacy testing. Our results highlight the need to use a collaborative approach in the early stage of the development of self-management PTSD interventions.

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.

Mindfulness as a predictor of cognitive-behavioral therapy outcomes in inner-city adults with posttraumatic stress and substance dependence

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent and difficult-to-treat. Mindfulness, defined as nonjudgmental attention to and awareness of present-moment experiences, represents a targetable mechanism with potential to predict and improve treatment outcomes for PTSD/SUD populations. We hypothesized that greater self-reported mindfulness at baseline (pre-treatment) would predict (a) lower end-of-treatment PTSD severity and (b) greater longest sustained abstinence during a 12-week cognitive-behavioral treatment program. Participants included 53 inner-city adults meeting at least four current symptoms of DSM-5 PTSD and current (DSM-IV) substance dependence (51% women; 75.5% African American; Mage = 45.42, SD = 9.99). Hierarchical regression analysis results indicated that higher levels of baseline mindfulness predicted lower end-of-treatment PTSD severity but not longest sustained abstinence from the primary substance of choice. Post hoc exploration of end-of-treatment PTSD symptom clusters indicated that higher baseline mindfulness predicted lower intrusion, negative alterations in cognitions and mood, and arousal and reactivity symptoms but not avoidance symptoms. Clinical and research implications are discussed.

Dispositional mindfulness is associated with heart rate reactivity and recovery in response to a lab stressor

Heightened perceived stress is consistently associated with symptoms of psychopathology. Perceived stress can be reliably linked with physiological responses, such as increased heart rate. Even though dispositional mindfulness is associated with lower self-reported stress, no studies to date have examined whether dispositional mindfulness can predict physiological responses to and recovery from stress. We recruited 142 student participants and administered a measure of dispositional mindfulness (Five Facet Mindfulness Questionnaire-Short Form/FFMQ-SF) and a modified version of the Trier Social Stress Test (TSST). Specifically, during the TSST, we instructed participants that they were about to deliver a presentation to a panel of judges, then informed them they no longer need to deliver this presentation, all while measuring their heart rate. We found that total FFMQ-SF and non-reactivity subscale scores were positively and significantly correlated with heart rate reactivity to the lab stressor. Further, we found that the FFMQ-SF facet of non-judgment was negatively and significantly correlated with the time it took for participants' heart rates to return to and stabilize at baseline. The results of this study elucidate potential mechanisms of mindfulness in stress. Specifically, mindfulness may not necessarily make people less reactive to stressors, but may operate through top-down processes to enhance recovery and resilience during stress.

Emotion Regulation as a Mediator between Childhood Abuse and Neglect and Posttraumatic Stress Disorder in Women with Substance Use Disorders

A history of childhood abuse and neglect (CAN) is significantly associated with psychopathologies in adulthood, including comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Difficulties in emotion regulation (ER) might influence the association between CAN and PTSD. The aim of this study was to examine the relationship between CAN and PTSD symptom severity in women with SUD and to investigate the mediating role of general difficulties in ER and its specific dimensions. Method: We examined 320 women, with a current diagnosis of at least subsyndromal PTSD and SUD, using self-report measures of CAN, PTSD symptom severity, and ER difficulties. We conducted both simple and multiple bootstrapping-enhanced mediation analysis to investigate whether general difficulties in ER and its specific dimensions mediate the relationship between CAN and PTSD symptom severity. Results: General difficulties in ER mediated the association between CAN and PTSD symptom severity. CAN significantly predicted adult PTSD symptom severity, directly and indirectly, through ER difficulties. Difficulties engaging in goal directed behavior when distressed was the only ER dimension, which mediated the effect of CAN on PTSD symptoms. Conclusions: Our results suggest that difficulties in ER and specifically difficulties engaging in goal directed behavior when distressed might constitute an influential factor in the relationship between CAN and PTSD symptom severity in a sample of SUD patients, and highlight the importance of targeting ER as a potential treatment focus for patients with comorbid PTSD and SUD.

Measuring Experiential Avoidance and Posttraumatic Stress in Families

Experiential avoidance (EA) is receiving attention as an emotion regulation strategy and critical factor in the development and maintenance of posttraumatic stress disorder (PTSD) Evidence suggests that EA explains co-varying relationships among topographically dissimilar problem behaviors. The transmission of emotion regulatory strategies is important to understanding the development of these problems. EA may be a learned response style. This conceptual framework was used to test parent EA as a predictor of young adult/older adolescent (offspring) EA, posttraumatic stress symptoms (PTSS), and problem behaviors in a university context as well as to test the best predictors of these outcomes individually for parents and offspring. Two measures of experiential avoidance, the unwillingness to be in contact with distressing emotions, thoughts, and memories were used to predict the outcomes of interest. The Acceptance and Action Questionnaire-II (AAQ-II) was the strongest and only statistically significant predictor of PTSS and problem behaviors for parents and offspring above and beyond trauma history, while the Multidimensional Experiential Avoidance Questionnaire (MEAQ) remained non-significant. Implications regarding measurement discrepancies, PTSS, and harmful behavior trajectories are discussed.

A Brief Review of the EEG Literature on Mindfulness and Fear Extinction and its Potential Implications for Posttraumatic Stress Symptoms (PTSS)

Neuroimaging studies in the area of mindfulness research have provided preliminary support for the idea of fear extinction as a plausible underlying mechanism through which mindfulness exerts its positive benefits. Whilst brain regions identified in the fear extinction network are typically found at a subcortical level, studies have also demonstrated the feasibility of cortical measures of the brain, such as electroencephalogram (EEG), in implying subcortical activations of the fear extinction network. Such EEG studies have also found evidence of a relationship between brain reactivity to unpleasant stimuli (i.e., fear extinction) and severity of posttraumatic stress symptoms (PTSS). Therefore, the present paper seeks to briefly review the parallel findings between the neurophysiological literature of mindfulness and fear extinction (particularly that yielded by EEG measures), and discusses the implications of this for fear-based psychopathologies, such as trauma, and finally presents suggestions for future studies. This paper also discusses the clinical value in integrating EEG in psychological treatment for trauma, as it holds the unique potential to detect neuromarkers, which may enable earlier diagnoses, and can also provide neurofeedback over the course of treatment.

Evaluating the Indirect Effects of Trait Mindfulness Facets on State Tripartite Components Through State Rumination and State Experiential Avoidance

The present study investigated whether specific trait mindfulness facets indirectly influenced state negative affect (NA), positive affect (PA), and physiological hyperarousal (PH) through state rumination and state experiential avoidance. Participants (n = 360, 68% female) rated trait mindfulness facets, then completed an interview task about life experiences intended to elicit state NA, PA, and PH. After the interview task, participants completed measures of state NA, PA, and PH, and state measures of rumination and experiential avoidance. Indirect effect results indicated that the relationships between Nonjudge, Nonreact, and Describe, and each of the state tripartite components indirectly flowed through state rumination. Further, there was a significant indirect effect of Nonjudge and Actaware on each of the three state tripartite components through experiential avoidance. Overall, strengthening the mindfulness skills of Nonjudge, Nonreact, Describe, and Actaware may have positive downstream effects via reducing reliance on maladaptive emotion regulation strategies, such as rumination or experiential avoidance.

Safety behaviors, experiential avoidance, and anxiety: A path analysis approach

Avoidance has long been viewed as an etiological mechanism of anxiety disorders. Of more recent focus within this literature is the distinction between avoidance that is trait-based (experiential avoidance) versus contextual (safety behaviors). Whereas both experiential avoidance and safety behaviors have been studied within anxiety research, no known studies have evaluated the direct and indirect relationships of these forms of avoidance in predicting critical outcomes, particularly in conjunction with symptom severity. To address this gap, the current study assessed social anxiety and panic symptoms, experiential avoidance, use of preventive and restorative safety behaviors, and quality of life to determine the direct and indirect contributions of trait-based and contextual avoidance in predicting clinically relevant outcomes via path analysis. U.S. adults with elevated social anxiety or panic symptoms (n = 254) were recruited online. Results from path analysis showed that, across groups, the relationship between symptoms and quality of life was indirectly accounted for by use of preventive safety behaviors. Further, for participants with panic symptoms (but not for those with social anxiety symptoms), experiential avoidance predicted quality of life even after accounting for use of preventive safety behaviors. The results of this study indicate that trait-based and contextual avoidance contribute significantly to clinically relevant outcomes.