Dispositional mindfulness in trauma recovery: Prospective relations and mediating mechanisms

Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey

BACKGROUND/OBJECTIVES

Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs.

DESIGN/METHOD

We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator.

RESULTS

In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time.

CONCLUSIONS

Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

A prospective examination of the role of psychological (in)flexibility in posttraumatic stress: A cross-lagged panel design

Functional contextualist models of psychopathology suggest that psychological inflexibility and psychological flexibility are of central importance for understanding the development and maintenance of posttraumatic stress (PTS) symptomatology. To our knowledge, these two constructs and their domain-specific factors (e.g., cognitive fusion, experiential avoidance) have not been assessed in their entirety and examined in relation to PTS symptoms using a longitudinal study design. As such, the primary aim of the present study was to use cross-lagged panel analysis, an analytic approach that allows stronger causal inferences to be made regarding the nature of temporal relations among study variables, to determine the directional relations among PTS symptoms and psychological flexibility and inflexibility over an eight-month time period. Trauma-exposed adults (N = 810), recruited online via Amazon's Mechanical Turk (MTurk), completed a battery of self-report measures via a secure online platform at three time points, spanning eight months. Results suggest that the relationship between psychological inflexibility and PTS symptoms is bidirectional and mutually reinforcing. In contrast, significant prospective relations were not observed between psychological flexibility and PTS symptoms. Results of a follow-up exploratory path analysis showed that cognitive fusion was the only psychological inflexibility subfactor that partially mediated the relationship between PTS symptoms from baseline to the eight-month follow-up assessment. Taken together, these results suggest that psychological inflexibility, and primarily the domain of cognitive fusion, maintains PTS symptoms following trauma exposure. As such, it may important to integrate cognitive defusion techniques into evidence-based treatments for Posttraumatic Stress Disorder (PTSD).

Relationship between mindfulness, meaning in life and post-traumatic growth among Nigerian cancer patients

Understanding the psychosocial factors that predict recovery and promote growth from trauma is critical to effective management of oncology patients. Although previous studies have shown that mindfulness and meaning in life could be predictors of post-traumatic growth (PTG), no study to date has explored the combined role of mindfulness and meaning in life in the development of PTG among cancer patients. Using a cross-sectional design, data were collected from 957 cancer patients (46.8% male, 53.2% female) who completed relevant self-report measures. Results showed that the presence of meaning in life mediated the relationship between mindfulness and PTG. However, the mediation effect of search for meaning in life was not significant. These findings indicate that the presence of meaning in life is an essential mechanism of mindfulness in facilitating PTG. Therefore, psychosocial interventions geared towards promoting PTG should consider mindfulness as a potential effective component in improving cancer patients' ability to find meaning in life and possibly promote recovery.

The potential mediating role of anxiety sensitivity in the impact of mindfulness training on anxiety and depression severity and impairment: A randomized controlled trial

The benefits of mindfulness-based interventions to alleviate anxiety and depression have been supported by many studies. Given the effectiveness of mindfulness-based interventions on anxiety and depression, the underlying mechanisms need to be explored. Using a randomized waitlist-controlled design, this study investigated whether anxiety sensitivity was a potential mechanism for the impact of mindfulness training on anxiety and depression. Participants with high psychological distress were randomly assigned to an eight-week mindfulness intervention (N = 35) or a wait-list control group (N = 34). Before and after the intervention or corresponding waitlist period, participants completed measures of anxiety and depression severity and impairment and anxiety sensitivity. Separate mixed ANOVA demonstrated significant group (intervention vs. control group) × time (pre- vs. post-test) interactions for anxiety sensitivity and overall anxiety severity and impairment and marginally significant interaction for overall depression severity and impairment. Moreover, simple mediation models showed that reductions of anxiety sensitivity from pre- to post-test mediated the impact of mindfulness training on changes in anxiety and depression severity and impairment. The findings suggest that anxiety sensitivity is a potential mechanism underlying the effect of mindfulness training on anxiety and depression, which provides a new perspective for the study of processes of change of mindfulness-based interventions.

Cognitive fusion and personality traits in the context of mindfulness: A cross-sectional study

Objectives

Meditation and mindfulness, though rooted in eastern traditions, have been increasingly embraced in western psychology. However, questions remain regarding the mechanisms through which the beneficial effects of mindfulness occur. The present study aimed to address cognitive fusion as a potential mediator between mindfulness and negative affect and whether the mindfulness-cognitive fusion link is moderated by personality factors in an international sample of frequent meditators.

Methods

An international sample of 739 frequent meditators completed measures of mindfulness (Southampton Mindfulness Questionnaire), cognitive fusion (Cognitive Fusion Questionnaire), negative affect (Brief Symptom Checklist), and personality (Big Five Inventory) in an online survey. Using SPSS Process Macro, cognitive fusion was examined as a mediator between mindfulness and negative affect. Furthermore, Extraversion, Conscientiousness, and Neuroticism were investigated as moderators in the mediation model.

Results

Cognitive fusion was found to be a partial mediator between mindfulness and negative affect (b = -0.249; 95% CI, [-0.289, -0.203]), whereas the examined personality factors were not found to moderate the present model (E: t(734) = 0.951, p = .342); C: t(734) = -0.042, p = .967; N: t(734) = -2.271, p = .023).

Conclusions

This study suggests that cognitive fusion plays a significant role in the association between mindfulness and negative affect. These findings indicate the importance of how individuals internally respond and relate to experiences and the instrumental value of mindfulness effects beyond and outside of mindfulness-based interventions.

Psychological resources and flexibility predict resilient mental health trajectories during the French covid-19 lockdown

The implementation of lockdowns and the Covid-19 pandemic situation have negatively impacted mental health (anxiety, depression). However, little is known about individual differences in the longitudinal reactions to lockdown. We designed a longitudinal study (a) to identify the various trajectories of symptoms of depression and anxiety in the general population during and after lockdown; (b) to determine which positive psychological resources prevent individuals from falling into groups with the most severe trajectories; (c) to test the mediating role of psychological flexibility. We collected and analysed longitudinal data on a sample of French participants (N = 1399, M_age = 43.4; SD_age = 12; 87.8% women) during the end of the first lockdown. Participants were asked to report their psychological resources and (in)flexibility at baseline and symptoms of anxiety and depression at each measurment occasion (five weekly observations from 17 March to 11 May 2020, including baseline). Using growth mixture modelling, seven dynamic profiles of symptoms were identified: four for depression and three for anxiety. Resilience emerged as the most frequent trajectory. Wisdom, optimism, hope, self-efficacy and peaceful disengagement significantly prevented individuals from belonging to the symptomatic groups. Moreover, psychological flexibility emerged as a significant mediator of these effects. This study highlights the importance of cultivating protective factors and psychological flexibility to prevent mental health damage during potentially traumatic events (PTE) and to favour resilience trajectories.

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.

Examining the associations between PTSD symptoms and aspects of emotion dysregulation through network analysis

Despite the clearly established link between posttraumatic stress disorder (PTSD) and emotion dysregulation, little is known about how individual symptoms of PTSD and aspects of emotion dysregulation interrelate. The network approach to mental health disorders provides a novel framework for conceptualizing the association between PTSD and emotion dysregulation as a system of interacting nodes. In this study, we estimated the structural relations among PTSD symptoms and aspects of emotion dysregulation within a large sample of women who participated in a multi-site study of sexual revictimization (N = 463). We estimated expected influence to reveal differential associations among PTSD symptoms and aspects of emotion dysregulation. Further, we estimated bridge expected influence to identify influential nodes connecting PTSD symptoms and aspects of emotion dysregulation. Results highlighted the key role of concentration difficulties in expected influence and bridge expected influence. Findings highlight several PTSD symptoms and aspects of emotion dysregulation that may be targets for future intervention.

Resilience and Posttraumatic Growth of Patients With Breast Cancer During the COVID-19 Pandemic in China: The Mediating Effect of Recovery

Purpose

This study aims to examine the mediating role recovery plays in the relationship between resilience and posttraumatic growth (PTG) among breast cancer patients.

Methods

A cross-sectional study design was implemented between January 02, 2021 and April 29, 2021. A total of 789 breast cancer patients from eight hospitals in Liaoning province were selected for participation in this study. These participants completed questionnaires, which included the Post-Traumatic Growth Inventory, EGO Resilience Scale and the Questionnaire about the Process of Recovery. The associated factors of PTG were analyzed using hierarchical multiple regression (HMR). The proposed relationships among resilience, recovery, and PTG were checked by structural equation modeling (SEM) analyses.

Results

The average PTG score of breast cancer patients was 53.00 ± 28.30. PTG was positively correlated with both recovery and PTG (a*b = 0.1, BCa95% CI: 0.154 ∼ 0.054).

Conclusion

Breast cancer patients were found to exhibit a moderate degree of PTG. Resilience was positively associated with PTG and recovery mediated the positive effect of resilience on PTG. Resilience might serve as a crucial protective factor that could explain positive growth in life-threatening illnesses through the mediating path of recovery.

Mindfulness as an intervention after multisystem trauma

Background

There is a known significant risk of negative mental health consequences following traumatic injury, yet no standard approach to prevent psychiatric illness in trauma patients currently exists. Mindfulness-based psychotherapies have been shown to reduce symptoms of post-traumatic stress disorder, depression and anxiety and improve resiliency, however it is unknown whether a mindfulness intervention immediately following traumatic injury would lead to diminished mental health consequences.

Methods

Multi-system trauma patients at the University of Alberta Hospital (N = 63) and the Foothills Hospital (N = 60) were assigned to the experimental and control groups respectively. Patients in the experimental group were asked to use the guided mindfulness application “Stop, Breathe & Think” for 28 consecutive days. All patients completed the Depression Anxiety Stress Scale (DASS-21) and Connor-Davidson Resilience Scale (CD-RISC) 48 hours and 28 days following admission. An exit interview was conducted for patients in the experimental group.

Results

There was no significant difference in mean enrollment DASS-21 scores, mean enrollment CD-RISC scores, mean follow-up DASS-21 scores and mean follow-up CD-RISC scores between experimental and control groups. Paired t-tests of mean admission and mean follow-up DASS-21 and CD-RISC scores were not significantly different in the experimental group. Paired t-tests of mean admission and follow-up CD-RISC scores were not significantly different in the control group whereas mean followup DASS-21 scores were decreased in the control group relative to enrolment DASS-21 scores (p = 0.014). Patients reported improved mood after use of mindfulness, and most planned to continue using the therapy and would recommend it to others.

Conclusion

Our study did not demonstrate an objective benefit of mindfulness intervention immediately following traumatic injury. Exit interview data suggests that a web-based mindfulness intervention may be beneficial for certain trauma patients however further research is required to identify those most likely to realize substantial gains.

Americans' distress early in the COVID-19 pandemic: Protective resources and coping strategies

OBJECTIVE

The rapid emergence of the coronavirus disease 2019 (COVID-19) pandemic in the United States has dramatically altered daily life and taken a toll on Americans' physical, mental, social, and financial well-being. Based on previous widespread disasters, future high prevalence of short- and long-term adverse mental health consequences are anticipated. Studies of COVID-19 outside the United States indicated moderately high levels of distress, but we have little information regarding Americans' distress nor the factors associated with relative distress or adjustment during this unprecedented time. This study represents the first national view of Americans' distress during the massive disruption of COVID-19 and identifies levels of stress exposure, protective psychosocial resources, and coping strategies.

METHOD

Data were collected April 7-9, 2020 from an online platform, using best practices for ensuring high-quality data; 1,015 completed respondents are included ([53.9%] women; average age = 38.9 years; mostly White [82.4%] and non-Hispanic [91.5%]). Respondents' locations ranged across the United States, from 18.5% in the Northeast to 37.8% in the South.

RESULTS

Fairly high levels of stress exposure and peritraumatic and general distress (depression, anxiety, and stress) were reported. Emotion regulation skills along with active and distraction coping emerged as the strongest predictors of lower distress levels.

CONCLUSIONS

These results identify potential targets for online mental health interventions-focusing on engaging in adaptive emotion regulation and coping (e.g., through telehealth mental health first aid)-during the pandemic to offset the likely rise in distress over the months ahead. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mindful attention awareness and cognitive defusion are indirectly associated with less PTSD-like symptoms via reduced maladaptive posttraumatic cognitions and avoidance coping

Recently, the effects of mindfulness-based interventions for posttraumatic stress disorder (PTSD) have been studied. However, we lack knowledge of the processes or mechanisms through which mindfulness influences resilience or promotes recovery following exposure to trauma. In this study, we examine the process by which mindfulness and cognitive-behavioral factors such as posttraumatic negative cognition and avoidance behaviors are associated with reduced PTSD-like symptoms. A questionnaire survey was conducted with 885 university students, using the Trauma Experience Questionnaire, Mindful Attention Awareness Scale, Cognitive Fusion Questionnaire, Post-Traumatic Stress Disorder Checklist, revised Ways of Coping Checklist, and a brief version of the Posttraumatic Cognitions Inventory. Data from 254 participants who experienced trauma with PTSD-like symptoms were analyzed. The final model using SEM indicated no direct association of mindful attention awareness on PTSD-like symptoms, a small direct association of cognitive defusion on PTSD-like symptoms, and a large indirect association mediated by posttraumatic negative cognitions and avoidance coping. Owing to the study’s cross-sectional design, strong conclusions cannot be drawn regarding the causal relationship of mindfulness and cognitive-behavioral factors or generalizations. However, our findings suggest that it would be worthwhile to continue to clarify the mechanism of mindfulness and to investigate its use in the treatment of PTSD. In the future, a highly accurate study design will hopefully be used to examine the mechanisms of several different factors associated with improvement in posttraumatic stress symptoms, preferably including them in the same model.

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.

Effect of a mindfulness intervention on patients admitted after multisystem trauma

Background

The incidence of depression, anxiety, and post-traumatic stress disorders is reported to be as high as 50% in trauma patients. The perpetual negative emotions and state of mind in these disorders predisposes patients to negative mental health outcomes. Mindfulness, on the other hand, helps people to process their experience and emotions in a non-judgmental manner, and recently, there has been increased utilization of mindfulness-based therapies for the treatment of mental health conditions. This proof-of-concept study evaluates the use of a mindfulness-based online application in patients admitted to the trauma service at a Level 1 Trauma Centre.

Methods

Trauma patients who were English speaking, over the age of 18, and without brain injury or pre-existing neurocognitive disorder were included. Participants completed the Depression Anxiety Stress Scale (DASS)-21 to assess level of depression, anxiety, and stress, and the Connor-Davidson Resilience Scale (CD-RISC) to assess level of resiliency. Then, after 28 consecutive days of practicing mindfulness using the app ‘Stop, Breathe, and Think,’ the questionnaires were repeated and an exit survey conducted.

Results

For this study, 13 participants were enrolled, 2 withdrew, and 5 were lost to follow-up. The mean DASS-21 score at time enrollment was 16.4 and was 11.2 at follow-up ( p = 0.10). There were no differences between the level of depression and stress from enrollment to follow-up, but there was significant decrease in anxiety symptoms from 7.2 to 3.0 (<0.05). CD-RISC scores at enrollment and follow-up were 77.8 and 81 ( p = 0.23), respectively. At the time of exit interview, 67% of patients continued to use the application three to four times a week and 67% responded they plan to continue using the application. In addition, 83% of patients always or often felt better after practicing mindfulness and stated they would recommend the application to others.

Conclusions

Mindfulness shows promising potential to decrease psychological distress in trauma patients.

Psychological Resources Against the Traumatic Experience of Covid-19

Psychological resources, such as defense mechanism and mindfulness practice, can mediate the individual reaction to traumatic experiences as the ongoing COVID-19 pandemic outbreak. A novel self-reported measure based on the DMRS (DMRS-SR-30), has been developed with the aim of assessing potential adaptive defensive strategies against the traumatic experience of COVID-19. Preliminary validation of the DMRS-SR-30 showed good internal consistency in both overall defensive functioning and subscales. Combining adaptive defense mechanisms and mindfulness practice could prevent psychological distress due to the effect of COVID-19 losses and quarantining.

Cognitive Fusion Mediates the Relationship between Dispositional Mindfulness and Negative Affects: A Study in a Sample of Spanish Children and Adolescent School Students

Nowadays, mindfulness-based interventions (MBI) have experienced a remarkable development of studies among childhood and adolescent interventions. For this reason, dispositional mindfulness (DM) measures for children and adolescents have been developed to determine the effectiveness of MBI at this age stage. However, little is known about how key elements of DM (for example, cognitive de/fusion or experiential avoidance that both confirm psychological inflexibility) are involved in the mechanisms of the children and adolescents' mental health outcomes. This research examined the mediating effect of cognitive fusion between DM and anxiety and other negative emotional states in a sample of 318 Spanish primary-school students (aged between 8 and 16 years, M = 11.24, SD = 2.19, 50.8% males). Participants completed the AFQ-Y (Avoidance and Fusion Questionnaire for youth), which is a measure of psychological inflexibility that encompasses cognitive defusion and experiential avoidance; CAMM (DM for children and adolescents), PANAS-N (positive and negative affect measure for children, Spanish version of PANASC), and STAIC (an anxiety measure for children). The study accomplished ethical standards. As MBI relevant literature has suggested, cognitive defusion was a significant mediator between DM and symptoms of both negative emotions and anxiety in children and adolescents. However, experiential avoidance did not show any significant mediating relationship. Probably, an improvement of the assessment of experiential avoidance is needed. MBI programs for children and adolescents may include more activities for reducing effects of the cognitive defusion on their emotional distress.

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence

Mindfulness-based treatments for posttraumatic stress disorder (PTSD) have emerged as promising adjunctive or alternative intervention approaches. A scoping review of the literature on PTSD treatment studies, including approaches such as mindfulness-based stress reduction, mindfulness-based cognitive therapy and metta mindfulness, reveals low attrition with medium to large effect sizes. We review the convergence between neurobiological models of PTSD and neuroimaging findings in the mindfulness literature, where mindfulness interventions may target emotional under- and overmodulation, both of which are critical features of PTSD symptomatology. Recent emerging work indicates that mindfulness-based treatments may also be effective in restoring connectivity between large-scale brain networks among individuals with PTSD, including connectivity between the default mode network and the central executive and salience networks. Future directions, including further identification of the neurobiological mechanisms of mindfulness interventions in patients with PTSD and direct comparison of these interventions to first-line treatments for PTSD are discussed.

ROLE OF RESILIENCE IN MINDFULNESS TRAINING FOR FIRST RESPONDERS

First responders are exposed to critical incidents and chronic stressors that contribute to a higher prevalence of negative health outcomes compared to other occupations. Psychological resilience, a learnable process of positive adaptation to stress, has been identified as a protective factor against the negative impact of burnout. Mindfulness-Based Resilience Training (MBRT) is a preventive intervention tailored for first responders to reduce negative health outcomes, such as burnout. This study is a secondary analysis of law enforcement and firefighters samples to examine the mechanistic role of psychological resilience on burnout. Results indicated that changes in resilience partially mediated the relationship between mindfulness and burnout, and that increased mindfulness was related to increased resilience (b = .41, SE = .11, p < .01), which in turn was related to decreased burnout (b = -.25, SE = .12, p = .03). The bootstrapped confidence interval of the indirect effect did not contain zero [95% CI; -.27, -.01], providing evidence for mediation. Limitations and implications are discussed.