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Mindfulness

, Volume 9, Issue 5, pp 1594–1603 | Cite as

Childhood Cumulative Trauma and Depressive Symptoms in Adulthood: the Role of Mindfulness and Dissociation

  • Roxanne Bolduc
  • Noémie Bigras
  • Marie-Ève Daspe
  • Martine Hébert
  • Natacha Godbout
ORIGINAL PAPER
  • 265 Downloads

Abstract

Considering the heightened risk of adults who have experienced childhood cumulative trauma (CCT) to suffer from depressive symptoms, the present study aimed to investigate mindfulness and dissociation as possible mechanisms implicated in this relationship. A total of 234 clients seeking psychotherapy for sexual and/or relational difficulties completed self-reported questionnaires as part of the evaluation phase within their treatment. The assessment tools evaluated the experience of childhood trauma, depressive symptoms, mindfulness levels, and dissociative symptoms. Results of structural equation modeling indicated that the link between CCT and depressive symptoms was fully mediated by both mindfulness and dissociation. In light of our results, it is recommended to assess systematically the presence of CCT, depressive symptoms, and dissociation in clients seeking help for sexual and/or relational issues, even though their primary motive may seem unrelated. Findings suggest that treatments focusing on fostering mindfulness might be beneficial in reducing depressive symptoms for individuals who experienced CCT.

Keywords

Childhood cumulative trauma Depressive symptoms Mindfulness Dissociation 

Notes

Acknowledgements

The authors want to thank all the clients who participated in this study. Also, this study would not have been possible without the valuable collaboration of the graduate interns in sexology as well as a number of student members of the Trauma and Couple Research and Intervention Unit (TRACE), who collaborated in the data collection. Finally, we want to acknowledge Michel Goulet, sexologist and clinical professor of sexology, UQAM, without whom this collaboration between research and clinical work would have not been possible.

Author Contributions

RB: acquisition of data, designed and executed the study, assisted with the data analyses, and drafted the manuscript. NB: designed and executed the study, assisted with the data analyses, and collaborated with the writing and editing of the paper. MÈD: performed the structural equation analysis as well as writing data analyses section, provided critical review and final approval of the manuscript. MH: provided critical review and final approval for the manuscript. NG: responsible of the project, acquisition of data, designed and executed the study, wrote the paper, supervision, review, and editing of the final manuscript.

Funding

This study was partially funded by grants from the Fonds de Recherche du Québec—Santé (FRQS), the Fonds de Recherche du Québec—Société et Culture (FRQSC), the Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse (CRIPCAS), and UQAM, to the last author.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethic Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Université du Québec à Montréal (UQAM) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The research project was approved by the UQAM Ethic Institutional Board.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association.CrossRefGoogle Scholar
  2. Batink, T., Peeters, F., Geschwind, N., van Os, J., & Wichers, M. (2013). How does MBCT for depression work? Studying cognitive and affective mediation pathways. PLoS One, 8(8), e72778.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Beck, A. T. (1978). Depression inventory. Philadelphia, PA: Center for Cognitive Therapy.Google Scholar
  4. Belvederi Murri, M., Ferrigno, G., Penati, S., Muzio, C., Piccinini, G., Innamorati, M., et al. (2017). Mentalization and depressive symptoms in a clinical sample of adolescents and young adults. Child and Adolescent Mental Health, 22(2), 69–76.CrossRefGoogle Scholar
  5. Bentler, P. M. (1990). Comparative fit indices in structural models. Psychological Bulletin, 107(2), 38–246.CrossRefGoogle Scholar
  6. Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., et al. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190.CrossRefGoogle Scholar
  7. Berthelot, N., Hébert, M., Godbout, N., Goulet, M., Bergeron, S., & Boucher, S. (2014). Childhood maltreatment increases the risk of intimate partner violence via PTSD and anger personality traits in individuals consulting for sexual problems. Journal of Aggression, Maltreatment & Trauma, 23(9), 982–998.CrossRefGoogle Scholar
  8. Bigras, N., Daspe, M.-È., Godbout, N., Briere, J., & Sabourin, S. (2017a). Cumulative childhood trauma and adult sexual satisfaction: mediation by affect dysregulation and sexual anxiety in men and women. Journal of Sex & Marital Therapy, 43(4), 377–396.CrossRefGoogle Scholar
  9. Bigras, N., Godbout, N., Hébert, M., & Sabourin, S. (2017b). Cumulative adverse childhood experiences and sexual satisfaction in sex therapy patients: what role for symptom complexity? The Journal of Sexual Medicine, 14(3), 444–454.CrossRefPubMedGoogle Scholar
  10. Bourque, P., & Beaudette, D. (1982). Étude psychométrique du questionnaire de dépression de Beck auprès d'un échantillon d'étudiants universitaires francophones. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 14(3), 211–218.CrossRefGoogle Scholar
  11. Boyer, R., Préville, M., Légaré, G., & Valois, P. (1993). La détresse psychologique dans la population du Québec non institutionnalisée: résultats normatifs de l'enquête Santé Québec. The Canadian Journal of Psychiatry, 38(5), 339–343.CrossRefPubMedGoogle Scholar
  12. Brach, T. (2003). Radical acceptance: embracing your life with the heart of a Buddha. New York, NY: Bantam Dell.Google Scholar
  13. Bremner, J. D., Bolus, R., & Mayer, E. A. (2007). Psychometric properties of the early trauma inventory—self report. The Journal of Nervous and Mental Disease, 195(3), 211–218.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Briere, J. (2002). Treating adult survivors of severe childhood. In J. E. B. Myers, L. Berliner, J. Briere, C. T. Hendrix, T. Reid, & C. Jenny (Eds.), The APSAC handbook on child maltreatment (2nd ed., pp. 175–202). Newbury Park, CA: Sage Publications.Google Scholar
  15. Briere, J. (2011). Trauma symptom inventory–2 (TSI–2). Odessa, FL: Psychological Assessment Resources.Google Scholar
  16. Briere, J. (2015). Pain and suffering: a synthesis of Buddhist and Western approaches to trauma. In V. M. Follette, J. Briere, D. Rozelle, J. Hopper, & D. I. Rome (Eds.), Mindfulness-oriented interventions for trauma: integrating contemplative practices (pp. 11–30). New York, NY: Guilford.Google Scholar
  17. Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27(10), 1205–1222.CrossRefGoogle Scholar
  18. Briere, J., Hodges, M., & Godbout, N. (2010). Traumatic stress, affect dysregulation, and dysfunctional avoidance: a structural equation model. Journal of Traumatic Stress, 23(6), 767–774.CrossRefPubMedGoogle Scholar
  19. Briere, J., Godbout, N., & Runtz, M. (2012). The psychological maltreatment review (PMR): initial reliability and association with insecure attachment in adults. Journal of Aggression, Maltreatment & Trauma, 21(3), 300–320.CrossRefGoogle Scholar
  20. Briere, J., Dietrich, A., & Semple, R. J. (2016). Dissociative complexity: antecedents and clinical correlates of a new construct. Psychological Trauma: Theory, Research, Practice, and Policy, 8(5), 577–584.CrossRefGoogle Scholar
  21. Brotto, L., Atallah, S., Johnson-Agbakwu, C., Rosenbaum, T., Abdo, C., Byers, E. S., et al. (2016). Psychological and interpersonal dimensions of sexual function and dysfunction. The Journal of Sexual Medicine, 13(4), 538–571.CrossRefPubMedGoogle Scholar
  22. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.CrossRefPubMedGoogle Scholar
  23. Burns, D. D., & Beck, A. T. (1978). Cognitive behavior modification of mood disorders. Cognitive behavior therapy: Research and application, 109–134.Google Scholar
  24. Colman, I., Garad, Y., Zeng, Y., Naicker, K., Weeks, M., Patten, S. B., et al. (2013). Stress and development of depression and heavy drinking in adulthood: moderating effects of childhood trauma. Social Psychiatry and Psychiatric Epidemiology, 48(2), 265–274.CrossRefPubMedGoogle Scholar
  25. Dugal, C., Bigras, N., Godbout, N., & Bélanger, C. (2016). Childhood interpersonal trauma and its repercussions in adulthood: an analysis of psychological and interpersonal sequelae. In G. El-Baalbaki & C. Fortin (Eds.), A multidimensional approach to post-traumatic stress disorder: from theory to practice. Rijeka: InTech Open science publishers.Google Scholar
  26. Dulin, P. L., & Passmore, T. (2010). Avoidance of potentially traumatic stimuli mediates the relationship between accumulated lifetime trauma and late-life depression and anxiety. Journal of Traumatic Stress, 23(2), 296–299.PubMedGoogle Scholar
  27. Felder, A. J., Aten, H. M., Neudeck, J. A., Shiomi-Chen, J., & Robbins, B. D. (2014). Mindfulness at the heart of existential-phenomenology and humanistic psychology: a century of contemplation and elaboration. The Humanistic Psychologist, 42(1), 6–23.CrossRefGoogle Scholar
  28. Follette, V. M., & Pistorello, J. (2007). Finding life beyond trauma: using acceptance and commitment therapy to heal from post-traumatic stress and trauma-related problems. Oakland, CA: New Harbinger Publications.Google Scholar
  29. Follette, V. M., Palm, K. M., & Hall, M. L. R. (2004). Acceptance, mindfulness, and trauma. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: expanding the cognitive-behavioral tradition (pp. 192–208). New York, NY: Guilford Press.Google Scholar
  30. Follette, V. M., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: implications for treatment. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 24(1), 45–61.CrossRefGoogle Scholar
  31. Forbes, M. K., Baillie, A. J., & Schniering, C. A. (2016). A structural equation modeling analysis of the relationships between depression, anxiety, and sexual problems over time. The Journal of Sex Research, 53(8), 942–954.CrossRefPubMedGoogle Scholar
  32. Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31(6), 772–799.CrossRefPubMedGoogle Scholar
  33. Francia-Martínez, M., de Torres, I. R., Alvarado, C. S., Martínez-Taboas, A., & Sayers, S. (2003). Dissociation, depression and trauma in psychiatric inpatients in Puerto Rico. Journal of Trauma & Dissociation, 4(4), 47–61.CrossRefGoogle Scholar
  34. Godbout, N., Dutton, D. G., Lussier, Y., & Sabourin, S. (2009). Early exposure to violence, domestic violence, attachment representations, and marital adjustment. Personal Relationships, 16(3), 365–384.CrossRefGoogle Scholar
  35. Godbout, N., Bigras, N., & Dion, J. (2016). Présence attentive et traumas interpersonnels subis durant l’enfance. In S. Grégoire, L. Lachance, & L. Richer (Eds.), La présence attentive (mindfulness): État des connaissances théoriques, empiriques et pratiques (pp. 229-251). Québec, Qc: Presses de l’Université du Québec (PUQ).Google Scholar
  36. Hayes, S. C., & Gifford, E. V. (1997). The trouble with language: experiential avoidance, rules, and the nature of verbal events. Psychological Science, 8(3), 170–173.CrossRefGoogle Scholar
  37. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.CrossRefPubMedGoogle Scholar
  38. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experiential approach to behavior change. New York, NY: Guilford Press.Google Scholar
  39. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: the process and practice of mindful change. New York, NY: Guilford Press.Google Scholar
  40. Herman, J. L. (1992). Trauma and recovery. New York, NY: Basic Books.Google Scholar
  41. Higgins, D. J., & McCabe, M. P. (2001). Multiple forms of child abuse and neglect: adult retrospective reports. Aggression and Violent Behavior, 6(6), 547–578.CrossRefGoogle Scholar
  42. Hodges, M., Godbout, N., Briere, J., Lanktree, C., Gilbert, A., & Kletzka, N. T. (2013). Cumulative trauma and symptom complexity in children: a path analysis. Child Abuse & Neglect, 37(11), 891–898.CrossRefGoogle Scholar
  43. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Hu, L.-t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.CrossRefGoogle Scholar
  45. Ilfeld, F. W. (1976). Further validation of a psychiatric symptom index in a normal population. Psychological Reports, 39(3), 1215–1228.CrossRefGoogle Scholar
  46. Jermann, F., Billieux, J., Larøi, F., d’Argembeau, A., Bondolfi, G., Zermatten, A., & Van der Linden, M. (2009). Mindful attention awareness scale (MAAS): psychometric properties of the French translation and exploration of its relations with emotion regulation strategies. Psychological Assessment, 21(4), 506–514.CrossRefPubMedGoogle Scholar
  47. Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York, NY: Guilford Press.Google Scholar
  48. Knoll, A. D., & MacLennan, R. N. (2017). Prevalence and correlates of depression in Canada: findings from the Canadian Community Health Survey. Canadian Psychology / Psychologie canadienne, 58(2), 116–123.CrossRefGoogle Scholar
  49. Lanktree, C. B., Gilbert, A. M., Briere, J., Taylor, N., Chen, K., Maida, C. A., & Saltzman, W. R. (2008). Multi-informant assessment of maltreated children: convergent and discriminant validity of the TSCC and TSCYC. Child Abuse & Neglect, 32(6), 621–625.CrossRefGoogle Scholar
  50. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31–40.CrossRefPubMedGoogle Scholar
  51. MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18(1), 16–20.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Michal, M., Beutel, M. E., Jordan, J., Zimmermann, M., Wolters, S., & Heidenreich, T. (2007). Depersonalization, mindfulness, and childhood trauma. The Journal of Nervous and Mental Disease, 195(8), 693–696.CrossRefPubMedGoogle Scholar
  53. Min, M., Farkas, K., Minnes, S., & Singer, L. T. (2007). Impact of childhood abuse and neglect on substance abuse and psychological distress in adulthood. Journal of Traumatic Stress, 20(5), 833–844.CrossRefPubMedGoogle Scholar
  54. Muthén, L. K., & Muthén, B. O. (1998-2012). Mplus User’s Guide (7th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
  55. Nam, B., Hilimire, M., Schiffman, J., & DeVylder, J. (2016). Psychotic experiences in the context of depression: the cumulative role of victimization. Journal of Psychiatric Research, 82, 136–140.CrossRefPubMedGoogle Scholar
  56. Nelson, J., Klumparendt, A., Doebler, P., & Ehring, T. (2017). Childhood maltreatment and characteristics of adult depression: meta-analysis. The British Journal of Psychiatry, 201, 96–104.CrossRefGoogle Scholar
  57. Pratt, L. A., & Brody, D. J. (2014). Depression in the U.S. household population, 2009-2012. NCHS data brief, no 172. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  58. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments and Computers, 36, 717–731.CrossRefGoogle Scholar
  59. Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93–115.CrossRefPubMedGoogle Scholar
  60. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to relapse prevention. New York, NY: Guilford.Google Scholar
  61. Spss, I. (2012). IBM SPSS statistics version 21 (p. 126). Boston, Mass: International Business Machines Corp.Google Scholar
  62. Steiger, J. H. (1990). Structural model evaluation and modification: an interval estimation approach. Multivariate Behavioral Research, 25(2), 173–180.CrossRefPubMedGoogle Scholar
  63. Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33(1), 25–39.CrossRefPubMedGoogle Scholar
  64. Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of Consulting and Clinical Psychology, 70, 275–287.CrossRefPubMedGoogle Scholar
  65. Teasdale, J. D., Williams, J. M. G., & Segal, Z. V. (2014). The mindful way workbook: an 8-week program to free yourself from depression and emotional distress. New York, NY: Guilford Publications.Google Scholar
  66. Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24(4), 409–415.CrossRefPubMedGoogle Scholar
  67. Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, & Abuse, 12(4), 220–235.CrossRefGoogle Scholar
  68. Ullman, S. E. (2001). Structural equation modeling. In B. G. Tabachnick & L. S. Fidell (Eds.), Using multivariate statistics (4th ed., pp. 653–771). New York, NY: Allyn and Bacon.Google Scholar
  69. Wanklyn, S. G., Day, D. M., Hart, T. A., & Girard, T. A. (2012). Cumulative childhood maltreatment and depression among incarcerated youth: impulsivity and hopelessness as potential intervening variables. Child Maltreatment, 17(4), 306–317.CrossRefPubMedGoogle Scholar
  70. Zvolensky, M. J., Feldner, M. T., Leen-Feldner, E., & Yartz, A. R. (2005). Exploring basic processes underlying acceptance and mindfulness. In S. Orsillo & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety: conceptualization and treatment (pp. 325–359). New York, NY: Springer.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of SexologyUniversité du Québec à MontréalMontrealCanada
  2. 2.Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse (CRIPCAS)MontrealCanada
  3. 3.Department of PsychologyUniversité du Québec à MontréalMontrealCanada
  4. 4.Department of PsychologyUniversity of Southern CaliforniaLos AngelesUSA

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