Abstract
Although the negative impact of posttraumatic stress disorder (PTSD) on psychological distress is broadly consistent across the literature, the psychological mechanisms underpinning this relationship need further exploration. Pain paradox theory has postulated the important role of PTSD, avoidance strategies, mindfulness, and distress following trauma. However, a more comprehensive study is needed to understand their interactive effects over time. This current longitudinal study aimed to examine the associations between these factors. 201 participants completed the questionnaire survey (i.e., the PTSD Checklist for DSM-5, Toronto Alexithymia Scale, Mindfulness Attention Awareness Scale, and the General Health Questionnaire) at two time points nine months apart. An autoregressive cross-lagged panel with structural equation modelling was used for data analysis. Initial PTSD symptoms predicted subsequent psychological distress. Initial mindfulness was significantly negatively correlated with subsequent alexithymia, PTSD, and distress outcomes. Furthermore, initial alexithymia was significantly positively associated with subsequent PTSD and distress. Following trauma exposure, individuals may develop PTSD that impairs mental health. However, individuals with higher levels of mindfulness tend to experience less alexithymia and PTSD symptoms, which in turn may lead to lower levels of psychological distress over time. Meanwhile, individuals with lower levels of difficulty identifying and describing emotions are less likely to develop PTSD symptoms and experience psychological distress over time.
Similar content being viewed by others
Data Availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Acock, A. C. (2005). Working with missing values. Journal of Marriage and Family, 67(4), 1012–1028.
Arbuckle, J. L., & Wothke, W. (1999). Amos 4.0 user's guide. SmallWaters corporation Chicago.
Association, A. P. (2013). Diagnostic and statistical manual of mental disorders 5th ed. American Psychiatric Association.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty- item Toronto alexithymia scale—I. item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38(1), 23–32. https://doi.org/10.1016/0022-3999(94)90005-1
Batten, S. V., Orsillo, S. M., & Walser, R. D. (2005). Acceptance and mindfulness-based approaches to the treatment of posttraumatic stress disorder. In acceptance and mindfulness-based approaches to anxiety (pp. 241–269). Springer.
Black, D. S., Sussman, S., Johnson, C. A., & Milam, J. (2012). Psychometric assessment of the mindful attention awareness scale (MAAS) among Chinese adolescents. Assessment, 19(1), 42–52.
Bolduc, R., Bigras, N., Daspe, M.-È., Hébert, M., & Godbout, N. (2018). Childhood cumulative trauma and depressive symptoms in adulthood: The role of mindfulness and dissociation. Mindfulness, 9(5), 1594–1603.
Breslau, N. (2002). Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Sage Publications.
Briere, J. (2002). Treating adult survivors of severe childhood abuse and neglect: Further development of an integrative model. In L. Myers, L. Berliner, J. Briere, C. T. Hendrix, T. Reid, & C. Jenny (Eds.), The APSAC handbook on child maltreatment, 2nd edition (2nd edition ed., Vol. 175–203). Sage Publications.
Briere, J. (2015). Pain and suffering: A synthesis of Buddhist and Western approaches to trauma. In V. M. Follete, et al. (Eds), Mindfulness-oriented interventions for trauma: Integrating contemplative practices (pp. 11-30). The Guilford Press.
Briere, J., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (DSM-5 update). Sage Publications.
Britton, W. B., Shahar, B., Szepsenwol, O., & Jacobs, W. J. (2012). Mindfulness-based cognitive therapy improves emotional reactivity to social stress: Results from a randomized controlled trial. Behavior Therapy, 43(2), 365–380.
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.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. Sage focus editions, 154, 136–136.
Byrne, B. M. (2013). Structural equation modeling with Mplus: Basic concepts, applications, and programming. Routledge.
Chen, Z. S., & Chung, M. C. (2016). The relationship between gender, posttraumatic stress disorder from past trauma, alexithymia and psychiatric co-morbidity in Chinese adolescents: A moderated mediational analysis. Psychiatric Quarterly, 87(4), 1–13. https://doi.org/10.1007/s11126-016-9419-1
Chung, M. C., Jalal, S., & Khan, N. U. (2014). Posttraumatic stress disorder and psychiatric comorbidity following the 2010 flood in Pakistan: Exposure characteristics, cognitive distortions, and emotional suppression. Psychiatry: Interpersonal & Biological Processes, 77(3), 289–304.
Chung, M. C., & Wall, N. (2013). Alexithymia and posttraumatic stress disorder following asthma attack. Psychiatric Quarterly, 84, 287–302. https://doi.org/10.1007/s11126-012-9244-0
Consoli, S. M., Rolhion, S., Martin, C., Ruel, K., Cambazard, F., Pellet, J., & Misery, L. (2006). Low levels of emotional awareness predict a better response to dermatological treatment in patients with psoriasis. Dermatology, 212(2), 128–136.
Daigneault, I., Dion, J., Hébert, M., & Bourgeois, C. (2016). Mindfulness as mediator and moderator of post-traumatic symptomatology in adolescence following childhood sexual abuse or assault. Mindfulness, 7(6), 1306–1315.
Fang, S., & Chung, M. C. (2019). The impact of past trauma on psychological distress among Chinese students: The roles of cognitive distortion and alexithymia. Psychiatry Research, 271, 136–143.
Fang, S., Chung, M. C., & Wang, Y. (2020). The impact of past trauma on psychological distress: The roles of defense mechanisms and alexithymia. Frontiers in Psychology, 11, 992.
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.
Follette, V. M., & Pistorello, J. (2007). Finding life beyond trauma: Using acceptance and commitment therapy to heal from post-traumatic stress and trauma-related proble. New Harbinger Publications.
Frewen, P. A., Dozois, D. J., Neufeld, R. W., & Lanius, R. A. (2008a). Meta-analysis of alexithymia in posttraumatic stress disorder. Journal of Traumatic Stress, 21(2), 243–246. https://doi.org/10.1002/jts.20320
Frewen, P. A., Lanius, R. A., Dozois, D. J., Neufeld, R. W., Pain, C., Hopper, J. W., Densmore, M., & Stevens, T. K. (2008b). Clinical and neural correlates of alexithymia in posttraumatic stress disorder. Journal of Abnormal Psychology, 117(1), 171–181.
Garland, E. L., & Roberts-Lewis, A. (2013). Differential roles of thought suppression and dispositional mindfulness in posttraumatic stress symptoms and craving. Addictive Behaviors, 38(2), 1555–1562.
Gilbert, P., McEwan, K., Gibbons, L., Chotai, S., Duarte, J., & Matos, M. (2012). Fears of compassion and happiness in relation to alexithymia, mindfulness, and self-criticism. Psychology and Psychotherapy: Theory, Research and Practice, 85(4), 374–390. https://doi.org/10.1111/j.2044-8341.2011.02046.x
Godbout, N., Bakhos, G., Dussault, É., & Hébert, M. (2020). Childhood interpersonal trauma and sexual satisfaction in patients seeing sex therapy: Examining mindfulness and psychological distress as mediators. Journal of Sex & Marital Therapy, 46(1), 43–56.
Godbout, N., Bigras, N., & Dion, J. (2016). Présence attentive et traumas interpersonnels subis durant l’enfance. La présence attentive (mindfulness): État des connaissances théoriques, empiriques et pratiques, 229–251.
Goldberg, D., & Hillier, V. F. (1979). A scaled version of the general health questionnaire. Psychological Medicine, 9(01), 139–145. https://doi.org/10.1017/S0033291700021644
Hagen, C., Lien, L., Hauff, E., & Heir, T. (2016). Mindfulness, sustained attention and post-traumatic stress in tsunami Sur-vivors. Psychology and Cognitive Sciences – Open Journal, 2(2), 54–63.
Hendryx, M. S., Haviland, M. G., & Shaw, D. G. (1991). Dimensions of alexithymia and their relationships to anxiety and depression. Journal of Personality Assessment, 56(2), 227–237. https://doi.org/10.1207/s15327752jpa5602_4
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.
Honkalampi, K., Koivumaa-Honkanen, H., Tanskanen, A., Hintikka, J., Lehtonen, J., & Viinamäki, H. (2001). Why do alexithymic features appear to be stable? Psychotherapy and Psychosomatics, 70(5), 247–253.
Hopwood, T. L., & Schutte, N. S. (2017). A meta-analytic investigation of the impact of mindfulness-based interventions on post traumatic stress. Clinical Psychology Review, 57, 12–20.
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.
Hund, A. R., & Espelage, D. L. (2006). Childhood emotional abuse and disordered eating among undergraduate females: Mediating influence of alexithymia and distress. Child Abuse & Neglect, 30(4), 393–407. https://doi.org/10.1016/j.chiabu.2005.11.003
Kabat-Zinn, J. (1990). Full catastrophe living: The program of the stress reduction clinic at the University of Massachusetts Medical Center. Delta.
Kendall-Tackett, K. A. (2014). The effects of childhood maltreatment and of exposure to early toxic stress. Child Abuse and Neglect Worldwide 3, 155–176.
Kiken, L. G., & Shook, N. J. (2014). Does mindfulness attenuate thoughts emphasizing negativity, but not positivity? Journal of Research in Personality, 53, 22–30.
Kline, R. B. (2015). Principles and practice of structural equation modeling. Guilford publications.
Lilly, M., & Valdez, C. (2012). The unique relationship of emotion regulation and alexithymia in predicting somatization versus PTSD symptoms. Journal of Aggression, Maltreatment & Trauma, 21(6), 609–625.
Lumley, M. A., Neely, L. C., & Burger, A. J. (2007). The assessment of alexithymia in medical settings: Implications for understanding and treating health problems. Journal of Personality Assessment, 89(3), 230–246. https://doi.org/10.1080/00223890701629698
Lustyk, M., Chawla, N., Nolan, R., & Marlatt, G. (2009). Mindfulness meditation research: Issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine, 24(1), 20–30.
MacDonald, H. Z., & Price, J. L. (2017). Emotional understanding: Examining alexithymia as a mediator of the relationship between mindfulness and empathy. Mindfulness, 8(6), 1644–1652.
Mazzeo, S. E., Mitchell, K. S., & Williams, L. J. (2008). Anxiety, alexithymia, and depression as mediators of the association between childhood abuse and eating disordered behavior in african american and european american women. Psychology of Women Quarterly, 32(3), 267–280. https://doi.org/10.1111/j.1471-6402.2008.00435.x
Messina, A., Beadle, J., & Paradiso, S. (2014). Towards a classification of alexithymia: Primary, secondary and organic. Journal of Psychopathology, 20, 38–49.
Miller, M. W., Kaloupek, D. G., Dillon, A. L., & Keane, T. M. (2004). Externalizing and internalizing subtypes of combat-related PTSD: A replication and extension using the PSY-5 scales. Journal of Abnormal Psychology, 113(4), 636–645. https://doi.org/10.1037/0021-843X.113.4.636
National Collaborating Centre for Mental Health. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Gaskell.
Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60(3), 409–418.
Pitts, S. C., West, S. G., & Tein, J.-Y. (1996). Longitudinal measurement models in evaluation research: Examining stability and change. Evaluation and Program Planning, 19(4), 333–350.
Rubin, D. B. (1996). Multiple imputation after 18+ years. Journal of the American Statistical Association, 91(434), 473–489.
Sifneos, P. E. (1994). Affect deficit and alexithymia. New Trends in Experimental and Clinical Psychiatry, 10(4), 193–195.
Smith, B. W., Ortiz, J. A., Steffen, L. E., Tooley, E. M., Wiggins, K. T., Yeater, E. A., Montoya, J. D., & Bernard, M. L. (2011). Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters. Journal of Consulting and Clinical Psychology, 79(5), 613–617.
Spek, V., Nyklíček, I., Cuijpers, P., & Pop, V. (2008). Alexithymia and cognitive behaviour therapy outcome for subthreshold depression. Acta Psychiatrica Scandinavica, 118(2), 164–167.
Stein, D. J., McLaughlin, K. A., Koenen, K. C., Atwoli, L., Friedman, M. J., Hill, E. D., Maercker, A., Petukhova, M., Shahly, V., & Van Ommeren, M. (2014). DSM-5 and ICD-11 definitions of posttraumatic stress disorder: Investigating “narrow” and “broad” approaches. Depression and Anxiety, 31(6), 494–505.
Sterling, M. (2011). General health questionnaire – 28 (GHQ-28). Journal of Physiotherapy, 57(4), 259. https://doi.org/10.1016/S1836-9553(11)70060-1
Taylor, G. J., Bagby, R. M., & Parker, J. D. (1991). The alexithymia construct: A potential paradigm for psychosomatic medicine. Psychosomatics, 32(2), 153–164. https://doi.org/10.1016/S0033-3182(91)72086-0
Taylor, G. J., Bagby, R. M., & Parker, J. D. (1997). Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge University Press.
Teixeira, R. J., & Pereira, M. G. (2015). Examining mindfulness and its relation to self-differentiation and alexithymia. Mindfulness, 6(1), 79–87.
Tomlinson, E. R., Yousaf, O., Vittersø, A. D., & Jones, L. (2018). Dispositional mindfulness and psychological health: A systematic review. Mindfulness, 9(1), 23–43.
Verhaeghe, P., & Vanheule, S. (2005). Actual neurosis and PTSD: The impact of the other. Psychoanalytic Psychology, 22(4), 493–507. https://doi.org/10.1037/0736-9735.22.4.493
Vujanovic, A. A., Niles, B., Pietrefesa, A., Potter, C. M., & Schmertz, S. (2012). Potential of mindfulness in treating trauma reactions. From United States Department of Veteran Affairs—National Center for PTSD: http://www.PTSD. Va. Gov/professional/pages/mindful-PTSD. Asp. Accessed, 16.
Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Spirituality in Clinical Practice, 1(S), 15–25.
Wang, N., Chung, M. C., & Wang, Y. (2020). The relationship between posttraumatic stress disorder, trauma centrality, posttraumatic growth and psychiatric co-morbidity among Chinese adolescents. Asian Journal of Psychiatry, 49, 101940.
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P., Marx, B., & Schnurr, P. (2013). The PTSD checklist for DSM-5 (PCL-5). National Center for PTSD at www. ptsd. va. gov.
Sylvia YC, Lai & Shek, D. T. (2008). Socio-demographic correlates of suicidal ideation among Chinese adolescents in Hong Kong. International journal of adolescent medicine and health, 20(4), 463–472.
Funding
No funding was received to assist with the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of Interest/Competing Interests
The authors have no conflicts of interest to declare that are relevant to the content of this article.
Ethics Approval
The questionnaire and methodology for this study was approved by the Human Research Ethics committee of the affiliated University (Ethics approval number: EDU2016–0218).
Informed Consent
Consent to Participate Informed consent was obtained from all individual participants included in the study.
Consent to Publish The participant has consented to the submission of the case report to the journal.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
ESM 1
(DOCX 95 kb)
Rights and permissions
About this article
Cite this article
Fang, S., Chung, M.C. Testing the pain paradox: a longitudinal study on PTSD from past trauma, alexithymia, mindfulness, and psychological distress. Curr Psychol 42, 8844–8854 (2023). https://doi.org/10.1007/s12144-021-02162-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-021-02162-z