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

Kratzer, Leonhard; Heinz, Peter; Pfitzer, Franz; Padberg, Frank; Jobst, Andrea; Schennach, Rebecca

doi:10.1016/j.ejtd.2017.06.004

Cited by 38 publications

(27 citation statements)

References 75 publications

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“…The results from the mediating variables to PTSD severity also displayed significant associations. These findings are consistent with previous research in the area (Franzke, Wabnitz, & Catani, ; Kratzer et al, ; Marx & Sloan, ; Smith et al, ).…”

Section: Discussionsupporting

confidence: 93%

“…Both dissociation and ER strategies have been found to mediate the association between childhood trauma and PTSD separately (e.g., John, Cisler, & Sigel, 2017;Kratzer et al, 2017;Louison Vang, Shevlin, Karatzias, Fyvie, & Hyland, 2018). Dissociation is regarded as a dysfunctional ER strategy, that is, dissociation prevents trauma-exposed individuals from processing their traumatic memories and therefore maintaining PTSD symptoms (Briere, 2006;Briere, Scott, & Weathers, 2005;Van Der Kolk et al, 1996;Wagner & Linehan, 1998).…”

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confidence: 99%

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

Bradley

Karatzias

Coyle

2018

Clin Psychology and Psychoth

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

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

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

Bradley

Karatzias

Coyle

2018

Clin Psychology and Psychoth

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“…By contrast, repeated traumas often take the form of chronic physical, sexual, or psychological trauma, as well as prolonged torture, and are associated with dissociation, a psychological escape when a physical escape is not possible (Choi, Lee, & Lee, ; Cloitre et al, ; Hagan, Gentry, Ippen, & Lieberman, ; Herman, ; Palic, Carlsson, Armour, & Elklit, ; for a review, see Dalenberg et al, ; Lyssenko et al, ; Putnam, ; Schauer & Elbert, ; Vermetten, Dorahy, & Spiegel, ). These traumas are frequently experienced during childhood or during prolonged torture, where the survivor is less equipped to defend against the perpetrator and, in turn, may feel helpless throughout their experience (Krammer, Kleim, Simmen‐Janevska, & Maercker, ; Kratzer et al, ; for a review, see Foa & Hearst‐Ikeda, ; van der Kolk, ). Under these conditions, active defenses can be perceived as futile and, hence, discarded for a passive response.…”

Section: Introductionmentioning

confidence: 99%

“…Collectively, these studies suggest that persons with a history of childhood abuse can and do engage in passive defensive responses and that such responses are associated with dissociative symptomatology. Moreover, the proclivity to engage in dissociative states in childhood, or, the vulnerability to experience peritraumatic dissociation, is predictive for the development of PTSD later in life (Bennett, Modrowski, Kerig, & Chaplo, ; Bovin & Marx, ; Bryant et al, ; Frewen & Lanius, ; Greene, ; Kratzer et al, ; Peltonen, Kangaslampi, Saranpää, Qouta, & Punamäki, ; van der Hart, Ochten, Son, Steele, & Lensvelt‐Mulders, ). Taken together, active and passive defenses appear to vary as a function of the trauma origin in PTSD.…”

Section: Introductionmentioning

confidence: 99%

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

Terpou

Harricharan

McKinnon

et al. 2019

J of Neuroscience Research

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Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid-and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems. K E Y W O R D Sbrainstem, dissociation, periaqueductal gray, PTSD, trauma | INTRODUC TI ONIn this review, we integrate literature from trauma experiences, the defense cascade, and the threat-response neurocircuitry within a framework of post-traumatic stress disorder (PTSD). We begin by introducing the concepts of the hypothalamic-pituitary-adrenal (HPA) axis, general PTSD, and defensive responses. Following these primers, we discuss the influences of trauma onset and prolonged exposure to trauma and their effects on the development of PTSD and the dissociative subtype of PTSD. Next, we introduce the defense cascade model and its underlying neurocircuitry as described in the animal literature and relate it to PTSD. In addition, we discuss the current state of the neuroimaging literature, which Edited by Sandra Chanraud.All peer review communications can be found with the online version of the article. | 1111TERPOU ET al. suggests that functional alterations are detectable in the midbrain of individuals with PTSD and its dissociative subtype as compared to healthy controls. We conclude by presenting directions for future research and the clinical implications for treatment of persons with PTSD that arise from this review of the extant literature.

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“…Gleichzeitig stehen die vorliegenden Ergebnisse auch mit Befunden im Einklang, die darauf hinweisen, dass ein traumafokussiertes Vorgehen in der Therapie geeignet ist, dissoziative Symptome zu reduzieren [52]. Mit somatoformen Beschwerden konnten wir darüber hinaus einen Prädiktor für die Behandlung der PTBS [54]. Achtsamkeit scheint die negative Wirkung von dysfunktionalen Kognitionen abzuschwächen, während Achtsamkeitsdefizite mit Störungen der Emotionsregulation sowie Vermeidungsverhalten assoziiert sind [55,56].…”

Section: Zur Bedeutung Der Prädiktorenunclassified

Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs

Kratzer

Heinz

Schennach

et al. 2018

Psychother Psych Med

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

Cited by 38 publications

References 75 publications

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

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

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

Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs

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