Entropy Rules

Overcoming Child Maltreatment:

Synonym For Mindful Recovery Value

    Although the research examining direct associations between mindfulness and child maltreatment is sparse, understanding how mindfulness relates to psychopathology, especially complex, comorbid clinical presentations, may provide a starting point for understanding mindfulness' potential with maltreatment survivors, given their higher rates of complex psychopathology. Many studies have found mindfulness to be helpful in overcoming a range of diagnoses that are often garnered by survivors of maltreatment. For example, mindfulness has been associated with significant improvement in depression, anxiety, and drug cravings in an Iranian sample of individuals comorbid for depression and substance abuse, diagnoses that have been associated with trauma histories, including child maltreatment (Zemestani & Ottaviani, 2016). Another study found that both group and individualized Mindfulness Based Cognitive Therapy (MBCT) were effective at reducing depression and anxiety and enhancing mindfulness and self-compassion in individuals with comorbid diagnoses of depression and a somatic disorder (Schroevers, Tovote, Snippe, & Fleer, 2016). Mindfulness has been positively associated with coping self-efficacy, which fully mediated the negative association between mindfulness and nonsuicidal self-injury, a behavior associated with BPD (Heath, Joly, & Carsley, 2016). Still another study examined the impact of a clinical intervention consisting of Mindfulness Based Cognitive Therapy and safety planning (MBCT-S) in a group of high-suicide risk outpatients (Chesin et al., 2016). Results indicated MBCT-S led to improved executive attention, increased mindful acting with awareness, and decreased rumination and cognitive reactivity to suicidal thoughts. Although these results are promising, none of these changes were related to improved depression or reduced suicidal ideation (Chesin et al., 2016). These are just a few of many studies that provide indirect support that mindfulness may be helpful in overcoming the wide variety of problems experienced by adult survivors of child maltreatment. Yet, most of these studies fail to assess for previous experiences of child maltreatment. Therefore, a review of the literature concerned with mindfulness and child maltreatment specifically is considered next.
    Frewen, Dozois, Neufel, and Lanius (2016) examined associations of mindfulness with alexithymia (i.e., lack of the ability to clearly describe emotional experience) in a group of female child maltreatment survivors diagnosed with PTSD. They found that mindfulness was negatively associated with alexithymia. Higher levels of alexithymia were correlated with PTSD, and PTSD was associated with greater difficulty putting both negative and positive feelings into words. The authors highlight the role of PTSD and child maltreatment in difficulty with emotional expression. They speculate as to whether this represents true deficits in ability to put words to feelings, or instead a cognitively mediated reluctance to do so driven by shame and anxiety (Frewen et al., 2016).
    Daigneault, Dion, H┼Żbert and Bourgeois (2016) studied both mediation and moderation of mindfulness in associations between childhood sexual abuse or assault (CSA) and later problems in a sample of Canadian adolescents from rural, impoverished settings. As expected, youth with a history of CSA reported less mindfulness, which mediated the association between CSA and posttraumatic stress symptoms. Moderation analyses showed that mindfulness only moderated the impact of CSA on trauma related anxiety and anger. Contrary to the authors' hypotheses, youth with a history of CSA and greater mindfulness reported experiencing more anxiety and anger. The authors expressed surprise at this since they were expecting a "protective" effect of mindfulness (Daigneault et al., 2016), yet this unexpected finding is consistent with other studies finding some overlap between certain facets of trait mindfulness (e.g., observing) and symptoms of psychopathology such as PTSD hypervigilance (e.g., Royuela-Colomer & Calvete, 2016). However, from a nonstigmatizing position, which views emotions as valid responses to experience, it makes sense that these youth survivors of sexual assault and abuse would report greater trauma related anxiety and anger. Anxiety and anger are expectable emotional reactions to sexual abuse and assault. It should be noted that this study was cross-sectional. The impact on CSA survivors may be different when guided by an experienced interventionist to develop and sustain state mindfulness.
    Whitaker et al. (2014) explored associations between adverse childhood events (ACEs), trait mindfulness, and health outcomes including multiple health conditions, poor health behavior and poor quality of life related to health. Poor health outcomes were positively associated with ACE exposure. Dispositional mindfulness predicted better health outcomes regardless of number of ACEs experienced. In other words health issues were less prevalent among those reporting higher mindfulness (Whitaker et al., 2014).
    Considered together these findings suggest that mindfulness may serve as a resilience factor for adult survivors of child maltreatment, with more mindfulness being associated with fewer maltreatment-related difficulties, with the exception of more mindful Canadian CSA survivors in the Daigneault et al. (2016) study who reported more anxiety and anger. These findings are from cross-sectional studies and correlational in nature, leaving open the question of whether mindfulness can be utilized clinically to promote positive change in adult survivors of child maltreatment. Studies involving the application of MBIs in populations of child maltreatment survivors are considered next.
    One study examined effects of an 8-week MBSR program on a group of 27 adult survivors of sexual abuse (Kimbrough, Magyari, Langenberg, Chesney, & Berman, 2009). This program demonstrated good retention of participants and a high level of engagement in home practice, leading to statistically significant reduction in symptoms of PTSD, depression, and anxiety, as well as increases in mindfulness. Effect sizes (d) were above 1.0 on all outcomes and improvements were sustained at the 6-month follow up. MBSR appeared to have the greatest impact on reducing avoidance and numbing associated with PTSD. However, there were no significant associations found between amount of home practice completed and outcomes, calling into question the relative role of common factors versus meditation and mindfulness specifically on symptom reduction (Kimbrough et al., 2009)
    Two and one-half years after the conclusion of the Kimbrough et al. (2009) study, Earley and colleagues (2016) followed up with the same cohort of participants with a history of childhood sexual abuse to see if the gains they had achieved through participating in MBSR had been maintained. Data showed the participants had maintained the reductions in depressive, anxious, and PTSD symptomology as well as increases in mindfulness. Effect sizes for these effects were medium to large (d=.5 - 1.1; Earley et al., 2016).
    Relatedly, a brief mindfulness and acceptance-based program geared towards decreasing stress and increasing well being in college women was found to reduce the risk of revictimization in survivors of childhood sexual abuse (Hill, Vernig, Lee Brown, & Orsillo, 2011). Mindfulness was posited to reduce revictimization risk indirectly by reducing experiential avoidance. Experiential avoidance in trauma survivors has been associated with a variety of risk factors for further victimization, including drug and alcohol abuse, increased sexual activity, and diminished risk recognition (Hill et al., 2011).
    Yet another study of National Health Interview Survey (NHIS) data revealed that MBIs have been successfully utilized by children who have experienced a problematic number of ACEs; albeit, this study revealed that MBIs are often utilized as a last resort (Bethell, Gombojav, Solloway, & Wissow, 2016). It was suggested that since parental stress and aggravation had the most pronounced effect on prevalence of negative child health outcomes indicates parent functioning may be a better target for MBIs (Bethell et al., 2016).
    Finally, Lord (2014) has identified therapeutic co-meditation (i.e., mutual meditation occurring between therapist and client, including an element of interpersonal communication) as helpful in working with adult survivors of child maltreatment who often have a decreased capacity for empathy and compassion. This restriction in empathic ability is especially crucial to address when child maltreatment survivors become parents, so as to interrupt the cycle of intergenerational transmission (Lord, 2014).
    Considered together, this literature suggests MBIs might be effectively utilized in populations who have experienced child maltreatment to reduce symptoms of psychopathology and increase quality of life. However, given the scope of child-maltreatment and its cumulative impact on public health cost, the efficacy of MBIs in this population is grossly understudied. Bethell and colleagues (2016) have suggested that rather than being used as a last resort, nonpharmacological approaches to treating ACE related sequelae, such as MBIs, might be used as front line treatments. The feasibility of doing so would be bolstered by efforts to increase the evidence base in this area.

⇲ About The Author

Robin Hertz, MA is currently in the process of completing a PhD in Clinical Psychology at the University of Oregon.