Entropy Rules

Summary Conclusions:

Maltreatment And Cultivation Of Mindfulness

    This integrated empirical and theoretical review addressed the question of whether the cultivation of mindfulness among adult survivors of child maltreatment could help reduce the risk of the intergenerational transmission of child maltreatment. Part I described the impact of child maltreatment on development, showing child maltreatment exerts deleterious effects on a wide array of developmental outcomes, including individual factors (e.g., functional neural connectivity; emotion regulation capacities) and relational factors (e.g., attachment; relationship functioning). Part II described how mindfulness has been shown to be associated with many of the same constructs, and that, in general, mindfulness is associated with enhanced functioning and well-being. Mindfulness training is associated with beneficial brain changes that promote effective extinction of fear-based learning, enhanced emotion regulation, and better social-emotional functioning. Additionally, mindfulness is associated with emotional resiliency and regulation. Mindfulness appears to support a healthy metacognitive capacity, and allows for better attentional control, response inhibition, and reduced influence of cognitive biases. Mindfulness has been shown to be effective in ameliorating distress in trauma survivors, including survivors of child maltreatment, and is associated with reduced attachment insecurity. Finally, in Part III we considered evidence to suggest mindful parenting can help promote attachment security and reduce factors associated with child maltreatment risk in both healthy community samples and at-risk clinical samples.
    As others have suggested (e.g., Chambers, Gullone, and Allen, 2009) several psychological mechanisms are potentially responsible for the beneficial outcomes associated with mindfulness. These include increased relaxation and decreased emotional arousal, cognitive flexibility (i.e., decentering, defusion), reduced secondary processing (such as rumination and worry), and increased acceptance of experience. Particularly relevant for trauma survivors, mindfulness is associated with increased exposure to and decreased avoidance of difficult aspects of experience, such as automatic psychological and behavioral defenses. Reduced avoidance of potentially distressing experiences (i.e., exposure) is considered the sin qua non of effective trauma treatment (APA Presidential Task Force on Evidence-Based Practice, 2006). Reduced avoidance and exposure are also key aspects of the Acceptance and Commitment Therapy, a treatment model partially grounded in mindfulness that promotes mental health via the cultivation of psychological flexibility (Hayes, Strosahl, and Wilson, 1999), a characteristic that is key to effective parenting (e.g., Siegel & Hartzell, 2014). For adult survivors of child maltreatment, the extent to which mindfulness promotes effective exposure to and tolerance of distressing situations, thoughts, and feelings within a parenting context could promote healing from maltreatment trauma and interrupt the intergenerational transmission of child maltreatment. In promoting greater self-awareness and executive control, mindfulness may help parents choose ways of responding to their children that are in line with their intentions and values as a parent, rather than simply reacting emotionally and acting out habitual, problematic attachment patterns.
    However, it should be noted that mindfulness itself, in addition to referring to a specific state of consciousness, is actually laden with culturally specific values related to parenting (e.g., compassion) that may be in conflict with other cultural views on child rearing (e.g., "spare the rod, spoil the child"). Highlighting the benefit of including mindfulness' historical values, Shaver, Lavy, Saron, and Mikulincer (2007) pointed out how mindfulness, like secure attachment, promotes ethical, pro-social behavior. They highlighted that the secularization of mindfulness has perhaps artificially separated it from one of its traditionally religious or spiritual functions - to cultivate pro-social attitudes and caring behavior towards all living beings (Shaver et al., 2007). Far from being incompatible with a secular, empirical approach, this traditionally spiritual aspect of mindfulness can be considered as an empirical question - does the cultivation of secure attachment lead to greater mindfulness; and, conversely, does the cultivation of mindfulness lead to more secure attachments between parents and children? Research suggests the answer to this question is yes (e.g., Siegel, 2007). However, the research is less clear about whether the cultivation of mindfulness among adult survivors of child maltreatment could lead to parenting that supports secure attachment in the next generation. The necessary neural, physiological, and psychosocial substrates of effective parenting and secure attachment may be lacking or severely underdeveloped in these individuals.
    It is worth noting that some evidence suggests explicit mindful attention to distressing stimuli may temporarily worsen subjective distress, especially in trauma survivors (e.g., Bergeron & Dandeneau, 2016). Some activation of trauma related distress is considered necessary for trauma recovery by exposure therapists, so this increased awareness of distress could actually serve a clinically useful function (e.g., Rothbaum, Foa, & Hembree, 2007). Considered alongside the finding that most interventions designed to reduce child maltreatment risk have had the highest success rate when focused on behavior change with the support of a trained interventionist (e.g., Bakermans-Kranenbug et al., 2005), this risk of temporary, increased distress highlights the importance of providing adequate psychosocial support to adult survivors of child maltreatment. One way of addressing this need would be to make high quality trauma-informed training in MBIs and MBPIs accessible to more clinicians, especially those mental health professionals who are most likely to interface with at-risk parents and families (e.g., social workers). This represents a challenge to the enterprise of secular mindfulness training, which often involves expensive, long retreats in specific locations requiring economic resources for travel, time away from employment, etc. Additionally, this suggests clinicians who practice MBPIs with this population should also have a solid background in understanding posttraumatic processes, as well as their own ongoing mindfulness practice, promoting expertise in the subtleties involved in applying mindfulness to posttraumatic distress. For example, one study found that mindful observing predicted greater depressive symptoms, and this effect was mediated by increased rumination (Royuela-Colomer & Calvete, 2016). An experienced mindfulness instructor would be able to coach a client to increase mindfulness of other aspects of experience, such as body sensations, and to decrease engagement with self-focused, ruminative thoughts as they come and go. In contrast, a self-guided approach, such as through a self-help book or smart phone app, may not work for the adult survivor of child maltreatment, who already struggles with metacognition and may not be able to disentangle themselves from rumination, initially, without the support and guidance of a trained interventionist.
    Future research on mindful parenting would be greatly enhanced by the consistent inclusion of some metric of child maltreatment (e.g., ACE score) as well as measurement of exposure to and use of mindfulness practices. Without this data we can only extrapolate about the causal role of mindfulness practice itself. Moreover, there are few findings in the mindful parenting literature that can unequivocally be generalized to maltreatment survivors, because the majority of researchers are simply ignoring this issue and failing to account for it. Another way mindfulness researchers can begin to clarify the effectiveness of MBPIs in this population would be to include other dependent variables in MBPI studies that represent variables closely associated with parenting capacities and maltreatment risk (e.g., attachment; emotion regulation; reflective functioning).
    The literature on mindful parenting, especially for child maltreatment survivors is very much in its infancy. Limitations notwithstanding, the literature reviewed here suggests that mindfulness may be able to help rehabilitate and cultivate some of the capacities that have yet to develop fully in the adult survivor of child maltreatment, helping them become better parents. With mindfulness, survivors of child maltreatment can end the cycle of intergenerational maltreatment and raise healthy, well-adjusted children.

⇲ About The Author

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