Document Type : Research Article
Authors
1 Assistant Professor, Department of Psychology, Salman Farsi university,Kazerun,Iran
2 Department of psychology, Salman Farsi University of Kazerun
3 Professor of psychology, Shiraz university
Abstract
The present study aimed to determine the relationship between childhood maltreatment and mental health through the mediating role of experiential avoidance in girl students. The research method was descriptive-correlation and structural equation modeling. The statistical population included all-girl undergraduate students of Razi University of Kermanshah in the academic year 2019-2020, from which 366 students were selected as a sample group by multi-stage cluster sampling and were surveyed by Child Abuse Self-Report Scale (SASRS), Depression, Anxiety & Stress Scale (DASS-21), and Acceptance and Action Questionnaire-II (AAQ-II). Data were analyzed using Pearson correlation and path analysis using version 26 of SPSS and AMOS software. The results indicate a significant mediating role of experiential avoidance for the relationship between childhood maltreatment and depression (β: 0.22), anxiety (β: 0.12), and stress (0.17). According to the results of the present study, childhood maltreatment is the basis for using an experiential avoidance strategy, which leads to an increase in depression, anxiety, and stress in victims of childhood maltreatment.
Keywords
Abbasi, E., Fati, L., Molodi, R., & Zarabi, H. (2013). Psychometric properties of the Persian version of acceptance and action questionnaire –II. Psychological Methods and Models, 2(10), 65-80. [Persian]
Akbari, M., & Khanipour, H. (2018). The transdiagnostic model of worry: Th mediating role of experiential avoidance. Personality and Individual Differences, 135, 166-172
Andreoni, J., Rao, J. M., & Trachtman, H. (2017). Avoiding the ask: A field experiment on altruism, empathy, and charitable giving. Journal of Political Economy, 125(3), 625-653.
Bardeen, J. R., & Fergus, T. A. (2016). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. Journal of Contextual Behavioral Science, 5(1), 1-6.
Bradbury, L. L., & Shaffer, A. (2012). Emotion dysregulation mediates the link between childhood emotional maltreatment and young adult romantic relationship satisfaction. Journal of Aggression, Maltreatment & Trauma, 21(5), 497-515.
Bond, F. W., Hayes, S. C., Bear, R. A., Carpenter, K. M., Guenole. N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688.
Carr, A., Duff, H., & Craddock, F. (2018). A systematic review of reviews of the outcome of child maltreatment. Trauma Violence Abuse, 21(4), 828-843.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behavior Research and Therapy, 44(3), 371-394.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY: Guilford Press.
Cohen, J. R., & Thakur, H. (2021). Developmental consequences of emotional abuse and neglect in vulnerable adolescents: A multi-informant, multi-wave study. Child Abuse & Neglect, 111, 104811.
Edraki, M., & Rambod, M. (2018). Psychological predictors of resilience in parents of insulin-dependent children and adolescents. International Journal of Community Based Nursing and Midwifery, 6(3), 239-249.
Erfanifar, F., Zarani, F., & Shokri, O. (2017). Emotional maltreatment and internalized disorders in adolescent girls: the role of mediator of emotional regulation. Biannual Journal of Woman and Family Studies, 6(1), 93-108. [Persian]
Farazmand, Sh., Mohammadkhani, P., Pourshahbaz, A., & Dolatshahee, B. (2017). The role of sources of childhood emotional maltreatment in predicting conditional and unconditional maladaptive schemas in adulthood. Thought & Behavior in Clinical Psychology, 44(11), 37-64. [Persian]
Falgares, G., Marchetti, D., De Santis, S., Carrozzino, D., Kopala-Sibley, D. C., Fulcheri, M., & Verrocchio, M. C. (2017). Attachment styles and suicide-related behaviors in adolescence: The mediating role of self-criticism and dependency. Frontiers in Psychiatry, 8, 1-9.
Fitzgerald, M., & Gallus, K. (2020). Emotional support as a mechanism linking childhood maltreatment and adult's depressive and social anxiety symptoms. Child Abuse & Neglect, 108, 104645.
Freedman, S., & Enright, R.D. (2017). The use of forgiveness therapy with female survivors of abuse. Journal of Women’s Health Care, 6(3), 1-6.
Gallo, E. A. G., Munhoz, T. N., Mola, C. L., Murray. J. (2018). Gender differences in the effects of childhood maltreatment on adult depression and anxiety: A systematic review and meta-analysis. Child Abuse & Neglect, 79, 107-114.
Gilbert, P., McEwan, K., Matos, M., & Rivis, A. (2011). Fears of compassion: Development of three self-report measures. Psychology and Psychotherapy: Theory, Research and Practice, 84(3), 239-255.
Godint, M. T., Li, F., & Berg, T. (2014). Early childhood maltreatment and trajectories of behavioral problems: Exploring gender and racial differences. Child Abuse and Neglect, 38(3), 544-556.
Goulter, N., Moretti, M. M., Del Casal, J. M., & Dietterle, Ph. (2019). Attachment insecurity accounts for the relationship between maternal and paternal maltreatment and adolescent health. Child Abuse & Neglect, 96, 1-8.
Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., Lejuez, C. W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38(3), 256-268.
Hayes-Skelton, S. A., & Eustis, E. H. (2020). Experiential avoidance. In J. S. Abramowitz & S. M. Blakey (Eds.), Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms (115–131). American Psychological Association.
Hayes, S. C., Strosahl, K., D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553-578.
Hosseini-Ramaghani, N. S., Rezaei, F., Sepahvandi, M. A., Gholam-Rezaei, S., Mirdrikvand, F. (2019). The mediating role of the metacognitions and experiential avoidance on the relationship between childhood trauma and PTSD symptoms. Feyz, 23(5), 543-53. [Persian]
Howe‐Martin, L. S., Murrell, A. R., & Guarnaccia, C. A. (2012). Repetitive non-suicidal self‐injury as experiential avoidance among a community sample of adolescents. Journal of Clinical Psychology, 68(7), 809-829.
Karimi, J., Homayuni, A., & Homayuni, F. (2019). The prediction of health anxiety based on experiential avoidance and anxiety sensitivity among non-clinical population. Journal of Research in Psychological Health, 12(4), 66-79. [Persian]
Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behavior Research and Therapy, 44, 1301–1320
Kendall-Tackett, K. A., & Giacomoni, S. M. (2005). Child victimization: Maltreatment, bullying and dating violence. Prevention and Intervention: Civic Research Institute, Inc.
Kirk, A., Broman-Fulks, J. J., & Arch, J. J. (2021). A taximetrics’ analysis of experiential avoidance. Behavior Therapy, 52(1), 208-220.
Kline, N. K., Berke, D. S., Rhodes, C. A., Steenkamp, M. M., & Litz, B. T. (2021). Self-blame and PTSD following sexual assault: A longitudinal analysis. Journal of Interpersonal Violence, 36(5-6), 3153–3168.
Kline, R. B. (2015). Principles and practice of structural equation modeling. Guilford publications.
Leahy, R. L., Tirch, D. D., & Napolitano, L. A. (2012). Why is emotion regulation important? Psychotherapy in Australia, 19(1), 1-10.
Li, Q., Guo, L., Zhang, S., Wang, W., Li, W., Chen, X., Shi, J., Lu, C., & ve McIntyre, R. S. (2021). The relationship between childhood emotional abuse and depressive symptoms among Chinese college students: The multiple mediating effects of emotional and behavioral problems. Journal of Affective Disorders, 288, 129-135.
Lovibond, S., & Lovibond, P. (1995). Manual for the depression anxiety stress scales (2nd Ed.). Sydney: Psychology Foundation Australia.
Mafakheri Bashmaq, S., Nafaszadeh, Y., & Kazemi, F. (2018). Neurobiological assessment of child abuse. Quarterly Journal of Child Mental Health, 5(1), 138-153. [Persian]
Mahmoud-Aliloo, M., Hashemi, T., Birami, M., Bakhshipour, A., & Sharifi, M. A. (2014). Investigating the relationship between child maltreatment, Losses and primary separation, and emotional dysregulation with a borderline personality disorder. Journal of Psychological Achievements, 4(21), 65-88. [Persian]
Marx, B. P., & Sloan, D. M. (2002). The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse. Behavior Therapy, 33, 563–577.
Mills, P., Newman, E. F., Cossar, J., & Murray, G. (2015). Emotional maltreatment and disordered eating in adolescents: Testing the mediating role of emotion regulation. Child Abuse & Neglect, 39, 156-166.
Mohammad Khani, P., Mohammadi, M. R., Nazari, M. A., & Salavati, M. (2002). Development, validity and reliability of child abuse self-assessment scale in Iranian students. Medical Journal of the Islamic Republic of Iran, 97, 51-58. [Persian]
Müller, M., Vandeleur, C., Rodgers, S., Rössler, W., Castelao, E., Preisig, M., & Ajdacic-Gross, V. (2015). Posttraumatic stress avoidance symptoms as mediators in the development of alcohol use disorders after exposure to childhood sexual abuse in a Swiss community sample. Child Abuse & Neglect, 46, 8-15.
Myers, S. G., & Wells, A. (2015). Early trauma, negative affect, and anxious attachment: the role of metacognition. Anxiety Stress Coping, 28(6), 634-49.
Newbury, J. B., Arseneault, L., Moffitt, T. E Caspi, A., Danese, A., Baldwin, J. R., & Fisher, H. L. (2018). Measuring childhood maltreatment to predict early-adult psychopathology: comparison of prospective informant-reports and retrospective self-reports. Journal of Psychiatric Research, 96(1), 57-64.
O’Mahen, H. A., Karl, A., Moberly, N., & Fedock, G. (2015). The association between childhood maltreatment and emotion regulation: Two different mechanisms contributing to depression? Journal of Affective Disorders, 174, 287-295.
O'Reilly, L. M., Pettersson, E., Quinn, P. D., Klonsky, E. D., Lundström, S., Larsson, H., ... & D'Onofrio, B. M. (2020). The association between general childhood psychopathology and adolescent suicide attempt and self-harm: A prospective, population-based twin study. Journal of Abnormal Psychology, 129(4), 364-375.
Oshri, A., Sutton, T. E., Clay-Warner, J., & Miller, J. D. (2015). Child maltreatment types and risk behaviors: Associations with attachment style and emotion regulation dimensions. Personality and Individual Differences, 73, 127-33.
Polusny, M. A., Rosenthal, M. Z., Aban, I., & Follette, V. M. (2004). Experiential avoidance as a mediator of the effects of adolescent sexual victimization on adult psychological distress. Violence and Victims, 19, 1–12.
Rezaee, M., Ghadampour, E., & Kazemi, R. (2018). The mediating role of emotional invalidation between sexual-emotional abuse and depression symptoms of female Payame-Noor University students in Tehran. Journal of Psychological Achievements, 25(1), 75-92. [Persian]
Roche, A. I., Krosha, E. B., Miller, M. L., Krosha, S. K., & OHara, M. W. (2019). Childhood trauma and problem behavior: Examining the mediating roles of experiential avoidance and mindfulness processes. J Am Coll Health., 67(1), 17-26.
Rostami, M., Abdi, M., & Heidari, H. (2014). Correlation of childhood maltreatment, self-compassion and mental health in married people. Journal of Fundamentals of Mental Health, 16(1), 61-73. [Persian]
Seligowski, A. V., Rogers, A. P., & Orcutt, H. K. (2016). Relations among emotion regulation and DSM-5 symptom clusters of PTSD. Pers Indiv Differ, 92, 104-108.
Sheffler, J. L., Piazza, J. R., Quinn, J. M., Sachs-Ericsson, N. J., & Stanley, I. H. (2019). Adverse childhood experiences and coping strategies: Identifying pathways to resiliency in adulthood. Anxiety, Stress & Coping, 32(5), 594-609.
Shenk, Ch. E., Putnam, F. W., & Noll, J. G. (2012). Experiential avoidance and the relationship between child maltreatment and PTSD systems: Preliminary evidence. Child Abuse & Neglect, 36, 118-126.
Sinclair, S. J., Siefert, C. J., Slavin-Mulford, J. M., Stein, M. B., Renna, M., & Blais, M. A. (2012). Psychometric evaluation and normative data for the depression, anxiety, and stress scale-21 (DASS -21) in a non-clinical sample of US adults. Evaluation & the Health Professions, 35(3), 259-279.
Szabo, M. (2010). The short version of the Depression Anxiety Stress Scales (DASS-21): Factor structure in a young adolescent sample. Journal of Adolescence, 33(1), 1-8.
Tajik Nejad, M. (2016). Investigating the relationship between child abuse and absence, emotional disorder, and borderline personality disorder. Master Thesis, Shahroud, Islamic Azad University. [Persian]
Ullman, S. E., Peter-Hagene, L. C., & Relyea, M. (2014). Coping, emotion regulation, and self-blame as mediators of sexual abuse and psychological symptoms in adult sexual assault. Journal of Child Sexual Abuse, 23(1), 74–93.
Veilleux, J. C., Pollert, G., A., Skinner, K. D., Chamberlain, K. D., Baker, D. E., & Hill, M. A. (2021). Individual beliefs about emotion and perceptions of belief stability are associated with symptoms of psychopathology and emotional processes. Personality and Individual Differences, 171, 110541
Vîslă, A., Flückiger, C., Holtforth, M. G., & David, D. (2016). Irrational beliefs and psychological distress: A meta-analysis. Psychother Psychosom, 85(1), 8-15.
World Health Organization. (2020). Child maltreatment. World Health Organization, Geneva. Available from: http://www.who.int/mediacentre/ factsheets/fs150/en/index.html.
Warrier, V., Kwong, A. S., Luo, M., Dalvie, Sh., Croft, J., Sallis, H. M., …, & Cecil, Ch. A. M. (2021). Gene–environment correlations and causal effects of childhood maltreatment on physical and mental health: A genetically informed approach. Psychiatry the Lancet, 8(5), 373-386.
)