The indirect effect from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal

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Highlights

  • Childhood maltreatment was associated with PTSD symptoms directly, as well as indirectly via cognitive reappraisal.

  • Thought suppression was directly associated with PTSD symptoms.

  • The overall indirect effect from childhood maltreatment on PTSD via thought suppression was not significant.

  • Negative affect was directly and indirectly associated with PTSD symptoms, via both cognitive appraisal and thought suppression.

  • The present study demonstrates the significant indirect effect from childhood maltreatment to PTSD symptoms via cognitive reappraisal and underscores the robust association between thought suppression and PTSD symptoms.

Abstract

Background

Emotion regulation strategies may help explain the risk of experiencing posttraumatic stress disorder (PTSD) symptoms among adults with a history of child maltreatment. However, no study to date has examined the roles of both thought suppression and cognitive reappraisal in the association between childhood maltreatment and PTSD symptoms.

Objective

The current study sought to understand the associations between childhood maltreatment, thought suppression, cognitive reappraisal, and PTSD symptoms while controlling for negative affect and gender.

Participants and setting

Data were collected on 660 university students (71 % female) ages 18–25 between 2013 and 2014. Participants completed self-report measures of childhood maltreatment, PTSD symptoms, and emotion regulation strategies.

Method

A structural equation model was tested to examine the direct and indirect effects from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal, over and above gender and negative affect.

Results

Childhood maltreatment was directly associated with PTSD symptoms (β = 0.28, SE = 0.04, p < .001). Childhood maltreatment also had a significant indirect effect on PTSD via cognitive reappraisal (β = 0.01, CI 95 % [0.00, 0.03]), but not through thought suppression, although (β = 0.01, CI 95 % [−0.00, 0.04]) thought suppression was significantly positively associated with PTSD symptoms (β = 0.21, SE = 0.04, p < .001).

Conclusion

The present study sheds light on the effect of childhood maltreatment and two commonly used emotion regulation strategies on PTSD symptoms.

Introduction

Individuals with a history of child maltreatment, relative to adult trauma victims, are at increased risk of developing PTSD (Berntsen et al., 2012; Woon & Hedges, 2008). Rates of child maltreatment are alarmingly high in the United States (World Health Organization, 2016). In 2017, 3.5 million allegations of child abuse and neglect were received by child protective services; this is a 10 % increase from 2013 (U.S. Department of Health and Human Services [HHS], 2019). Likewise, nearly 335,000 children were served at the Children’s Advocacy Center due to maltreatment characterized by drug endangerment, neglect, as well as physical, emotional, and sexual abuse (National Children’s Alliance, 2017). Approximately three-quarters of victims of child maltreatment are neglected, 18 % physically abused, and 9 % sexually abused (HHS, 2019). Children with a history of maltreatment not only experience more stress, but also lack the support provided by caregivers to learn how to appropriately regulate and manage stress (Milot, Éthier, St-Laurent, & Provost, 2010). Early exposure to traumatic events and stress negatively impacts psychological and social functioning, typically leading to poor mental health outcomes in adulthood (Crusto et al., 2010). Specifically, chronic abuse and neglect are especially deleterious on the development of emotional and behavioral regulation, increasing the risk for PTSD symptoms (Kessler, 1995; Milot et al., 2010).

One reason for the risk of PTSD symptoms may be the use of maladaptive emotion regulation strategies (Cisler and Olatunji, 2012; Gross, 1998; Moore, Zoellner, & Mollenholt, 2008; Tull, Barrett, McMillan, & Roemer, 2007; Weissman et al., 2019). Childhood maltreatment may undermine the development of emotion regulation skills and increase the risk of using maladaptive strategies, such as avoidance (O’Mahen et al., 2015). Hence, the use of maladaptive emotion regulation strategies is proposed as a factor which contributes to the risk of PTSD among those with a history of childhood maltreatment (Weiss, Tull, Viana, Anestis, & Gratz, 2012). Emotion regulation encompasses a variety of specific processes, including cognitive strategies such as thought suppression and cognitive reappraisal (Gross, 2001). Thought suppression is theorized to be less effective in modifying emotions relative to cognitive reappraisal (Gross, 1998) and tends to be used by individuals with a history of childhood maltreatment (Krause et al., 2003) and PTSD relative to those without (Beck et al., 2006; Shipherd & Beck, 2005). Conversely, cognitive reappraisal is associated with less severe PTSD symptom presentation (Boden et al., 2012, Boden et al., 2013) and has been described as a marker of resilience among children exposed to adversity (Rodman, Jenness, Weissman, Pine, & McLaughlin, 2019). The concurrent effects of each strategy on PTSD symptoms among adults with childhood maltreatment has not been empirically demonstrated to date. Individuals experiencing PTSD symptoms also tend to experience erratic negative emotions (e.g., negative affect reactivity and lability; Simons, Simons, Grimm, Keith, & Stoltenberg, 2020) and thus negative affect was controlled for. In sum, the current study aims to examine whether cognitive reappraisal and thought suppression mediate the effect of childhood maltreatment on PTSD symptoms.

Section snippets

Cognitive reappraisal and PTSD

Cognitive reappraisal entails flexibility in perspective taking (e.g., “I control my emotions by changing the way I think about the situation I’m in”), such that emotional situations are construed in a particular way to change the emotional impact (Boden et al., 2012). Cognitive reappraisal is an adaptive emotion regulation strategy in that unpleasant emotions can be downregulated following stressful events (Gross & John, 2003). Following trauma exposure, initial thoughts are associated with

Thought suppression and PTSD

Thought suppression is considered a maladaptive emotion regulation strategy with the goal of reducing negative thoughts and related feelings via avoidance (Gross & John, 2003). The use of thought suppression to regulate emotions may contribute to the risk of psychopathology and have a paradoxical effect, such that suppression actually increases distress (Beck et al., 2006). Namely, Wegner (1994) hypothesized a two-part system to explain the paradoxical effect of thought suppression where one

Current study

Emotion regulation strategies may explain some of the risk of PTSD among adults with a history of child maltreatment (Cisler and Olatunji, 2012; Gross, 1998; Moore et al., 2008; Tull et al., 2007; Weissman et al., 2019). The use of one strategy may influence engagement in another; however, further research is warranted due to mixed results. For example, the correlation between thought suppression and cognitive reappraisal has been significant and negative (Boden et al., 2013; Gross & John, 2003

Participants

Six hundred and sixty participants initially took the survey. However, data from 54 participants were ultimately excluded from the final analysis. Thirty-nine (6 %) participants were excluded due to exceeding the age limit of 25 years. Fifteen participants (2 %) were also excluded due to completing the survey in less than five minutes. The final sample consisted of 586 participants (70.70 % female) between the ages 18 and 25 (M = 19.58, SD = 1.57). Eighty-seven percent of the participants were

Descriptive statistics and correlations

Descriptive statistics are presented in Table 1 and bivariate correlations are presented in Table 2. Childhood maltreatment was moderately positively correlated with negative affect and the three PTSD symptom clusters, weakly positively correlated with the three thought suppression indicators, and weakly negatively correlated with the three cognitive reappraisal indicators. The three PTSD symptom clusters were moderately positively correlated with negative affect and the three indicators of

Discussion

This study tested a structural equation model to examine the indirect effect from childhood maltreatment to PTSD symptoms via thought suppression and cognitive reappraisal, over and above gender and negative affect. Childhood maltreatment was associated with PTSD symptoms directly, as well as indirectly via cognitive reappraisal (partial mediation). Surprisingly, childhood maltreatment was not associated with thought suppression. Although thought suppression had a significant direct positive

Cognitive reappraisal, childhood maltreatment, and PTSD

Consistent with hypotheses, the indirect effect from childhood maltreatment to PTSD symptoms via cognitive reappraisal was significant, over and above general negative affectivity and gender. As expected, childhood maltreatment had a negative association with the use of cognitive reappraisal. This is congruent with the literature indicating that childhood maltreatment impairs the development of emotion regulation abilities in general (Heleniak, Jenness, Vander Stoep, McCauley, & McLaughlin, 2016

Thought suppression, childhood maltreatment, and PTSD

At the bivariate level, childhood maltreatment was significantly positively correlated with the three indicators of thought suppression. Also, the effect of thought suppression on PTSD symptoms was significant. However, contrary to hypotheses, the overall indirect effect from childhood maltreatment to PTSD symptoms via thought suppression was not significant. This is attributed to the lack of a significant effect from childhood maltreatment to thought suppression. This unexpected lack of

Strengths and limitations

Notable strengths of this study include testing two well-supported emotion regulation strategies, the measured constructs, and the covariates. The statistical approach used in the current study illuminates the indirect effects from childhood maltreatment to PTSD symptoms via two commonly used emotion regulation strategies, thought suppression and cognitive reappraisal. Moreover, the measurement of childhood maltreatment as a total of different types of abuse and neglect is also a strength, as

Summary

Childhood maltreatment was directly associated with PTSD symptoms, as well as indirectly associated with PTSD symptoms via cognitive reappraisal, over and above the effects of negative affect and gender. Contrary to hypothesis, the indirect effect from childhood maltreatment to PTSD symptoms via thought suppression was not significant. The effect of childhood maltreatment on thought suppression was also not significant. However, the effect of thought suppression on PTSD symptoms was significant

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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