Elsevier

Psychiatry Research

Volume 246, 30 December 2016, Pages 407-414
Psychiatry Research

The role of childhood trauma, early maladaptive schemas, emotional schemas and experimental avoidance on depression: A structural equation modeling

https://doi.org/10.1016/j.psychres.2016.10.037Get rights and content

Highlights

  • Disconnection and rejection schemas was mediator of the relation between childhood trauma and depression.

  • Disconnection and rejection schemas affected depression through negative emotional schemas and experimental avoidance.

  • Experimental avoidance was mediator of the relation between negative emotional schemas and depression.

  • CT did not predict depression symptoms, through the NESs and EA.

Abstract

The present investigation was designed to examine disconnection and rejection (DR) schemas, negative emotional schemas (NESs) and experimental avoidance (EA) as mediating variables of the relationship between the childhood trauma (CT) and depression. Specifically we examined the mediating role of NESs and EA between DR schemas and depression. The study sample consist of 439 female college students (Mage=22.47; SD=6.0), of whom 88 met the criteria for current major depressive disorder (MDD) and 351 who had history of MDD in the last 12 months. Subjects were assessed by Structured Clinical Interview for DSM-IV (SCID) and completed the Childhood Trauma Questionnaire (CTQ), the Early Maladaptive Schemas Questionnaire (SQ-SF), the Leahy Emotional Schemas Scale (LESS), the Acceptance and Action Questionnaire (AAQ-II), and the Beck Depression Inventory-II (BDI-II). The findings showed that DR schemas were mediator of the relationship CT and depression but CT through the NESs and EA did not predict depression. NESs were mediator of the relationship between DR schemas and depression and EA was mediator of the relationship between DR schemas and depression. In general, results suggest that intervention of depressed women may need to target the changing of DR schemas, NESs and reduction of EA.

Introduction

Cognitive model (Beck, 1983) of depression shows that negative cognitive styles work as key vulnerability factors for depression, especially when interacting with early adverse relational experiences. Cognitive therapy model (Beck, 1983) and schema theory (Young et al., 2003) are two of the most important models to explain the development and sustenance of psychopathology including depression. According to cognitive therapy, the key vulnerability factor to depression are negative core beliefs, or “schemas” about the world, the self, and the future (Beck, 1983).

Young et al. (2003) identified a variety of early maladaptive schemas that are hypothesized to underlie several psychological disorder, including depression by integrating the Beck's cognitive model (1983) and others (e.g., Bowlby, 1980). According to schema therapy (Young et al., 2003), abused children are at risk for developing early maladaptive schemas. More specifically, early maladaptive schemas arise when psychological needs (e.g., freedom to express valid needs and emotions, autonomy, secure attachment) are not met. Therefore, early maladaptive schemas act as pattern for information processing which affect an individual's emotional response to life events (Dozois et al., 2009).

In cross-sectional studies, early trauma (abuse and neglect) have been found to be predictors of adulthood depressive disorder (Schulz et al., 2014, Suzukia et al., 2014, Agorastos et al., 2014, Pompili et al., 2014). For example Comijs et al. (2013) revealed that individuals who experienced early trauma have greater tendency to be diagnosed with major depressive disorder. Demirci et al. (2016) established positive correlations between the type D personality and depression, emotional neglect, physical neglect, and emotional abuse in university students. In fact, some studies revealed that childhood trauma can predict depression directly (Kounou et al., 2013; Michopoulos et al., 2015; Miron and Orcutt, 2014) and indirectly, through early maladaptive schemas (EMSs; Calvete et al., 2013), emotional schemas (ESs; Leahy, 2015), and experimental avoidance (EA; Bell and Higgins, 2015). However, none of the mentioned studies considered these variables consistently in a structural equation model. The first objective of this study was to test early maladaptive schemas, negative emotional schemas and experimental avoidance as mediators of childhood trauma on depressive symptoms. Therefore, in the present study we hypothesized that childhood trauma would contribute to the depressive symptoms through early maladaptive schemas, emotional schemas and experimental avoidance. Though, as direct support for this hypothesis, Westpha et al. (2016) found that invalidation, which is a specific type of emotional schemas, mediated the link between the parental abuse and depression symptoms in a sample of psychiatric outpatients. Akbaba et al. (2015) studied the relationship between childhood trauma and dysfunctional attitudes in women with depression. They found that childhood trauma scores were significantly associated with depression. Wright et al. (2009) revealed that emotional abuse and emotional neglect are connected with later symptoms of depression and mediated by schemas of defectiveness/shame. In another study, avoidance mediated the association between psychological maltreatment and depression in college students (Reddy et al., 2006). Lately, O’Mahen et al. (2015) found that rumination, which is a specific type of negative emotional schemas (Leahy, 2002), mediated between emotional abuse and depression in a sample of major depressive disorder and women who had high levels of depressive symptoms but did not meet diagnostic criteria for major depressive disorder.

Furthermore, numerous researches have shown the impact of early maladaptive schemas on mood disorders (Hawke and Provencher, 2012) especially on depression (Halvorsen et al., 2010; Orue et al., 2014; Renner et al., 2012). Researchers propose that disconnection/rejection (DR) domain is a robust predictor depression among all domains of early maladaptive schemas (Eberhart et al., 2011, Calvete, 2014, Calvete et al., 2005, Renner et al., 2012, Roelofs et al., 2011). Hence, disconnection/rejection domain is the focus of the present study.

According to the schema therapy model, the early maladaptive schemas develop behavioral (e.g., avoidance) and emotional (e.g., emotional schemas) maladaptive coping styles (Young et al., 2003). Consequently, early maladaptive schemas could be the mechanism via the negative emotional schemas and experimental avoidance increase symptoms of depression. The second objective was to test emotional schemas and experimental avoidance as mediators of the impact of disconnection and rejection schemas on depressive symptoms. In this study we hypothesized that early maladaptive schemas would guide information processing resulting in negative emotional schemas (NESs) and experimental avoidance, which in turn would contribute to the increase of depressive symptoms. This hypothesis has not been previously evaluated. Nevertheless, as indirect supports for this hypothesis, Calvete (2014) and Orue et al. (2014) established that rumination, which is a specific type of emotional schemas, mediated the link between the early maladaptive schemas and depression symptoms in a sample of school students.

Emotional schemas “refer to plans, concepts, and strategies employed in ‘response to’ an emotion” (Leahy, 2002, p. 179). Leahy, 2002, Leahy, 2007a, Leahy, 2007b assumed that different types of emotional schemas develop and maintain depression through the depressogenic appraisal of emotions and the application of maladaptive coping strategies such as avoidance. Therefore, negative attributions and interpretations with regards to emotions (emotional schemas) would probably result in avoidance strategy (Leahy et al., 2011). Previous studies indicate that the emotional schemas has powerful predictive associations with the development of psychological disorders such as obsessive-compulsive disorder (OCD), resistant treatment anxiety (Leahy, 2007a), generalized anxiety (GAD; Sardarzadeh et al., 2014) and depression (Batmaz et al., 2014; Khanzade et al., 2012; Leahy, 2002; Leahy et al., 2012; Silberstein et al., 2012; Yavuz et al., 2011). The third objective was to test experimental avoidance as a mediator of the impact of negative emotional schemas on depressive symptoms. In the current study, we hypothesized that negative emotional schemas would contribute to the depressive symptoms through experimental avoidance. This hypothesis has not been previously assessed but Leahy believes that negative emotional schemas increase depressive symptoms through experimental avoidance (Leahy, 2002, Leahy, 2015, Leahy et al., 2011) and Silberstein et al. (2012) found that negative emotional schemas is positively related with experimental avoidance.

Experiential avoidance signifies an unwillingness to remain in contact with unwanted inner experiences (i.e., negative emotions, thoughts, memories; Hayes et al., 1999). Experimental avoidance has been suggested to trigger several undesirable outcomes such as depression (Biglan et al., 2015, Brockmeyer et al., 2015, McCracken et al., 2015; Ottenbreit et al., 2014).

The principal objective of the present study is the determination of the fitness of the proposed model (Fig. 1). The present study examined the predictive associations among childhood trauma, early maladaptive schema (disconnection and rejection schemas), negative emotional schemas, experimental avoidance and depressive symptoms in female college students with current major depressive disorder and with history of major depressive disorder. In summary, the following hypotheses are proposed:

Hypothesis 1

Childhood trauma (CT) would contribute to the depressive symptoms through disconnection and rejection (DR) schemas, negative emotional schemas (NESs) and experimental avoidance (EA).

Hypothesis 2

Disconnection and rejection (DR) schemas would contribute to the depressive symptoms through negative emotional schemas (NESs) and experimental avoidance (EA).

Hypothesis 3

Negative emotional schemas (NESs) would contribute to the depressive symptoms through experimental avoidance (EA).

Section snippets

Participants and procedures

The present investigation is a descriptive-cross-sectional study. The population of this study was 21,000 female college students in six different branches of Payam-e-Noor University with Persian language (Baharestan, Eslamshahr, Parand, Tehran Souht, Robatkarim and Varamin). Data were obtained from college women enrolled in a clinical research study of mood disorders and behavior in 2014 to 2016 academic year (N=879). Female students were eligible for participation if they were at least 19

Preliminary analyses: descriptive statistics and correlation between

The means, standard deviations and zero order correlations among the key variables are presented in Table 1. As can be seen, emotional abuse, physical abuse, emotional neglect, physical neglect, abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame, social isolation/alienation, rigid emotional schemas negative beliefs regarding emotions and depressive symptoms were positively correlated (P<.05).

Supposed models examination

Examination of the structural equation model (Fig. 1) was performed via

Discussion

The present research was designed to support and bridge the space between theory and data and add to the growing body of study on developmental and schema-level caused by testing a model which evaluated the role of childhood trauma on the development of maladaptive cognitive (early maladaptive schemas), behavioral (experimental avoidance) and emotional (emotional schemas) structures which may be essential in explaining the depression. In other words, the main objective of the present study was

Role of funding source

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

Conflicts of interest

The authors have no conflicts of interest to declare.

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