Disentangling the Link Between Mindfulness and Dissociation in PTSD: The Mediating Role of Attention and Emotional Acceptance.

INTRODUCTION: A number of studies have investigated the relationship between mindfulness and dissociation and suggested that mindfulness-based interventions could be effective in the treatment of dissociative symptoms. A recent study in healthy volunteers found that attention and emotional acceptance mediates this relationship. However, no study has yet been performed among a clinical sample to assess this association. METHOD: We recruited 90 patients (76 women) suffering from Posttraumatic Stress Disorder (PTSD). They completed self-report questionnaires to measure PTSD, dissociation, emotion regulation difficulties, childhood trauma, mindfulness abilities and cognitive abilities. RESULTS: We found that mindfulness abilities, emotional difficulties, dissociation and attention-concentration were all related to each other. Using a step-by-step approach and bootstrapping techniques, we found a significant indirect effect of mindfulness abilities on dissociation through non-acceptance (confidence interval 95%=-.14 to -.01) and attentional difficulties (confidence interval 95%=-.23 to -.05). CONCLUSION: Patients with higher levels of dissociative symptoms have less capacity for mindfulness. Our results support Bishop et al.'s model proposing that attention and emotional acceptance are the two active components of mindfulness. To extend our findings, clinical trials are required to evaluate a causal relationship and the effectiveness of mindfulness-based interventions for patients suffering from dissociation.

Development and validation of the Symptomatic Transdiagnostic Test (S2T).

INTRODUCTION: The categorical approach in psychiatry has received many criticisms. Modern research tends to develop a transdiagnostic approach. However, transdiagnostic works lack an overall understanding and focus mainly on anxiety and depression. The aim of the present study was to develop an easy to use tool to evaluate multiple dimensions opening the way for further research in the transdiagnostic approach. This will allow researchers to quickly assess the efficacy of psychotherapeutic interventions on multiple psychopathological dimensions. METHOD: First, we identified the main symptoms of psychopathology in a sample of mental healthcare workers. Second, we developed the Symptomatic Transdiagnostic Test (S2T) to assess the main symptoms of psychopathology. Third, we evaluated its psychometric properties (exploratory and confirmatory factor analysis, internal consistency) in three non-clinical samples and one clinical sample. RESULTS: The 66-item S2T included eleven factors referring to: i) negative thoughts and mood; ii) psycho-traumatic and maladaptive symptoms; iii) addiction symptoms; iv) disturbed eating behavior; v) disturbed perception and behavior; vi) panic and agoraphobia; vii) emotional lability; viii) dejection; ix) neurodevelopmental manifestations; x) anxiety and xi) psychic hyperactivity. We found a high internal consistency for the general scale (α=0.96) and the subscales. We found a good concurrent validity. As expected, we found higher levels of symptoms within the clinical population as compared to the non-clinical samples, except for addiction symptoms and disrupted eating behavior. We found negative associations between the symptomatic dimensions and psychological skills. CONCLUSION: The S2T is a relevant tool for clinicians and researchers to assess the psychopathological profile. The main psychopathological symptoms are negatively related to the psychological skills.

Validation of the French version of the Emotion and Regulation Beliefs Scale (ERBS) and Dissociation Belief Scale (DBS).

INTRODUCTION: Dissociation is a recurrent symptom of post-traumatic stress disorder (PTSD) and is associated with emotional dysregulation. Beliefs about emotions seem to be involved in emotional dysregulation but have not been studied in relation to dissociation. Likewise, there is currently little empirical evidence of beliefs about dissociation. The aims of the study were to validate psychometric tools assessing these beliefs, to assess their role in dissociation, and to explore the mediating role of emotional dysregulation and beliefs about dissociation in the relationship between beliefs about emotion and dissociation. METHOD: We recruited a sample from the general population (n=1009) and a sample of patients with PTSD (n=90). All participants completed self-report questionnaires to evaluate symptoms of PTSD (PTSD Checklist/Impact of Event Scale, PCL-5/IES-6), dissociation (Dissociative Experiences Scale, DES), difficulties in emotion regulation (Difficulties in Emotion Regulation Scale, DERS), beliefs about dissociation (Dissociation Beliefs Scale, DBS), and beliefs about emotion (Emotion and Regulation Beliefs Scale, ERBS). RESULTS: The questionnaires used to assess the beliefs about emotion (ERBS) and dissociation (DBS) had good psychometric properties. Dissociation was positively associated with positive and negative beliefs about dissociation and with negative beliefs about emotions in both the clinical and non-clinical groups. The relationship between beliefs about emotions and dissociation was mediated by emotional dysregulation and positive beliefs about dissociation in both groups. CONCLUSION: The ERBS and DBS are effective tools to assess beliefs. Beliefs about emotion and dissociation seem to be involved in dissociative manifestations in both clinical and non-clinical individuals.

Inhibition, Attentional Control and Binding Abilities in Relation to Dissociative Symptoms Among PTSD Patients.

INTRODUCTION: The relationship between dissociation and cognitive abilities remains controversial. Empirical studies have reported positive, negative and non-existent associations between dissociation and cognition. These inconsistent results may be due to the fact that the studies focused mainly on trait dissociation, while dissociation is not stable but transient. After validating the French version of the Clinician Administered Dissociative States Scale (CADSS), the aim of the present study was to evaluate the relationship between state dissociation and cognitive abilities. METHOD: We recruited 83 patients suffering from post-traumatic stress disorder (PTSD) and assessed them twice. At T1, they performed a neutral Stroop task and a neutral binding task. At T2 (one to three weeks later), after a script-driven dissociative induction, they performed an emotional Stroop task and an emotional binding task. Between the two sessions, they completed questionnaires at home evaluating PTSD severity, trait dissociation and cognitive difficulties. State dissociation was assessed at T1 and T2 using the Clinician-Administered Dissociative States Scale (CADSS). RESULTS: We found good psychometric properties of the French version of the CADSS. After inducing dissociation, significantly lower attentional performance was found among patients with than without dissociative reactions. We found a significant positive correlation between state dissociation and increased attention and memory difficulties after induction. CONCLUSION: The French version of the CADSS is a reliable and valid tool to assess state dissociation, which is correlated with attentional difficulties. Attentional training is recommended to help patients control dissociative symptoms.

Interaction of mediation and moderation effects of positivity, cognitive fusion, brooding and mindfulness.

INTRODUCTION: Currently, cognitive behavior therapy (CBT) targets multiple cognitive processes. However, only a few studies have focused on the interaction among these processes. Preliminary studies have identified a moderation effect of rumination on the link between thought content and emotional difficulties, and a mediation effect of ruminations on the link between mindfulness and emotional difficulties. METHOD: We recruited 236 participants (185 women) who consented online to participate by choosing to either continue with the study or decline to proceed. They completed a battery of questionnaires online, namely Positivity scale, General Health Questionnaire, Rumination Response Scale, Five Facet Mindfulness Questionnaire and Cognitive Fusion Questionnaire. RESULTS: All cognitive processes were significantly correlated with emotional distress. Step-by-step linear regression analysis revealed that positivity, cognitive fusion and brooding were significant independent predictors of emotional difficulties. Bootstrapping analysis confirmed that cognitive fusion and brooding mediate the link between mindfulness and depression and anxiety-insomnia. They also demonstrated that cognitive fusion moderates the link between positivity and depression but not anxiety-insomnia. CONCLUSION: Cognitive processes interact with each other. Taken together, these results suggest that combining cognitive interventions is not useful and that different cognitive interventions may be selected depending on the patient's profile.

Psychological consequences of the COVID-19 pandemic: A qualitative study.

Multiple psychological health problems related to the COVID-19 pandemic among both the general public and health-care workers have been identified in the scientific literature. However, most studies used quantitative methods with scales selected on the basis of the researchers' pre-established knowledge derived from the experience of other situations and which can therefore induce biases. The dual aim of the present study was to explore qualitatively the perceived psychological consequences of lockdown on members of the general public and the perceived psychological consequences of COVID-19 on health-care workers. We recruited 241 participants from the general public and 120 health-care workers. They consented online to participate and completed open-ended questions evaluating the consequence of the health crisis on their life as a couple, on their friendships, family life, work, studies, psychological health, stress, and vision of the future. Finally, participants were asked to add any further consequences that had not been mentioned. We used double coding to process the data. We identified five main themes among the participants from the general public: improved and maintained social relationships, deterioration of health, improved health, personal growth, and lack of direct social contact. We also identified five main issues among the health-care workers: psychological and emotional impact, adjusting, negative impact on work, worries, and uncertainty about the future. The results confirmed the existence of psychological health problems related to the COVID-19 pandemic. They also highlighted positive consequences. Health-care workers tended to perceive more negative consequences than the participants from the general public.

Validation of the French ADNM-20 in the assessment of emotional difficulties resulting from COVID-19 quarantine and outbreak.

BACKGROUND: Multiple psychological consequences of the COVID-19 outbreak and quarantine have been described. However, there is a lack of global conceptualization. We argue that the stressful aspects of the situation, the multiple environmental consequences of the outbreak, and the diversity of symptoms observed in such a situation, suggest that Adjustment disorder (AD) is a promising way to conceptualize the psychological consequences of the outbreak and quarantine. The first aim of the study was to validate the French version of the ADNM. The second aim was to set out adjustment difficulties resulting from COVID-19 outbreak and quarantine. METHOD: We recruited 1010 (840 women, 170 men) who consented online to participate. They filled out the French ADNM, visual analogic scales, HADS, IES, and the COPE, to evaluate coping strategies. RESULTS: We confirmed the factor structure of the ADNM and we found good psychometric properties. We found that 61.3% of participants presented an adjustment disorder related to COVID-19 outbreak. We found multiple risk factors and protective factors to AD due to quarantine and outbreak. We also identified the coping strategies negatively and positively associated with AD. CONCLUSION: Adjustment disorder is a relevant concept to understand psychological manifestations caused by quarantine and outbreak. The French ANDM has good psychometric properties to evaluate such manifestations. The association between coping strategies and AD symptoms suggest that CBT may be the best intervention to help people suffering from AD.