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Cited by 81Obsessive-Compulsive Spectrum DisordersPsychoanalysis and Psychopathology ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Effects of traumatic experiences on obsessive-compulsive and internalizing symptoms: The role of avoidance and mindfulness.

Open access
Kroska, Emily B., Miller, Michelle L., Roche, Anne I., Kroska, Sydney K., O’Hara, Michael W.·2018·Journal of Affective Disorders
DOI 10.1016/j.jad.2017.08.039PMC PMC5654743
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Abstract

Background: Trauma exposure is associated with adverse psychological outcomes including anxiety, depression, and obsessive-compulsive (OC) symptoms. Adolescence is increasingly recognized as a period of vulnerability for the onset of these types of psychological symptoms. The current study explored the mediating roles of experiential avoidance and mindfulness processes in the association between retrospective reports of childhood trauma and current internalizing and OC symptoms in adolescents.Method: A group of at-risk adolescents (N = 51) and a group of college students (N = 400) reported on childhood trauma, experiential avoidance, mindfulness, anxiety, depressive, and OC symptoms. Mediation analyses were performed to examine the mechanistic roles of avoidance and mindfulness in the association between trauma and internalizing and OC-specific symptoms.Results: In the group of at-risk adolescents, experiential avoidance and mindfulness both significantly mediated the association between childhood trauma and OC symptoms. In the college student sample, experiential avoidance mediated the association between trauma and OC symptoms. Experiential avoidance, as well as the observe, act with awareness, and nonjudgmental facets of mindfulness all significantly mediated the association between trauma and internalizing symptoms.Limitations: The group of at-risk adolescents was small, and the college student group was demographically homogeneous. All data was self-report and cross-sectional.Conclusion: The current study demonstrated that experiential avoidance and mindfulness processes may be the mechanisms through which the association between trauma and obsessive-compulsive and trauma and internalizing symptoms exist in adolescents. These findings provide potential targets for clinical intervention to improve outcomes for adolescents who have experienced trauma.

Integrity signals

Registry

Crossref · 10.1016/j.jad.2017.08.039

Cites

86 of 86 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

11 of 47 cited sources checked · 8 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    The few adolescent studies on trauma history and obsessive-compulsive symptoms focused on comorbid OCD and PTSD rather than trauma history itself.

    “The few studies that have examined trauma history and OC symptoms in adolescents have focused on comorbid OCD and PTSD symptoms rather than history of trauma specifically (Essau et al., 2000; Lafleur et al., 2011).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Essau et al., 2000 source
    • cites Lafleur et al., 2011 source

      The Introduction describes an adolescent study focused on OCD–PTSD comorbidity, but it says Lafleur et al. also set out to examine trauma history in children with OCD. The Results report trauma without PTSD separately, and the Conclusions discuss the higher rate of psychological trauma in children with OCD. Thus this source does not support the claim that the studies focused on comorbidity rather than trauma history itself. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Individuals with OCD report more childhood trauma than healthy controls.

    “For example, individuals with a diagnosis of obsessive-compulsive disorder (OCD) reported significantly more childhood trauma compared to healthy controls (Lochner et al., 2002).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lochner et al., 2002 source
  • Premisecitation

    Avoidant coping after trauma is associated with psychological difficulties such as PTSD symptoms.

    “as well as with psychological difficulties, such as PTSD symptoms (Batten et al., 2002; Brockman et al., 2016; Orcutt et al., 2005).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Batten et al., 2002 source
    • cites Brockman et al., 2016 source
    • cites Orcutt et al., 2005 source
  • Premisecitation

    This vulnerability is especially pronounced after childhood interpersonal trauma or witnessing violence.

    “especially after experiencing a childhood interpersonal trauma or witnessing violence as a child (Brown et al., 1999; Russell et al., 2010).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Brown et al., 1999 source
    • cites Russell et al., 2010 source

      The Results and Discussion (page unavailable) link frequent childhood witnessing of domestic abuse to greater depressive symptoms in young adulthood. The paper measures direct physical or sexual abuse as a control, but these passages do not establish the broader claim about vulnerability after childhood interpersonal trauma generally; its independent finding also concerns frequent witnessing of domestic abuse, not all witnessed violence. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Avoidant coping after trauma is associated with problematic behaviors such as less social engagement or high-risk sexual behavior.

    “The employment of avoidant coping strategies in response to trauma is associated with potentially problematic behaviors, such as less social engagement or high-risk sexual behavior”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Batten et al., 2002 source
    • cites Brockman et al., 2016 source

      The Discussion reports that service members’ experiential avoidance was associated with less positive social engagement during interactions with spouses and children. The cited paper does not support the claim’s additional example of high-risk sexual behavior; its reported behavioral outcomes concern family interaction. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Orcutt et al., 2005 source
  • Classified as probably not a substantial claim. 26
  • May combine two claims. 11
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim.

    Premisecitation

    Neuroimaging studies show that the brain continues to develop into the twenties.

    “neuroimaging studies have shown that the brain continues to develop well into a person’s twenties”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Curtis, 2015

      Not checked in the free run.

    • cites Johnson et al., 2009 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The AAQ-II has good internal consistency in other samples (mean alpha .84).

    “Good internal consistency has been demonstrated in other samples (mean alpha coefficient = .84 across various samples).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bond et al., 2011 source

  • May combine two claims.

    Premisecitation

    The ETI-SR-SF's four trauma domains have adequate internal consistency (Cronbach's α 0.70-0.87), and the short form correlates highly with the long form.

    “The four domains of trauma display adequate internal consistency (Cronbach’s α’s 0.70–0.87; Bremner et al., 2007), and the short-form correlates highly with the long form.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bremner et al., 2007 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Adolescence is a period of increased vulnerability to anxiety or depressive symptoms.

    “Further, adolescence is a time of increased vulnerability to develop anxiety or depressive symptoms (Paus et al., 2008)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Paus et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The FFMQ has adequate internal consistency for each facet (αs = .75-.91).

    “Internal consistency of each facet is adequate (αs = .75–.91).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Baer et al., 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The PHQ-9 has established criterion, construct, and external validity.

    “Criterion, construct, and external validity were established in several samples (Kroenke et al., 2001).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Kroenke et al., 2001 source

  • May combine two claims.

    Findingown data

    A PCA of the 16 PHQ-9 and GAD-7 items produced one factor that explained 48.55% of the variance, with all loadings above .64.

    “The items loaded onto one factor that accounted for 48.55% of the total variance, and all factor loadings were above .64.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In Study 2, previous trauma was significantly negatively associated with the Act with Awareness facet in the internalizing model (b = −.27, 95% CI [−.38, −.16], p < .001).

    “Act with Awareness (coefficient: −.27, CI: [−.38, −.16], p < .001)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The college student sample was demographically homogeneous.

    “the college student group was demographically homogeneous”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    All data were cross-sectional.

    “All data was self-report and cross-sectional.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All data were self-report.

    “All data was self-report and cross-sectional.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The CAMM-10 has good internal consistency and convergent, construct, and incremental validity.

    “Research has indicated good internal consistency and convergent, construct, and incremental validity (Greco et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Greco et al., 2011 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Recent work suggests that mindfulness processes build on one another and can be targeted individually in clinical work.

    “because recent work has suggested that mindfulness processes build upon one another and therefore may be targeted individually in clinical work (Strosahl et al., 2015)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Strosahl et al., 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The GAD-7 had good reliability in the Study 2 sample (α = .89).

    “Reliability in this sample was good (α = .89).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The OCI-R had excellent reliability in the Study 1 sample (α = .95).

    “Reliability in this sample was excellent (α = .95).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The AFQ-Y has good internal consistency and convergent and construct validity.

    “The AFQ-Y demonstrates good internal consistency and convergent and construct validity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Greco et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The AAQ-II had excellent reliability in the Study 2 sample (α = .91).

    “Reliability in this sample was excellent (α = .91).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The OCI-R has good internal consistency.

    “Internal consistency was good (Foa et al., 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Foa et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The ETI-SR-SF had good reliability in the Study 1 sample (α = .87).

    “Reliability in this sample was good (α = .87).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The OCI-R had excellent reliability in the Study 2 sample (α = .94).

    “Reliability in this sample was excellent (α = .94).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Early-onset obsessive-compulsive symptoms are particularly detrimental.

    “with early-onset symptoms being particularly detrimental (do Rosario-Campos et al., 2001; Wang et al., 2012).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites do Rosario-Campos et al., 2001 source
    • cites Wang et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The GAD-7 has adequate internal consistency and established criterion, construct, and procedural validity.

    “Internal consistency was adequate in the validation study, and criterion, construct, and procedural validity were established (Spitzer et al., 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Spitzer et al., 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The FFMQ facets had adequate internal consistency in the Study 2 sample: Observe α = .76, Describe α = .84, Act with Awareness α = .87, Nonjudgment α = .88, and Nonreactivity α = .72.

    “Internal consistency in this sample was adequate for each facet: Observe (α = .76), Describe (α = .84), Act with Awareness (α = .87), Nonjudgment (α = .88), and Nonreactivity (α = .72).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    OCD is one of the most common psychiatric conditions in youth.

    “OCD has been identified as one of the most common psychiatric conditions affecting youth (Stewart et al., 2004; Valleni-Basile et al., 1994)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Stewart et al., 2004 source
    • cites Valleni-Basile et al., 1994 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Emerging research examines a unique relation between trauma exposure and obsessive-compulsive symptoms.

    “In addition to trauma-related disorders, there is emerging research examining a unique relation between trauma exposure and obsessive-compulsive (OC) symptoms (Fontenelle et al., 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fontenelle et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Obsessive-compulsive symptoms often begin in two developmental peaks: puberty and early adulthood.

    “Onset of OC symptoms often appears in two developmental periods, with one peak around puberty (10–13 years) and another in early adulthood (21-29 years) (De Luca et al., 2011; Zohar, 1999).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites De Luca et al., 2011 source
    • cites Zohar, 1999 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The PHQ-9 had excellent reliability in the Study 2 sample (α = .92).

    “Reliability in this sample was excellent (α = .92).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The AFQ-Y had excellent reliability in the Study 1 sample (α = .97).

    “Reliability in this sample was excellent (α = .97).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    There is less information on how mindfulness- and acceptance-based interventions may reduce psychiatric symptoms in adolescents.

    “There is less information on how interventions based on principles of mindfulness and acceptance may mitigate psychiatric symptoms in adolescents.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The number of traumatic experiences was examined collectively, so results cannot determine if specific traumatic events play a role in later outcomes.

    “Finally, the number of traumatic experiences was examined collectively (a total number of traumas). Thus, results are unable to determine if specific traumatic events play a role in later outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Trauma reports were retrospective, so findings are not specific to the timing of trauma.

    “Report on traumatic experiences was retrospective, so the findings are not specific with regard to the timing of the trauma.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The undergraduate sample in Study 2 was demographically homogenous and lacked the diversity of the first sample.

    “Nevertheless, the sample of undergraduates was demographically homogenous, lacking the diversity represented in the first sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Higher Observe skills were predictive of more severe OC symptoms and internalizing symptoms.

    “In relation to specific mindfulness facets and psychopathology, higher Observe skills were predictive of more severe OC symptoms and internalizing symptoms.”
    Quote in the paperSubstantial claim
33 of 33

  • The paper relies on this without support.

    The cross-sectional mediation models reflect the hypothesized temporal ordering, with trauma preceding avoidance/mindfulness and symptoms.

    “All data was self-report and cross-sectional.”

  • The paper relies on this without support.

    The mediation analyses are free from unmeasured confounding.

    “Mediation analyses were performed to examine the mechanistic roles of avoidance and mindfulness in the association between trauma and internalizing and OC-specific symptoms.”

  • The paper relies on this without support.

    Retrospective reports of childhood trauma accurately reflect actual childhood trauma exposure.

    “retrospective reports of childhood trauma”

  • The paper relies on this without support.

    The mediation models assume that traumatic experiences temporally precede and causally influence avoidance/mindfulness and symptoms.

    “Mediation analyses for both studies were conducted using the PROCESS macro (Hayes, 2013) in SPSS, version 23.”

  • The paper relies on this without support.

    Retrospective reports of childhood trauma accurately reflect actual traumatic experiences.

    “Report on traumatic experiences was retrospective, so the findings are not specific with regard to the timing of the trauma.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Study 2 Observe indirect effect does not match its path coefficients

    Major

    The reported trauma-to-Observe coefficient is .24 and the Observe-to-OC-symptoms coefficient is .63. Their product is .1512, not the reported indirect effect of .33.

    Reported 0.33 · recomputed 0.1512

  • Study 2 sample size is inconsistent

    Minor

    One place says the college student sample had 400 usable responses, but another says the mediation analyses included 390 participants and 24 were excluded. Those numbers cannot both describe the same analyzed sample unless additional exclusions are explained, which they are not.

2 of 2

Cites

Flagged first, then by citations

1 of the 87 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
Kroska, E. B., Miller, M. L., Roche, A. I., Kroska, S. K., & O’Hara, M. W.
Affiliations
University of Iowa (US)
Corresponding author
Kroska, Emily B.
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2018-01
Volume
225
Pages
326-336
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2017.08.039
PMC
PMC5654743
OpenAlex
W2751045919
Cited by
80
References
87
Citations by year
2026: 6 · 2025: 7 · 2024: 8 · 2023: 15 · 2022: 14 · 2021: 10 · 2020: 11 · 2019: 7 · 2018: 2
FWCI
6.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Graduate College, University of Iowa
  • University of Iowa
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
childhood trauma, trauma exposure, obsessive-compulsive symptoms, internalizing problems, experiential avoidance, mindfulness, anxiety, depression, adolescents, mediation, at-risk youth, university students
MeSH terms
Adaptation, Psychological, Adolescent, Anxiety Disorders, Avoidance Learning, Cross-Sectional Studies, Depressive Disorder, Female, Humans, Male, Obsessive-Compulsive Disorder, Retrospective Studies, Stress Disorders, Post-Traumatic, Wounds and Injuries, Young Adult, Self Report, Mindfulness

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