Exploring the Mediating Influence of Psychological Flexibility and Self-Compassion on the Relationship Between Adverse Childhood Experiences and Post-Traumatic Growth among Young Adults in India

Abstract

Through the course of the last few decades researchers have observed that Adverse Childhood Experiences (ACE) can act as a breeding ground for transformative positive changes to develop in the face of adversity. This process of enhanced growth is systematically studied as ‘Post Traumatic Growth’ (PTG). Though there is an existing association between ACE and PTG, yet there is a paucity of studies that explores the mediating variables in this relationship. The current study aims to explore the role of self-compassion (SC) and psychological flexibility (PF) between ACE and PTG among Indian young adults. The study was conducted on 298 Indian participants who were in the age bracket of 18–25 years. The study variables were assessed using self-administered rating scales. Participants were screened for ACE using Adverse Childhood Experiences (ACEs) Questionnaire. Additionally, Self-Compassion Scale (SCS-SF), Acceptance and Action Questionnaire-II (AAQ-II), Posttraumatic Growth Inventory- Short Form were other tools used. The results have indicated that both Psychological Flexibility and Self-Compassion mediate the relationship of ACE with PTG. The current findings have emphasized on the role of Psychological Flexibility and Self-Compassion in moving towards Post Traumatic Growth. These findings reassert that Psychological Flexibility and Self-Compassion are foundational to Acceptance Commitment Therapy and highly useful especially while working with trauma affected populations.

Keywords

Adverse childhood experiences self-compassion psychological flexibility post traumatic growth trauma

Get full access to this article

View all access options for this article.

References

Adams

Leary

M. R.

(2007). Promoting self-compassionate attitudes toward eating among restrictive and guilty eaters. Journal of Social and Clinical Psychology, 26(10), 1120–1144. https://doi.org/10.1521/jscp.2007.26.10.1120

Allen

A. B.

Leary

M. R.

(2010). Self-compassion, stress, and coping. Social and Personality Psychology Compass, 4(2), 107–118. https://doi.org/10.1111/j.1751-9004.2009.00246.x

Arnedo

C. O.

Sánchez

Sumalla

E. C.

Casellas-Grau

(2019). Stress and growth in cancer: Mechanisms and psychotherapeutic interventions to facilitate a constructive balance. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00177

Bellis

M. A.

Hughes

Leckenby

Perkins

Lowey

(2014). National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England. BMC Medicine, 12(1), 72. https://doi.org/10.1186/1741-7015-12-72

Bennett-Goleman

(2001). Emotional alchemy: How the mind can heal the heart. Retrieved from: https://ci.nii.ac.jp/ncid/BA54472470

Bluett

E. J.

Homan

K. J.

Morrison

K. L.

Levin

M. E.

Twohig

M. P.

(2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 28(6), 612–624. https://doi.org/10.1016/j.janxdis.2014.06.008

Bond

F. W.

Hayes

S. C.

Baer

R. A.

Carpenter

K. M.

Guenole

Orcutt

H. K.

Waltz

T. J.

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. https://doi.org/10.1016/j.beth.2011.03.007

Boykin

D. M.

Anyanwu

Calvin

Orcutt

H. K.

(2020). The moderating effect of psychological flexibility on event centrality in determining trauma outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 12(2), 193–199. https://doi.org/10.1037/tra0000490

Brinckman

Alfaro

Wooten

Herringa

R. J.

(2024). The promise of compassion-based therapy as a novel intervention for adolescent PTSD. Journal of Affective Disorders Reports, 15(1), 100694. https://doi.org/10.1016/j.jadr.2023.100694

10.

Brooks

Graham-Kevan

Robinson

Lowe

(2018). Trauma characteristics and posttraumatic growth: The mediating role of avoidance coping, intrusive thoughts, and social support. Psychological Trauma Theory Research Practice and Policy, 11(2), 232–238. https://doi.org/10.1037/tra0000372

11.

Calhoun

L. G.

Tedeschi

R. G.

(2001). Posttraumatic growth: The positive lessons of loss. In Neimeyer

R. A.

. Meaning reconstruction & the experience of loss. (Ed.), (pp. 157–172). American Psychological Association eBooks. https://doi.org/10.1037/10397-008

12.

Cann

Calhoun

L. G.

Tedeschi

R. G.

Taku

Vishnevsky

Triplett

K. N.

Danhauer

S. C.

(2010). A short form of the posttraumatic growth inventory. Anxiety, Stress & Coping, 23(2), 127–137. https://doi.org/10.1080/10615800903094273

13.

Cox

J. W.

(1963). Book review: Man’s search for meaning: An introduction to logotherapy. Review and Expositor, 60(4), 468. https://doi.org/10.1177/003463736306000445

14.

Dahm

K. A.

Meyer

E. C.

Neff

K. D.

Kimbrel

N. A.

Gulliver

S. B.

Morissette

S. B.

(2015). Mindfulness, self‐compassion, posttraumatic stress disorder symptoms, and functional disability in U.S. Iraq and Afghanistan war veterans. Journal of Traumatic Stress, 28(5), 460–464. https://doi.org/10.1002/jts.22045

15.

D'Amore

Martin

S. L.

Wood

Brooks

(2021). Themes of healing and posttraumatic growth in women survivors' narratives of ıntimate partner violence. Journal of Interpersonal Violence, 36(5-6), 2697–2724. https://doi.org/10.1177/0886260518767909

16.

Dutra

S. J.

Sadeh

(2018). Psychological flexibility mitigates effects of PTSD symptoms and negative urgency on aggressive behavior in trauma-exposed veterans. Personality Disorders: Theory, Research, and Treatment, 9(4), 315–323. https://doi.org/10.1037/per0000251

17.

Elliott

T. R.

Hsiao

Kimbrel

N. A.

DeBeer

B. B.

Gulliver

S. B.

Kwok

Morissette

S. B.

Meyer

E. C.

(2019). Resilience facilitates adjustment through greater psychological flexibility among Iraq/Afghanistan war veterans with and without mild traumatic brain injury. Rehabilitation Psychology, 64(4), 383–397. https://doi.org/10.1037/rep0000282

18.

Epstein

(1990). Cognitive-experiential self-theory. In Pervin

L. A.

. Handbook of personality: Theory and research. (Ed.), (pp. 165–192). The Guilford Press.

19.

Epstein

(1998). Cognitive-experiential self-theory. In The plenum series in social/clinical psychology (pp. 211–238). Springer Nature. https://doi.org/10.1007/978-1-4419-8580-4_9

20.

Eze

J. E.

Ifeagwazi

C. M.

Chukwuorji

J. C.

(2019). Core Beliefs challenge and posttraumatic growth: Mediating role of rumination among internally displaced survivors of terror attacks. Journal of Happiness Studies, 21(2), 659–676. https://doi.org/10.1007/s10902-019-00105-x

21.

Felitti

V. J.

Anda

R. F.

Nordenberg

Williamson

D. F.

Spitz

A. M.

Edwards

V. J.

Koss

M. P.

Marks

J. S.

(1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8

22.

Gunaratana

(1992). Mindfulness in plain English. Retrieved from: https://ci.nii.ac.jp/ncid/BA64515795

23.

Hafstad

G. S.

Kilmer

R. P.

Gil-Rivas

(2011). Posttraumatic growth among Norwegian children and adolescents exposed to the 2004 tsunami. Psychological Trauma Theory Research Practice and Policy, 3(2), 130–138. https://doi.org/10.1037/a0023236

24.

Hayes

A. F.

(2012). Process: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling, (White paper). Retrieved from: https://www.afhayes.com/public/process2012.pdf.

25.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.

26.

Hayes

L. L.

(2023). Psychological flexibility is the ACE we need: A commentary on ACEs screening in adolescent primary care: Psychological flexibility as a moderator. Families, Systems & Health, 41(2), 274–275. https://doi.org/10.1037/fsh0000810

27.

Hayes

S. C.

Luoma

J. B.

Bond

F. W.

Masuda

Lillis

(2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006

28.

Hayes

S. C.

Strosahl

K. D.

Wilson

K. G.

(2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). The Guilford Press.

29.

Heffernan

Quinn Griffin

M. T.

McNulty

S. R.

Fitzpatrick

J. J.

(2010). Self-compassion and emotional intelligence in nurses. International Journal of Nursing Practice, 16(4), 366–373. https://doi.org/10.1111/j.1440-172x.2010.01853.x

30.

Holmes

Singewald

(2012). Individual differences in recovery from traumatic fear. Trends in Neurosciences, 36(1), 23–31. https://doi.org/10.1016/j.tins.2012.11.003

31.

Hostutler

C. A.

Snider

Wolf

Grant

(2022). ACEs screening in adolescent primary care: Psychological flexibility as a moderator. Families, Systems & Health, 41(2), 182–191. https://doi.org/10.1037/fsh0000717

32.

Hughes

Bellis

M. A.

Hardcastle

K. A.

Sethi

Butchart

Mikton

Jones

Dunne

M. P.

(2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/s2468-2667(17)30118-4

33.

Janoff-Bulman

(1992). Shattered assumptions: Towards a new psychology of trauma. Retrieved from: https://ci.nii.ac.jp/ncid/BA24488245

34.

Kabat-Zinn

(2005). Wherever you go, there you are: Mindfulness meditation in everyday life. Retrieved from: https://ci.nii.ac.jp/ncid/BA23570260

35.

Karanci

A. N.

Erkam

(2007). Variables related to stress -related growth among Turkish breast cancer patients. Stress and Health, 23(5), 315–322. https://doi.org/10.1002/smi.1154

36.

Kashdan

T. B.

Rottenberg

(2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878. https://doi.org/10.1016/j.cpr.2010.03.001

37.

Kelly

G. A.

(1955). The psychology of personal constructs (vol. 1: A theory of personality; vol. 2: Clinical diagnosis and psychotherapy). American Psychological Association.

38.

Landi

Pakenham

K. I.

Mattioli

Crocetti

Agostini

Grandi

Tossani

(2022). Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility. Journal of Contextual Behavioral Science, 26, 44–55. https://doi.org/10.1016/j.jcbs.2022.08.008

39.

Langer

E. J.

(1989). Mindfulness. Da Capo lifelong books.

40.

Lilly

M. M.

Allen

C. E.

(2015). Psychological inflexibility and psychopathology in 9-1-1 telecommunicators. Journal of Traumatic Stress, 28(3), 262–266. https://doi.org/10.1002/jts.22004

41.

Linley

P. A.

Joseph

(2004). Positive change following trauma and adversity: A review. Journal of Traumatic Stress, 17(1), 11–21. https://doi.org/10.1023/b:jots.0000014671.27856.7e

42.

Martin

E. L.

Neelon

Brady

K. T.

Guille

Baker

N. L.

Ramakrishnan

Gray

K. M.

Saladin

M. E.

McRae-Clark

A. L.

(2023). Differential prevalence of adverse childhood experiences (ACEs) by gender and substance used in individuals with cannabis, cocaine, opioid, and tobacco use disorders. The American Journal of Drug and Alcohol Abuse, 49(2), 190–198. https://doi.org/10.1080/00952990.2023.2171301

43.

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(4), 563–577. https://doi.org/10.1016/s0005-7894(02)80017-x

44.

Maslow

A. H.

(1970). New introduction: Religions, values, and peak-experiences. Journal of Transpersonal Psychology, 2(2), 83–90.

45.

Meyer

E. C.

Szabo

Y. Z.

Frankfurt

Kimbrel

N. A.

DeBeer

B. B.

Morissette

S. B.

(2019). Predictors of recovery from post-deployment posttraumatic stress disorder symptoms in war veterans: The contributions of psychological flexibility, mindfulness, and self-compassion. Behaviour Research and Therapy, 114, 7–14. https://doi.org/10.1016/j.brat.2019.01.002

46.

Michael

Cooper

(2013). Research paper post-traumatic growth following bereavement: A systematic review of the literature. Counselling Psychology Review, 28(4), 18–33. https://doi.org/10.53841/bpscpr.2013.28.4.18

47.

Moore

S. K.

Okst

Smith

Fatkin

Creedon

T. B.

Fredericksen

A. K.

Gawande

Schuman-Olivier

(2022). Today I can look in the mirror and like myself: Effects of a trauma-informed mindful recovery program on self-compassion. Frontiers in Psychology, 13, 780383. https://doi.org/10.3389/fpsyg.2022.780383

48.

Muldoon

O. T.

Acharya

Jay

Adhikari

Pettigrew

Lowe

R. D.

(2017). Community identity and collective efficacy: A social cure for traumatic stress in post‐earthquake Nepal. European Journal of Social Psychology, 47(7), 904–915. https://doi.org/10.1002/ejsp.2330

49.

Naismith

Ferro

C. D.

Ingram

G. P. D.

Leal

W. J.

(2019). Compassion-focused imagery reduces shame and is moderated by shame, self-reassurance, and multisensory imagery vividness. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(1), 329. https://doi.org/10.4081/ripppo.2019.329

50.

Neff

K. D.

(2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032

51.

Neff

K. D.

Dahm

K. A.

(2015). Self-compassion: What it is, what it does, and how it relates to mindfulness (pp. 121–137). Springer eBooks. https://doi.org/10.1007/978-1-4939-2263-5_10

52.

Neff

K. D.

Tirch

(2013). Self-compassion and ACT. Mindfulness, acceptance, and positive psychology (pp. 78–106). New Harbinger Publications. https://psycnet.apa.org/record/2013-10674-004

53.

Nelson

C. A.

Scott

R. D.

Bhutta

Z. A.

Harris

N. B.

Danese

Samara

(2020). Adversity in childhood is linked to mental and physical health throughout life. BMJ, 371, m3048. https://doi.org/10.1136/bmj.m3048

54.

Nisker

(1998). Buddha’s nature: A practical guide to enlightenment through evolution. Bantam.

55.

Pepping

C. A.

Davis

P. J.

O’Donovan

(2015). The association between state attachment security and state mindfulness. PLoS One, 10(3), e0116779. https://doi.org/10.1371/journal.pone.0116779

56.

Raes

Pommier

Neff

K. D.

Van Gucht

(2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702

57.

Reddy

M. K.

Meis

Erbes

C. R.

Polusny

M. A.

Compton

J. S.

(2011). Associations among experiential avoidance, couple adjustment, and interpersonal aggression in returning Iraqi war veterans and their partners. Journal of Consulting and Clinical Psychology, 79(4), 515–520. https://doi.org/10.1037/a0023929

58.

Reddy

M. K.

Pickett

S. M.

Orcutt

H. K.

(2006). Experiential avoidance as a mediator in the relationship between childhood psychological abuse and current mental health symptoms in college students. Journal of Emotional Abuse, 6(1), 67–85. https://doi.org/10.1300/j135v06n01_04

59.

Richardson

C. M. E.

Jost

S. A.

(2019). Psychological flexibility as a mediator of the association between early life trauma and psychological symptoms. Personality and Individual Differences, 141(1), 101–106. https://doi.org/10.1016/j.paid.2018.12.029

60.

Rosenberg

J. I.

(1999). Suicide prevention: An integrated training model using affective and action-based interventions. Professional Psychology: Research and Practice, 30(1), 83–87. https://doi.org/10.1037/0735-7028.30.1.83

61.

Rosenthal

M. Z.

Polusny

M. A.

Follette

V. M.

(2006). Avoidance mediates the relationship between perceived criticism in the family of origin and psychological distress in adulthood. Journal of Emotional Abuse, 6(1), 87–102. https://doi.org/10.1300/j135v06n01_05

62.

Rushforth

Durk

Rothwell-Blake

G. A.

Kirkman

Kotera

(2023). Self-compassion interventions to target secondary traumatic stress in healthcare workers: A systematic review. International Journal of Environmental Research and Public Health, 20(12), 6109. https://doi.org/10.3390/ijerph20126109

63.

Rzeszutek

Gruszczyńska

(2018). Posttraumatic growth among people living with HIV: A systematic review. Journal of Psychosomatic Research, 114(12), 81–91. https://doi.org/10.1016/j.jpsychores.2018.09.006

64.

Schaer

(2021). The role of social support and disclosure on posttraumatic growth and posttraumatic stress disorder in adult survivors of adverse childhood experiences. Alliant International University.

65.

Schwarzer

Luszczynska

Boehmer

Taubert

Knoll

(2006). Changes in finding benefit after cancer surgery and the prediction of well-being one year later. Social Science & Medicine, 63(6), 1614–1624. https://doi.org/10.1016/j.socscimed.2006.04.004

66.

Seligowski

A. V.

Lee

D. J.

Bardeen

J. R.

Orcutt

H. K.

(2014). Emotion regulation and posttraumatic stress symptoms: A meta-analysis. Cognitive Behaviour Therapy, 44(2), 87–102. https://doi.org/10.1080/16506073.2014.980753

67.

Shakespeare-Finch

Armstrong

(2010). Trauma type and posttrauma outcomes: Differences between survivors of motor vehicle accidents, sexual assault, and bereavement. Journal of Loss & Trauma, 15(2), 69–82. https://doi.org/10.1080/15325020903373151

68.

Shenk

C. E.

Putnam

F. W.

Noll

J. G.

(2012). Experiential avoidance and the relationship between child maltreatment and PTSD symptoms: Preliminary evidence. Child Abuse & Neglect, 36(2), 118–126. https://doi.org/10.1016/j.chiabu.2011.09.012

69.

Sheridan

Carr

(2020). Survivors’ lived experiences of posttraumatic growth after institutional childhood abuse: An interpretative phenomenological analysis. Child Abuse & Neglect, 103, 104430. https://doi.org/10.1016/j.chiabu.2020.104430

70.

Tanaka

Wekerle

Schmuck

M. L.

Paglia-Boak

MAP Research Team . (2011). The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents. Child Abuse & Neglect, 35(10), 887–898. https://doi.org/10.1016/j.chiabu.2011.07.003

71.

Tedeschi

R. G.

Calhoun

L. G.

(2004). Target article: Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18. https://doi.org/10.1207/s15327965pli1501_01

72.

Tedeschi

R. G.

Shakespeare-Finch

Taku

Calhoun

L. G.

(2018). Posttraumatic growth. Routledge. https://doi.org/10.4324/9781315527451

73.

Thompson

B. L.

Waltz

(2007). Mindfulness, self-esteem, and unconditional self-acceptance. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 26(2), 119–126. https://doi.org/10.1007/s10942-007-0059-0

74.

Tranter

Brooks

M. L.

Khan

(2021). Emotional resilience and event centrality mediate posttraumatic growth following adverse childhood experiences. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 165–173. https://doi.org/10.1037/tra0000953

75.

Trivedi

G. Y.

Pillai

Trivedi

R. G.

(2021). Adverse Childhood Experiences & mental health - the urgent need for public health intervention in India. PubMed, 62(3), E728–E735. https://doi.org/10.15167/2421-4248/jpmh2021.62.3.1785

76.

Urcuyo

K. R.

Boyers

Carver

C. S.

Antoni

M. H.

(2005). Finding benefit in breast cancer: Relations with personality, coping, and concurrent well-being. Psychology and Health, 20(2), 175–192. https://doi.org/10.1080/08870440512331317634

77.

Van Dam

N. T.

Sheppard

S. C.

Forsyth

J. P.

Earleywine

(2011). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders, 25(1), 123–130. https://doi.org/10.1016/j.janxdis.2010.08.011

78.

Vettese

L. C.

Dyer

C. E.

W. L.

Wekerle

(2011). Does self-compassion mitigate the association between childhood maltreatment and later emotion regulation difficulties? A preliminary investigation. International Journal of Mental Health and Addiction, 9(5), 480–491. https://doi.org/10.1007/s11469-011-9340-7

79.

Woodruff

S. C.

Glass

C. R.

Arnkoff

D. B.

Crowley

Hindman

Hirschhorn

E. W.

(2013). Comparing self-compassion, mindfulness, and psychological inflexibility as predictors of psychological health. Mindfulness, 5(4), 410–421. https://doi.org/10.1007/s12671-013-0195-9

80.

Kaminga

A. C.

Dai

Deng

Wang

Pan

Liu

(2019). The prevalence of moderate-to-high posttraumatic growth: A systematic review and meta-analysis. Journal of Affective Disorders, 243, 408–415. https://doi.org/10.1016/j.jad.2018.09.023

81.

Yundt

G. C.

(2021). The effect of adverse childhood experiences on psychosocial wellbeing (order No. 27837633). (Doctoral dissertation, George Fox University). ProQuest Dissertations and Theses Global.

82.

Zalta

A. K.

Gerhart

Hall

B. J.

Rajan

K. B.

Vechiu

Canetti

Hobfoll

S. E.

(2016). Self-reported posttraumatic growth predicts greater subsequent posttraumatic stress amidst war and terrorism. Anxiety, Stress & Coping, 30(2), 176–187. https://doi.org/10.1080/10615806.2016.1229467

83.

Zeller

Yuval

Nitzan-Assayag

Bernstein

(2014). Self-compassion in recovery following potentially traumatic stress: Longitudinal study of at-risk youth. Journal of Abnormal Child Psychology, 43(4), 645–653. https://doi.org/10.1007/s10802-014-9937-y