The Relevance of Mindfulness and Social Connectedness in Trauma Survivors during COVID-19

Review Article

Austin J Psychiatry Behav Sci. 2023; 9(1): 1090.

The Relevance of Mindfulness and Social Connectedness in Trauma Survivors during COVID-19

Maggie M Parker¹*; Stephanie F Dailey²

¹Department of Counseling and Human Development, The George Washington University, Washington, DC, USA

²College of Education and Human Development, George Mason University, Fairfax, Virginia, USA

*Corresponding author: Maggie M Parker Graduate School of Education and Human Development, The George Washington University, 2136 G Street NW, Washington, DC 20052, USA Email: mmparker@gwu.edu

Received: April 26, 2023 Accepted: May 23, 2023 Published: May 30, 2023

Abstract

Objective: Extensive literature has demonstrated that subsequent trauma exposure can further exacerbate trauma survivors’ psychological distress and that social connectedness and mindfulness mediate trauma symptoms. The COVID-19 pandemic, deemed within current literature as a collective trauma, continues to impact individuals’ mental health and is especially relevant for individuals in marginalized communities and those with previous mental health diagnoses. The current study examined whether social connectedness and dispositional mindfulness mediated the relationship between trauma exposure before the COVID-19 pandemic and psychological symptoms and whether the strength and direction of this relationship is moderated by race.

Method: Using a mediation–moderation model, the current study examines whether social connectedness and dispositional mindfulness buffer adverse psychological symptoms for trauma survivors and whether race moderates the mediating effects of social connectedness and dispositional mindfulness.

Results: For trauma survivors during COVID-19 lockdowns, social connectedness and dispositional mindfulness were associated with decreased anxiety and depression. Race was not a moderator of social connectedness, but race did moderate dispositional mindfulness for individuals identifying as European American.

Conclusions: Results suggest the importance of utilizing social connectedness and dispositional mindfulness when counseling trauma survivors, highlighting the vital need for mental health professionals to incorporate culturally relevant, trauma-informed practices associated with increasing social connectedness and dispositional mindfulness to address symptoms of anxiety and depression.

Introduction

Researchers consistently identify the global mental health crisis triggered by the coronavirus disease-19 (COVID-19) pandemic as a collective trauma [100,101,107]. While rates of anxiety and depression in adults increasing from 11% to 40% (Panchal et al., 2021) [73] is alarming, the true magnitude of pandemic-related mental health needs remains unknown. Another grave concern is how COVID-19 highlights the far-reaching impact of health inequality among vulnerable populations, specifically among racially minoritized populations [66,103].

Following historical trends of public health crises, communities of color, adults with less education, and lower-income households are more vulnerable to pandemic-related anxiety and mood disorders [59,69,70,73]. These groups also report higher rates of pre-pandemic trauma exposure [74]. As such, researchers must investigate the psychological impact of COVID-19 within the context of collective trauma and identify evidence-based practices counselors can use to support high-risk client populations.

COVID-19 as a Collective Trauma

Collective trauma is a traumatic event that impacts entire groups of people, communities, or societies [54]. The impact of collective trauma persists, with multigenerational implications for impacted communities. As a collective trauma, COVID-19 placed individuals with a history of emotional health concerns, particularly trauma survivors, at risk [81]. Trauma researchers have long supported the idea that multiple traumatic experiences, including real or perceived physical health threats, amplify traumatic stress symptoms in survivors [16,81] (Breslaue et al., 2008). During the COVID-19 pandemic, the lack of social connectivity, limited access to mental health support services, the loss of family and friends to COVID-19, and survivors’ inability to access previously identified natural support systems and treatment due to social distancing restrictions severely limited vital post-trauma interventions and recovery efforts [47].

Despite emerging findings on stress-related mental health disorders during COVID-19 (Alzueta et al., 2020) [87,112], research on the impact of prior trauma exposure and increased psychological risk is limited, and the relationship between trauma exposure and COVID-related stress symptoms are particularly understudied among racially minoritized groups [57]. Extant research demonstrates that prior trauma exposure amplifies the risk for physical and mental health problems when individuals are exposed to additional trauma (Author et al., 2022a; Breslaue et al., 2008; [81].

Trauma and COVID-19

The impacts of traumatic experiences are wide-ranging and vary in severity [16]. Individuals who experienced trauma are more likely to be diagnosed with Generalized Anxiety Disorder (GAD), depression (Breslau, 2009; Ghafoori et al., 2015) [15], substance use disorders [79] (Fernandez & Osório, 2015), and posttraumatic stress disorder [16,62]. Subsequent trauma exposures, including medical threats such as COVID-19 [46,64], increase trauma survivors' risk for further psychological distress (Breslau et al., 2008) [81]. Author et al. (2020a) found that during the first months of the COVID-19 pandemic, individuals who reported previous trauma exposure reported significantly higher levels of anxiety and depression. Over decades, researchers continued to demonstrate that reported trauma exposure is linked to increased adult risk of health conditions (Kilpatrick et al., 2013), even when the trauma occurred during childhood [30,36].

Trauma Impacts and Moderators

Trauma encompasses events experienced or perceived as harmful or life-threatening that result in long-lasting negative impacts on individuals' "mental, physical, social, emotional, or spiritual well-being” [89]. An estimated 46% of Americans experienced at least one traumatic event during childhood [88], and 89.7% reported exposure to at least one traumatic event in adulthood [62]. In the United States, individuals of lower socioeconomic status, historically minoritized groups, including BIPOC and LGBTQ+ populations, and individuals living with intellectual and developmental disabilities report higher rates of trauma exposure [50,71,74,90].

Individuals from minoritized populations also face an increased risk of living in poverty, being exposed to higher rates of crime and unemployment, and multigenerational stressors associated with pervasive racism and systemic discrimination [40,42]. Consequently, these groups also report higher rates of trauma exposure, both in childhood [62] and adulthood [40]. To fully understand the impact of COVID-19 on minoritized populations, the impact of intersectional trauma - or the complex, multiple, and often ongoing ways in which trauma can be caused by or exacerbated by social injustice and discrimination - must be considered [30,35]. Historically, significant racial and ethnic differences in infection rates within the US population are well documented [5,31,57,60,93]. For persons identifying as Black, Indigenous, or Persons of Color (BIPOC), these trends continued during the COVID-19 pandemic [57]. Lower Socioeconomic Status (SES), limited access to health care, increased rates of unemployment, and living or being employed in areas where social distancing was challenging [25,57] deepened existing health disparities. As a collective trauma, COVID-19 had a global impact. Consistent with an intersectional trauma lens, this impact can be magnified by socio-structural sources of trauma and stress, such as systemic discrimination and oppression, that is often ignored or overlooked in mental health practice [35,40,57].

Social Connectedness as a Mediator of Anxiety and Depression

One of the most challenging aspects of COVID-19 may be the restriction of human connection. People cannot survive alone; they need to connect with other people. Social connection to others is essential to mental and physical health [111]. As such, social connectedness serves as a buffer against highly stressful circumstances (Gariépy et al., 2018), mediates stress and mental health outcomes [26], and is linked to increased psychological wellness [111]. In trauma survivors, researchers demonstrated that even perceived social support can reduce feelings of distress and lower the risk of trauma-related disorders [22,72]. Additionally, [77] found that individuals diagnosed with PTSD recover faster when they experience increased levels of social connectedness.

Within a meta-analysis of predictors of PTSD symptomology, lack of social support was conveyed as one of the strongest risk indicators [16]. Conversely, researchers found that social disconnectedness is associated with impaired recovery and greater symptom severity in individuals diagnosed with depression (Gariépy et al., 2018). While officials enacted social distancing and stay-at-home mandates to protect individuals' physical health, those mandates likely augmented mental health difficulties [10,21] Braunack-Mayer et al., 2009). For many trauma survivors, social distancing mandates were a continuation or re-emergence of traumatic stress.

Mindfulness as a Mediator of Anxiety and Depression

Good et al. (2015) described mindfulness as the ability to observe and recognize internal and external experiences without evaluation, judgment, or interpretation, remaining present in the experience, and accepting the emotions and outcomes that occur [8]. Dispositional, or trait, mindfulness is distinct from mindfulness. In addition to present-moment awareness, Dispositional Mindfulness (DMDM) incorporates the innate capacity of an individual to maintain awareness (Tomlinson et al., 2018). Individuals with higher levels of mindfulness tend to be more aware and accepting of their emotions, cognitions, and behaviors, resulting in lower levels of distress or negative reactivity [96]. DM is reported as being associated with individuals being able to adopt and maintain a particular state of mind spontaneously; remaining attentive to and accepting of whatever stimuli enter one's awareness [96]. Researchers found that DM may reduce trauma's psychological impact among trauma survivors [37,61,99].

Individuals' experience of DMDM can occur regardless of mindfulness practice, though it can be strengthened through mindfulness meditation or other training in emotional awareness, self-acceptance, and compassion [51,53,84,94]. Like social connectedness, researchers found that individuals displaying higher levels of DMDM reported lower stress levels five and thirty minutes following a stressful event [108]. Low mindfulness levels increase stress and negative health impacts [98].

In addition to being a dispositional trait, current research on the efficacy of mindfulness-based mental health interventions in reducing symptoms of anxiety and depression is promising [55,76,102]. Researchers found positive relationships between dispositional mindfulness and subjective well-being [11], self-acceptance [113], and negative associations with perceived stress [1] and symptoms of anxiety and depression [17]. For trauma survivors, higher levels of dispositional mindfulness are associated with decreased severity of PTSD symptoms [37,61,99], increased self-acceptance [80,110], and increased ability to speak of their experiences [80]. Researchers also found DMDM as a protective factor during shutdowns associated with COVID-19, as individuals with higher levels of mindfulness may be more likely to tolerate the negative emotions derived from physical distancing, such as boredom, loneliness, or fear (Author et al., 2022b) [28].

Purpose

This research aims to broaden mental health professionals' understanding of how dispositional mindfulness and social connectedness mediate adverse psychological outcomes in trauma survivors and whether these outcomes are moderated by race. We aimed to address the gap in the current research, which fails to adequately address the impact of intersectional trauma on trauma survivors during COVID-19. Leveraging research on mindfulness and social connectivity, specifically evidence that persons with higher levels of mindfulness and social connectivity report higher levels of psychological well-being (Ciesak et al., 2009; Luszcynska et al., 2007) [37,61,99], we hypothesized that these factors would mediate adverse psychological outcomes. Additionally, we sought to investigate the potential differences in impact of social connectedness and DM based on racial identity, as communities of color are more vulnerable to pandemic-related anxiety and mood disorders [59,73] Litam & Hipolito-Delgado, 2020; Liu et al., 2020) and report higher rates of pre-pandemic trauma exposure [74]. Therefore, exploring the impact of social connectedness and DM within higher-risk client populations is vital to provide necessary evidence-based care.

Methodology

Moderation-mediation models are advantageous when researchers seek to understand whether one or more variables' effects are contingent upon another variable (Edwards & Konold, 2022). Using a mediation–moderation model, we examined the impact of trauma exposure on depression and anxiety, how social connectedness and dispositional mindfulness may buffer adverse symptoms, and whether mediating effects are moderated by race (Figure 1 & Figure 2). Using a combined model allows us to simultaneously investigate whether interaction effects (i.e., the buffering effect of social connectedness and dispositional mindfulness on symptoms of anxiety and depression) are contingent upon a specific condition, such as race [52].