儿童期创伤对特质抑郁和特质焦虑的影响：图式中介特异性研究

The Influence of Childhood Trauma on Trait-depression and Trait-anxiety: the Mediation-specificity of Schemas

根据Beck的认知内容特异性假说(Cognitive Content Specificity Hypothesis,CCSH),本研究假设早期适应不良图式(EMSs)在儿童期创伤与特质抑郁和特质焦虑间存在中介效应的特异性。然后对668名大学生施以儿童期创伤问卷(CTQ-SF),Young图式问卷短版(YSQ-SF),特质抑郁问卷(T-DEP)以及特质焦虑问卷(T-AI),经中介效应检验程序分析,结果表明:(1)三类儿童期创伤:情感虐待、情感忽视和躯体忽视与特质抑郁和特质焦虑相关均显著,且三类创伤与特质抑郁和特质焦虑的相关系数差异不显著;(2)针对三类创伤的中介分析均表明情感剥夺、羞耻、社交孤立/疏离和自我牺牲等与没价值、无能力有关的图式在儿童期创伤和特质抑郁间起中介作用,而不信任/虐待和对疾病/伤害易感性等与危险有关的图式在儿童期创伤和特质焦虑间起中介作用。结论:早期适应不良图式在儿童期创伤与特质抑郁和特质焦虑间存在中介效应的特异性。

One of the most prominent cognitive theories of differentiation between anxiety and depression is Beck’s Cognitive Content Specificity Hypothesis （CCSH） developed in 1976, which suggests that specific cognitive content is associated with specific psychological disorders of anxiety and depression. While speci？c cognition, such as negative automatic thoughts, attributionnal style, have been examined, yet Early Maladaptive Schemas （EMSs） defined by Young （Young, Klosko, Weishaar, 2003） as ‘extremely stable and enduring theme that develop during childhood and adolescence and are elaborated upon throughout the individual’s life-time, and that are dysfunctional to a significant degree’ has been not fully investigated. In particular it is still unknown. Thus, the present study was to investigate the mediation-specificity of schemas between early childhood trauma and depression and anxiety. We hypothesized that EMSs relating to danger, threat and uncertainty would mediate between children trauma relating to abuse and anxiety and EMSs relating to loss, hopeless, failure would mediate between children trauma relating to neglect and depression. 668 undergraduate students completed Childhood Trauma Questionnaire （CTQ-SF; Bernstein Fink, 1998）, Young Schema Questionnaire-Short Form （YSQ-SF; Young, 1998）, Trait-Depression Questionnaire （T-DEP; Ritterband Spielberger, 1996）, and Trait-Anxiety Inventory （T-AI; Spielberger, 1983）. Data was analyzed using the mediation analysis procedure proposed by Baron and Kenny （1986）. According to their definitions trait-depression and trait-anxiety should be more closely related to childhood trauma and EMSs. Thus in this study we used the trait-depression scale and trait-anxiety scale instead of state-depression scales and state-anxiety scales which were used in the past studies. The research focus was the mediation-specificity of schemas between childhood trauma and trait-depression and trait-anxiety. The results were： （1） Three kinds of childhood trauma （emotional maltreatment, emotional neglect and physical neglect） were significantly related to higher scores on trait-depression and trait-anxiety and no significant difference emerged between the correlation coefficient relating childhood trauma to trait-anxiety and that relating childhood trauma to trait-depression; （2） For all three kinds of childhood trauma schemas with themes of loss/worthlessness （Emotional Deprivation, Defectiveness/Shame schemas, Self-sacrifice and Social isolation/alienation） preferentially mediated the relation between childhood trauma and trait-depression, while schemas with themes of danger （Mistrust/Abuse and Vulnerability to harm or illness） preferentially mediated the relation between childhood trauma and trait-anxiety. Our results confirmed the mediation-specificity of EMSs. The specificity emerged in the mediation analyses added much to understanding of the different pathology of depression and anxiety. The same childhood trauma could lead to the development of EMSs in different individuals and result in different mood disorders. But Young’s theory that linked specific early traumatic experiences to the development of specific EMSs was not confirmed. Consistent with Young’s theory, all five of the early childhood trauma examined in this study correlated highly with scores on several EMSs and influenced trait-anxiety and trait-depression by different mediating EMSs. This confirmed Young’s theory that suggested childhood trauma was of great importance in the development of EMSs. Additionally, the important clinical implications are that insight into the process by which childhood maltreatment leads to specific symptom profiles in depression may help clinicians in tailoring individual treatments. Information regarding a client’s early history may need to be supplemented by an assessment of the schemas that have been formed as a result of that history in order to provide a full conceptualization of the client’s pathology.