Role of Mindfulness between Early Maladaptive Schemas and Post-Partum Depression: a Ray of Hope

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Primenjena psihologija

Vol. 15, No. 4, pp.435-452, 2022

Research Article

Role of Mindfulness between Early

Maladaptive Schemas and Post-Partum

Depression: a Ray of Hope

Rida Fatima1 , Alishba Hania1 and Momal Zafar1

1 Department of Psychology, Institute of Southern Punjab, Multan, Pakistan

ABSTRACT

Mothers of a newborn face a lot of physical and psychological challenges and early

maladaptive schemas play a significant part in determining long-term negative

consequences such as post-partum depressive symptoms. This research proposed

that mindfulness could play a positive role between the early schemas and post-

partum depressive symptoms among new mothers. Data was collected from a

sample of 170 mothers who gave birth from February 2020 to August 2020. The

young schema questionnaire-SF, Edinburgh postnatal depression scale, and the

Kentucky inventory for mindfulness scale were administered. Study findings show

mindfulness mediates the association between five sub-domains of maladaptive

schemas namely impaired autonomy, impaired limits, disconnection, over-vigilance,

other-directedness, and post-partum depression. Findings indicate that mindfulness

could be a contributing factor against postpartum symptoms and play significant

role in mother and infant’s well-being during the challenging time of transition.

Keywords

: early maladaptive schemas, mindfulness, postpartum depression

UDC: 364.624.2:618.4:159.9

DOI: 10.19090/pp.v15i4.2374

Received: 09.10.2021.

Revised: 04.04.2022.

Accepted: 14.06.2022.

This is an open access article distributed

under the terms of the Creative Commons Attribution

License, which permits unrestricted use, distribution, and

reproduction in any medium, provided the original author

and source are credited.

 Corresponding author email: alishba_hania92@hotmail.com

Fatima et al.

PP (2022) 15(4), 435-452

436

Introduction

Buddhism proposed the fundamental idea that life is primarily defined

by imperfections. Consequently, our psychological capacity to remember

positive things and fight negative experiences is futile. Giving birth is a

potentially stressful and critical experience and event for mothers, entailing

different changes at the interpersonal and individual levels. This can cause

various types of distress running in force and span (e.g., Guzzo & Hayford, 2020).

Both carrying a child and giving birth can be considered traumatic and potentially

stressful experiences requiring mothers to deal with several adjustments in their

habits, priorities, lifestyles, self-image, and personal identity (Molgora et al., 2018).

Even though most women overcome numerous challenges in the time of

pregnancy and postpartum, it has additionally been seen that a proportionate

number of mothers think that it is hard to recuperate from post-partum

depression (e.g., Nagy et al., 2011).

Early maladaptive schemas can be explained as broad, self-perpetuating,

and maladaptive life events starting from hostile social encounters with

important characters in both childhood and teenage years. It was also purported

that the main reason behind the development of maladaptive cognitive schemas

is repeated neglect of childs’ universal core psychological needs (autonomy,

spontaneity and play, secure attachment, realistic limits, freedom to express his

needs and emotions). Maladaptive schemas are unavoidable and stable over the

long run and significantly influence general information processing (Young et al.,

2003). Once a schema gets activated, a person experiences disturbing negative

emotions and feelings like shame, fear, and disgust. Some intrapsychic facets

could be significantly activated during the process of becoming a mother, for

instance, early relational experiences with significant figures in life. According to

Merle-Fishman (2010), the intricate psychological process of being transformed

into the role of a mother includes the re-organization of oneself. The outcome

of this process and experience are influenced by the mother's early social

encounters, portrayals, and re-lived memories.

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Early Maladaptive Schemas and Post-Partum Depression

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Headed for the cognitive theory of depression, early schemas proposed

precious addition to the idea of dysfunctional attitudes and automatic thoughts.

It is known that maladaptive schemas like failure, defectiveness, and self-

sacrifice were associated to the gravity of depressive symptoms in non-clinically

depressed samples (Calvete & Cardeñoso, 2005). According to Colodro-Conde

et al. (2018), childbirth is a stressful life event than can trigger the underlying

diathesis, resulting in symptoms of depression. Moreover, the diathesis-stress

model of depression purports that certain individuals are highly predisposed to

depression in the context of adverse life events. The empirical outcomes

proposed cognitive vulnerability as a particular diathesis for depression

symptomatology (Kenny et al., 1993). Renner et al. (2012) suggested specific

maladaptive schemas like emotional deprivation, instability, and failure were also

related to the severity of depressive symptoms. Likewise, the disconnection

domain has been related to depression prospectively and cross-sectionally (Van

Vlierberghe et al., 2010).

Research results also indicate that the schema domain of impaired

autonomy, disconnection, and other-directedness, is related to the level of social

anxiety and depressive symptoms and the stability of depressive symptoms with

time (Calvete et al., 2015). The schema of self-sacrifice and social isolation,

mistrust and social isolation, and other-directedness facilitated the relation

between depressive symptoms and estrangement from peers, trust in parents,

and quality of attachment relationships, respectively (Roelofs et al., 2011).

Depressive symptoms and impaired autonomy association had also been found

in prior literature (Shih, 2006). The schema domain of other-directedness that

focuses on others, such as approval, sociology, social evaluation concern, and

neediness forecast depressive symptoms (Rudolph & Conley, 2005).

During the transition of motherhood, a woman’s encounters with a

significant change in life might be triggered accompanied by serious uneasiness,

vulnerability, emotional fluctuation, and uncertainty related to parenthood.

Considering postpartum depression, some studies validate a significant

connection between insecure attachment style and depressive indicators (Ikeda

et al., 2014). Though these findings provide empirical evidence that mothers’ early

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438

social experiences affect the adjustment level post-partum. Consequently,

considering the predisposition of post-partum symptoms, this research intends

to highlight a protective factor that is hypothesized to intervene between two

negatively influencing variables called early maladaptive schemas and post-

partum depressive symptoms. This protective factor is supposed to have the

potential of becoming a ray of hope in a time of despair.

Mindfulness is characterized as a state of mind in which an individual

focuses on experience in the current moment in a non-judgmental manner

(Miller et al., 1995). The concept of mindfulness originated from Buddhist practice

(Van Gordon et al., 2016). Prior studies have revealed that positive significant

relationships exist between mental health and mindfulness (Desrosiers et al.,

2013) and the positive outcomes of applying mindfulness-based techniques for

mental distress (Eberth & Sedlmeier, 2012; Khoury et al., 2013). Cecero et al. (2008)

studied the relationships between maladaptive schemas and mindfulness. The

researcher found a negative relationship between maladaptive schemas and

psychological mindfulness except for the abandonment schema (Bishop et al.,

2004).

Mindfulness whether enhanced and learned through meditation

intervention or dispositional, is constantly related to lower rates of depression

and anxiety (Tran et al., 2014). Improved mindfulness skills are known to diminish

depressive symptoms later in the prenatal period (Nyklíček et al., 2018), prevent

depression relapse (Kuyken et al., 2016), and promote mother and infant well-

being (Guo et al., 2020). Previous literature shows mindfulness has a negative

relationship with several depressive disorders and their predictors (Carmody &

Baer, 2008; Radford et al., 2014). Additionally, if mindfulness increases, the usage

of maladaptive schemas would decrease (Arpaci, 2019; Hosseinzadeh et al., 2019;

Martin et al., 2018; Yalcin et al., 2017). Grigorian et al. (2020) revealed that the early

schemas of disconnection and over-vigilance are negatively related to acting

with awareness. Furthermore, mindfulness is reported to be negatively related

to impaired limits, however, describing and observing experience (sub-levels of

mindfulness) are related to disconnection/rejection.

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Early Maladaptive Schemas and Post-Partum Depression

439

According to Janovsky et al. (2019), some sides of mindfulness may

partially operate the relationship between maladaptive schemas and

interpersonal difficulties. A significant relationship was observed between the

mindfulness levels of females and the early maladaptive schemas except for the

enmeshment, emotional deprivation, pessimism, abandonment emotional

inhibition, and entitlement schemas (Shorey, Anderson, et al., 2015). On the

contrary, (Shorey, Brasfield, et al., 2015) among males there is a strong negative

relationship between mindfulness and early maladaptive schemas, except for

entitlement, unrelenting standards, and emotional deprivation. Early

maladaptive schemas can be activated when the individuals as adults are unable

to enact the healthy adult mode and their mindfulness levels supposedly

decrease due to triggered schemas (Thimm, 2017).

As suggested by positive psychology, constructive characteristics in a

person should be emphasized rather than negative, in order to bring long-term

psychological strength. Likewise, it is essential not to activate individuals' early

maladaptive schemas and improve their level of mindfulness. People need

understanding and empathy, instead of being criticized harshly, their self needs

should be improved, as they need advice to make up for their deficiency, and

decrease unrelenting standards. All these factors consequently improve

mindfulness (Young et al., 2009). We hypothesized that the negative schemas

and postpartum depressions are two negatively influencing factors and the

disputing variable that could be enlightened as a positive ray of light in between

them could be the mindfulness level of a person. This research intends to spread

awareness among researchers and victims of postpartum depression that

mindfulness can play an intervening role between two connecting negative

factors in a time of despair.

Method

Participants

The current study involved 170 mothers who gave birth from February

2020 to August 2020. The demographic characteristics of respondents were

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440

noted and later on converted to categorical variables to explain the sample

characteristics. Respondents’ age ranged from 18 years to 43 years old (

= 25.73;

= 4.94). Some other demographic properties that were noted, were level of

education (8.8% were illiterate, 5.4% were primary graduates, 41.4% were middle

school graduates, 44.6% were college graduates), duration after childbirth (1 to

12 weeks passed for 49.50%, 13 to 25 weeks passed for 14.10% and 26 to 36 weeks

passed for 36.90%, Duration of marriage (11 to 53 months for 40.00%, 54 to 96

months for 40.20%, 97 to 139 months for 11.40% and 140 to 180 months for 7.50%,

and the type of birth (43% C-section delivery and 58% vaginal delivery).

Measures

Data was collected in person through the paper and pencil method using

purposive sampling. To ensure validity, all measure items had been translated

using the forward-backward method of translation.

Edinburgh Postnatal Depression scale (Naveed et al., 2015)

Edinburgh Postnatal Depression Scale (EPDS) is a renowned self-report

10-item scale. It was constructed for examining postpartum depression.

Respondents were asked to answer the questions using a four-point scale that

ranges from 0 to 3 (

as much as I always could to not at all

). The total score of the

scale was taken by the sum of scores of 10 items (Cox et al., 1987). The composite

reliability for Urdu translated scale was .86.

The Young Schema Questionnaire-Short Form (Young et al., 2003)

The Young Schema Questionnaire-Short Form (Young et al., 2003) is a

75-item self-report scale that is used to assess the severity of early maladaptive

schemas, which are grouped into five domains. Each of the 15 sub-schemas

consists of five items and every item is rated on a six-point Likert- scale that

ranged from 1 -

completely untrue of me

to 6 -

describes me perfectly

. The sub-

scales composite reliability (Over vigilance/Inhibition, Disconnection/Rejection,

Impaired autonomy/Performance, Impaired Limits, Other Directedness) for the

current study was .881, .876, .765, .897, and .773 respectively.

PP (2022) 15(4), 453-472

Early Maladaptive Schemas and Post-Partum Depression

441

Disconnection/rejection is comprised of social isolation, mistrust, and emotional

deprivation. Impaired autonomy is explained by dependence, enmeshment, or

vulnerability to harm. Impaired limit is defined by entitlement and insufficient

self-control. Other directedness is explained by subjugation and self-sacrifice.

Lastly, over-vigilance is explained by schemas of emotional inhibition and

unrelenting standards.

Kentucky Inventory of Mindfulness Skills (KIMS) (Baer et al., 2004)

Kentucky Inventory of Mindfulness Skills is 39 items scale that measures

the four components of mindfulness including acting with awareness,

describing, accepting without judgment, and observing (Baer et al., 2004). The

scale ranged from 1 -

never or rarely true

to 5 -

always or almost always true

Internal consistency of scale in the current study found overall .781 and .605 to

.797 across subscales.

Results

Study data analysis was carried out using SMART-PLS 3.2.8 (Ringle et al.,

2015) to check the indirect effect of early maladaptive schemas on post-partum

depression through mindfulness. Early maladaptive schemas domains (Impaired

Limits, Impaired autonomy/Performance, Over-vigilance/Inhibition, Other

Directedness, and Disconnection/ Rejection,) were considered as explanatory

variables and postpartum depression was measured as the criterion variable in

the path analysis. Data analysis included the measurement and structural model.

Measurement model

A measurement model was run to assess the convergent validity of the

tools used for research and the evaluation was conducted through average

variance extracted (AVE). The outer model was validated via a path weighing

scheme as suggested by (Garson, 2012; Hair et al., 2012). The outer loading was

considered to be significant with a score of .6 (Hair et al., 2011). The psychometric

effectiveness was improved by excluding the items with outer loadings lesser

than .6. the composite reliability was accepted with a value greater than .6. As

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442

shown in Table 1, AVE, as well as composite reliability, appeared to be

satisfactory in the measurement model.

Table 1

The measurement model test

Variables

Composite Reliability

(CR)

Average Variance

Extracted

(AVE)

Postpartum Depression

.825

.758

Mindfulness

.811

.670

Early Maladaptive Schemas

.941

.587

Other-directedness

.800

.567

Impaired autonomy or

Performance

.764

.582

Disconnection and rejection

.820

.543

Impaired limits

.774

.644

Over vigilance/ inhibition

.901

.544

Structural Model

Direct and indirect relationships were analyzed through bootstrapping

technique (Preacher & Hayes, 2008). Dimension vise results have been presented

in Figure 1 and comprehensive results are explained in Table 2.

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Figure 1. Specific indirect effect

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Table 2

Mediation through Mindfulness on Early Maladaptive Schemas and Postpartum

Depression

Variables

Impaired autonomy or Performance ->

Mindfulness -> Post-Partum Depression

.147

0.151

0.042

3.506

.000

Other-directedness -> Mindfulness -> Post-

Partum Depression

.033

0.035

0.012

2.744

.006

Disconnection and rejection -> Mindfulness ->

Post-Partum Depression

.081

0.084

0.024

3.404

.001

Impaired limits -> Mindfulness -> Post-Partum

Depression

.056

0.055

0.016

3.447

.001

Over vigilance/ inhibition -> Mindfulness -> Post-

Partum Depression

.032

0.033

0.013

2.526

.012

Note

. β – standardized beta coefficient; M – Mean; SD – Standard deviation; t – t-test; p

– p value.

Five domains of early maladaptive schemas namely (Impaired

autonomy/Performance, Other Directedness, Disconnection/ Rejection, and

Over-vigilance/Inhibition, and Impaired Limits,) showed significant mediation

through mindfulness to postpartum depression. Thus, from these results, we can

say that mindfulness mediates the relationship between early maladaptive

schemas and post-partum depression.

Discussion

Nurturing an infant is significant life stress and a critical time for mothers.

Some mothers encounter trouble adapting to this significant life changes

(Sheinkopf et al., 2006). Though most women are resilient towards stress

(Holopainen & Hakulinen, 2019), some of them face some psycho-social

challenges that threaten their subjective well-being. Consequently, it can disturb

daily personal and occupational functioning (Diorgu et al., 2016). This research

contributes to existing research related to maternal health.

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Early Maladaptive Schemas and Post-Partum Depression

445

The current research focused on examining the intervening function of

mindfulness between predisposed early maladaptive schemas and post-partum

depression in women after giving birth. This conclusion supported prior research

(Grigorian et al., 2020) that the EMSs domains of disconnection/rejection, and

over-vigilance and inhibition are negatively associated with a sub-level of

mindfulness called acting with awareness. Additionally, disconnection/rejection

are negatively related to unfolding experiences, and observing encounters and

impaired limits are associated to the other four mindfulness facets.

Current study outcomes were supported because five domains of

predisposed early maladaptive schemas namely (Other Directedness,

Disconnection/ Rejection, Impaired autonomy/Performance, Impaired Limits,

and Over-vigilance/Inhibition,) showed significant mediation through

mindfulness to post-partum depression. These findings are backed by the

propositions of Shorey, Brasfield, et al. (2015) in which early maladaptive schemas

and mindfulness separately for females and male substance users are studied.

The association between mindfulness and predisposed early schemas is

consistent because the occurrence of maladaptive schemas is intervened the

level of mindfulness.

A massive body of literature suggests that self-compassion and

mindfulness are key methods in appeasing depressive symptoms which might

have adverse effects on both the infant and the mother (Luberto et al., 2018;

Malis et al., 2017). Improved maternal mindfulness may strengthen positive

experience before and after giving birth. Mindfulness may decrease adverse

outcomes of unavoidable difficult events and enhance productive coping from

these circumstances (Bergomi et al., 2013). Aligned with these propositions, a

qualitative study outcome proves that mothers who attend an ante-natal

mindfulness based childbirth training program stay more confident during

childbirth and after (Fisher et al., 2012). Although, as far we know, no quantitative

study investigated the impact of motherly dispositional mindfulness on

subjective childbearing experience and postpartum symptoms.

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Conclusion

These findings provide significance on the potential advantages of

mindfulness-based practices in health advancement outreach endeavors

designed for such a population. It could influence mothers' and mothers-to-be’

intentions to seek mindfulness-based practices. Developing mental health

facilities and intervention and compassion-based approaches that are effective

in persuading and motivating mothers to explore the possible benefits from such

practices as mindfulness meditation may help the mothers to develop positive

attitudes that can provide lifelong mental and physical health benefits. Thus, the

present study can be useful in order to enhance subjective well-being by

developing mindfulness competency during pregnancy.

Limitations and Future directions

Despite the current study's contributions, few barriers exist that should

be addressed. The study outcomes were derived from a small sample of mothers

after childbirth from Pakistan. Future researchers should replicate the study with

samples from other countries to ensure that the study findings can be

generalized across samples. An experimental study can test whether

mindfulness-based intervention during pregnancy help to reduce the risk of

post-partum depression.

Conflict of interest

We have no conflicts of interest to disclose.

Data availability statement

The data that support the findings of this study are available from the

corresponding author upon reasonable request.

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