Association of childhood emotional maltreatment with depression and anxiety: Serial mediating roles of distress intolerance and repetitive negative thinking

Childhood emotional maltreatment (CEM) is characterized by recurring destructive interactions (i.e., emotional abuse and emotional neglect) between a child and their caregiver(s), which become habitual and ingrained within the relational context. CEM had been consistently demonstrated to be strongly linked to the development of depressive and anxiety disorders. On the other hand, distress tolerance is defined as one's capacity to endure and tolerate negative experiential and emotional states, and it is conceptualized as one's propensity for aversive reactivity. Lack of distress tolerance, or distress intolerance, is associated with maladaptive emotion regulation and coping strategies, such as repetitive negative thinking (RNT). RNT is characterized by a cognitive tendency to recurrently engage in negative thinking. This style is distinguished by its repetitive, intrusive nature, and difficulty in disengagement. While RNT may create a false sense of control over distressing emotions and situations, it ultimately sustains a cycle of negative affect and maladaptive coping. Although several studies have shown that CEM is associated with distress intolerance, there is a need in the literature for a transdiagnostic investigation of whether CEM is associated with depression and anxiety through distress intolerance and RNT, respectively. Therefore, the current study aims to investigate a multiple serial mediation model by proposing that the relationship between CEM and both depression and anxiety is serially mediated by distress intolerance and RNT. A further objective of the current study is to explore an alternative multiple serial mediation model, wherein the relationship between CEM and empathy is serially mediated by distress intolerance, RNT, and both depression and anxiety. Within this exploratory framework, it was hypothesized, based on existing literature, that only distress intolerance serves as a mediator between CEM and empathy. A total of 548 participants (86.9% women), aged 18 to 66 (M = 32.8, SD = 9.1), completed scales measuring CEM, distress intolerance, RNT, empathy, depression, and anxiety. The findings revealed that distress intolerance and RNT serially and significantly mediated the relationship between CEM and both depression and anxiety. Furthermore, although distress intolerance functioned as a mediator in the association between CEM and empathy, the exploratory analysis showed that distress intolerance, RNT, and depression or anxiety did not serially mediate this association. Importantly, the results have implications for transdiagnostic models and treatments of emotional disorders emphasizing aversive reactivity to negative emotions and maladaptive emotion regulation and avoidant coping strategies.