Self-awareness in nursing: A scoping review


  • 1 Shifa College of Nursing, Islamabad, Pakistan.
  • 2 Memorial School of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
  • 3 School of Social Work, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
  • 4 Al-Shifa Eye Trust Hospital, Rawalpindi, Pakistan.
  • 5 Healthcare Management at RIPAH University, Islamabad, Pakistan.
  • PMID: 30362645
  • DOI: 10.1111/jocn.14708

Aims and objectives: To outline and examine the literature about self-awareness in nursing and to identify areas for future research and practice.

Background: Self-awareness is important for the personal and professional development of nurses, for developing an effective nurse-patient relationship and for improving nursing abilities. Despite its importance in nursing and therapeutic nurse-patient relationship and its evolving nature, the knowledge base for self-awareness in nursing remains under-examined.

Design: A scoping review using PRISMA guidelines.

Methods: A five-step approach: (a) identification of research question; (b) identification of relevant studies using a three-step search: keywords search within PubMed and CINAHL, literature search within PubMed, CINAHL, ERIC, PsycINFO, Science Direct and Google Scholar, and literature search of references lists; (c) study selection; (d) data extraction and charting; (e) data collation, summarisation and reporting, was used.

Findings: Of 1,531 identified sources, 76 full-text sources were read and 29 English language sources, published from January 1980 until January 2018, which included nurses or nursing students, were reviewed. Two themes: perspectives on self-awareness and strategies for enhancing self-awareness emerged. Under these themes, conceptualisation of self-awareness; its antecedents and value; and theory-based, educational and personal strategies for its enhancement were described. There is sufficient literature regarding self-awareness conceptualisation and theory-based strategies for its enhancement, but inconclusive evidence regarding value of self-awareness, and educational and personal strategies for its improvement.

Conclusion: There is limited research on self-awareness. Most of the literature comprises of theoretical discussions and opinions which adequately provide a conceptual understanding of self-awareness. However, more empirical and applied research is needed to apply the available theoretical knowledge in practice.

Relevance to clinical practice: This review delineated theoretical, educational and personal strategies for nurses to improve their self-awareness and indicated that engagement in self-awareness at relational and contextual levels is essential for developing nurse-patient relationship.

Keywords: interpersonal relationship; nurse-patient relationship; nursing; reflection; self-awareness.

© 2018 John Wiley & Sons Ltd.

Publication types

  • Nurses / psychology*
  • Self Concept*
  • Students, Nursing / psychology*

U.S. flag

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

  • Publications
  • Account settings
  • Advanced Search
  • Journal List
  • Front Psychol

The Effect of Trait Self-Awareness, Self-Reflection, and Perceptions of Choice Meaningfulness on Indicators of Social Identity within a Decision-Making Context

Noam dishon.

1 Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia

Julian A. Oldmeadow

Christine critchley.

2 Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia

Jordy Kaufman

Theorists operating from within a narrative identity framework have suggested that self-reflective reasoning plays a central role in the development of the self. Typically, however, narrative identity researchers have investigated this relationship using correlational rather than experimental methods. In the present study, leveraging on a classic research paradigm from within the social identity literature we developed an experiment to test the extent to which self-reflection might have a causal impact on the self-concept within a decision-making context. In a minimal group paradigm participants were prompted to reflect on their painting choices either before or after allocating points to in-group∖ out-group members. As anticipated, self-reflection augmented social identification, but only when participants felt their choices were personally meaningful. Participants who reasoned about their choices and felt they were subjectively meaningful showed stronger similarity and liking for in-group members compared to those who did not reflect on their choices or found them to be subjectively meaningless. Hence, reflecting on and finding meaning in one’s choices may be an important step in linking behavior with in-group identification and thus the self-concept in turn. The absence of any effects on in-group favoritism (a third indicator of social identification measured) as well as implications of the study’s findings for self-perception, cognitive dissonance and social identity processes are also discussed.


Psychological scientists have approached the issue of self and identity from a range of different positions. For example, some social and cultural psychologists have investigated self and identity using a social identity theory framework whereas other personality and developmental psychologists have pursued an approach informed by narrative identity theory (see, Tajfel and Turner, 1986 ; McAdams, 2001 ; Pasupathi et al., 2007 ; Miramontez et al., 2008 ). In the present paper, we synthesize aspects of both identity projects by utilizing an experimental paradigm associated with social identity theory (i.e., the minimal group paradigm), to investigate whether self-reflective reasoning, a cognitive process theorized to be central to narrative identity development, can have a causal effect on the self and identity. We also explore if such an effect could be impacted by the level of meaningfulness one associates with their self-reflective reasoning and modulated by individual differences in trait self-awareness.

Identity from a Narrative Identity Framework

McAdams (1985 , 2001 ) model of narrative identity postulates that our sense of identity is inextricably linked with the creation of a life story. According to this model, self-narratives have two primary functions. They facilitate our sense of self-continuity across time and they help us give context and meaning to the events of our lives so that we can make sense of who we are ( McAdams and McLean, 2013 ). Self-narratives, as McAdams and McLean (2013) , state facilitate meaning making because they allow the narrator to draw “…a semantic conclusion about the self from the episodic information that the story conveys” (pp. 236). Within the narrative identity literature the process of self-reflection coupled with the extraction of self-relevant meaning is referred to as autobiographical reasoning and it is theorized to be an essential cognitive process in narrative identity development and construction ( Singer et al., 2013 ). However, as Adler et al. (2016) note, within the narrative identity literature investigators have typically employed correlational research designs thereby rendering it difficult to draw causal conclusions. Adler et al. (2016) develop this idea further stating that given this paucity of experimental work “increasing methodological sophistication and variety in the study of narrative identity with an eye toward drawing causal inferences is vital” (pp. 29).

Self-Reflection, Meaning and the Self

Although research from within the narrative identity literature demonstrating a causal link between self-reflection and identity development remains scarce, several other lines of converging research also suggest that self-reflection should play an important role in self-concept development. For example within the clinical psychology literature, reflective functioning has been used to describe a persons ability to reflect on experiences, draw inferences about behavior from these reflections, and then use those inferences to construct and develop representations of the self ( Katznelson, 2014 ). Research which has investigated reflective functioning has demonstrated that changes in reflective functioning are linked to self-concept change. For example, in research with persons affected by borderline personality disorder, (a condition which is characterized by an unstable sense of self) Levy et al. (2006) found that improvements in reflective functioning were associated with improvements in self-representations and a more integrated sense of self.

Another reason for thinking that self-reflection should represent an important mechanism in self-concept construction and development comes from research which has utilized the self-referential memory paradigm. In a typical self-referential memory paradigm study, different word categories (i.e., traits and adjectives verse semantically and orthographically related words) are presented to participants who are instructed to remember them at exposure and then asked to recall them at a later time ( Rogers et al., 1977 ). The self-reference effect describes the tendency for participants to retrieve traits and adjectives that are self-related more successfully than words that are semantically or orthographically related ( Symons and Johnson, 1997 ). Schizophrenia is another condition of which an unstable sense of self represents a core feature (see Sass and Parnas, 2003 ), and research has demonstrated that persons affected by schizophrenia tend to display weaker self-reference effects compared to healthy controls which researchers have interpreted as an indication of reduced self-reflective capacity ( Harvey et al., 2011 ).

There are also several reasons for thinking that meaning-making tendencies should play an important role in self-concept construction and development in addition to the emphasis placed upon this process by narrative identity theorists as noted previously. Firstly, in a theoretical sense, influential thinkers such as Erikson (1963) , Frankl (1969) , and Bruner (1990) , have all argued strongly for the idea that meaning is likely to play an important role in self and identity development. At the same time, research from within the organizational psychology literature has demonstrated empirically that perceptions of meaningfulness are associated with a range of self-related outcomes. Psychological empowerment captures an employees cognitive-motivational stance toward their work and is comprised of four dimensions, impact , competence , autonomy , and of particular pertinence given the current investigation, meaning which reflects the degree to which one perceives their work as being personally meaningful ( Spreitzer, 1995 ; Holdsworth and Cartwright, 2003 ). The importance of perceptions of meaningfulness within the context of psychological empowerment is further highlighted by Spreitzer et al. ( 1997 , pp. 681) who argue that the dimension of meaning “serves as the ‘engine’ of empowerment.” Research exploring psychological empowerment at an individual factor level has noted that differences in meaning are positively associated with several self-related outcomes such as self-esteem and self-efficacy ( McAllister, 2016 ).

In our own research we have found that individual differences in trait self-awareness are associated with perceptions of choice meaningfulness within a decision-making context (Dishon et al., under review). Based on pre-existing literature which has explored self-awareness more generally (e.g., Morin, 2011 ) we defined trait self-awareness as individual differences in the capacity to access knowledge, insight and understanding of internal self-related experiences. We found that participants with higher levels of trait self-awareness perceived significantly more meaning in a series of minor experimentally induced choices compared to those with lower levels of trait self-awareness. Moreover, this difference remained irrespective of whether or not participants were told that their choices were diagnostic of important personal characteristics. We concluded from this research that individuals high in trait self-awareness are more likely to reflect on their choices and more likely to find them meaningful than individuals low in trait self-awareness. Extending on this work and drawing upon the literature previously presented, in the present paper we propose and explore a theoretical model (see Figure ​ Figure1 1 ) that articulates how self-reflection and perceptions of meaningfulness might affect the self within a choice context.

An external file that holds a picture, illustration, etc.
Object name is fpsyg-08-02034-g001.jpg

Self-reflection model.

Overview of the Self-Reflection Model

The assumptions underpinning this model are that when one is presented with a potential trigger event such as (but not limited to) a choice or behavior, the self will be affected (i.e., the choice/behavior will inform the self) as a consequence of (a) whether or not self-reflection takes place, and (b) the degree to which the choice is perceived to be personally meaningful. Moreover, (c) whether or not reflection takes place may be determined by individual or situational factors. For example, individuals with higher levels of trait self-awareness may be more predisposed to engage in self-reflective reasoning, whereas for others, situational cues such as an unexpected occurrence or a prompt from a third party might act as the catalyst for self-reflective reasoning. Several predictions arise from the model.

Prediction 1: If self-reflective reasoning does occur and the choice or behavior is perceived to be highly meaningful, then self-perception will occur (by which we mean the self-concept will be modified or changed as result of the behavior or action).
Prediction 2: If self-reflective reasoning does occur and the level of personal meaning associated with the choice or behavior is perceived to be low, its affect on the self will be weak or absent.
Prediction 3: If no self-reflective reasoning occurs there will be a weak effect on the self through an automatic self-perception process. Rather than predict no effect on the self in the absence of self-reflection, we allow for the possibility of an automatic or implicit self-perception process to occur because research has demonstrated that the self-concept can be impacted even in the absence of explicit reasoning. For example, in one demonstration of this type of effect, Klimmt et al. (2010) observed that exposing participants to different types of characters in video games led to automatic shifts in self-perception as measured in a follow up Implicit Association Test.
Prediction 4: Individuals high in trait self-awareness will be more likely to engage in self-reflective reasoning than individuals low in trait self-awareness 1 .
Prediction 5: Individuals low in trait self-awareness will engage in self-reflective reasoning only if prompted, or if some other situational cue triggers self-reflection.

Although narrative identity researchers have primarily looked at self-reflective reasoning in the context of autobiographical memories (see, Pasupathi, 2015 ), in the present study we sought to initially test the veracity of our self-reflection model on a smaller scale in a relatively minimal decision-making context. We did so for several reasons. First, decision-making lends itself well to experimental testing ( Carroll and Johnson, 1990 ). This is important because as noted earlier, to date, research investigating the relationship between self-reflective reasoning and the self has largely been correlational by design and attempts to test this possibility experimentally have been insufficient ( Adler et al., 2016 ). Second, consumer decision-making research has suggested that self-narratives often arise in every day decision-making contexts ( Phillips et al., 1995 ) and some narrative identity scholars have argued that day-to-day narratives which might not be overtly autobiographical nevertheless remain tightly linked to self and identity ( Bamberg, 2011 ; Pasupathi, 2015 ). Third, behaviorist and cognitive theories (i.e., self-perception theory and cognitive dissonance theory) suggest that the self is often informed by after-the-fact explanations for behaviors or post hoc reasoning for choices ( Brehm, 1956 ; Festinger, 1957 ; Bem, 1972 ). Another reason for thinking that self-reflection could impact self-perception stems from research by Wilson et al. (1993) which demonstrated that self-reflection can impact attitudes and post-choice satisfaction within a decision-making context.

Identity from a Social Identity Framework

From the view of social identity theory, our sense of identity is heavily influenced by the social groups that we belong to ( Tajfel and Turner, 1986 ). Social identity as originally conceptualized by Tajfel (1981) refers to “…that part of an individual’s self-concept which derives from his knowledge of his membership of a social group” (p. 255). According to the theory, we come to identify with certain social groups based upon the extent to which we think we share similarities with other group members. Then, in order to maintain a positive sense of our social identity we try to ensure that our group (the in-group) is favored over other out-groups. One way of doing this is by favoring one’s in-group and discriminating against the out-group. Within the social identity literature, the extent to which we feel similar to, like, or favor other in-group members is indicative of the extent to which our identification with that group has been incorporated into our self-concept ( Hogg, 1992 , 1993 ; Ellemers et al., 1999 ; Leach et al., 2008 ). The minimal group paradigm which facilitates the measurement of in-group favoritism and out-group discrimination is one way of measuring the extent to which group membership has been incorporated into the self-concept and therefore had an effect on social identity ( Otten, 2016 ).

In a typical minimal group paradigm experiment, participants are randomly allocated to a group and then asked to concurrently distribute resources to in-group and out-group members on allocation matrices specifically designed to measure allocation strategies that favor the in-group and∖or discriminate against an out-group ( Tajfel et al., 1971 ). Research in the field has consistently demonstrated that even when people are led to believe that their assignment to a group is for a trivial reason, such as their preferences for abstract artwork, they still tend to allocate resources more favorably to in-group members ( Otten, 2016 ). Whilst researchers have often been interested in using this methodology to investigate topics such as prejudice and discrimination, the allocation of resources within a minimal group paradigm environment need not be used exclusively for this end ( Bourhis et al., 1994 ). The allocation of resources within a minimal group paradigm context can also serve as a subtle and discreet measure of the degree to which group membership has been incorporated into the self-concept and one’s sense of social identity more generally ( Otten, 2016 ). Another way that social identity researchers have measured the extent to which commitment to a group can impact one’s self-concept and sense of identity is by measuring self-reported liking of, and similarity with, other anonymous in-group members (e.g., Hogg, 1992 , 1993 ; Ellemers et al., 1999 ; Leach et al., 2008 ). Ellemers et al. (1999) research is also important in the context of the current study because it demonstrates that social identification is more strongly affected when people are able to self-select into a group (as opposed to being assigned a group) and it would seem reasonable to think that self-reflective reasoning is a process that could be quite important for self-selection decisions.

The Current Study

In recent research in our lab we investigated the connection between self-reflective reasoning within a decision-making context and the self. We found that the degree of personal meaning that was given to a trivial choice was associated with individual differences in trait self-awareness (Dishon et al., under review). In the present study we sought to extend this research by investigating further if the cognitive process of engaging in self-reflective reasoning could affect one’s sense of identity. We also sought to explore whether an effect of this kind might be impacted by the extent to which one felt as though their reasoning had been personally meaningful and also moderated by individual differences in trait self-awareness. To test this model we developed an experiment that utilized and extended upon traditional minimal group paradigm work. Participants were randomly assigned to either an experimental or control condition. In the experimental condition participants were prompted to engage in self-reflective reasoning immediately after making painting choices whereas in the control condition participants went on to allocate resources immediately after selecting paintings. We used in-group∖out-group allocation strategies as one dependent measure of identity and we also used similarity and liking ratings with in-group∖out-group members as additional dependent measures of identity.

Based on the proposed model we hypothesized that participants who are relatively high in trait self-awareness would be more likely to spontaneously self-reflect on their choices and therefore be relatively unaffected by the self-reflection prompt manipulation. As such it was expected that for these participants, self-perception would be related to the perceived meaningfulness of their painting choices more so than condition. We also expected that participants who are relatively low in trait self-awareness would be less likely to spontaneously self-reflect on their choices and therefore more greatly affected by the self-reflection prompt manipulation. As such it was expected that for these participants, self-perception would be related to the perceived meaningfulness of their painting choices only in the experimental condition (i.e., when they have been prompted to self-reflect.)

Materials and Methods


Two hundred and six undergraduate psychology students voluntarily participated in the study in exchange for course credit. During the procedure, a manipulation check was administered to ensure that participants had attended to feedback regarding group allocation (the details of which are explained further in the Procedure section below). The responses of 32 participants who failed the manipulation check were discarded leaving a remaining pool of 174 participants (139 female, 35 male) with a mean age of 33.06 years ( SD = 11.78). The difference in failure rates between conditions was not significant ( p = 0.518). Ethical approval for the study was provided by Swinburne University’s Human Research Ethics Committee (SUHREC).

Effects of the experimental manipulation on identity were inferred by, (a) the extent to which participants incorporated their in-group identification into their self-concept and measured by participant’s in-group favoritism when distributing resources to in-group∖out-group members on Tajfel matrices and, (b) participant’s self-identification with in-group∖out-group members which was assessed by measuring their liking of, and perceived similarity with, in-group∖out-group members.

Tajfel matrices

Tajfel matrices consist of six matrices in which participants are asked to allocate resources concurrently to an in-group member and out-group member along a spectrum of pre-determined in-group to out-group ratios. The six matrices comprise three pairs (one of each pair is a reversed version of the original).

There are four main allocation strategies that can be measured with Tajfel matrices. Parity is an allocation strategy whereby the participant distributes an equal amount of resources to both in-group and out-group recipients. Maximum In-Group Profit is an allocation strategy that sees the greatest possible amount of resources awarded to the in-group recipient irrespective of what is awarded to the out-group recipient. Maximum Difference reflects a strategy that optimizes the differential allocation of resources between recipients in favor of the in-group recipient at the expense, however, of absolute in-group profit. Maximum Joint Profit reflects a strategy in which overall allocation of resources is maximized across both in-group and out-group.

The matrices facilitated the calculation of pull scores which reflected participants’ gravitation toward particular allocation strategies. Matrix pair A compared the pull of Maximum In-Group Profit and Maximum Difference (i.e., in-group favoritism) against Maximum Joint Profit. Matrix pair B compared the pull of Maximum Difference against Maximum In-Group Profit and Maximum Joint Profit. Matrix C compared the pull of Parity against Maximum In-Group Profit and Maximum Difference [See Bourhis et al. ( 1994 ) for a comprehensive and in-depth account of the procedure involved in Tajfel matrix preparation, administration, and calculation].

Following a similar procedure to Grieve and Hogg (1999) we then conducted a factor analysis of the pull scores using principal axis factoring with promax rotation to examine the possibility of computing an overall in-group favoritism score. This revealed a single in-group favoritism factor which explained 48.9% of the variance (all loadings ≥ 0.63). The items were then summed and averaged to produced an overall measure of in-group favoritism with higher scores representing greater in-group favoritism (Cronbach’s α = 0.74).

In-group self-identification

As other researchers have done previously (e.g., Hains et al., 1997 ; Grieve and Hogg, 1999 ), participants’ liking of, and perceived similarity with, in-group∖out-group members were recorded to measure their level of self-identification with their in-group. To do so, after being presented with pairs of de-identified paintings by Paul Klee and Wassily Kandinsky and receiving feedback that their choices indicated a preference for the work of Klee irrespective of their actual choices, (see the Procedure section below for a more detailed account of the process involved,) participants were asked to imagine themselves meeting two people, one who had a preference for Klee and the other who had a preference for Kandinsky. Participants then rated on a seven-point scale which of these two people they thought they were most similar to in general (Q1), in artistic preferences (Q2), in painting preferences (Q3), in academic ability (Q4), and in political opinions (Q5). Using the same scenario, participants were also asked to rate who they thought they would like more (Q6), who they thought they would get along with more (Q7), and who they would like to meet more (Q8). Responses on questions 1–5 were summed and averaged to calculate an overall similarity score with higher scores representing a greater level of similarity with an in-group member (Cronbach’s α = 0.75). Response for questions 6–8 were summed and averaged to calculate an overall liking score with higher scores representing a greater level of liking for an in-group member (Cronbach’s α = 0.82).


Meaningfulness associated with self-reflective reasoning was measured by providing participants with a five-item Subjective Meaningfulness Scale which included items such as “I feel as though my choices were genuine” and, “My choices were meaningless.” Participants were asked to indicate their level of agreement with each statement on a 5-point scale (1 = strongly disagree, 5 = strongly agree). Responses were coded so that higher scores indicated greater level of meaningfulness. A factor analysis using principal axis factoring and promax rotation revealed that all five items loaded on a single factor which explained 32.6% of the variance (all loadings ≥ 0.43). Scores were then summed and averaged and an overall meaningfulness score was calculated (Cronbach’s α = 0.69; Guttman’s Lambda 2 = 0.70).

Trait Self-Awareness

Trait Self-Awareness was operationalized as function of participants’ scores on the Sense of Self Scale (SOSS; Flury and Ickes, 2007 ) which is a single factor 12-item measure designed to assess sense of self and self-understanding (Cronbach’s α = 0.86) and the Self-Reflection and Insight Scale (SRIS; Grant et al., 2002 ) which is a two factor 20-item measure of self-reflection and insight (Cronbach’s α = 0.88). In the present sample, using principal axis factoring and promax rotation, both measures retained their original factor structures with the SOSS exhibiting a single factor which accounted for 36.3% of the variance and the SRIS exhibiting two factors which accounted for a combined 53.6% of the variance (Factor 1 = 34.3%, Factor 2 = 19.3%). Both measures were scored so that higher scores indicated stronger sense of self and greater levels of self-reflection and insight and both measures were significantly correlated ( r = 0.35, p < 0.001). Scores on these scales were then summed to create an overall trait self-awareness score with higher scores representing greater levels of trait self-awareness (Cronbach’s α across the total 32-items = 0.77; principal axis factoring with promax rotation revealed three factors accounting for 50.6% of the variance [Factor 1 = 24.6%, Factor 2 = 21.8%, Factor 3 = 3.9%]).

Six pairs of images of paintings by Paul Klee and Wassily Kandinsky were utilized as the painting stimuli.

The experiment was administered online. Once consent to participate was provided, participants were informed they would be required to choose their preferred painting from six pairs of paintings which were then presented sequentially. All paintings were presented without the artists’ names attached to any of the works. After making their painting selections participants were randomly assigned to one of two conditions (a reasoning pre resource allocation, similarity and liking ratings condition or, a reasoning post resource allocation, similarity and liking ratings condition). Participants in both conditions were presented with all the same stimuli and experiences except the order of exposure was manipulated slightly between conditions as outlined below.

In the reasoning pre condition, after the initial painting selection phase, participants took part in the self-reflective reasoning phase. In the self-reflective reasoning phase participants were presented with and asked to reflect on a 15-item list of potential reasons for their painting selections and then presented with an open text box and asked to reflect further in their own words about their reasons for their painting choices. Following this participants were presented with and completed the subjective meaningfulness measure. Then although they remained unware to it at the time, irrespective of their actual choices participants were informed that their choices indicated that they preferred the works of Paul Klee 2 . Participants were then presented with instructions pertaining to the completion of the Tajfel matrices before moving on to complete them. Following this, participants were presented with the in-group∖out-group similarity and liking measure. Participants then completed the trait self-awareness measures before recording their gender (female, male, or other) and age. A manipulation check was then conducted whereby participants were asked to indicate who they had previously been informed that their painting choices indicated they preferred the works of (possible response were, Paul Klee, Wassily Kandinsky, or Don’t remember). Participants were then presented with a debriefing statement, informed the experiment was over and thanked for their participation.

In the reasoning post condition, the order of exposure was manipulated so that after making painting selections, participants were told their choices indicated a preference for Paul Klee 3 and were administered with the matrices and in-group∖out-group similarity and liking measures before the self-reflective reasoning phase. After completing the choice reasoning phase and the subjective meaningfulness measure, participants in this condition were also then presented with the same trait self-awareness 4 measures, demographic questions, manipulation check and debriefing as their counterparts in the alternate condition.

Outlier Analysis

Three multivariate outliers (1 in the control and 2 in the self-reflection condition) were detected and removed from the analysis thereby leaving a total sample of 171 (86 in the control condition and 85 in the self-reflection condition).

Descriptive Statistics

Descriptive statistics for trait self-awareness, choice meaningfulness, in-group similarity, in-group liking, and in-group favoritism as a function of self-reflection condition are presented in Table ​ Table1 1 .

Means and standard deviations for trait self-awareness, choice meaningfulness, similarity, liking, and in-group favoritism by self-reflection condition.

Effect of Experimental Manipulation on IV’s

We conducted between groups analyses to investigate if the self-reflection and control groups differed on the IV’s of choice meaningfulness and trait self-awareness as a function of the self-reflection manipulation. Independent samples t -test’s revealed that there was no significant difference in choice meaningfulness ( p = 0.365) or trait self-awareness ( p = 0.218) between conditions thereby demonstrating the IV’s were robust to the self-reflection manipulation.

Multiple-Sample Path Analysis

We ran a multiple-sample path analysis using the structural equation modeling program MPLUS (v 7.4) to investigate if the main effects of meaningfulness and trait self-awareness as well as the interaction effects (i.e., choice meaningfulness × trait self-awareness) on the DV’s differed between the experimental self-reflection and control non-self-reflection conditions. The model tested three exogenous/independent variables all predicting the three endogenous/dependent variables, in-group favoritism, similarity and liking. The exogenous variables were the main effects of trait self-awareness and choice meaningfulness, and a trait self-awareness × choice meaningfulness interaction.

Because the parameter to case ratio was under the required minimum of 1 parameter to 5 cases (1:4.75 or 36:171) as suggested by Kline (2011) , we discreetly tested each section of the model. In other words, three independent models with each of the three endogenous dependant variables were examined separately thereby ensuring that the parameter to case ratio was sufficient (i.e., 1:17.1 or 10:171). In all models the Satorra–Bentler robust estimator was used to account for multivariate non-normality, and all parameters were free across the self-reflection and control conditions. Chi-square Wald tests were utilized on a fully unconstrained model to test significant differences in the effects across conditions given the expectation that there would be differences in regression weights across groups ( Muthén and Muthén, 1998–2017 ). There were no significant differences in the results of these separate models and the full model 5 . Given this, the parameters for the full model are presented in Table ​ Table2 2 . Because the model was saturated with zero degrees of freedom fit indices are not reported.

Unstandardized regression weights and Wald Tests for the multi-sample path analysis.

Main Effects of Choice Meaningfulness and Trait Self-Awareness

The results in Table ​ Table2 2 reveal that there was a significant main effect for choice meaningfulness in both the control and self-reflection conditions for similarity, however, Wald tests reveal that the difference in effects between conditions was not significant. This suggests that higher choice meaningfulness scores were associated with higher similarity scores in both the self-reflection and control conditions. The results in Table ​ Table2 2 also demonstrate that there was a significant main effect of choice meaningfulness for liking in the self-reflection condition whereas the main effect of choice meaningfulness for liking in the control condition was not significant. The Wald test demonstrates that this difference in effects between conditions was significant, suggesting that higher choice meaningfulness scores were associated with higher liking scores in the self-reflection condition only. Whilst there was also a significant main effect of trait self-awareness on liking in the self-reflection condition, the Wald test demonstrates that this was not significantly different from the non-significant main effect of trait self-awareness in the control condition.

Trait Self-Awareness × Choice Meaningfulness Interaction Effects

As seen in Table ​ Table2 2 , for liking, the interaction between trait self-awareness and choice meaningfulness was only significant in the self-reflection condition and as the significant Wald test demonstrates, the strength of this interaction effect was also significantly different between the control and self-reflection conditions (see Figure ​ Figure2 2 ).

An external file that holds a picture, illustration, etc.
Object name is fpsyg-08-02034-g002.jpg

Predicted liking scores by trait self-awareness and choice meaningfulness groups across conditions. Groups were defined as 1 standard deviation above (high) and below (low) the mean (moderate).

The results in Figure ​ Figure2 2 suggest that for the self-reflection group the relationship between choice meaningfulness and liking strengthens as trait self-awareness scores decrease. That is, higher choice meaningfulness scores appear to be strongly associated with higher liking scores for those with lower trait self-awareness scores. This demonstrates a stronger impact of the self-reflection manipulation on participants lower in trait self-awareness and a reduction in the impact of the manipulation as trait self-awareness levels increase. Parallel trends were observed for similarity though the Wald test was only marginally significant.

The present study explored whether engaging in self-reflective reasoning could affect in-group identification and thereby demonstrate an effect of self-reflection on indicators of social identity and the self-concept. The possibility that such an effect could be impacted by the perceived level of meaningfulness associated with reasoning, and modulated by individual differences in trait self-awareness was also explored. Based on previous research, we developed a model which predicted that participants with higher levels of trait self-awareness would be minimally affected by the self-reflection manipulation. It was therefore hypothesized that for these participants self-perception would be related to the perceived meaningfulness of their painting choices more so than condition. The model further predicted that the self-reflection manipulation would have a greater impact on participants lower in trait self-awareness. Consequently, it was further anticipated that for these participants, self-perception would be related to perceived meaningfulness of their painting choices only in the experimental condition (i.e., when they were prompted to self-reflect). Participants’ in-group similarity and liking ratings (but not in-group favoritism allocations) supported these predictions and provided general support for the theoretical model proposed earlier.

Considering first the main effects of meaningfulness across conditions, the data demonstrated that whilst greater levels of meaning were associated with greater in-group similarity scores in both conditions, greater levels of meaning were only associated with in-group liking scores in the self-reflection condition. Taken together these results suggest that compared to the control condition, in the self-reflection condition stronger perceptions of meaningfulness led to stronger in-group identification. This is in line with predictions 1 and 2 relating to the self-reflection pathway in the theoretical model. Additionally, in line with prediction 3 of the theoretical model relating to the no self-reflection pathway, the effect of meaning on in-group perceptions in the control condition was smaller relative to the self-reflection condition. Moreover, the fact that there was no interaction between trait self-awareness and choice meaningfulness in the control group is suggestive of the possibility that in this condition, the main effect of meaning on in-group liking was the product of automatic or implicit processing because it occurred in the absence of any situational prompting and was not also impacted by pre-existing individual dispositions toward spontaneous self-reflection.

At the same time, the interaction between trait self-awareness and choice meaningfulness in the experimental condition indicates that the relationship between perceptions of choice meaningfulness and in-group liking strengthens as trait self-awareness levels decrease. This result suggests that the situational self-reflection prompt exhibited a stronger impact on participants who were less inclined (in terms of individual disposition) to engage in spontaneous self-reflection, and had less of an impact on participants with greater levels of individual disposition toward spontaneous self-reflection. This provides support for the hypothesis presented earlier and is also in line with predictions 4 and 5 of the theoretical model. A similar trend was also noted for in-group similarity, however, the difference in the strength of the effect between conditions was only marginally significant.

Limitations and Future Directions

One aspect of the study that could be viewed as both a limitation and strength is the way in which identity was measured. In the present study utilizing an already established experimental paradigm we developed a subtle way of testing the effect of self-reflective reasoning on identity. However, the cognitive process we were investigating was a process theorized from a narrative identity theory perspective, and the methodology used was born out of the social identity theory literature. On the one hand this approach represented a strength of the design in that it facilitated a discreet measurement of the effect of self-reflective reasoning on identity. At the same time, however, there are differences in the way that identity is conceptualized across both projects. To provide a stronger test of the hypothesis that self-reflective reasoning can affect narrative identity, experimental work with a more traditional dependent measure of narrative identity would be useful.

Another limitation was the way in which trait self-awareness was operationalized. In the present study trait self-awareness was operationalized as a function of participants’ scores on the SOSS and the SRIS. Whilst we had good reason to combine and operationalize these measures as a means of measuring trait self-awareness, future research aimed at the development of a dedicated measure of trait self-awareness would be worthwhile.

Though we were able to ensure that the modeling we conducted was sufficiently powered the present study could have benefited from a larger sample size. In the present study the parameter to cases ratio for the overall model was less then recommended (e.g., Kline, 2011 ). Therefore as outlined in the results section, to ensure that our modeling was sufficiently powered we initially computed three discreet models, one for each dependent variable. Although there was no significant difference in the outcomes between the individual and the combined models, in future to avoid the necessity of running independent models for each dependent variable it would be beneficial to recruit a larger sample which meets the parameter to cases ratio for the entire model in the first instance.

It is also possible that the deception that we engaged in (i.e., providing all participants with feedback that they preferred the work of Klee, irrespective of their actual choices) could have raised suspicions amongst participants who may have actually had some pre-existing knowledge of Klee and∖or Kandinsky (i.e., the artists whose works were used as the choice stimuli). Whilst we did include a manipulation check to ensure that the deception had had its intended effect, in future research, to address this issue more comprehensively it would be beneficial if participants were also directly questioned about their pre-existing knowledge of the artists whose works are used as the choice stimuli. Another way that this issue could be controlled for in the future would be to use the works of unknown artists as the choice stimuli.


The results of the present study may be of value to researchers who are interested in the developmental trajectory of narrative identity and autobiographical reasoning. Previous research looking at the development of narrative identity has suggested that the ability to cultivate a life-story tends to arise on average by about 14 years of age and that this is preceded by autobiographical reasoning for memorable life events which tends to first arise between the ages of nine and ten ( Bohn and Berntsen, 2008 ). Little is known, however, about the antecedents to the onset of autobiographical reasoning processes. Whilst it could be the case that development of autobiographical reasoning processes occurs in a stepwise fashion with little preceding them, the results of this study which demonstrate that reasoning about a trivial choice can effect the self and identity, beg the question that perhaps autobiographical reasoning processes develop as a continuous extension of more basic self-reflective reasoning processes which develop earlier in childhood. Perhaps it is the practice of more basic self-reflective reasoning which lays the cognitive foundations for, and facilitates the development of, more advanced autobiographical reasoning. One piece of recent research which dovetails with this idea comes from Bryan et al. (2014) who found in their work that children between the ages of three and six are already engaging in everyday decision making behaviors that are motivated by their developing sense of self and identity.

The fact that we observed significant effects for in-group identification and no effects on in-group favoritism has implications for researchers interested in intergroup discrimination and self-categorization. Specifically, the effects that we observed for in-group liking and in-group similarity suggest that self-categorization is likely to be influenced by both self-reflection and the level of subjective meaningfulness associated with choices or behaviors on which self-categorization is based. The absence of any effect on in-group favoritism suggests that intergroup discrimination is unlikely to be substantially impacted by self-reflection or choice meaningfulness. Research which has investigated positive-negative asymmetry within a minimal group paradigm context may help explain the discrepancy in effects between the attitudinal and behavioral measures. Positive-negative asymmetry research (see, Buhl, 1999 ; Mummendey et al., 2000 ) has demonstrated that group members tend to display stronger in-group preferences on positive stimuli compared to negative stimuli (i.e., evaluations of well regarded attributes such as creativity or intelligence, verses allocations of aversive noise). Given this research, one possibility that exists then is that in the current study, the attitudinal in-group liking and similarity measures which required participants to evaluate group members along positive dimensions were perceived more favorably compared to the behavioral measure of in-group favoritism which required participants to make allocation choices that had the potential to disadvantage out-group members.

Another possible explanation, however, for the absence of an effect on in-group favoritism could be due to aspects of the wider cultural climate within which participants were located at the time. Specifically, when this experiment took place Australia remained in the midst of a nation-wide debate regarding the legalization of same-sex marriage. Within the context of this debate university students have had strong messages of social justice and fairness directed at them at a cultural level. For example, the National Union of Students, which is the nations peak student representative body strongly advocated for students to support marriage equality ( Barlow, 2017 ). Given the cultural climate and the strong messages of social justice and fairness directed at students during the period in which this experiment took place, it is possible that in the allocation matrix tasks participants felt more compelled to engage in resource allocations which emphasized parity rather than discrimination. At the same time, in-group similarity and in-group liking ratings may have remained relatively immune to the impact of these cultural messages because perceptions of in-group identification do not necessarily equate to out-group discrimination and therefore do not have the same kinds of implications for one’s sense of fairness or social justice.

The present study may also have some implications for researchers whose work is informed by self-perception and cognitive dissonance theories. The results of the present study suggest that the application of self-reflection theory could be useful in some contexts in which cognitive dissonance and self-perception theories are not well positioned to explain the effect of choice or behavior on the self. According to self-perception theory ( Bem, 1972 ), after-the-fact explanations for behavior are generally limited to attributions about the internal (dispositional) or external (situational) cause of a behavior and are also only likely to occur in circumstances in which there is a weak or non-existent pre-existing explanation for the behavior. From the view of cognitive dissonance theory ( Festinger, 1957 ), post hoc reasoning about choices is limited to choices that induce dissonance and are motivated by a desire to reduce dissonance. Our model, however, suggests that choice or behavior is likely to effect the self as a consequence of whether it was actually perceived to be personally meaningful and that this needn’t be exclusive to dissonance inducing choices, nor to behaviors for which one does not have a pre-existing explanation.

Within the narrative identity literature, reflecting on life events in a personally meaningful way has been conceptualized as one of the key psychological mechanisms underpinning our sense of identity. To date, however, research on this issue has been largely correlational with little causal evidence available to confirm or disconfirm this claim. In the present study we sought to test experimentally if this cognitive process theorized to be so vital for identity development, could have a causal effect on self and identity. We also sought to explore the possibility that such an effect could be impacted by the level of meaningfulness associated with self-reflective reasoning, and modulated by individual differences in trait self-awareness. The results of this study largely supported our hypothesis and the proposed model from which those predictions were derived. For participants who were high in trait self-awareness, being prompted to engage in self-reflective reasoning mattered little. For this group of participants, in-group liking and similarity was related to perceptions of subjective meaningfulness relatively equally across conditions. At the same time, however, for participants low in trait self-awareness, being prompted to engage in self-reflection mattered a great deal. For these participants, subjective meaningfulness moderated in-group liking and similarity only when they had been prompted to engage in self-reflection. Overall the results of this study provide evidence to suggest that engaging in self-reflective reasoning can affect the self and identity and that this effect is impacted by both choices meaningfulness and individual differences in trait self-awareness.

Author Contributions

ND, JAO, CC, and JK all contributed to the paper and approved it for publication.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding. ND was supported by an Australian Government funded Research Training Program Scholarship.

1 Even though we predict that those high in trait self-awareness will be more likely to engage in self-reflection, given the magnitude of the relationship between trait self-awareness and perceptions of choice meaningfulness noted in our previous study (Dishon et al., under review) there is still scope for those high in trait self-awareness to find their choices meaningless.

2 Participants remained unware of this deception until they were debriefed at the end of the study.

3 As was the case in the reasoning pre condition, participants in this condition also remained unaware to the fact that they had received this feedback irrespective of their actual choices up until they were debriefed at the end of the study.

4 Even though individual differences in trait self-awareness represent a starting point in the theoretical model, in both conditions the trait self-awareness measure was administered after the self-reflection manipulation and in-group∖out-group ratings had taken place because we wanted to avoid potentially priming self-reflection processes in participants prior to their exposure to the self-reflection manipulation.

5 We also unpacked the in-group favoritism factor and ran the model on each of the individual pull scores. There was no significant difference between these models and the models using the in-group favoritism factor.

  • Adler J. M., Lodi-Smith J., Philippe F. L., Houle I. (2016). The incremental validity of narrative identity in predicting well-being a review of the field and recommendations for the future. Pers. Soc. Psychol. Rev. 20 142–175. 10.1177/1088868315585068 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Bamberg M. (2011). Who am I? Big or small—shallow or deep? Theory Psychol. 21 122–129. 10.1177/0959354309357646 [ CrossRef ] [ Google Scholar ]
  • Barlow K. (2017). The Massive Drive to Get Students to Enroll for Same-Sex Marriage Vote. The Huffington Post Australia. Available at: [accessed August 22 2017]. [ Google Scholar ]
  • Bem D. J. (1972). Self-perception theory. Adv. Exp. Soc. Psychol. 6 1–62. 10.1016/S0065-2601(08)60024-6 [ CrossRef ] [ Google Scholar ]
  • Bohn A., Berntsen D. (2008). Life story development in childhood: the development of life story abilities and the acquisition of cultural life scripts from late middle childhood to adolescence. Dev. Psychol. 44 1135–1147. 10.1037/0012-1649.44.4.1135 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Bourhis R. Y., Sachdev I., Gagnon A. (1994). “Intergroup research with the Tajfel matrices: methodological notes,” in The Psychology of Prejudice: the Ontario Symposium on Personality and Social Psychology , eds Zanna M., Olson J. (Hillsdale, NJ: Lawrence Erlbaum; ), 209–232. [ Google Scholar ]
  • Brehm J. W. (1956). Postdecision changes in the desirability of alternatives. J. Abnorm. Soc. Psychol. 52 384–389. 10.1037/h0041006 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Bruner J. S. (1990). Acts of Meaning. Cambridge, MA: Harvard University Press. [ Google Scholar ]
  • Bryan C. J., Master A., Walton G. M. (2014). “Helping” versus “being a helper”: invoking the self to increase helping in young children. Child Dev. 85 1836–1842. 10.1111/cdev.12244 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Buhl T. (1999). Positive-negative asymmetry in social discrimination: meta-analytical evidence. Group Process. Intergroup Relat. 2 51–58. 10.1177/1368430299021004 [ CrossRef ] [ Google Scholar ]
  • Carroll J. S., Johnson E. J. (1990). Decision Research: A Field Guide. Thousand Oaks, CA: Sage Publications, Inc. [ Google Scholar ]
  • Ellemers N., Kortekaas P., Ouwerkerk J. W. (1999). Self-categorisation, commitment to the group and group self-esteem as related but distinct aspects of social identity. Eur. J. Soc. Psychol. 29 371–389. 10.1002/(SICI)1099-0992(199903/05)29:2/3<371::AID-EJSP932>3.0.CO;2-U [ CrossRef ] [ Google Scholar ]
  • Erikson E. H. (1963). Childhood and Society. New York, NY: Norton. [ Google Scholar ]
  • Festinger L. (1957). A Theory of Cognitive Dissonance. Standford, CA: Stanford University Press. [ Google Scholar ]
  • Flury J. M., Ickes W. (2007). Having a weak versus strong sense of self: the sense of self scale (SOSS). Self Identity 6 281–303. 10.1080/15298860601033208 [ CrossRef ] [ Google Scholar ]
  • Frankl V. E. (1969). The Will to Meaning: Principles and Application of Logotherapy. New York, NY: World Publishing. [ Google Scholar ]
  • Grant A. M., Franklin J., Langford P. (2002). The self-reflection and insight scale: a new measure of private self-consciousness. Soc. Behav. Pers. 30 821–835. 10.2224/sbp.2002.30.8.821 [ CrossRef ] [ Google Scholar ]
  • Grieve P. G., Hogg M. A. (1999). Subjective uncertainty and intergroup discrimination in the minimal group situation. Pers. Soc. Psychol. Bull. 25 926–940. 10.1177/01461672992511002 [ CrossRef ] [ Google Scholar ]
  • Hains S. C., Hogg M. A., Duck J. M. (1997). Self-categorization and leadership: effects of group prototypicality and leader stereotypicality. Pers. Soc. Psychol. Bull. 23 1087–1100. 10.1177/01461672972310009 [ CrossRef ] [ Google Scholar ]
  • Harvey P. O., Lee J., Horan W. P., Ochsner K., Green M. F. (2011). Do patients with schizophrenia benefit from a self-referential memory bias? Schizophr. Res. 127 171–177. 10.1016/j.schres.2010.11.011 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Hogg M. A. (1992). The Social Psychology of Group Cohesiveness: From Attraction to Social Identity. London: Harvester Wheatsheaf. [ Google Scholar ]
  • Hogg M. A. (1993). Group cohesiveness: a critical review and some new directions. Eur. Rev. Soc. Psychol. 4 85–111. 10.1080/14792779343000031 [ CrossRef ] [ Google Scholar ]
  • Holdsworth L., Cartwright S. (2003). Empowerment, stress and satisfaction: an exploratory study of a call centre. Leadersh. Organ. Dev. J. 24 131–140. 10.1108/01437730310469552 [ CrossRef ] [ Google Scholar ]
  • Katznelson H. (2014). Reflective functioning: a review. Clin. Psychol. Rev. 34 107–117. 10.1016/j.cpr.2013.12.003 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Klimmt C., Hefner D., Vorderer P., Roth C., Blake C. (2010). Identification with video game characters as automatic shift of self-perceptions. Media Psychol. 13 323–338. 10.1080/15213269.2010.524911 [ CrossRef ] [ Google Scholar ]
  • Kline R. B. (2011). Principles and Practice of Structural Equation Modeling. New York, NY: Guilford Press. [ Google Scholar ]
  • Leach C. W., Van Zomeren M., Zebel S., Vliek M. L., Pennekamp S. F., Doosje B., et al. (2008). Group-level self-definition and self-investment: a hierarchical (multicomponent) model of in-group identification. J. Pers. Soc. Psychol. 95 144–165. 10.1037/0022-3514.95.1.144 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Levy K. N., Clarkin J. F., Yeomans F. E., Scott L. N., Wasserman R. H., Kernberg O. F. (2006). The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. J. Clin. Psychol. 62 481–501. 10.1002/jclp.20239 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • McAdams D. P. (1985). Power, Intimacy, and the Life Story: Personological Inquiries into Identity. New York, NY: Guilford Press. [ Google Scholar ]
  • McAdams D. P. (2001). The psychology of life stories. Rev. Gen. Psychol. 5 100–122. 10.1037/1089-2680.5.2.100 [ CrossRef ] [ Google Scholar ]
  • McAdams D. P., McLean K. C. (2013). Narrative identity. Curr. Dir. Psychol. Sci. 22 233–238. 10.1177/0963721413475622 [ CrossRef ] [ Google Scholar ]
  • McAllister I. (2016). The Mediating Role of Psychological Empowerment on the Relationship between Job and Personal Resources and Employee Engagement. Master’s thesis, San Jose State University, San Jose, CA. [ Google Scholar ]
  • Miramontez D. R., Benet-Martinez V., Nguyen A.-M. D. (2008). Bicultural identity and self/group personality perceptions. Self Identity 7 430–445. 10.1080/15298860701833119 [ CrossRef ] [ Google Scholar ]
  • Morin A. (2011). Self-awareness part 1: definition, measures, effects, functions, and antecedents. Soc. Pers. Psychol. Compass 5 807–823. 10.1111/j.1751-9004.2011.00387.x [ CrossRef ] [ Google Scholar ]
  • Mummendey A., Otten S., Berger U., Kessler T. (2000). Positive-negative asymmetry in social discrimination: valence of evaluation and salience of categorization. Pers. Soc. Psychol. Bull. 26 1258–1270. 10.1177/0146167200262007 [ CrossRef ] [ Google Scholar ]
  • Muthén L. K., Muthén B. O. (1998–2017). Mplus User’s Guide. 8th Edn Los Angeles, CA: Muthén & Muthén. [ Google Scholar ]
  • Otten S. (2016). The minimal group paradigm and its maximal impact in research on social categorization. Curr. Opin. Psychol. 11 85–89. 10.1016/j.copsyc.2016.06.010 [ CrossRef ] [ Google Scholar ]
  • Pasupathi M. (2015). “Autobiographical reasoning and my discontent: alternative paths from narrative to identity,” in The Oxford Handbook of Identity Development , eds McLean K. C., Syed M. (New York, NY: Oxford; ), 166–181. [ Google Scholar ]
  • Pasupathi M., Mansour E., Brubaker J. R. (2007). Developing a life story: constructing relations between self and experience in autobiographical narratives. Hum. Dev. 50 85–110. 10.1159/000100939 [ CrossRef ] [ Google Scholar ]
  • Phillips D. M., Olson J. C., Baumgartner H. (1995). Consumption visions in consumer decision making. Adv. Consum. Res. 22 280–284. [ Google Scholar ]
  • Rogers T. B., Kuiper N. A., Kirker W. S. (1977). Self-reference and the encoding of personal information. J. Pers. Soc. Psychol. 35 677–688. 10.1037/0022-3514.35.9.677 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Sass L. A., Parnas J. (2003). Schizophrenia, consciousness, and the self. Schizophr. Bull. 29 427–444. 10.1093/oxfordjournals.schbul.a007017 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Singer J. A., Blagov P., Berry M., Oost K. M. (2013). Self-defining memories, scripts, and the life story: narrative identity in personality and psychotherapy. J. Pers. 81 569–582. 10.1111/jopy.12005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Spreitzer G. M. (1995). Psychological empowerment in the workplace: dimensions, measurement, and validation. Acad. Manage. J. 38 1442–1465. 10.2307/256865 [ CrossRef ] [ Google Scholar ]
  • Spreitzer G. M., Kizilos M. A., Nason S. W. (1997). A dimensional analysis of the relationship between psychological empowerment and effectiveness, satisfaction, and strain. J. Manag. 23 679–704. [ Google Scholar ]
  • Symons C. S., Johnson B. T. (1997). The self-reference effect in memory: a meta- analysis. Psychol. Bull. 121 371–394. 10.1037/0033-2909.121.3.371 [ PubMed ] [ CrossRef ] [ Google Scholar ]
  • Tajfel H. (1981). Human Groups and Social Categories: Studies in Social Psychology. Cambridge, MA: Cambridge University Press. [ Google Scholar ]
  • Tajfel H., Billig M. G., Bundy R. P., Flament C. (1971). Social categorization and intergroup behaviour. Eur. J. Soc. Psychol. 1 149–178. 10.1002/ejsp.2420010202 [ CrossRef ] [ Google Scholar ]
  • Tajfel H., Turner J. C. (1986). “The social identity theory of intergroup behavior,” in The Psychology of Intergroup Relations , eds Worchel S., Austin W. (Chicago, IL: Nelson-Hall; ), 7–24. [ Google Scholar ]
  • Wilson T. D., Lisle D. J., Schooler J. W., Hodges S. D., Klaaren K. J., LaFleur S. J. (1993). Introspecting about reasons can reduce post-choice satisfaction. Pers. Soc. Psychol. Bull. 19 331–339. 10.1177/0146167293193010 [ CrossRef ] [ Google Scholar ]
  • Open access
  • Published: 14 February 2024

Trauma, early life stress, and mindfulness in adulthood

  • Jonathan Gibson 1  

BMC Psychology volume  12 , Article number:  71 ( 2024 ) Cite this article

154 Accesses

Metrics details

This article is a review that was inspired by recent studies investigating the effects of childhood trauma or early life stress (ELS) and mindfulness in adulthood. One recent study found that some forms of abuse and neglect led to higher scores in several subscales of a self-report measure of mindfulness. The authors concluded that some forms of ELS can help cultivate certain aspects of mindfulness in adulthood. However, and in contrast to this recent finding, much of the extant literature investigating ELS and trauma are linked to emotional dysregulation, alexithymia, and a host of psychopathologies in adulthood which makes the results of this study surprising. Central to the mindfulness literature is cultivating an open, non-reactive, or non-judgment awareness of inner experiences which are important for emotional regulation. In this paper, I review some of the effects of trauma or ELS on critical neural circuits linked to mindfulness, interoception, attachment, and alexithymia which I hope may clarify some of the conflicting findings from this study and throughout the literature and provide additional context and a framework that may inform research investigating these two constructs going forward.

Peer Review reports


A recent study [ 1 ] set out to explore the link between early life stress (ELS) and trait mindfulness in adulthood. Trait mindfulness was defined as: “the awareness that emerges through deliberate attention in the present moment, with intention, without judgment, making the most of the current experience” [1 p. 2]. As the authors point out, there is a gap in the literature exploring these two constructs and little is known whether ELS can affect the latter or vice versa. There is a wealth of literature demonstrating the benefits of mindfulness and how mindfulness can help build resilience, manage stress and emotions, and improve the overall quality of life which might have an indirect effect on childhood trauma [ 2 , 3 , 4 ], but the authors claimed a study exploring the link between the two had yet been done. It is important to note that there is at least one prior study that has explored the link between childhood and lifetime trauma, mindfulness, PTSD, and dissociative symptoms. That study will be reviewed in a subsequent section below. The authors in this recent study [ 1 ] conducted a cross-sectional correlational design from a Brazilian public university and most of the findings corroborate prior research on ELS and mindfulness. That is, those who experienced less ELS tended to score higher in various facets of mindfulness, at least as it was measured by the Five-Facet Mindfulness Questionnaire (FFMQ) and the Childhood Trauma Questionnaire (CTQ).

However, the researchers found some forms of ELS may help cultivate certain aspects of mindfulness in adulthood. Specifically, participants in their study who experienced more emotional abuse, emotional neglect, and physical abuse scored higher in the subscale of “non-reactivity to inner experience” and those who experienced more emotional abuse, emotional neglect, sexual abuse, physical neglect, and physical abuse scored higher in “acting with awareness,” though those correlations were modest [ 1 ]. The non-reactivity facet of this assessment tool is believed to measure one’s ability to notice internal sensations and emotions and mindfully process those and let them pass without overreacting or being overrun by them. The “acting with awareness” is believed to measure engagement and awareness of the present moment rather than being distracted or on autopilot. This type of awareness and non-reaction or non-judgment of inner experiences are central facets to the mindfulness literature and are critical for emotional regulation and psychological well-being [ 1 , 5 , 6 , 7 ]. This novel finding is provocative especially when compared to prior studies investigating ELS or trauma which have been consistently linked to emotional dysregulation and a host of psychopathologies in adulthood. The authors suggest that this specific population may have learned to cultivate emotional regulation even in the presence of childhood trauma [ 1 ].

The purpose of this article is to provide additional context and a framework that may help inform some of the conceptual and methodological baggage that shapes these constructs. This paper is not meant to be comprehensive, but I will review some of the effects of trauma or ELS on critical neural circuits that influence the development of mindfulness, interoception, attachment, and alexithymia and how those capacities appear to be fundamentally shaped by the relational environment, or as the authors described it as ‘bio-social functions’ [ 1 ]. It may be possible the results of the study [ 1 ] may be skewed due to construct conceptualization and methodological limitation. In short, it is hoped that this framework can shed light and help account for some of the inconsistent and even contradictory findings in the contemplative or mindfulness literature and help identify putative neurological target interventions in the clinical literature.

As the authors [ 1 ] highlight, ELS including emotional, physical, sexual abuse, and neglect is linked to a number of physical and psychological disorders [ 4 , 8 , 9 , 10 ]. These negative outcomes are consistent and well documented throughout the literature. Moreover, ELS has been shown to influence the development of neural structures linked to emotion processing and memory, [ 10 , 11 , 12 , 13 , 14 ] attachment and relational patterns, [ 15 , 16 , 17 , 18 ] interoception (awareness of the internal state of the body), [ 5 , 6 , 7 , 19 , 20 , 21 , 22 ] which is believed to be foundational to mindfulness [ 5 , 22 , 23 , 24 , 25 , 26 ], and alexithymia [ 27 ]. It is generally accepted that ELS can lead to maladaptive or unhealthy emotional and behavioral responses and a myriad of psychological disorders in adult life [see 1 for review].

  • Mindfulness

To begin, a close examination of the constructs described in this study is needed. Despite its growing popularity in the scientific community and society generally, mindfulness itself remains broadly defined and loosely conceptualized [ 26 , 28 – 29 ]. Critics [ 28 ] have emphasized that mindfulness has become an umbrella term that characterizes a large number of practices, processes, and characteristics spanning acceptance, awareness, non-judgment and memory. The confusion surrounding mindfulness includes the problems of defining and measuring it. The capacity to be mindful is believed to be multi-faceted [ 28 , 29 , 30 , 17 ]. Some have argued that attention to the present moment may be the single most critical aspect of mindfulness [ 30 ]. Others emphasize a particular attentional style. For example, Kabat-Zinn [ 31 ] argued that mindfulness is not just moment-to-moment awareness, but a specific type of awareness that includes an objective, non-reactive, non-judgmental, and open-heart. These definitions, however, still leave room for interpretation [see 28 for review].

In addition to its broad definition, sometimes researchers refer to mindfulness as a particular meditation – whether it is an open-monitoring meditation, breathing mediation, or body scan [ 28 ]. This is also problematic because each meditation produces different effects and requires different attentional styles [ 26 , 32 ]. It is generally believed in the contemplative literature that attention regulation is the prerequisite for other beneficial outcomes to take place [ 5 , 33 ]. However, each of those meditations have been categorized in different ways. For example, a mindfulness meditation is often referred to as ‘open-monitoring’ (OM) meditation which explicitly prescribes a mindful attentional style to both interoceptive and exteroceptive sensations, thoughts, and emotions [ 34 , 35 ]. Breathing and body scan meditations have been categorized as a focused attention (FA) meditation [ 34 , 35 , 36 ]. Focused attention meditations involve focusing and maintaining attention on a single object such as one’s breath, heartbeat, or a mantra [ 33 ].

The semantic ambiguity in the meaning of mindfulness or mindful meditations has implications. Van Dam and his colleagues [ 28 ] argued that any study using the term mindfulness must be carefully scrutinized to accurately ascertain what type of “mindfulness” was involved. They also urged scientists, practitioners, and the media alike to move away from the broad use of the term mindfulness and more clearly specify exactly what practices and processes are being taught. That is, when formal meditation is used in a study, one ought to consider whether a mindful or open-monitoring meditation or a focused attention meditation was the target intervention. For instance, the mindfulness-based stress reduction (MBSR) program consists of multicomponent treatments and employs both FA meditative techniques (body scan and yoga) and an OM or mindfulness technique (sitting meditation). Yet, all of these interventions require different attentional styles which produce different effects [ 26 , 37 ]. As Holzel et al., [ 33 ] point out, it is unclear what role “mindfulness” may play in the various, documented outcomes. These distinctions are critical because how mindfulness is operationalized will determine what is measured and how and those differences can vary from scale to scale [ 29 ].

Even though mindfulness has its roots in Buddhism, the scientific investigation of mindfulness has been shaped by Western scientific methodologies and assumptions. Grossman [ 29 ] argued that mindfulness, in the Buddhist tradition, is meant to cultivate “truths” about personal, lived experience which is a subjective phenomenon that is difficult to measure using traditional, Western methodologies. This effort is further problematized because the definition and measurement of mindfulness is enmeshed in a ‘complex web of historical, social, economic, political, and technological factors’ [ 29 ]. The mindfulness assessments themselves – even with good psychometric scores of reliability and validity – are often operationalized in different ways and those meanings (including the meaning of mindfulness itself), and can differ from scale to scale [ 38 ]. Furthermore, there are semantic ambiguities in assessment items which have led to questionable outcomes e.g., binge-drinking students score more “mindfully” than healthy controls or long-term mindfulness meditators [see 29 for review]. It has also been shown that various scales don’t often correlate highly with one another [ 38 , 39 ]. All of these challenges measuring and defining mindfulness should cause one to remain cautious in interpreting results. Mindfulness remains a broadly defined and loosely conceptualized construct and the assessment tools may be too imprecise to ideally capture these nuanced abilities.

Mindfulness, the insula, and interoceptive or salience network

Both the FA and OM mediations produce different neurological and functional effects, [ 26 , 33 ] but there are important commonalities. Research has shown that all meditations included in mindfulness practices directly shape the anatomy and function of the insula and interoceptive network (IA) or salience network (SN) [ 23 , 24 , 25 , 26 , 32 , 40 , 41 , 42 , 43 , 44 , 45 ]. The IA/SN network spans various brain regions, which include the insular cortex, anterior cingulate cortex (ACC), the inferior frontal gyrus, and the sensorimotor cortex, but also presents multiple connections to the amygdala, hypothalamus, hippocampus, and brainstem [ 5 , 23 , 24 , 25 , 26 ]. To be clear, a recent meta-analysis has shown that every meditation type including FA, OM, mantra, and loving/kindness meditations have been shown to modulate the insula in some way [ 32 ]. Furthermore, the insula is believed to be the only neural structure that is modified by any and all meditations [ 32 ]. As Fox and Cahn [ 32 ] point out, given that the insula is the hub for interoception, this finding shouldn’t be surprising as the body plays a central role in mindfulness practices [ 5 , 6 , 7 , 23 , 24 , 25 , 26 ].

Studies have consistently shown that dispositional and trait mindfulness is linked with increased activity and cortical thickness in the insula [ 23 , 24 , 25 , 26 , 42 , 43 , 44 , 45 ]. Friedel et al., [ 25 ] found that these neuroplasticity changes are true not only in adults but also in adolescents. The authors argue: “While evidence for anterior insula involvement in adult long-term meditator has been interpreted to indicate an effect of mindfulness meditation on insula structure and function, the current results suggest that structural development of the anterior insula may contribute to the development of dispositional mindfulness” (pp. 67). Indeed, many have argued that increased interoception and the neuroplasticity changes produced within the insula, ACC, and IA/SN network are foundational to developing mindfulness [ 5 , 6 , 7 , 22 , 23 , 24 , 25 , 26 ]. Thus, a close examination of the functions of insula, ACC, and IA/SN circuits will prove useful here.

Emotional awareness, regulation, and interoception

de Morales et al., [ 1 ] rightly point to emotional awareness and emotional regulation as central facets of mindfulness as it is a consistent theme throughout the literature. Emotion regulation is also at the heart of psychological well-being as it enables an individual to develop appropriate, flexible, and adaptable responses in adult life [ 1 ]. Emotion regulation begins with recognizing a stimulus and then establishing a meaning [ 1 ]. Studies have shown that effective emotional regulation appears to be at least partly dependent upon accurate interoception [ 45 , 46 , 47 , 5 ]. Indeed, in Buddhist philosophy, the first pillar to develop mindfulness is to develop a sense of the body, which includes an awareness of momentary sensation while distinguishing sensation from conceptual thought [ 5 , 48 ].

The insula, ACC, and IA/SN network have been shown to be essential circuits not only for emotional awareness, but awareness of the present moment [see 49 for review] – a salient facet in the mindfulness literature. Craig [ 49 , 50 ] connected human awareness to emotional awareness and interoception. In his review, he discussed how all stimuli or sensations that are salient to the individual are ultimately represented by feelings which are crucial neuropsychological constructs that function as the currency of awareness [ 49 ]. The insula, ACC, and IA/SN network translate interoceptive signals into feelings and emotions. This framework isn’t new as early and modern theories of emotion have emphasized the importance of interoceptive feedback in emotional states and cognitive processes [ 21 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]. For example, Damasio, [ 51 ] building off the work of William James, [ 52 ] argued that positive or negative emotional feeling states are associated with visceral and other bodily responses to certain situations and awareness of those are essential for affective, cognitive, and interpersonal processes.

Studies have shown that individuals who are more aware of their body – higher levels of interoceptive awareness – report more intense emotional experiences than those who are less aware [ 54 , 55 , 56 ]. This is important because emotional experiences appear be associated with individual differences in one’s ability to both generate and perceive subtle bodily changes [ 56 , 57 , 58 ]. Zaki et al., [ 58 ] demonstrated that the interoceptive network is highly engaged in emotional processing and that “emotional experience is intimately tied to information about internal bodily states” (p. 498). The insula has been shown to be the key region which integrates information from the body via lamina 1 spinothalamic and vagal afferent tracts [ 49 ]. Much of those body sensations projects ultimately into the posterior portion of the insula and somatosensory cortices and is re-represented in the mid and anterior portion of the insula which is then sent to the prefrontal regions bringing subtle, interoceptive sensations into awareness [ 5 , 49 ]. The anterior portion of the insula provides a multilevel integrated meta-representation of the state of the entire body integrating body sensations and top-down processes into a broader context [ 49 , 50 , 51 , 5 ].

There is a growing body of literature indicating that learning to accurately discern bodily signals through meditation and mindfulness can enhance one’s ability to understand one’s emotional state [ 23 , 24 , 25 , 60 , 61 , 62 ]. Contemplative practices, including mindfulness, produce neuroplasticity changes within IA/SN circuits increasing interoception by bringing subtle interoceptive cues into awareness [ 23 , 24 , 25 , 26 , 43 , 44 , 45 , 46 , 47 ]. The observed neuroplasticity changes within those circuits can explain how meditation and mindfulness enhance interoceptive sensations and emotional awareness [see 26 for review]. This increased awareness can then be used to develop adaptive strategies to regulate stress and improve well-being [ 5 , 63 ].

To summarize, emotional awareness and effective emotional regulation appear to be dependent upon accurate interoception [ 45 , 46 , 47 , 55 , 56 , 57 , 58 ]. Interoception is necessary for emotional awareness, and thus, interoception becomes a basis for engaging emotional processing. To be mindfully aware of interoceptive sensations and resultant emotions in a stable, non-reactive awareness in stressful situations is a central feature in the mindfulness literature [ 5 , 6 , 7 , 63 ]. Mehling and his colleagues [ 63 ] point out, being able to mindfully accept body sensations may reduce the emotional impact of unpleasant ones. This capacity may also enable one to “listen” to emotion-related sensations that are central to insight and decision making rather than being “overrun” by them. This raises two important questions: do individuals who have suffered from various forms of ELS mindfully process interoceptive sensations and the emotional effects? And, in addition, can the assessment tools used accurately capture this refined, nuanced ability?

Interoception and mindfulness

Interoceptive awareness and mindfulness are associated but distinct constructs in mind-body interactions [ 26 , 63 ]. Attention regulation is a critical distinction in teasing these two constructs apart [ 26 , 63 ]. For example, in some mindfulness practices there is no distinction between attention directed to interoceptive sensations, exteroceptive stimuli, or conscious thoughts [ 63 ]. This is relevant as several studies highlight different attentional styles (that is, how and where one focuses attention) elicit different neural responses [ 32 , 45 , 62 ]. In the interoception literature, the assessments tools often fail to distinguish between different attention styles [ 63 ]. For instance, some scales do not differentiate from anxiety or hypervigilant attentional style to interoceptive sensations and mindful and open-monitoring styles [ 63 ]. Training individuals to focus solely on interoceptive sensations does not necessarily imbue participants with knowledge on how to alter attentional style or mental habits commonly employed to avoid unpleasant sensations when they emerge [ 5 , 6 , 26 , 63 ].

Dispositional mindfulness may promote more adaptive interoceptive attentional style and enhance or illuminate discriminative capacities related to various bodily sensations [ 5 , 6 , 26 , 63 ]. That is, intentional mindful awareness may provide a safe focal point from which one can view various signals from the body. As Hanley et al., [ 6 ] argue: “awareness of bodily sensations and the evaluative or regulatory tendencies applied to such sensations are important determinants of emotional health” (p. 5). One way to investigate how some can develop the mindful capacity to be aware of and sift through various interoceptive and emotional processes in a non-reactive, non-judgmental manner is to examine the development of the insula, ACC, and IA/SN network through the biosocial functions [ 1 ], specifically the attachment relationship [ 18 ].

Insula and attachment

There is extensive empirical evidence demonstrating that early childhood relationships and experiences, including ELS, directly shape the development of a number of brain circuits, including and especially the insula, ACC, and IA/SN network [ 15 , 16 , 18 ]. Investigating ELS from the attachment relationship should help clarify how ELS directly shapes mindfulness abilities in adulthood. Indeed, a recent study found attachment orientation seems to have a unidirectional and causal effect on mindfulness in adulthood [ 17 ]. That is, those who had insecure attachments in childhood due to neglect or other forms of ELS, were unable to cultivate trait mindfulness in adulthood.

de Morales et al., [ 1 ] aptly point to biosocial functions in their discussion section. Research has clearly demonstrated that early life experiences, including attachment patterns in childhood, have enduring consequences throughout the lifespan on emotional regulation [ 64 , 65 , 66 , 67 ]. Oldroyd et al., [ 18 ] point out that the insula and IA/SN neural circuits that are necessary for interoception and emotional regulation show protracted post-natal development. The architecture and function of these neural circuits are heavily shaped by early experiences and relationships. Some have even argued that normal brain development may be dependent upon a secure attachment [ 15 , 68 ] which is characterized by sensitive, loving, and supportive relationships [ 68 , 69 ].

Children with secure attachments who have formed a secure bond with their primary caregiver manage their anxiety and autonomic arousal with a degree of trust due to the caregiver’s consistent and attentive response to the child’s needs [ 18 , 68 , 69 ]. Those interpersonal experiences shape internal working models and the development of the neural circuits involved not only in relational processes, but also interoception, mindfulness, and emotional regulation. These processes will be further unpacked below. In summary, when a child feels loved, secure, and trust in their relationship with their caregiver, they will use the caregiver as a “secure base” from which to explore the environment and manage their stress response [ 69 ].

Several studies have shown that individual differences in attachment patterns are characterized by different neural responses to stress [see 18 for review]. When a parent avoids responding to or delays meeting the child’s immediate needs (e.g., neglect), or is inconsistent or only conditionally available, then the child may develop an insecure avoidant or anxious attachment pattern [ 18 ]. Insecure attachment orientation is typically conceptualized along two dimensions: anxious and avoidant [ 70 ]. Individuals with insecure avoidant or insecure anxious attachments show not only altered IA/SN networks, but these individuals also suffer from dysregulated hypothalamus-pituitary-adrenal (HPA) axis activity in response to stress across the lifespan [ 71 , 72 ].

Stress regulation and interoception utilize many of the same anatomical pathways between the brain and body [ 49 , 54 , 73 , 74 , 75 ]. Trauma or ELS found in the attachment relationship directly shape the neural circuits that govern interoception and distress, both of which are necessary for emotional regulation. Furthermore, researchers [ 73 , 74 ] identified a direct link from the sympathetic nervous system to the insula, ACC, and IA/SN network with specialized neurons within that network called Von Economo Neurons (VEN’s). These neurons are believed to be a cerebral representation of the autonomic nervous system [ 73 , 74 ]. Interestingly, these neurons are only found in the IA/SN network [ 49 , 73 , 74 ] and the gut or enteric nervous system [ 53 ] and are believed to process and integrate emotion and behavior [ 49 , 73 , 74 ]. Research is reliably showing that ELS affects the development of the HPA axis, the insula, ACC, and IA/SN network, which, in turn, affects interoception, one’s ability to be mindful, and to regulate stress and emotion. Furthermore, trauma and ELS have been shown to affect both the strength of those interoceptive signals and how those signals are perceived [ 18 ]. Friedel et al., [ 25 ] argue that there should be increased emphasis on the insula, and the IA/SN network as these circuits not only play a critical role in maintaining emotion and self-regulation, but also provides a distinct construct with a measurable neurobiological imprint.

Attachment, interoception, and non-reactivity

Attachment related processes have also been linked to insular anatomy and activity. Studies have shown that those with an avoidant or anxious attachment pattern have markedly lower insular volume and smaller surface areas than those with a secure attachment [ 76 , 77 , 78 , 79 ]. Furthermore, those with avoidant attachment patterns have decreased insular electrical activity compared to securely attached controls [ 78 ]. Oldroyd et al., [ 18 ] argue, insensitive, slow, inconsistent caregiving or rejection of the infant’s distress impairs the child’s ability to form accurate bodily representations because the infant must rely on caregivers’ responses to help shape and inform accurate interoceptive states.

The insula also plays a critical role in comparing feelings in the present moment with those of the past and anticipation of the future [ 80 ], which plays an important role in meta-memory processing [ 81 ]. This meta-memory process can explain why interoceptive predictions that are associated with trauma or ELS are often distorted [ 40 ] as the insula becomes unusually overactive in individuals who have experienced abuse or trauma [ 21 , 49 ] or underactive in those who have been neglected [ 17 , 18 , 82 ]. Individuals with an anxious attachment pattern might overemphasize or exaggerate bodily cues leading to emotional distress and dysregulation. In contrast, those with avoidant attachment patterns might minimize or suppress bodily cues [ 17 , 18 ]. “This means that the more avoidant a person’s attachment style, the less attention they paid to their bodily cues and the less they tended to trust those cues” [18 pp. 5].

ELS and mindfulness

The result de Morales et al., [ 1 ] found that various forms of ELS might help cultivate increased awareness of and non-reactive response to inner experience (i.e., interoception) is surprising because a central facet to mindfulness is the ability to pause, increase awareness, and gain greater access to sensations and emotions without being overcome by those feelings [ 5 , 6 , 7 , 63 ]. The hypothesis in the original study [ 1 ] was that those who experienced certain types of ELS, including neglect and several forms of abuse, may be more aware and less judgmental of bodily sensations. However, the authors [ 1 ] highlight those participants continued to react with “greater intensity to their inner experiences” [ p. 9] which they argued revealed a deficit in their coping or emotional regulation strategies [p. 9]. This raises important questions: Are those participants mindfully processing interoceptive sensations and emotions? Or did those who experienced heightened levels of ELS develop patterns similar to an insecure attachment style consistent with the anatomical and functional neural changes characteristic of those patterns?

Avoidant individuals have often been described in the literature as manifesting a disconnect between bodily cues and their physiological responses [ 82 ]. These individuals may present as if they were calm while in a distressing situation (e.g., mindful), when they simply dissociated from or suppressed those sensations in a non-reactive way [ 83 , 84 ]. As Oldroyd and her colleagues [ 18 ] argue, those with avoidant attachment patterns have learned to either minimize or suppress those signals. It is also possible those participants developed alexithymia which is defined as an impaired ability to be aware of, explicitly identify, and describe one’s feelings [ 85 ]. Those participants may be unable to accurately perceive and identify interoceptive signals and use those to inform their emotional state.

A recent study investigated the effects of childhood trauma, attachment, addiction, and alexithymia [ 27 ]. The results of this recent study [ 27 ] corroborated prior studies which found alexithymia is a common result of childhood trauma or ELS. Moreover, alexithymia is now recognized as a key factor responsible for non-adaptive strategies of regulating emotions [ 27 , 86 ]. Characteristics of alexithymia include (1) difficulty identifying feelings and distinguishing between feelings and bodily sensations of emotional arousal, (2) difficulty describing feelings toward other people, (3) externally oriented cognitive style, and (4) low perspective taking, as well as difficulty describing and understanding the emotions of others [ 86 ].

Interestingly, the authors [ 27 ] found that the strongest predictor for developing alexithymia in adulthood were insecure anxious and avoidant attachment patterns from childhood. Specifically, the authors [ 27 ] found that “avoidant attachment style has the strongest negative impact on the development of a strategy for affect regulation and general emotional development” [p. 9]. Conversely, studies have shown that those with a secure attachment have an inverse relation to alexithymia [see 27 for review]. Insecure avoidant attachment styles also demonstrate lower levels of trust in personal relationships, [ 87 ] trust in themselves, [ 88 ] and the insula has been shown to be the neural correlate for evaluating trustworthiness of others [ 49 ]. The insula is also believed to be a critical neural circuit linked to alexithymia [ 49 ]. Thus, an individual who has not developed trust in a loving caregiver has not learned to trust others or themselves, nor can they expect their body to give them reliable signals that inform their emotional state [ 18 , 27 ]. Indeed, there is an extensive body of literature that has linked insecure attachment styles to alexithymia [see 27, 90–91 for review].

There is growing evidence that accurate interoception develops initially in the context of interpersonal relationships [ 18 ]. A child’s attachment relationship characterized by either a warm and responsive connection with the primary caregiver, or a distressing relationship characterized by trauma, neglect, or indifference inevitably shapes those neural circuits related to stress and interoception. “To the extent that a child’s bodily experiences are denied, devalued, ignored, or punished by parents, the child will find ways to avoid feeling them, and develop a distorted sense of interoception” [18 pp. 10].

de Morales et al., [ 1 ] point to the “biosocial” facet of cultivating emotional awareness, emotional regulation, and mindfulness. It appears that ELS and trauma disrupt the attachment system which creates a ripple effect. In concert with a large body of literature, increased awareness and effective emotional regulation appear to be dependent upon accurate interoception. Accurate interoception is shaped by early life experiences, including the attachment relationship. Accurate interoception and proper development of the insula, ACC, and IA/SN network has been shown to be foundational to developing mindfulness and emotional regulation. Trauma or ELS seems to lead to insecure attachments, alexithymia, and host of psychopathologies.

Attachment and mindfulness

Some research has explored why attachment and mindfulness may be linked. Both constructs are linked to the same neural circuitry, and both contribute to a range of positive outcomes including mental health, and self and emotion regulation [ 89 , 90 ]. Ryan et al., [ 89 ] suggested that mindfulness and attachment have a bi-directional relationship. They argued that attachment security fostered enhanced awareness and attentiveness to relational patterns while mindfulness was believed to increase one’s capacity for a secure relationship by cultivating an open, receptive attention to relationship partners. Stevenson et al., [ 17 ] has challenged that assumption as they found that attachment orientation seems to play a unidirectional, causal role in the development of mindfulness. The authors wrote: “the organization of the attachment system and inner working models, resultant of caregiver warmth and availability, not only influence the way in which we view ourselves and others, but also the capacity in which we attend to our experiences” (pp. 21). Their research indicates that attachment orientation comes first and can predict and affect the capacity for mindfulness in adulthood.

Mindfulness, trauma, PTSD, and dissociation

As mentioned in the introduction, there was at least one prior study investigating childhood trauma and mindfulness. Specifically, the authors explored whether mindfulness traits (measured using the FFMQ) would mediate the relationship between childhood and lifetime trauma, PTSD, and dissociative symptoms [ 91 ]. The authors found an inverse relationship between mindfulness, trauma, PTSD, dissociative PTSD, and trauma-related altered states of consciousness (TRASC). That is, those who had increased traumatic experiences and PTSD symptomology had a decreased capacity for trait mindfulness. Unlike de Moralez et al., [ 1 ], this study did not find a relationship between trauma and the mindfulness facets of non-reactivity and acting with awareness. Moreover, the authors argued that a decreased capacity for different facets of mindfulness may be one mechanism by which trauma exposure leads to the development of PTSD or trauma-related distress or dissociation.

Interestingly, however, the authors did find that individual differences in mindfulness traits may partially mediate the association between increased lifetime and childhood trauma exposure and posttraumatic symptoms [ 91 ]. They found the facets of describing, acting with awareness, non-judgment, and non-reactivity revealed a negative relationship with trauma, PTSD, and PTSD symptomology. They did make particular note of the observing facet. They found observing was associated with increased PTSD symptomology and linked to childhood and lifetime trauma and exposure. The authors wrote: “Observing trait may be a risk factor for , rather than a protective factor against , mental health problems” (pp. 678).

This is interesting because some studies have found a link with the observing trait and a history of trauma [ 91 , 92 ], while others have linked the observing trait with measures of good psychological health [ 93 ]. Herein lies a contradiction as some critics [see 28 for review] have pointed out. How can the observing trait be linked to both mindfulness and emotional regulation, while also linked to emotion dysregulation and a host of psychopathologies? Some hypothesize that the observing facet serves as a marker of vividness or depth of experience [ 91 , 92 ]. Boughner et al., [ 91 ] wrote: “in persons exposed to life experiences that are for the most part positive, nurturing, and safe, being more mindfully observant will heighten the influence of such adaptive life experiences in encouraging psychological health. In contrast, if a person is repeatedly exposed to life events that are highly stressful or traumatic in nature, those who are predisposed toward heightened Observing may experience such events with increased intensity, increasing risk for aversive consequences” [pp. 677].

Early childhood experiences whether nurturing, safe, and secure, or traumatic, abusive, or neglectful alter internal working models and neural circuits linked to those functions that appear to have lifelong effects. Therefore, investigating mindfulness from a developmental and relational or attachment model may prove to be a useful framework in interpreting some of the inconsistent findings throughout the mindfulness and contemplative literature and help identify putative target interventions from a clinical perspective. Indeed, a recent study [ 94 ] has identified disruptions in the dorsal mid-insula across a number of psychological disorders, which the authors found were anatomically distinct from other brain regions in affective processing.

I have attempted to lay out a conceptual or theoretical framework from which to interpret the link between trauma, ELS, and mindfulness. It is my hope this article can prove to be a useful reference piece in aiding future research. It may be possible that ELS or trauma can help cultivate certain aspects of mindfulness in adulthood. If this is the case, this finding warrants further, careful investigation. It is also possible that the results of this recent study [ 1 ] may be skewed due to several factors. Among those is the definition and conceptualization of mindfulness. How mindfulness is operationalized changes how it is measured [ 29 ]. Popular scales don’t often highly correlate and the meanings within those scales can differ [ 29 , 38 ]. There are also semantic ambiguities in assessment items which have led to questionable outcomes such as binge-drinking students scoring higher in mindfulness than practiced meditators [ 29 , 38 ]. Boughner et al., [ 91 ] also pointed to construct limitations as a potential confound in the literature. They highlighted that a significant overlap exists between some mindfulness assessments and PTSD diagnostic criteria in the DSM-5. For example, the mindful trait of describing “overlaps considerably with alexithymic symptomology of PTSD associated with the emotional numbing criteria of DSM-5 PTSD” [pp. 677]. They argue further that the non-reactivity trait implies the opposite of emotion dysregulation but may overlap with trauma-related immobilization defenses [ 91 , 95 ], which is in concert with the conceptual framework of avoidant attachment and alexithymia described above.

de Moralez et al., [ 1 ] acknowledged the questionnaire as a limitation in their study and indicated that the questions “proved outdated, especially with those questions that started with the word “non” [p. 9]. The authors had to assist participants in answering the questions as some participants became fatigued during the process raising questions on the accuracy of the results [ 1 ]. Moreover, the authors noted that during data collection, stress levels were elevated for the given population due to a variety of factors. There are also a number of limitations using self-report assessments. For example, the use of questionnaires rather than interviews is believed to exaggerate the clinical significance of trauma-related symptoms in the general population [ 95 ]. Furthermore, trauma questionnaires measure only the occurrence of an event but not the frequency or severity [ 91 ]. Finally, it was reported that less than 20% of the participants in this study had a meditation or mindfulness practice [ 1 ]. This is relevant because a mindfulness meditation practice has shown to reliably produce neuroplasticity changes within the insula, ACC, and IA/SN network which could affect the results [see also 94]. However, mindfulness questionnaires do not always correlate with mindfulness meditation practices [ 96 ]. This variable ought to be explored more closely in the future.

The authors [ 1 ] also focused on emotion regulation. Emotional awareness is the first step to emotional regulation which requires recognition of a stimulus and to assign it meaning [ 1 ]. Key facets of emotional awareness and regulation appear to be dependent upon accurate interoception, [ 46 – 47 , 54 , 55 , 56 , 57 , 58 ] and interoception is believed to be foundational to mindfulness [ 5 , 22 , 23 , 24 , 25 , 26 ] as all three of these abilities utilize much of the same neural circuitry. Furthermore, a growing body of evidence indicates that accurate interoception is shaped by early life experiences. The effects of ELS and trauma on the nervous system is widely discussed in the literature and the results are consistently linked to emotional dysregulation and a host of psychopathologies [ 4 , 8 , 9 , 10 ]. In short, trauma or ELS have been shown to affect a number of brain regions. The focus here has been on the insula, ACC, and the IA/SN circuits as they appear to be critical circuits in attachment, interoception, which appears to be necessary for emotional awareness and regulation, mindfulness, and alexithymia. As Friedel and his colleagues [ 25 ] argue, there should be increased emphasis on these regions because it provides a distinct construct with a measurable neurobiological imprint. Furthermore, novel treatments focused on the insula may aid in more effective interventions from a clinical perspective as a number of psychological disorders have been shown to have disruptive functions within the insula that are showing to be anatomically distinct from other brain regions [ 94 ].

Some have argued that the insula is an ‘underestimated region of the brain’ [ 97 ] while others have argued that it is still poorly understood [ 98 ]. This is interesting because the insula and IA/SN circuits are not only linked to the functions described above, but also implicated in all subjective feelings [49. 50]. That is, these circuits appear to be the cortical structures that not only engender interoception and emotional awareness, but awareness in the present moment [ 50 ].

Emotional awareness and regulation are also associated with individual differences in ability to both generate and perceive subtle bodily changes [ 57 – 58 ]. Those who have experienced ELS often develop insecure attachments with the characteristic anatomical and functional effects on those neural circuits [ 15 , 16 , 17 , 18 , 76 , 77 , 78 , 79 , 82 , 83 , 84 ]. Someone with an insecure anxious attachment style might overreact to internal sensations while an insecure avoidant may suppress or ignore those. Therefore, the result that some forms of ELS might lead to a non-reactive and non-judgment heightened awareness of inner experience is provocative [ 1 ]. Alternatively, and consistent with an extensive body of literature, it seems plausible that those who scored higher in the awareness and non-reactive or non-judgmental aspect of the assessment tool [ 1 ] may be suppressing or minimizing those signals rather than mindfully, non-judgmentally or non-reactively processing them [see also 94]. This pattern is consistent with the avoidant attachment styles [ 18 , 82 , 83 , 84 ] and alexithymia [ 27 , 49 , 86 – 87 , 99 – 100 ] which could account for the results of the study [ 1 ].

As the authors emphasized, [ 1 ] understanding the link between ELS and mindfulness should encourage researchers to explore the two more carefully. Their findings emphasize the importance of emotional regulation as ELS is consistently linked to emotional dysregulation and psychological disorders later in life, but their results suggest there may be some positives. The authors [ 1 ] also suggested that those within that specific population may have developed various strategies to improve emotional regulation and became more mindful of their internal states. Thus, a more careful, precise analysis of these constructs is needed. I applaud the authors for their study as it brings these important constructs into focal view.

Data availability

Not Applicable.

de Moraes VS, Fernandes M, Fernandes MNF, Gimenez LBH, et al. Relationship between early-life stress and trait mindfulness in adulthood: a correlational study. BMC Psychol. 2023;11:15. .

Article   PubMed   PubMed Central   Google Scholar  

Bethell C, Gombojav N, Solloway M, Wissow L. Adverse childhood experiences, resilience and mindfulnessbased approaches: common denominator issues for children with emotional, mental, or behavioral problems. Child Adolesc Psychiatric Clin N Am. 2016;25:139–56. .

Article   Google Scholar  

Cohen ZP, Cosgrove KT, Akeman E, Coffey S, et al. The effect of a mindfulnessbased stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study. BMC Complement Med Ther. 2021. .

Chen J, Zhang C, Wang Y, Liu X, Xu W. A longitudinal study of childhood trauma impacting on negative emotional symptoms among college students: a moderated mediation analysis. Psychol Heal Med. 2022;27:3:571–88. .

Farb NAS, Daubenmier J, Price CJ, Gard, et al. Interoception, contemplative practice, and health. Front Psychol. 2015;6:886. .

Hanley AW, Mehling WE, Garland EL. Holding the body in mind: interoceptive awareness, dispositional mindfulness and psychological well-being. J Psychosom Res 2017 99, 13–20. .

Mehling WE, Chesney MA, Metzler TJ, Goldstein LA, et al. A 12-week integrative exercise program improves self-reported mindfulness and interoceptive awareness in war veterans with posttraumatic stress symptoms. J Clin Psychol. 2017;74:554–65. .

Article   PubMed   Google Scholar  

Smith KE, Pollak SD. Early life stress and development: potential mechanisms for adverse outcomes. J Neurodev Disord. 2020;12 1:1–15. .

Mehling WE, Gopisetty V, Daubenmier J, Price CJ, et al. Body awareness: construct and self-report measures. PLoS ONE. 2009;4:e5614. .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Cole PM, Martin SE, Dennis TA. Emotion regulation as a scientific construct: methodological challenges and directions for child development research. Child Dev. 2004 Mar-Apr;75(2):317–33. .

Mallorquí-Bagué N, Garfinkel SN, Engels M, Eccles JA, et al. Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility. Front Psychol. 2014;5:1162. .

Fischer D, Messner M, Pollatos O. Improvement of interoceptive processes after an 8-week body scan intervention. Front Hum Neurosci 2017 11:452. .

McLaughlin KA, Peverill M, Gold AL, Alves S, et al. Child maltreatment and neural systems underlying emotion regulation. J Am Acad Child Adolesc Psychiatry. 2015;54(9):753–62. .

Hein TC, Monk CS. Research review: neural response to threat in children, adolescents, and adults after child maltreatment—a quantitative metaanalysis. J Child Psychol Psychiatry Allied Discipl. 2017;58:222–30. .

Schore AN. Attachment and the regulation of the right brain. Attach Hum Dev. 2000;2:23–47. .

Article   CAS   PubMed   Google Scholar  

Schore AN. Attachment, affect regulation, and the developing right brain: linking developmental neuroscience to pediatrics. Pediatr Rev. 2005. .

Stevenson JC, Millings A, Emerson LM, Sirois F, et al. Adult attachment and mindfulness: examining directionality, causality, and theoretical implications. J Res Pers. 2021;90:104043. .

Oldroyd K, Pasupathi M, Wainryb C. Social antecedents to the development of Interoception: attachment related processes are Associated with Interoception. Front Psychol. 2019;10:712. .

Herbert BM, Pollatos O. Attenuated interoceptive sensitivity in overweight and obese individuals. Eat Behav. 2014;15:445–8. .

Terasawa Y, Shibata M, Moriguchi Y, Umeda S. Anterior insular cortex mediates bodily sensibility and social anxiety. Soc Cogn Affect Neurosci. 2013;8:259–66. .

Porges S. The polyvagal theory: neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York, NY: W.W. Norton & Company, Inc.; 2011.

Google Scholar  

Mehling WE, Price C, Daubenmier JJ, Acree M, et al. The multidimensional assessment of interoceptive awareness (MAIA). PLoS ONE. 2012;7:e48230. .

Farb N, Segal ZV, Mayberg H, Bean J et al. (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Soc. Cogn. Affect. Neurosci 2007 2, 313–322. .

Farb N, Segal ZV, Anderson AK. Mindfulness meditation training alters cortical representations of interoceptive attention. Soc Cogn Affect Neurosci. 2013;8:15–26. .

Friedel S, Whittle SL, Vijayakumar N, Simmons JG, et al. Dispositional mindfulness is predicted by structural development of the insula during late adolescence. Dev Cogn Neurosci. 2015;14:62–70. .

Gibson J. Mindfulness, interoception, and the body: a contemporary perspective. Front Psychol. 2019;10:Article2012. .

Zdankiewicz-Ścigała E, Ścigała DK. Attachment style, early Childhood Trauma, Alexithymia, and dissociation among persons addicted to Alcohol: structural equation model of dependencies. Front Psychol. 2020;10:2957. .

Van Dam NT, van Vugt MK, Vago DR, Schmalzl L et al. Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspect Psychol Sci 2017 13, 36–61. .

Grossman P. On the porosity of subject and object in mindfulness scientific study: challenges to scientific construction, operationalization and measurement of mindfulness. Curr Opin Psychol. 2019;28:102–7. .

Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822–48. .

Kabat-Zinn J. Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemp Buddhism. 2011;12:281–306. 0.1080/14639947.2011.564844.

Fox KCR, Cahn BR. ‘Meditation and the Brain in Health and Disease’, in Miguel Farias, David Brazier, and Mansur Lalljee, editors, The Oxford Handbook of Meditation , Oxford Library of Psychology (2021; online edn, Oxford Academic, 14 Mar. 2019), .

Hölzel B, Lazar S, Gard T, Schuman-Olivier Z, et al. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6:537–59. .

Raffone A, Srinivasan N. The exploration of meditation in the neuroscience of attention and consciousness. Cogn Process. 2010;11:1–7. .

Fissler M, Winnebeck E, Schroeter T, Gummersbach M, et al. An investigation of the effects of brief mindfulness training on self-reported interoceptive awareness, the ability to decenter, and their role in the reduction of depressive symptoms. Mindfulness. 2016;7:1170–81. .

Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention regulation and monitoring in meditation. Trends Cogn Sci. 2008;12:163–9. .

Carmody J, Baer RA, Lykins ELB, Olendzki N. An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. J Clin Psychol. 2009;65:613–26. .

Grossman P. Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology’s (re)invention of mindfulness: comment on Brown et al. Psychol Assess. 2011;23:1034–140. discussion 1041 – 1036.

Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Psychol Assess. 2006;13:27–45. .

Paulus MP, Flagan T, Simmons AN, Gillis K, et al. Subjecting elite athletes to inspiratory breathing load reveals behavioral and neural signatures of optimal performers in extreme environments. PLoS ONE. 2011;7:e29394. .

Article   CAS   Google Scholar  

Santarnecchi E, D’Arista S, Egiziano E, Gardi C, et al. Interaction between neuroanatomical and psychological changes after mindfulness-based training. PLoS ONE. 2014;9:e108359. .

Haase L, Thom NJ, Shukla A, Davenport PW, et al. Mindfulness-based training attenuates insula response to an aversive interoceptive challenge. Soc Cogn Affect Neurosci. 2016;11:1–9. .

Creswell JD, Way BM, Eisenberger NI, Lieberman MD. Neural correlates of dispositional mindfulness during affect labeling. Psychosom Med. 2007;69:560–5. .

Murakami H, Nakao T, Matsunaga M, Kasuya Y, Shinoda J, Yamada J, et al. The structure of mindful brain. PLoS ONE. 2012;7:e46377. .

Weng HY, Lewis-Peacock JA, Hecht FM, Uncapher MR, et al. Focus on the Breath: Brain Decoding reveals Internal States of attention during meditation. Front Hum Neurosci. 2020;14:336. .

Füstös J, Gramann K, Herbert BM, Pollatos O. On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal. Soc Cogn Affect Neurosci. 2012;8:911–7. .

Farb NA, Anderson AK, Mayberg H, Bean J, et al. Minding one’s emotions: mindfulness training alters the neural expression of sadness. Emotion. 2010;10(1):25–33. .

Buddhaghosa B. Visuddhimagga: the path of purification. Onalaska, WA: Pariyatti; 2010.

Craig AD. How do you feel—now? The anterior insula and human awareness. Nat Rev Neurosci. 2009;10:59–70. .

Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3:655–66. .

Damasio A. Descartes error: emotion, reason and the human brain. New York: G.P Putnam’s Sons; 1994 NY.

W. The physical basis of emotion. Psychol Rev. 1890;1:516–29. .

Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011;12:453–66. .

Critchley HD, Wiens S, Rotshtein P, Ohman A, et al. Neural systems supporting interoceptive awareness. Nat Neurosci. 2004;7:189–95. .

Barrett LF, Quigley KS, Bliss-Moreau E, Aronson KR. Interoceptive sensitivity and self-reports of emotional experience. J Pers Soc Psychol. 2004;87:684–97. .

Pollatos O, Gramann K, Schandry R. Neural systems connecting interoceptive awareness and feelings. Hum Brain Mapp. 2007;28:9–18. .

Dunn BD, Galton HC, Morgan R, Evans D, et al. Listening to your heart: how interoception shapes emotion experience and intuitive decision making. Psychol Sci. 2010;21:1835–44. .

Zaki J, Davis JI, Ochsner KN. Overlapping activity in anterior insula during interoception and emotional experience. NeuroImage 2012 62, 493–499. .

Damasio A, Carvalho GB. The nature of feelings: evolutionary and neurobiological origins. Nat Rev Neurosci. 2013;14:143–52. .

Bornemann B, Herbert BM, Mehling WE, Singer T. Differential changes in self-reported aspects of interoceptive awareness through three months of contemplative training. Front Psychol. 2015;5:1504. .

Bornemann B, Singer T. Taking time to feel our body: steady increases in heartbeat perception accuracy and decreases in alexithymia over 9 months of contemplative mental training. Psychophysiology. 2016;54:469–82. .

Garcia-Cordero I, Esteves S, Mikulan EP, Hesse E, et al. Attention, in and out: scalp-level and intracranial EEG correlates of interoception and exteroception. Front Neurosci. 2017;11:411. .

Mehling WE. Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philos Trans R Soc B. 2016;371:20160013. .

Feeney BC, Collins NL. Predictors of caregiving in adult intimate relationships: an attachment theoretical perspective. J Pers Soc Psychol. 2001;80:972–94. .

Raby KL, Labella MH, Martin J, Carlson EA, et al. Childhood abuse and neglect and insecure attachment states of mind in adulthood: prospective, longitudinal evidence from a high-risk sample. Dev Psychopathol. 2017;29:347–63. .

Fraley RC, Roisman GI. The development of adult attachment styles: four lessons. Curr Opin Psychol. 2018;25:26–30. .

Emde RN. Development terminable and interminable: I. Innate and motivational factors from infancy. Int J Psychoanal. 1988;69:23–42.

PubMed   Google Scholar  

Bowlby J. Attachment and loss: volume II: Separation, anxiety and anger, in Attachment and Loss: Separation, Anxiety and Anger , Vol. 2. ed. J. Bowlby 1973 (London: The Hogarth Press and the Institute of Psycho-Analysis), 1–429.

Ainsworth MDS, Blehar MC, Waters E, Wall SN. Patterns of attachment: a psychological study of the strange Situation. London: Psychology Press; 2015.

Book   Google Scholar  

Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: an integrative overview. In: Simpson JA, Rholes WS, editors. Attachment theory and close relationships. The Guilford Press; 1998. pp. 46–76.

Bush NR, Obradoviæ J, Adler N, Boyce WT. Kindergarten stressors and cumulative adrenocortical activation: the first straws of allostatic load? Dev Psychopathol. 2011;23:1089–106. .

Palmer FB, Anand KJS, Graff JC, Murphy LE, et al. Early adversity, socioemotional development, and stress in urban 1-year-old children. J Pediatr. 2013;163:1733–9. .

Seeley WW, Menon V, Schatzberg AF, Keller J, et al. Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci. 2007;27:2349–56. .

Seeley WW, Merkle FT, Gaus SE, Craig AD, et al. Distinctive neurons of the anterior cingulate and frontoinsular cortex: a historical perspective. Cereb Cortex. 2012;22(2):245–50. .

Seth AK. Interoceptive inference, emotion, and the embodied self. Trends Cogn Sci. 2013;17:167–74. .

Kühn S, Gallinat J. Gray matter correlates of posttraumatic stress disorder: a quantitative meta-analysis. Biol Psychiatry. 2013;73:70–4. .

Sheffield JM, Williams LE, Woodward ND, Heckers S. Reduced gray matter volume in psychotic disorder patients with a history of childhood sexual abuse. Schizophr Res. 2013;143:185–91. .

Lim L, Radua J, Rubia K. Gray Matter abnormalities in childhood maltreatment: a voxel-wise meta-analysis. Am J Psychiatry. 2014;171:854–63. .

DeWall CN, Masten CL, Powell C, Combs D, et al. Do neural responses to rejection depend on attachment style? An fMRI study. Soc Cogn Affect Neurosci. 2011;7:184–92. .

Preuschoff K, Quartz SR, Bossaerts P. Human insula activation reflects risk prediction errors as well as risk. J Neurosci. 2008;28:2745–52. .

Kikyo H, Ohki K, Miyashita Y. Neural correlates for feeling-of-knowing: an fMRI parametric analysis. Neuron. 2002;36:177–86. .

Diamond LM, Hicks AM, Otter-Henderson K. Physiological evidence for repressive coping among avoidantly attached adults. J Soc Pers Relat. 2006;23:205–29. .

Diamond LM, Fagundes CP. Psychobiological research on attachment. J Soc Pers Relat. 2010;27:218–25. .

Spangler G, Grossmann KE. Biobehavioral organization in securely and insecurely attached infants. Child Dev. 1993;64:1439–50. .

Hogeveen J, Grafman J, Alexithymia. Handb Clin Neurol. 2021;183:47–62. .

Samur D, Tops M, Schlinkert C, Quirin M, Cuijpers P, Koole SL. Four decades of research on alexithymia: moving toward clinical applications. Front Psychol. 2013;4:861. .

Mikulincer M. Attachment working models and the sense of trust: an exploration of interaction goals and affect regulation, in Close Relationships: Key Readings , eds H. T. Reis and C. E. Rusbult 2004 (NewYork, NY: Psychology Press), 215–235. .

Cassidy J. Truth, lies, and intimacy: an attachment perspective. Attach Hum Dev. 2001;3:121–55. .

Ryan RM, Brown KW, Creswell JD. How integrative is attachment theory? Unpacking the meaning and significance of felt security. Psychol Inq. 2007;18(3):177–82. .

Shaver PR, Lavy S, Saron CD, Mikulincer M. Social foundations of the capacity for mindfulness: an attachment perspective. Psychol Inq. 2007;18(4):264–71. .

Boughner E, Thornley E, Kharlas D, et al. Mindfulness-Related Traits Partially Mediate the Association between Lifetime and Childhood Trauma Exposure and PTSD and dissociative symptoms in a community sample assessed online. Mindfulness. 2016;7:672–9. .

Kharlas DA, Frewen P. Trait mindfulness correlates with individual differences in multisensory imagery vividness. Pers Indiv Differ. 2016;93:44–50. 10.1016/j. paid.2015.09.027.

Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, Walsh E, Duggan D, Williams JMG. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15(3):329–42. .

Nord CL, Lawson RP, Dalgleish T. Disrupted dorsal mid-insula activation during Interoception Across Psychiatric disorders. Am J Psychiatry. 2021;178(8):761–70. . Epub 2021 Jun 22. PMID: 34154372; PMCID: PMC7613124.

McDonald SD, Calhoun PS. The diagnostic accuracy of the PTSD Checklist: a critical review. Clin Psychol Rev. 2010;30:976–87. .

Manuel JA, Somohano VC, Bowen S. Mindfulness practice and its relationship to the five-facet mindfulness questionnaire. Mindfulness. 2017;8:361–7. .

Ho Namkung S-H, Kim. Akira Sawa, The Insula: An Underestimated Brain Area in Clinical Neuroscience, Psychiatry, and Neurology, Trends in Neurosciences, Volume 40, Issue 4, 2017, Pages 200–207, ISSN 0166–2236, .

Kortz MW, Lillehei KO, Insular C. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 34033368.

Zdankiewicz-Ścigała E, Ścigała DK. Relationship between attachment style in Adulthood, Alexithymia, and dissociation in Alcohol Use Disorder inpatients. Mediational Model. Front Psychol. 2018;9:2039. .

Hexel M. Alexithymia and attachment style in relation to locus of control. Pers Indiv Differ. 2003;35:1261–70.

Download references


Author information, authors and affiliations.

South Dakota School of Mines and Technology, 501 E St. Joseph Street, Rapid City, SD, 57701, United States of America

Jonathan Gibson

You can also search for this author in PubMed   Google Scholar


The author, Jonathan Gibson, confirms being the sole contributor of this work and has approved it for publication.

Corresponding author

Correspondence to Jonathan Gibson .

Ethics declarations

Ethics approval, consent for publication, competing interests.

I declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit . The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Gibson, J. Trauma, early life stress, and mindfulness in adulthood. BMC Psychol 12 , 71 (2024).

Download citation

Received : 31 October 2023

Accepted : 29 January 2024

Published : 14 February 2024


Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

  • Early life stress
  • Interoception
  • Emotion regulation
  • And alexithymia

BMC Psychology

ISSN: 2050-7283

literature review on self awareness

Peter Sear Ph.D.

The Power of Self-Awareness in Leadership

Leading yourself before you lead others..

Posted February 16, 2024 | Reviewed by Devon Frye

  • Leaders must learn how to lead themselves first.
  • Emotions will always be part of leadership.
  • Self-awareness is a continuous journey for leaders.

In the realm of leadership , a critical yet often overlooked quality is self-awareness . The ability to lead oneself before leading others is a fundamental principle that distinguishes exceptional leaders from the rest.

Understand Yourself

Understanding our own emotions and experienced trauma can prevent us from making intense reactions, enabling us to make better decisions in challenging leadership situations. According to classic research from the renowned neuroscientist Joseph LeDoux (2000), the key to consciously accessing the emotional brain lies in self-awareness.

LeDoux's research shed light on the intricate workings of our brain. He argues that the rational executive brain, while capable of controlling and regulating our emotions to some extent, cannot erase felt emotions or traumatic experiences. Instead, it is through self-awareness that we can gain a deeper understanding of these emotions and experiences, allowing us to navigate them effectively.

Andrea Piacquadio, Pexels

Leadership and Emotions

Leadership is not immune to the impact of emotions. In fact, emotions play a significant role in decision-making . When leaders find themselves feeling overwhelmed or on high alert, poor decisions are bound to follow. This is where self-awareness comes into play.

By cultivating self-awareness, leaders can develop the ability to recognise and manage their emotional states, preventing reactive responses that may hinder their decision-making process. Leaders who possess a high degree of self-awareness are better equipped to remain calm and focused in the face of adversity. They understand that their reactions are not solely determined by external circumstances but are also influenced by their internal emotional landscape. By acknowledging and addressing their emotions, these leaders gain the ability to detach themselves from immediate reactions and instead respond with clarity and intentionality.

A Leader's Journey

The journey towards self-awareness is rarely an easy one. It requires leaders to engage in a process of introspection and self-reflection. This entails exploring their own strengths, weaknesses, values, and beliefs. By delving into their own psyche, leaders can gain valuable insights into their own patterns of behaviour and emotional triggers.

Furthermore, self-awareness also involves seeking feedback from others. By actively seeking input and perspectives from their team members, peers, and mentors, leaders can gain a more accurate perception of their leadership style and its impact on others. This feedback acts as a mirror, allowing leaders to recognise blind spots and areas for growth.

A Continuous Process

Leaders who prioritise self-awareness in their journey to becoming effective leaders understand that it is not a destination but a continuous process. They commit themselves to ongoing self-reflection, seeking to uncover deeper layers of understanding about themselves and their impact on others. This commitment enables them to adapt and grow as leaders, thus fostering a culture of continuous improvement within their organisations.

The implications of self-awareness in leadership extend beyond individual growth. When leaders lead themselves with self-awareness, they inspire and empower their teams to do the same. By modelling emotional intelligence and thoughtful decision-making, leaders create an environment that encourages their team members to reflect on their own emotions, behaviours, and motivations.

Self-awareness is a vital skill for leaders seeking to navigate the complexities of the modern world. By understanding the power of self-awareness, leaders can consciously access their emotional brain, allowing them to make better decisions and prevent intense reactions. Self-awareness enables leaders to remain calm and focused, even in the midst of challenges, and empowers them to inspire and guide their teams towards greater self-awareness. Across industries, self-aware leaders will undoubtedly play a crucial role in shaping a better future for organisations and society as a whole.

J.E. LeDoux (2000), Emotion Circuits in the Brain, Annual Review of Neuroscience 2000 23:1, 155-184

Peter Sear Ph.D.

Peter Sear, Ph.D., is a psychologist, consultant, researcher, and writer completed. Sear completed his Ph.D. at Loughborough University, London: Understanding Empathic Leadership in Sport. He is the author of Empathic Leadership: Lessons From Elite Sport.

  • Find a Therapist
  • Find a Treatment Center
  • Find a Psychiatrist
  • Find a Support Group
  • Find Teletherapy
  • United States
  • Brooklyn, NY
  • Chicago, IL
  • Houston, TX
  • Los Angeles, CA
  • New York, NY
  • Portland, OR
  • San Diego, CA
  • San Francisco, CA
  • Seattle, WA
  • Washington, DC
  • Asperger's
  • Bipolar Disorder
  • Chronic Pain
  • Eating Disorders
  • Passive Aggression
  • Personality
  • Goal Setting
  • Positive Psychology
  • Stopping Smoking
  • Low Sexual Desire
  • Relationships
  • Child Development
  • Therapy Center NEW
  • Diagnosis Dictionary
  • Types of Therapy

January 2024 magazine cover

Overcome burnout, your burdens, and that endless to-do list.

  • Coronavirus Disease 2019
  • Affective Forecasting
  • Neuroscience


  1. Literature Review For Qualitative Research

    literature review on self awareness

  2. how to do a literature review quickly

    literature review on self awareness

  3. (PDF) An Integrative Literature Review on Self-awareness Education

    literature review on self awareness

  4. What is Self Awareness? 5 Tips to Become More Self Aware

    literature review on self awareness

  5. review of the related literature in research

    literature review on self awareness

  6. Self Awareness Explanation Free Essay Example

    literature review on self awareness


  1. Writing a Literature Review

  2. Literature review in Educational Research


  4. Methods L04


  6. Writing Literature review on history 2024


  1. Defining Self-Awareness in the Context of Adult Development: A

    Abstract Self-awareness is often seen as a critical component in leadership and career success, and has therefore become a feature in MBAs, leadership development, and management education. It has become a popular "buzzword" in management literature, yet when reviewing this literature, there appears to be no consistent definition of the construct.

  2. Developing Self-Awareness: Learning Processes for Self- and

    We build on extant comprehensive reviews of the literature to define self-awareness and its accuracy, measurement, and effects, including the dark side of being overly introspective. We offer a framework to integrate theory-based processes.

  3. Measuring the Effects of Self-Awareness: Construction of the Self

    Four decades ago, Fenigstein et al. wrote that "increased awareness of the self is both a tool and a goal" ( Fenigstein, Scheier, & Buss, 1975, p. 522), while more recently an extensive review has demonstrated that different aspects of self-awareness, including mindfulness and rumination, mediate the impact of mindfulness-based interventions on ...

  4. Defining Self-Awareness in the Context of Adult Development: A

    This article reports a systematic literature review, covering how the construct of self-awareness is defined and how it differs from self-consciousness and self-knowledge within the context of management education.

  5. (PDF) An Integrative Literature Review on Self-awareness Education

    (2013) Qualitative study / Nurse students Structured preclinical workshop ․ Perceptions about the psychiatric mental health clinical practicum ․ Positive insights on the efficacy of preparedness...

  6. Developing self-awareness: Learning processes for self- and

    Self-awareness—how we see ourselves and the effects we have on our environment—influences our behavior and the type of person we want to become. This article examines recent research and areas of practice that address the meaning of self-awareness and how it develops over time. We build on extant comprehensive reviews of the literature to define self-awareness and its accuracy, measurement ...

  7. [PDF] An Integrative Literature Review on Self-awareness Education

    The interventions were revealed to be effective in enhancing participants' self- awareness and future research with well-designed clinical trials applying self-awareness intervention needs to be conducted to enhanceSelf-awareness in the nursing area. Purpose: This paper is a review of interventions designed to promote self-awareness in the nursing area. The specific purpose was to analyze ...

  8. A systematic review of how emotional self-awareness is defined and

    This report presents the first part of a systematic literature review examining emotional self-awareness in autism. The review was initially designed to examine group differences in emotional self-awareness but the challenge arose of defining this term and its scope, and so this paper aims to address that specific problem.

  9. PDF An Integrative Literature Review on Self-awareness Education/Training

    Self-awareness is an introspective process to under-stand and know about one's thoughts, feelings, convic-tions, and values that is ongoing.1) It is a kind of capacity to accurately recognize...

  10. Who Is the ''Self'' in Self-Aware: Professional Self-Awareness from a

    I will review three ap- ... the importance of self-awareness, the literature varies a great deal in the ... of self-awareness—that is, the self being more fully aware.10 Hence, it is included in the present discussion. I use the term ''simple'' to describe this way of being aware in order to

  11. Self-awareness in nursing: A scoping review

    There is limited research on self-awareness. Most of the literature comprises of theoretical discussions and opinions which adequately provide a conceptual understanding of self-awareness. However, more empirical and applied research is needed to apply the available theoretical knowledge in practice.

  12. PDF Understanding self and objective self-awareness: Systematic review of

    Abstract. A systematic review of the origin of the self and the concept of objective self-awareness. Describing the earlier theories of the self, introducing the child behaviour and the influences of environment on the construction of the self. Specifically, in early childhood when self-awareness takes on more in psychological manifestation.

  13. Disentangling the Process and Content of Self-Awareness: A Review

    We review the organizational behavior and psychology literatures to distinguish, summarize, and assess research on self-awareness as both process and content. Our synthesis of past work on the content of self-awareness is organized around three distinct targets: internal, external, and social.

  14. Self-awareness in nursing: A scoping review

    There is limited research on self-awareness. Most of the literature comprises of theoretical discussions and opinions which adequately provide a conceptual understanding of self-awareness. However, more empirical and applied research is needed to apply the available theoretical knowledge in practice. Relevance to clinical practice

  15. Dear Mental Health Practitioners, Take Care of Yourselves: a Literature

    This literature review examines the role of self-care in the promotion of well-being among mental health practitioners. Specifically, empirical research is presented in relation to specific domains of self-care practice, including awareness, balance, flexibility, physical health, social support, and spirituality.

  16. The Impact of Self-Awareness on Leadership Behavior

    shrouded by moods and emotions, is self-awareness, which marks the mainstay of emotional intelligence (Goleman, 1995). Despite its seemingly obvious importance, self-awareness has received little credit insubordinates, but also leadership research so far, with the author's own research only yielding 127 results. The picture looks even more dire

  17. Defining Self-Awareness in the Context of Adult Development: A

    Defining Self-Awareness in the Context of Adult Development: A Systematic Literature Review Julia Carden1, Rebecca J. Jones1, and Jonathan Passmore1 Abstract Self-awareness is often seen as a critical component in leadership and career success, and has therefore become a feature in MBAs, leadership development, and management education.

  18. The Effect of Trait Self-Awareness, Self-Reflection, and Perceptions of

    Within the narrative identity literature the process of self-reflection coupled with the extraction of self-relevant meaning is referred to as autobiographical reasoning and it is theorized to be an essential cognitive process in narrative identity development and construction ( Singer et al., 2013 ).

  19. Trauma, early life stress, and mindfulness in adulthood

    This article is a review that was inspired by recent studies investigating the effects of childhood trauma or early life stress (ELS) and mindfulness in adulthood. One recent study found that some forms of abuse and neglect led to higher scores in several subscales of a self-report measure of mindfulness. The authors concluded that some forms of ELS can help cultivate certain aspects of ...

  20. Self Awareness Literature Review

    Self Awareness Literature Review 1098 Words5 Pages 1.2 Overview of Self-Awareness When self-awareness is used, it means to what extent people are aware of their thinking pattern, traits, feelings and behavior (Brown, 2012).

  21. A systematic review of how emotional self-awareness is defined and

    A systematic review of how emotional self-awareness is defined and measured when comparing autistic and non-autistic groups CC BY 4.0 Authors: C.F. Huggins G. Donnan I.M. Cameron Justin H G...

  22. The Power of Self-Awareness in Leadership

    Self-awareness is a vital skill for leaders seeking to navigate the complexities of the modern world. ... (2000), Emotion Circuits in the Brain, Annual Review of Neuroscience 2000 23:1, 155-184 ...

  23. Defining Self-Awareness in the Context of Adult Development: A

    This article reports a systematic literature review, covering how the construct of self-awareness is defined and how it differs from self-consciousness and self-knowledge within the...

  24. Self-Awareness, The Foundation of Leadership

    External self-awareness means the ability, as Robert Burns put it, "to see oursels as others see us." If you want to lead others, you must have a realistic sense of your effect on them.

  25. Empowering Students for Cybersecurity Awareness Management in the

    Our self-concept, or the mental image of who we are, and our self-esteem, or how we rate and evaluate those traits, is the two primary perceptual processes that comprise self-perception. Recent studies ( Heidt et al., 2019 ; Herbst, 2020 ; Singh & Singh, 2022 ) on self-perception focus on cyber security awareness and decision making demonstrate ...