ORIGINAL RESEARCH
published: 07 December 2018
doi: 10.3389/fpsyg.2018.02465
No Time Like the Present: Thinking
About the Past and the Future Is
Related to State Dissociation Among
Individuals With High Levels of
Psychopathological Symptoms
Miriam Vannikov-Lugassi* and Nirit Soffer-Dudek
Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev,
Beersheba, Israel
Edited by:
Roumen Kirov,
Institute of Neurobiology (BAS),
Bulgaria
Reviewed by:
Vedat Şar,
Koç University, Turkey
Dalena Van Heugten - Van Der
Kloet,
Oxford Brookes University,
United Kingdom
Paula Thomson,
California State University, Northridge,
United States
*Correspondence:
Miriam Vannikov-Lugassi
miriamv@post.bgu.ac.il;
miriam290@gmail.com
Specialty section:
This article was submitted to
Psychopathology,
a section of the journal
Frontiers in Psychology
Received: 07 September 2018
Accepted: 21 November 2018
Published: 07 December 2018
Citation:
Vannikov-Lugassi M and
Soffer-Dudek N (2018) No Time Like
the Present: Thinking About the Past
and the Future Is Related to State
Dissociation Among Individuals With
High Levels of Psychopathological
Symptoms. Front. Psychol. 9:2465.
doi: 10.3389/fpsyg.2018.02465
Several short-term pathways have been implicated in relation to dissociative
experiences, among them are daily stress, sleepiness, and rumination. In addition, it
has been claimed that mechanisms contributing to dissociative experiences may differ,
according to specific psychopathological symptoms. Accordingly, this study had two
aims. The first was to sample moment-to-moment increases or decreases in current
stress, sleepiness, and rumination, in order to assess their temporal relations with
state dissociation. Rumination was broken down to its basic two subcomponents: the
negative value of the thoughts and thinking about the past (in comparison to present or
future), in order to differentiate it from other repetitive thought patterns (e.g., worry). The
second goal was to explore whether depression, anxiety, and obsessive–compulsive
symptoms may moderate the links between the three mechanisms and specific
state dissociation scales [specifically, depersonalization-derealization (DEP-DER) and
absorption (ABS)]. Ninety-nine undergraduate students completed trait questionnaires
and then answered state items four times a day for 4 days. These experience
sampling data were analyzed using multilevel linear modeling (MLM) with Level 1 state
measurements and Level 2 demographic and trait variables of the participants. Moments
of stress, sleepiness, thinking about the past and negative thoughts were all associated
both with state DEP-DER and with state ABS. Dissociation, negative thinking, stress,
and sleepiness were positively associated with moments of thinking about the past and
the future but inversely associated with moments of thinking about the present. Finally,
in accordance with our expectations, the links between DEP-DER and hypothesized
mechanisms were mostly moderated by depression and anxiety symptoms, whereas
the links between ABS and hypothesized mechanisms were moderated mainly by
obsessive–compulsive symptoms. Our findings are in accordance with literature on the
efficacy of mindfulness as well as the maladaptive correlates of mind-wandering, as they
suggest that dissociative detachment from one’s present occupation is associated with
decreased well-being.
Keywords: dissociation, sleep, stress, rumination, worry, absorption, depersonalization-derealization, mindwandering
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INTRODUCTION
stress is associated with dissociative experiences both among
subjects who were exposed to trauma (e.g., Stiglmayr et al., 2008)
and non-clinical subjects that were probably not exposed to
trauma (Stiglmayr et al., 2008; Soffer-Dudek, 2017a). The aim of
this study is to explore the short-term predictors of dissociative
experiences and thus we focus on the relationship between
momentary stress and dissociation, regardless of possible past
traumas that may increase the tendency to dissociate.
Another short-term pathway which has been implicated in
relation to dissociative experiences are alterations in the sleep
cycle (van der Kloet et al., 2012b). Specifically, dissociation may
follow impaired sleep patterns, as it appears to be related to a
labile sleep–wake cycle and possibly represents intrusions of sleep
elements into waking consciousness (Mahowald and Schenck,
2001; Koffel and Watson, 2009; Lynn et al., 2012; van der Kloet
et al., 2012b) or waking elements into sleeping consciousness
(Soffer-Dudek, 2017b). Indeed, it has been demonstrated that
sleep deprivation significantly increases dissociative symptoms
(Giesbrecht et al., 2007; Selvi et al., 2015; van Heugten-van
der Kloet et al., 2015b; Soffer-Dudek et al., 2017). In addition,
practicing sleep hygiene is associated with a reduction of
dissociative symptoms in psychiatric inpatients (van der Kloet
et al., 2012a).
Recently, poor sleep quality was also identified as the
main factor responsible for the link between rumination
and dissociation (Vannikov-Lugassi and Soffer-Dudek, 2018).
Rumination is defined as a repetitive focusing on one’s distress, on
sadness, and on the circumstances associated with those feelings,
such as their causes and consequences (Nolen-Hoeksema, 1991;
Conway et al., 2000). Ruminative repetitive thoughts may also
represent goal discrepancy, i.e., the discrepancy between the
actual and desired status of achieving one’s goals (Martin and
Tesser, 1996). Although the definitions of rumination vary, all
refer to the experience of repetitive, intrusive, and negative
cognitions (Querstret and Cropley, 2013), and indeed, it plays
a role in the development and persistence of negative moods
(Smith and Alloy, 2009). Rumination is positively related to
dissociation (Armey and Crowther, 2008; Vannikov-Lugassi and
Soffer-Dudek, 2018). Notably, however, the studies regarding
the link between rumination and dissociation are cross-sectional
and may be biased by individual differences in self-reporting
patterns. Closely related concepts of thought styles have also
been associated with dissociation. For example, dissociation
partially mediated the relation between inner speech and selfreferential ideas (Bellido-Zanin et al., 2016); such inner speech
characterizes rumination, which is related to verbal processes
inherent in internal dialog (Nolen-Hoeksema, 2004). In addition,
an experience-sampling study conducted on a single clinical
case (Poerio et al., 2016) found that repetitive and negative
daydreaming by the client predicted increased dissociation.
Moreover, Recent evidence suggests that daydreaming may
be maladaptive and addictive, and that such maladaptive
daydreaming (MD) is related to psychopathological distress and
specifically to dissociation (Somer, 2002; Somer et al., 2017;
Soffer-Dudek and Somer, 2018). These findings imply that
rumination, which is characterized by inner speech (NolenHoeksema, 2004) and by repetitiveness and negative valence
Dissociation is a disruption of the normal integration of
consciousness (DSM-5, American Psychiatric Association, 2013),
i.e., a discontinuity between mental contents (e.g., thoughts,
feelings, or memories). The tendency to dissociate is maladaptive;
it is related to the experience of psychological distress (e.g.,
Gershuny and Thayer, 1999; Briere et al., 2005b; Dalenberg et al.,
2012; Soffer-Dudek, 2014). Dissociation is associated with several
psychopathological symptoms, such as post-traumatic stress,
depression, anxiety, eating disorders, and obsessive–compulsive
(OC) symptoms (e.g., Wise et al., 2000; Muris et al., 2003;
Lipsanen et al., 2004; Watson et al., 2004; Pastucha et al., 2009;
Paradisis et al., 2015; Soffer-Dudek, 2017a), as well as with poorer
treatment outcomes (Rufer et al., 2006; Spitzer et al., 2007;
Fassino et al., 2009; Semiz et al., 2014; Arntz et al., 2015). Thus, it
is important to understand specific daily variables that may be
associated with increases in dissociative experiences, and their
mechanisms of interaction with various types of psychological
distress symptoms (Soffer-Dudek, 2014). The present study
aimed to promote such understanding by employing a rigorous
experience-sampling methodology exploring these short-term
dynamics with a fine-grain resolution. In this study, we focused
on three factors that vary from one moment to the next and
have all been associated with dissociative experiences, specifically,
current stress, sleepiness, and rumination. As will be described in
detail below, we further explore rumination, and differentiate it
from worry, by breaking it down to its basic components. Thus,
we also explore correlates of thinking about the past, the present,
or the future, in this experience-sampling study.
Factors Related to Dissociative
Experiences: Daily Stress, Sleepiness,
and Rumination
Many researchers consider trauma to be the origin of
dissociation. Pierre Janet was the first to identify dissociation
as a defense or coping mechanism in the face of overwhelming
emotion (Van der Hart and Horst, 1989), and later theoreticians
(e.g., Putnam, 1991, 1996) expanded this view. They suggest
that dissociation enables mental escape from distress by denying
introspective access to unbearable mental contents. Importantly,
this coping strategy is considered to be maladaptive because
it interferes with adaptive emotional processing of distressing
experiences (Spiegel, 1991; Foa and Hearst-Ikeda, 1996; Schauer
and Elbert, 2010). In accordance with this theory, trauma
is related to dissociation (e.g., Morgan et al., 2001; Carlson
et al., 2012, 2016; Dalenberg et al., 2012; Terock et al., 2016).
Overwhelming anxiety in the form of a panic attack is also often
accompanied by dissociation (Hunter et al., 2004; Mendoza et al.,
2011). Researchers have suggested that the tendency to dissociate,
or to react with emotional detachment to trauma or to extreme
stress, may over time be used non-selectively when confronting
even minor stressors (Perry et al., 1995; Spiegel et al., 2011).
However, in comparison with trauma or extreme stress, current
daily stress has not been investigated as much in the context of
dissociation. Findings from longitudinal studies show that daily
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No Time Like the Present
point of obliviousness to the environment (Soffer-Dudek et al.,
2015) and it involves a temporary lack of reflective consciousness
(Butler, 2006).
Although the general dissociation score is often used when
measuring the correlations between dissociation and various
emotional states, Soffer-Dudek (2014) suggested that each
of the subcomponents of dissociation may play a unique
role in different psychopathologies. Specifically, Soffer-Dudek
hypothesized that DEP-DER is the dissociative factor that is
especially relevant to depression and anxiety, whereas ABS is
the dissociative factor particularly relevant to OC symptoms.
Indeed, DEP-DER was uniquely related to depression (GómezPérez et al., 2013). They both share similar properties such as
emotional numbing and feelings of detachment (Feeny et al.,
2000); in addition, they are both associated with poor sleep (e.g.,
Breslau et al., 1996; Hayashino et al., 2010; for depression; and
Giesbrecht et al., 2007 for dissociation). The specific link between
anxiety and DEP-DER is possibly due to the hyperarousal and the
hyperventilation that characterize anxiety and may produce DEPDER (Sterlini and Bryant, 2002; Lickel et al., 2008); in addition,
anxiety disorders are also related to impaired sleep (Ohayon
and Roth, 2003; Gregory et al., 2005). Conversely, ABS seems
to have a specific relation with OC symptoms (Soffer-Dudek,
2014, 2017a, 2018; Soffer-Dudek et al., 2015), possibly due to
similar attentional mechanisms. OC symptoms include totally
engaging one’s attention in internal obsessions such as imagined
consequences of one’s behavior, or external stimuli in the form
of compulsions. They are also characterized by a distrust of the
senses, termed inferential confusion (O’Connor and Robillard,
1995). Similarly, ABS is characterized by narrowing awareness
to one’s internal world (daydreaming) or external stimuli (e.g.,
a movie), with limited responsiveness to surroundings (SofferDudek et al., 2015). Recently, it has been found that intensive
absorption in daydreaming was related to OC symptoms (SofferDudek and Somer, 2018).
(Nolen-Hoeksema, 1991), predicts dissociation. However, they
also raise a question regarding the specificity of the effect of
ruminative thinking on dissociation, in comparison with closely
related types of thought styles.
Watkins (2008) argues that thinking is defined by three
factors: the value of the content, the structure of the thoughts,
and the context (e.g., mood, beliefs about the self). According
to this scheme, rumination may be viewed as possessing a
negative content value, including depression, pessimism, and
anxiety (e.g., Nolen-Hoeksema, 1991) and a passive and repetitive
thought structure. Both repetitiveness and negative emotion were
predictors of dissociation, mediated by poor sleep (VannikovLugassi and Soffer-Dudek, 2018), suggesting that both these
aspects of rumination play a role in the rumination-dissociation
link. Interestingly, the concept of worry is also characterized by
negative content and a repetitive structure (Borkovec et al.,1998),
and is thus closely related to rumination. In addition, like
rumination, worry is related to dissociation (Vannikov-Lugassi
and Soffer-Dudek, 2018; Yıldırım et al., 2018). However, despite
these similarities, the difference between rumination and worry
is in one element of their content: rumination includes focusing
on the past, whereas worry is defined by focusing on the future
(Borkovec et al., 1998). These similarities between rumination
and worry underscore the question regarding the specificity of
the effect of rumination on dissociation.
Rumination, as well as worry, is often explored as a whole
construct. In order to gain a better understanding of the relations
between thought components that associate with dissociation,
there is a need for a high-resolution study that may break these
concepts down to their foundations (i.e., the basic elements
of thought styles) and explore the temporal links between
the factors. Hence, in this study, we split the concept of
ruminative thought into two components: (a) negative value;
and (b) focusing on the past (in comparison to focusing
on the future as in worry, or to focusing on the present).
Our first aim of the study was to explore the links between
dissociation and possible short-term hypothesized predictors:
momentary stress, sleepiness, and the components representing
rumination, using an experience-sampling method, thus gaining
a better understanding of the moment-to-moment mechanisms
governing dissociative experiences.
The Present Study
We hypothesized that depressive, anxiety, and OC symptoms
may engender different links between the predictive momentary
factors (sleepiness, current stress, and the subcomponents of
rumination) and dissociative subscales. Specifically, we assumed
that depression and anxiety would moderate the links between
DEP-DER and its momentary predictors, so that these links
would be stronger among participants characterized by high
levels of trait anxiety or depression, than among participants
characterized by low levels of anxiety or depression. Similarly,
we hypothesized that OC symptoms would moderate the links
of momentary predictors with ABS, so that stronger correlations
would be found among participants with a high level of OC
symptoms. It should be noted that we did not focus on the
amnesia subcomponent of dissociation because it is less suitable
for state measurements (Stiglmayr et al., 2009) and it has often
been less useful in explorations of the specificity of relations
of dissociation with psychopathological symptoms (e.g., Zucker
et al., 2006; Simeon et al., 2007; Soffer-Dudek et al., 2015).
To conclude, the present study set out to: (1) examine
if momentary feelings of sleepiness, current stress, and the
Differentiating Between Types of
Dissociative Experiences
Notably, dissociation is not a homogeneous trait but a
multifaceted phenomenon (Briere et al., 2005a), and the
presentations of dissociation may include a variety of symptoms
(e.g., Holmes et al., 2005). Specifically, Carlson and Putnam
(1993) described three empirically derived factors based on factor
analyses of the revised version of the Dissociative Experiences
Survey (DES-II). Dissociative amnesia is a discontinuity between
memory and awareness, referring to difficulties in accessing
autobiographical memory. Depersonalization-derealization
(DEP-DER) is an experience of the self or the world as altered or
unfamiliar. Dissociative absorption and imaginative involvement
(ABS) is the tendency to involuntarily narrow attention to the
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subcomponents of ruminative thinking (negative value of the
thought and thinking about the past) would predict state
increased dissociation as assessed by specific scales: ABS and
DEP-DER, using an experience sampling method; and (2) explore
whether depression, anxiety, and OC symptoms play a role in
moderating these links. We predicted that depression and anxiety
would moderate links with DEP-DER and OC symptoms would
moderate links with ABS.
place on four consecutive weekdays. Four times a day, at fixed
times (10:00, 13:30, 17:00, 20:30) the participants were alerted
by the PACO application with a reminder to answer the state
items. Thus, according to the study protocol, they were supposed
to complete 16 experience-sampling assessment points overall;
however, several participants completed either less or more
assessment points on some of the days of the study, and some
also continued their reports for a fifth day, resulting in a variable
amount of overall assessment points (range 5–22, M = 16.03,
SD = 2.62). On each such assessment, they completed the items
via the application within approximately 5 min. Participants
were instructed to respond to the questions as honestly as
possible and to contact the researchers should they encounter
any difficulties or concerns. The participants were subsequently
debriefed regarding the purposes of the study. Notably, the
participants also completed short sleep and dream questionnaires
in the mornings, and four trait questionnaires (depression,
stress, sleep, and dissociation) after completing the 4-day state
assessment period. However, those measures are outside the
scope of the current exploration. This study received ethical
approval beforehand by the Ben-Gurion University institutional
review board.
MATERIALS AND METHODS
Participants and Procedure
Ninety-nine undergraduate students (78.78% females,
Mage = 23.96, SDage = 1.97) participated in the study in
exchange for 150 NIS (approximately $43). An additional two
participants dropped out before the beginning of the study due
to logistical or technical difficulties. Apart from age and gender,
we assessed socioeconomic and familial status. We also asked
whether they had ever taken part in psychotherapy (now or in
the past), in order to gain a rough sense of the type of sample
we have in relation to issues of mental health. The demographic
characteristics of the sample are presented in Table 1.
The participants signed up for a study labeled “The
relationship between patterns of sleep, thoughts, and mood”
via the institutional psychological experiments system. First,
participants received an explanation about study procedures
during a 15-min session at the lab, during which they also
signed a consent form, and downloaded the Personal Analytics
Companion Application (PACO1 ) for the daily assessments. This
application enables easy and accessible scheduled self-reports
from participants’ mobile phones. After signing the consent form
at the lab, during a time span of 2 days preceding the daily
assessments participants completed trait questionnaires from
their home computers, via online survey software (Qualtrics,
Provo, UT, United States) in a single session (approximately 30min). Next, they began the daily assessment phase, which took
1
Measures
Trait Measures
We refer to the following measures as trait measures because
they are usually used to assess interpersonal differences, and in
order to differentiate between them and momentary variables.
Notably, however, the variables assessed by these questionnaires
may not reflect stable characteristics of the individuals and rather
reflect the level of these variables at the last period as they refer
to the past weeks; still, they are assessed at the between-subjects
level and thus we refer to them as traits. The first three measures
(depression, anxiety, and OC symptoms) will be used in the main
analyses of interest, whereas the rest of the trait measures will be
used only for validating the state measures, described below. All
measures have validated Hebrew versions.
http://pacoapp.com
Depression
The 16-item Quick Inventory of Depressive SymptomatologySelf-Report (QIDS-SR; Rush et al., 2003) measures nine
components of depression (e.g., sad mood, sleep disturbance,
interest) based on experiences in the past 7 days. The response
scale ranges from 0 (e.g., “I do not feel sad”) to 3 (e.g., “I feel
sad nearly all of the time”). The QIDS-SR has demonstrated
reliability, validity, and sensitivity (Rush et al., 2003). Cronbach’s
alpha in the present study was 0.71.
TABLE 1 | Demographic characteristics of the sample.
Variable
N = 99
Age M (SD)
23.96 (1.97)
Gender
Male
n = 21 (21.21%)
Female
n = 78 (78.78%)
Marital status
Anxiety
Unmarried
n = 97 (97.97%)
Married
n = 1 (1.01%)
Missing
n = 1 (1.01%)
The 21-item Beck Anxiety Inventory (BAI; Beck et al., 1988)
assesses anxiety symptoms on a 4-point scale (0- Not at all, to
3- Severely- it bothered me a lot). We modified the questionnaire
from asking about the last 2 weeks to the last week in order to
keep the depression and the anxiety questionnaires consistent.
The BAI has demonstrated high internal consistency, test–retest
reliability, and internal and external validity (Beck et al., 1988).
Cronbach’s alpha in the present study was 0.86.
Socio-economic status
Low income family
n = 11 (11.11%)
Medium income family
n = 22 (22.22%)
High income family
n = 66 (66.66%)
M, Mean; SD, standard deviation.
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dysfunction, as well as a total sleep quality score, on which we
relied in the present study. Cronbach’s alpha in this study was
0.75.
OC symptoms
The 18-item Obsessive–Compulsive Inventory-Revised (OCI-R;
Foa et al., 2002) uses a 5-point Likert Scale (0- Not at all,
4- Extremely) that provides scores on six subscales (washing,
checking, ordering, obsessing, hoarding, and neutralizing) and a
total score. The OCI-R is a reliable and valid measure (Foa et al.,
2002). Cronbach’s alpha in the present study was 0.91.
State Measures
To examine the validity of state (momentary) measures, we
wished to correlate their averages with trait measures. Thus,
we calculated the mean score for each participant on each
state variable, across all assessment points. We report the
magnitude of these relationships below when describing each
state measure. The correlations are Pearson product-moment
coefficients with bootstrapped 95% confidence intervals (biascorrected and accelerated).
Stress
The 25-item Weekly Stress Inventory-Short Form (WSI- SF;
Brantley et al., 2007) measures minor stress. The participants
indicate whether various aversive events (e.g., “was ignored by
others”) occurred to them during the past week, and the extent to
which they were stressful, on a 7-point scale (0- Did not happen,
6- Very stressful). The WSI-SF was found to have good internal
consistency and good convergent validity (Brantley et al., 2007).
Cronbach’s alpha in the present study was 0.92.
Thinking about the Past
We used three items, based on Nezlek (2005), who measured
daily rumination without the negative valence of the ruminative
thinking (e.g., “How much today did you ruminate or dwell
on things that happened to you?”). For the purposes of this
study, instead of asking about today, we asked about the last few
minutes. The participants scored these items on a 5-point scale
(1- Not at all, 5- Extremely). The score for the “past” factor was
calculated by averaging these three items. State thinking about
the past (averaged across all measurements) and trait rumination
(which includes the element of thinking about the past) were
strongly correlated (r = 0.53 [0.33,0.70], p < 0.001).
Rumination
The 22-item Ruminative Response Scale (RRS) is a reliable and
valid measure of rumination (Nolen-Hoeksema and Morrow,
1991). The items assess rumination on a 4-point scale (1- Almost
never, 4- Almost always). According to Treynor et al. (2003),
the RRS contains three subscales: depression, reflection, and
brooding. The latter refers to passive and repetitive focus on the
negative symptoms, which best suits the definition of rumination.
Thus, we relied solely on the 5-item brooding factor as a measure
of negative, passive and repetitive rumination. Cronbach’s alpha
of the brooding scale in the present study was 0.78.
Thinking about the Present
The 22-item Anxious Thoughts Inventory (AnTI; Wells, 1994)
assesses worry in three basic dimensions: social worry, health
worry, and meta-worry on a 4-point scale (1- Almost never,
4- Almost always). The AnTI possesses excellent psychometric
properties (Wells, 1994). Cronbach’s alpha in the present study
was 0.93.
To parallel the past measure, we created three state items for
thinking about the present, with an identical response scale. The
three items of the “present” scale were: “In the last few minutes, to
what extent. . .”: (a) “were you completely focused on the things
that you were doing at the moment”; (b) “were your thoughts
about the things that you were doing in the present” (c) “was your
mind someplace else from your current occupation” (reversed
item). The score for the present factor was calculated by averaging
these three items.
Dissociation
Thinking about the Future
The 28-item revised version of the Dissociative Experiences Scale
(DES-II; Carlson and Putnam, 1993), measures the percentage
of time that the individual experiences dissociation on an 11point scale (0%- Never, 100%- Always). The three subscales
of dissociation (ABS, amnesia, and DEP-DER) were computed
based on a large-scale factor analysis including both psychiatric
and non-clinical subjects (Carlson et al., 1991). The DES-II
possesses excellent reliability and validity (Carlson and Putnam,
1993). Cronbach’s alpha in the present study was 0.89 for the total
score, 0.84 for ABS, a somewhat low 0.65 for DEP-DER, and a low
0.56 for amnesia.
With the same response scale, we also created a “future” measure,
based on the average of these three items: “In the last few minutes,
to what extent. . .”: (a) “did you play back in your mind how you
will act in a future situation”; (b) “did you dwell or ruminate
on things that might happen in the future”; and (c) “did you
dedicate time to re-think things that are expected to happen in
the future.” State thinking about the future (averaged across all
measurements) and trait worry (which includes the element of
focusing on the future) were moderately correlated (r = 0.27
[0.08,0.46], p < 0.01).
Sleep quality
State dissociation was assessed by a 4-item state scale taken from
Soffer-Dudek (2017a), which was originally adapted from the
Dissociation Tension Scale (DSS-4; Stiglmayr et al., 2003). The
participants were asked, regarding the last few minutes, to what
extent they got so involved in a daydream or in a movie/book
that they were unaware of other events happening around them
(ABS), and to what extent their body or the world felt strange
or unusual (DEP and DER), on a 10-point scale (0 = Not at all,
Worry
Dissociation
The 19-item Pittsburgh Sleep Quality Index (PSQI; Buysse
et al., 1989) assesses sleep quality during the past month. The
PSQI possesses acceptable internal homogeneity, consistency,
and validity (Buysse et al., 1989). The questionnaire includes
seven components on a 4-point scale (0–3): subjective sleep
quality, sleep latency, sleep duration, habitual sleep efficiency,
sleep disturbances, use of sleeping medication and daytime
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either ABS or DEP-DER, we included one state predictor, and
the measurement number variable (a variable ranging from 1
to a maximum of 22) in order to de-trend the model. We
also hypothesized that there will be cross-level interactions, in
that Level-1 predictive variables will interact with Level-2 trait
psychopathology in predicting Level-1 dissociation. Specifically,
we expected stronger effects of Level-1 predictors on dissociation
under higher levels of baseline psychopathology.
We employed MLM using SPSS mixed models (version 24).
The covariance structure type was AR(1), assuming stronger
correlations between close measurements for each participant.
Level-1 predictors (past, present, future, negative value,
sleepiness, and current stress), and the variable representing
time, were specified as both fixed and random effects, which
means that their intercepts and slopes were allowed to vary
among individuals. Level-2 depression, anxiety, and OC
symptoms, and their interactions with Level-1 predictors, were
specified only as fixed effects. Each model predicted either
ABS or DEP-DER. All continuous predictors were grand-mean
centered before conducting the analyses. Analyses of statistically
significant interactions were performed based on Preacher et al.
(2006), with high and low levels of trait variables defined as 1
SD above or below the sample mean, respectively. Standardized
effect sizes for fixed effects rely on semi-partial R2 statistics
(Edwards et al., 2008).
9 = Very strongly). We combined the DEP and DER items to one
DEP-DER score by averaging the two relevant items. However,
the two items referring to ABS were not averaged to a single
score, because we noticed that the items were uncorrelated with
each other and exhibited different patterns of correlations with
other items. We concluded that in hindsight, the absorption item
that asked about a movie/book was less suitable for momentary
experience-sampling because it was probably confounded with
the number of actual movies or books that participants watched
or read; thus, we decided not to use it, but rather to rely only
on one item to assess state ABS (being involved in a daydream
to the point of obliviousness to surroundings). The items of state
DEP and DER were strongly correlated among themselves (when
averaging state assessments across all measurements; r = 0.93,
p < 0.001). Both DEP-DER and ABS state measurements, when
averaged across all time points, were strongly correlated with
their trait counterparts (r = 0.62 [0.36,0.80], p < 0.001, for
DEP-DER; and r = 0.55 [0.28,0.75], p < 0.001 for ABS).
Momentary stress
The participants were asked to rate the extent to which they
experienced stress in the last few minutes on a 5-point scale (1Not at all, 5- Extremely) (Hellhammer and Schubert, 2012). State
stress (averaged across all measurements) and trait stress were
strongly correlated (r = 0.56 [0.40,0.70], p < 0.001).
Negative value of thoughts
The participants were probed about the emotional valence of
their thought content (“In the last few minutes, the content of
your thoughts was. . .”), rated on a 5-point symmetrical scale,
in which a high score indicates negative valence (1- Positive, 5Negative). This item, when averaged across all measurements,
was moderately correlated with trait rumination (which includes
focusing on negative content) (r = 0.31 [0.09,0.53], p < 0.005).
RESULTS
Notably, MLM is a flexible method which is suitable for exploring
linear associations even in the face of a variable number of
repeated assessment points for each individual (Tabachnick and
Fidell, 2007); there is no need to impute such missing data.
However, other types of missing data (e.g., skipping items)
should be evaluated and dealt with. Missing data patterns were
estimated using the missing values analysis (MVA) function of
SPSS (version 24). Missingness in this study varied between 0
to 2% for all variables. Little’s MCAR test was non-significant
(χ2 = 15.4, p = ns) suggesting that data were missing completely
at random. The low percentage of the missing values and the
random pattern of the missingness suggest that non-response in
these data is ignorable (Tabachnick and Fidell, 2007). Histograms
of all variables were inspected for detecting univariate outliers but
there were none.
In order to examine the components of between-subjects
and within-subjects variance for each Level-1 variable, we first
computed intercept-only (null) models, in which no predictors
were specified. The intraclass correlation (ICC) value reported
below for these variables represents the proportion of betweensubjects variance (i.e., the extent to which participants’ means
vary from the general mean) out of the total variance (which also
takes into account to what extent participants vary from their
own mean). The ICC indices were 0.25, 0.33, 0.13, 0.33, 0.26,
0.45, 0.44, and 0.19 for past, future, present, negative valence,
ABS, DEP-DER, current stress, and sleepiness, respectively. As
these were all lower than 0.50, it may be concluded that all
state measures varied more within the assessment points of each
Sleepiness
We used the Stanford Sleepiness Scale (SSS; Hoddes et al., 1973),
a valid and widely used method to measure state sleepiness
with a single item. The participants were asked to rate their
identification with one of 7 statements regarding the last few
minutes, whereby a higher score indicates higher sleepiness (1“Feeling active and vital; alert; wide awake,” 7- “Almost in reverie;
sleep onset soon; lost struggle to remain awake”). State sleepiness
averaged across all measurements was moderately correlated with
trait poor sleep quality (r = 0.35 [0.14,0.55], p < 0.001).
Data Analyses
The longitudinal design of the experience-sampling method
produced a multilevel structure (Raudenbush et al., 2001; Singer
and Willett, 2003). Thus, multilevel linear modeling (MLM)
analysis was used. Level-1 data were the state measurements
at each of the momentary assessment points. These Level-1
variables were nested within Level- 2 units, i.e., participants,
characterized by demographic and trait data. We expected
that Level-1 thinking about the past, and negative value of
the thoughts (both representing components of rumination),
sleepiness, and current stress, will predict Level-1 components
of dissociation: ABS and DEP-DER. In each model, predicting
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December 2018 | Volume 9 | Article 2465
Vannikov-Lugassi and Soffer-Dudek
No Time Like the Present
[0.01,0.06], SD = 0.01, t(1033.15) = 2.20, p < 0.0.05, R2 β = 0.01,
for negative valence), suggesting that dissociation is explained
uniquely and independently by each ruminative component.
In addition to these main effects, we found that the effect
of negative valence on DEP-DER was present only among
participants high in psychopathology (depression, anxiety, and
OC symptoms). Similarly, the relation of negative valence with
ABS was present only under high levels of depression and OC
symptoms. Notably, an reviewer suggested that these findings
may imply that negative valence and dissociation are not truly
related, i.e., psychopathology may pose a confound. However,
when examining the models, we found that the link between
negative value and DEP-DER and the link between negative
value and ABS remained statistically significant when depression,
anxiety or OC symptoms were included in the model. These
findings imply that the relationship between negative value and
dissociative components probably cannot be explained by the
confounding effect of psychopathology.
individual than between different individuals, suggesting that
they are very much suitable to explore as state variables.
In Table 2, we present Pearson correlation coefficients, means
and standard deviations of the trait variables (depression, anxiety,
and OCD), and the state variables averaged across all momentary
measurements (past, future, present, negative valence, current
stress, sleepiness, ABS, and DEP-DER). As can be seen in the
table, depression, anxiety, and OC symptoms were positively
correlated with past, future, negative valence, current stress, and
sleepiness, and inversely correlated with present.
In Tables 3, 4, we present MLM models based only on Level1 associations, and models depicting cross-level interactions,
respectively. Specifically, associations between each of the state
predictors (past, future, present, negative valence, current stress,
and sleepiness) and each of the two predicted dissociation
components (ABS and DEP-DER) are presented in Table 3,
whereas the extent that these associations may be moderated
by trait psychopathology variables can be seen in Table 4.
Below, we describe the results for each predictor separately, and
present results of simple slope analyses for statistically significant
interactions. The full results of the simple slope analyses of
the statistically significant interactions may be found in the
Supplementary Material (see Supplementary Tables S1–S3, for
depression, anxiety, and OCD, respectively).
Current Stress
Both DEP-DER and ABS were positively predicted by
current stress. In addition to these main effects, different
psychopathologies moderated these associations with DEP-DER
and ABS. Specifically, the effect of current stress on DEP-DER
was present only among those with high depression and anxiety,
and the effect of current stress on ABS was present only among
participants with high levels of OC symptoms.
Thinking About the Past, the Present,
and the Future
Both ABS and DEP-DER were positively predicted by past and
inversely predicted by present. Additionally, ABS was positively
predicted by future. In addition to these main effects, several
moderation effects emerged with all three psychopathology traits.
Specifically, past was positively associated with DEP-DER only
among those high in depression and OC symptoms (but not
among those low in these variables) and the relation was
significantly stronger among those with high levels of anxiety
compared to those with low levels of anxiety. Similarly, past and
present were more strongly associated with ABS among those
high in psychopathology (depression, anxiety, or OC symptoms),
compared to those low in psychopathology. Finally, the effect
of thinking about the future on ABS was significantly stronger
among participants with high levels of OC symptoms, compared
to those with low levels.
Sleepiness
Sleepiness positively predicted both DEP-DER and ABS. In
addition to these main effects, we found that the effect of
sleepiness on DEP-DER was present only among those high in
depression and anxiety.
DISCUSSION
The main purpose of the study was to assess the extent to which
hypothesized factors that fluctuate across different moments
of the daily routine, specifically, current stress, sleepiness, and
components of rumination (negative thinking and thinking about
the past), may oscillate concurrently along with dissociative
experiences, and whether symptoms of depression, anxiety, and
OC symptoms moderate these associations.
First, it is interesting to note that rumination, dissociation,
current stress, and sleepiness varied more within subjects
than between subjects. Dissociation and rumination are often
considered as trait characteristics, and individuals are described
as “ruminative” or “dissociative.” It seems that although there
are interpersonal differences in the inclination toward ruminative
thinking or dissociation, as well as current stress or sleepiness,
it is important to also explore these factors at the intrapersonal
level, as state variables, as well as consider state-trait interactions
as we did in the present study. Interestingly, trait and state
relationships were not always completely parallel. Specifically,
momentary increases in state DEP-DER were significantly related
to negative value of the thought and thinking about the past;
Negative Valence
Negative valence positively predicted DEP-DER and ABS. We
were also interested in exploring the unique contribution of
each one of the different ruminative thinking components to
the prediction of dissociation scales; thus, we ran a combined
model, in which we entered both past and negative valence as
predictors in a single model. Each of these ruminative thinking
elements remained statistically significant, both when predicting
ABS (b = 0.40 [0.33,0.47], SD = 0.04, t(1462.38) = 11.22,
p < 0.001, R2 β = 0.08, for past; b = 0.12 [0.04,0.19], SD = 0.04,
t(1451.16) = 3.11, p < 0.005, R2 β = 0.03, for negative valence)
and when predicting DEP-DER (b = 0.03 [0.01,0.06], SD = 0.01,
t(941.62) = 2.44, p < 0.05, R2 β = 0.01, for past and b = 0.03
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December 2018 | Volume 9 | Article 2465
(1) Depression (t) (M = 4.98,
SD = 3.37)
(2) Anxiety (t) (M = 6.49,
SD = 6.00)
1
2
3
4
5
1
0.57∗∗
0.38,0.72
0.59∗∗
0.44,0.72
0.38∗∗
0.16,0.55
0.30∗∗
0.12,.47
−0.42∗∗
−0.56
−0.24
0.49∗∗
0.30,0.68
0.53∗∗
0.35,0.67
0.49∗∗
0.35,0.62
0.37∗∗
0.15,0.55
1
1
(3) OC symptoms (t)
(M = 11.98, SD = 9.42)
1
(4) Thinking about the past (s)
(M = 1.77, SD = 0.56)
(5) Thinking about the future (s)
(M = 2.26, SD = 0.74)
8
(6) Thinking about the present
(s)
(M = 3.57, SD = 0.45)
(9) Sleepiness (s)
(M = 2.24, SD = 59 )
(10) DEP-DER (s)
(M = 1.12, SD = 0.40)
9
10
11
0.38∗∗
0.18,0.59
0.39∗∗
0.20,0.55
0.35∗∗
0.15,0.51
0.20∗
−0.01,0.46
0.47∗∗
0.28,0.63
0.40∗∗
−0.54, −0.25
0.36∗∗
0.20,0.52
0.57∗∗
0.41, 0.69
−0.27∗∗
0.06, 0.45
0.35∗∗
0.03,0.66
0.47∗∗
0.31,0.64
0.32∗∗
0.12,0.52
−0.33∗∗
−0.45,
−0.21
0.28∗∗
0.09,0.45
0.37∗∗
0.18,0.54
0.34∗∗
0.17, 0.48
0.20∗
−0.09,0.56
0.57∗∗
0.30,0.70
0.79∗∗
0.71,0.85
−0.44∗∗
−0.57, −0.29
0.37∗∗
0.19,0.54
0.48∗∗
0.31,0.62
0.35∗∗
0.15,0.52
0.18
−0.11,0.56
0.56∗∗
0.35,0.72
−0.49∗∗
−0.64
−0.33
0.35∗∗
0.17,0.53
0.57∗∗
0.37,0.65
−0.27∗∗
0.06,0.47
0.11
−0.10,0.41
0.48∗∗
0.30,0.63
−0.50∗∗
−0.63,−0.34
−0.23∗
−0.38,−0.15
−0.46∗∗
−0.58,−0.34
0.46∗∗
0.31,0.64
0.47∗∗
0.21,0.70
0.18
0.05,0.32
0.30∗∗
0.08,0.51
1
0.36∗∗
0.15,0.55
0.14
−0.07,0.42
0.24∗
0.07,0.45
1
0.24∗
0.10,0.40
0.34∗∗
0.14,0.52
1
0.41∗∗
0.16,0.60
,
,
−0.58∗∗
−0.72, −0.44
1
.
−0.50∗∗
−0.63,
−0.33
1
∗p
< 0.05, ∗∗ p < 0.01; Under each coefficient are 95% bootstrapped confidence intervals, using 1,000 resamples, calculated with the bias-corrected and accelerated method and rounded down to two decimals; Trait
variables are marked by "t" and averaged state variables are marked by "s" in brackets.
No Time Like the Present
December 2018 | Volume 9 | Article 2465
(11) ABS (s)
(M = 1.8, SD = 0.8)
8
1
(7) Negative value of the
thoughts (s)
(M = 2.41, SD = 0.6)
(8) Current stress (s)
(M = 1.82, SD = 0.69)
7
1
6
Vannikov-Lugassi and Soffer-Dudek
Frontiers in Psychology | www.frontiersin.org
TABLE 2 | Correlations, means, and standard deviations of trait variables (depression, anxiety, OC symptoms), and state variables averaged across all measurements for each participant (thinking about the past, the
future, and the present, negative value of thoughts, current stress, sleepiness, ABS, and DEP-DER).
Vannikov-Lugassi and Soffer-Dudek
No Time Like the Present
both momentary stress and sleepiness predicted ABS and
DEP-DER. Namely, when the participants reported that they felt
sleepy or stressed, they were also more absorbed in daydreams
and detached from the self or their surroundings. These
findings reinforce a growing body of research regarding the
relationship between sleep and dissociation (e.g., Giesbrecht
et al., 2007; van der Kloet et al., 2012b; Soffer-Dudek et al.,
2017). Additionally, they reinforce previous longitudinal (daily
or experience-sampling) studies demonstrating that daily
stress is temporally associated with dissociative experiences
(Stiglmayr et al., 2008; Soffer-Dudek, 2017a). Notably, whereas
the DEP-DER component is usually the one assessed in state
dissociation questionnaires, our results suggest that being
absorbed in daydreaming also relates contemporaneously
to current stress and sleep. This replicates recent results
regarding a contemporaneous relation of daily ABS with
daily stress (Soffer-Dudek, 2017a), and expands them to
an experience-sampling design, as well as to sleepiness.
Indeed, ABS longitudinally predicted an increase in sleepiness
in the face of sleep loss (Soffer-Dudek et al., 2017) and
is related to post-traumatic stress (Armour et al., 2014)
as well as psychopathological distress (Levin and Spei,
2004; Soffer-Dudek et al., 2015). These findings are also
compatible with the recently formulated concept of MD
(Somer, 2002); research on MD, which has been conceptualized
as a disorder of extreme dissociative absorption, shows a
relation with various comorbidities and psychopathological
symptoms (Somer et al., 2017). Future studies may assess
the extent to which the relation of current or daily stress
and dissociative components may be the consequence of
anteceding trauma; possibly the specific type of trauma is
also of importance (i.e., type I- unanticipated single events,
versus type II- repeated exposure to extreme events; Terr,
1995).
Regarding the components of negative thinking, we found that
both elements of rumination, i.e., thinking about the past and
negative value of the thought, significantly and independently
predicted DEP-DER and ABS. Both components of worry, i.e.,
thinking about the future and negative value of the thought,
predicted ABS, but only negative value predicted DEP-DER.
In other words, it seems that when individuals thought either
about the past or the future, they became absorbed in their
inner world. However, a sense of detachment was associated
only with thinking about the past. Possibly, negative events
from the past that are unamenable to change (in comparison
to future events), may bring about overwhelming sadness or
guilt, and thus the need to detach from those feelings may be
stronger. Moreover, DEP-DER may stem from intensely and
vividly imagining a past or future situation, causing a person
to feel disconnected from reality; it is possible that most people
can conjure up such a vivid image more readily regarding past
events that they have actually perceived, rather than imagined
future situations. However, a reverse direction between DEPDER and thinking about the past is also possible; for example,
sensations of depersonalization or derealization may bring about
thinking about the past in order to understand the origin of those
sensations.
TABLE 3 | Results of multilevel models predicting either ABS or DEP-DER. Each
model includes a Level-1 state predictor as well as the measurement number
variable.
Predicted variable Predictor
DEP-DER
ABS
Thinking about the past
b = 0.04
[0.02,0.07],
SD = 0.01,
t(1055.97) = 3.09,
p < 0.005
R2 β = 0.01
b = 0.43
[0.36,0.50],
SD = 0.03,
t(1442.77) = 12.3,
p < 0.001
R2 β = 0.10
Thinking about the future
b = 0.01
[−0.01,0.04],
SD = 0.01,
t(875.71) = 1.02,
p = ns
R2 β = 0.00
b = 0.36
[0.30,0.42],
SD = 0.03,
t(1336.57) = 11.85,
p < 0.001
R2 β = 0.10
Thinking about the present
b = −0.04
[−0.06,−0.01],
SD = 0.01,
t(1341.24) = −2.87,
p < 0.005
R2 β = 0.01
b = −0.60
[−0.56,−0.54],
SD = 0.03,
t(1501.6) = −19.73,
p < 0.001
R2 β = 0.21
Negative value of the thoughts
b = 0.04
[0.01,0.07],
SD = 0.01,
t(1170.27) = 2.73,
p < 0.01
R2 β = 0.01
b = 0.22
[0.14,0.30],
SD = 0.04,
t(1449.25) = 5.76,
p < 0.001
R2 β = 0.02
Current stress
b = 0.04
[0.01,0.07],
SD = 0.01,
t(1102.6) = 2.74,
p < 0.01
R2 β = 0.01
b = 0.28
[0.21,0.36],
SD = 0.04,
t(1349.9) = 7.22,
p < 0.001
R2 β = 0.04
Sleepiness
b = 0.06
[0.04,0.08],
SD = 0.01,
t(1147.62) = 5.14,
p < 0.001
R2 β = 0.02
b = 0.27
[0.21,0.33],
SD = 0.03,
t(1418.97) = 8.89,
p < 0.001
R2 β = 0.05
Statistically significant effects are bolded. Bootstrapping was performed using
1,000 resamples. CI = 95% bootstrapped confidence intervals, calculated with the
bias-corrected and accelerated method and rounded down to two decimals.
however, both negative valence of the thought and thinking
about the past were unrelated to DEP-DER when examined
as traits (i.e., averaged across all measurements). Apparently
almost all of the participants experienced moments of thinking
about the past or negative content at some point of the study.
Hence, averaging across all the state measurements and ignoring
momentary changes may result in missing some important effects
and thus may be less informative. Similarly, van Heugten-van
der Kloet et al. (2015a) have found that whereas dissociation
and creativity were uncorrelated at the trait level, they were
correlated at the state level. These results add precision to our
understanding of relationships and thus highlight the importance
of using person-centered designs, such as the present study.
Current Stress, Sleepiness, Thought
Components, and Dissociation
The findings support the suggested pathways between
current stress, sleepiness and dissociative experiences, as
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December 2018 | Volume 9 | Article 2465
Vannikov-Lugassi and Soffer-Dudek
No Time Like the Present
TABLE 4 | Interactive models predicting ABS and DEP-DER, in which each of the Level-1 (state) predictors (thinking about the past, the future, the present, negative
value of the thoughts, current stress, and sleepiness) is moderated by depression, anxiety, or OC symptoms.
The predicted
variable:
Moderator predictor
DEP-DER
Depression
ABS
Anxiety
OC symptoms
Depression
[0.00,0.01]∗
b = 0.02 [0.01,0.04]
SD = 0.01
t(1519.52) = 2.77,
p < 0.01
R2 β = 0.01
b = 0.01
SD = 0.00
t(415.66) = 3.69
p < 0.001
R2 β = 0.03
Anxiety
OC symptoms
[0.00,0.02]∗
b = 0.01
[0.01,0.02]SD = 0.00
t(1535.23) =
4.01, p < 0.001
R2 β = 0.01
b = 0.01
SD = 0.00
t(1536.02) = 2.34,
p < 0.05
R2 β = 0.00†
Thinking about the past b = 0.01 [0.01,0.02]
SD = 0.00,
t(329.72) = 3.89,
p < 0.001
R2 β = 0.04
b = 0.01 [0.01,0.01]
SD = 0.00
t(99.31) = 6.2,
p < 0.001
R2 β = 0.28
Thinking about the
future
b = 0.00 [0.00,0.01]
SD = 0.00
t(495.44) = 0.55,
p = 0.58
R2 β = 0.00
b = 0.00 [0.01,0.00]
SD = 0.00
t(508.47) = −1.94,
p = 0.053
R2 β = 0.01
b = 0.00 [0.00,0.00]
SD = 0.00
t(524.53) = 0.32,
p = 0.75
R2 β = 0.01
b = 0.01 [0.00,0.03]
SD = 0.01
t(1512.39) =
1.7, p = 0.09
R2 β = 0.00
b = 0.01 [0.00,0.01]
SD = 0.00
t(1506.22) = 1.47,
p = 0.14
R2 β = 0.00
b = 0.01 [0.01,0.02]
SD = 0.00
t(1494.54) = 4.22,
p < 0.001
R2 β = 0.01
Thinking about the
present
b = 0.00 [0.01,0.01]
SD = 0.00
t(1493.74) = −0.04
p = 0.96
R2 β = 0.00
b = 0.00 [−0.01,0.00]
SD = 0.00
t(1497.7) = −1.4,
p = 0.15
R2 β = 0.00
b = 0.00 [0.00,0.00]
SD = 0.00
t(1463.72) = 0.06,
p = 0.95
R2 β = 0.00
b = −0.04 [−0.06,
−0.02] SD = 0.01
t(1534.28) =
−4.34, p < 0.001
R2 β = 0.01
b = −0.03
[−0.04,−0.02]
SD = 0.00,
t(1538.6) = −5.43,
p < 0.001
R2 β = 0.02
b = −0.02
[−0.02,−0.01]
SD = 0.00
t(1499.55) = −5.15,
p < 0.001
R2 β = 0.02
Negative value of the
thought
b = 0.01 [0.00,0.02]∗
SD = 0.00
t(774.04) = 2.44,
p < 0.05
R2 β = 0.01
b = 0.01 [0.01,0.02]
SD = 0.00
t(1204.2) = 4.69,
p < 0.001
R2 β = 0.02
b = 0.00 [0.00,0.01]∗
SD = 0.00
t(590.88) = 1.99,
p < 0.05
R2 β = 0.01
b = 0.04 [0.02,0.06]
SD = 0.01
t(1523.43) =
3.55, p < 0.001
R2 β = 0.01
b = 0.00 [−0.01,0.01]
SD = 0.01
t(1513.96) = −0.19,
p = 0.85
R2 β = 0.00
b = 0.01 [0.01,0.02]
SD = 0.00
t(1537.63) = 5.55,
p < 0.001
R2 β = 0.02
Current stress
b = 0.01 [0.00,0.02]∗ b = 0.01 [0.00,0.01]∗
SD = 0.00
SD = 0.00
t(1022.06) = 2.22
t(1028.28) = 2.25,
p < 0.05
p < 0.05
R2 β = 0.01
R2 β = 0.01
b = 0.00 [0.00,0.01]
SD = 0.00
t(987.99) = 1.56,
p = 0.12
R2 β = 0.00
Sleepiness
b = 0.01 [0.00,0.01]∗
SD = 0.00
t(1512.98) = 2.32,
p < 0.05
R2 β = 0.01
b = 0.00 [0.00,0.00] b = 0.00 [−0.02,0.02] b = 0.00 [−0.01,0.01] b = 0.00 [−0.01,0.00]
SD = 0.00
SD = 0.00
SD = 0.00, t(1531.77) =
SD = 0.00
t(1541) = −0.13,
t(1540.67) = 0.44
0.2, p = 0.84
t(1490.7) = 1.65,
p = 0.89
p = 0.66
R2 β = .00
p = 0.1
R2 β = 0.00
R2 β = 0.00
R2 β = 0.00
b = 0.01 [0.01,0.01]
SD = 0.00
t(1497.12) = 5.65,
p < 0.001
R2 β = 0.02
b = 0.01 [−0.01,0.04] b = −0.01 [−0.02,0.00] b = 0.01 [0.01,0.02]
SD = 0.00
SD = 0.01
SD = 0.01, t(1454.4) =
t(1455) = −1.52,
t(1511.84) =
1.58, p = 0.11
p = 0.13
4.22, p < 0.005
R2 β = .00
R2 β = 0.00
R2 β = 0.01
Statistically significant effects are bolded. Bootstrapping was performed using 1,000 resamples. CI = 95% bootstrapped confidence intervals, calculated with the biascorrected and accelerated method and were rounded down to two decimals. ∗ After the rounding, some of the lower borders of the significant effects that were positive,
appear as if they are zero, when in fact they are positive but small. † This effect was larger than zero but appears as zero when it is rounded down to two decimals.
in itself lead to a deterioration in affect, but rather, the
affective content of the wandering thought does. Indeed, our
results show that thoughts about the present are often more
positive than thoughts about the future or the past. However,
thinking about the past predicted dissociative symptoms even
when controlling for the negative valence of the thoughts,
suggesting that this effect cannot be explained by affective
content alone. Similarly, Smallwood and Schooler (2015) have
noted that whereas poor mood has been related to mindwandering in general, it is especially related to mind-wandering
about the past. Importantly, despite the similarity between
mind-wandering and dissociative ABS, Soffer-Dudek (2018)
has found that these constructs are empirically disparate.
Theoretically, dissociative ABS is defined by the intensity of
focus on the stimuli (to the point of obliviousness to other
stimuli), whereas mind-wandering is defined by the nature
of the stimuli (internal rather than external; Soffer-Dudek,
2018).
Although thinking about the past and the future differed
in their links to DEP-DER, their relationships with the other
variables were similar, whereas thinking about the present
presented a completely opposite pattern. Specifically, both
past and future were positively related to ABS, negative
thinking, current stress, and sleepiness, whereas thinking
about the present was inversely associated with all of these
factors, as well as with DEP-DER. A closely related concept
to thinking about the present, or rather to not thinking
about the present, is mind-wandering. Mind-wandering is
defined as unconstrained mental activity, generated by the
individual rather than cued by an external environment
(Smallwood and Schooler, 2006, 2015; Smallwood, 2013).
Indeed, mind-wandering was strongly correlated with negative
mood (Smallwood et al., 2009; Killingsworth and Gilbert,
2010; Poerio et al., 2013). Poerio et al. (2013) claim that
mind-wandering, i.e., the trail of thought leaving external
reality in favor of internally generated information, does not
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Vannikov-Lugassi and Soffer-Dudek
No Time Like the Present
There seems to be a specific relation between ABS and
OC symptoms (Soffer-Dudek, 2014). In accordance with
our hypothesis, we found that OC symptoms moderated
the links between thinking components and current stress
on one hand, and with ABS on the other hand. For
example, only individuals who were characterized by high
levels of OC symptoms were inclined to report ABS alongside
moments of current stress. Possibly, mental states such as
thinking about the past or the future, negative content
of thoughts, or current stress, triggered obsessive thoughts
for high OC individuals, and during this process, they
became absorbed in their inner world and detached from
external stimuli. Conversely, becoming absorbed in thoughts
or daydreams may have triggered anxiety when realizing
their disconnection from reality, which may have induced
the urge to check or perform another mental or behavioral
compulsion.
Our findings are in accordance with the literature
regarding the positive benefits of mindfulness meditation
(e.g., Allen et al., 2006; Schonert-Reichl and Lawlor, 2010;
Cullen, 2011). The core of the mindfulness approach is
paying attention to the way that one’s experience occurs,
without judging it (Kabat-Zinn, 2003). This practice aids in
disengaging from mental states characterized by negative
and ruminative thoughts and leads to the acceptance of
mental contents (Morgan, 2003). In the present study,
moments of focusing on the present were indeed related to
decreased levels of momentary stress, sleepiness, negative
thinking, and dissociative symptoms. Possibly, focusing
on the present may prevent individuals from dissociating;
this is in accordance with the usefulness of grounding
techniques for coping with DEP-DER (Simeon, 2004), as
well as the well-documented efficiency of mindfulnessbased therapies for several psychopathological symptoms
(Baer, 2003; Keng et al., 2011). Indeed, dissociation is
detrimental to psychotherapy (Rufer et al., 2006; Spitzer
et al., 2007; Fassino et al., 2009; Semiz et al., 2014; Arntz
et al., 2015). Conversely, it is also possible that sleepiness,
current stress and dissociative symptoms bring about
thinking about the past or the future, possibly due to reduced
concentration and thus difficulties in focusing on the present
occupation.
Limitations and Conclusion
There are several limitations in this study that should be
addressed. First, all the measures were self-reported. Selfreport measures may be vulnerable to bias, due to overreporting (Frueh et al., 2000; Merckelbach et al., 2014).
However, over-reporting bias was found to be relevant only
to 4% of participants in studies with no secondary gain
(Merckelbach et al., 2014). Moreover, over-reporting often
decreases effect sizes rather than increases them (Merckelbach
et al., 2014) and the extent to which it distorts research
outcomes is limited (McGrath et al., 2010). Finally, individual
differences in the tendency to over-report are irrelevant to
within-subjects variance, which was the main focus of the
present investigation. Thus, our pattern of results probably
cannot be fully explained by over-reported symptoms of the
participants.
It is important to state that we did not assess trauma
in this study. The link between trauma and dissociation
has been extensively explored and trauma is considered to
be one of the main factors predicting dissociation (e.g.,
Gershuny and Thayer, 1999). Assessing past traumas in
this sample could have promoted a better understanding of
the possible interactions between long-term and short-term
correlates of dissociation. In addition, in the present study
we explored the structure components of rumination (past
focus and negative valence of the repetitive thought) but we
did not explore the contents or themes embodied in the
ruminative thoughts. For example, Sar and Ozturk (2006)
suggested that past unresolved traumatic events lead to repetitive
obsessions about these traumas. Further research is needed
in order to explore whether the effect of rumination in
predicting dissociation is related to specific (e.g., traumatic)
contents or rather if it is independent of any specific
content, stemming only from to the structure of this thought
style.
The participants were tested only for 4 days. The short
duration of the study was was determined in order to recruit
a larger sample by making the study more accessibe and less
demanding. In these 4 days, the participants answered the items
The Moderating Roles of Depression,
Anxiety, and Obsessive–Compulsive
Symptoms
In accordance with our expectation, the links described above
were influenced by trait levels of psychopathology. Overall,
we found support for our hypothesis that depression and
anxiety would be more dominant in moderating the links
with DEP-DER, whereas OC symptoms will demonstrate a
stronger role in moderating the links with ABS. Specifically, we
found that only depression and anxiety, but not OC symptoms,
moderated the links between sleepiness and DEP-DER, so that
moments of sleepiness were more strongly associated with
moments of DEP-DER among those reporting high levels of
depressive and anxiety symptoms. This may possibly be due
to lower sleep quality in those with depression and anxiety
(Breslau et al., 1996; Ohayon and Roth, 2003; Gregory et al.,
2005; Hayashino et al., 2010), which possibly impairs the
boundaries between sleep and waking states, resulting in DEPDER, a dream-like waking state (Holmes et al., 2005). In
addition, we found that current stress predicted DEP-DER
only among individuals who were characterized by high levels
of depression and anxiety. Anxiety, especially Panic Disorder,
is characterized by hyperarousal (Clark and Watson, 1991;
Joiner et al., 1999). Similarly, researchers studying depression
from a physiologic standpoint have noted that individuals with
depression have abnormally high levels of cortisol, similar to
anxiety disorders (De Souza, 1995; Thase et al., 1996). This
hyperarousal may possibly produce DEP-DER in order to
counteract elevated arousal in an attempt to restore balance
(Soffer-Dudek, 2014).
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Vannikov-Lugassi and Soffer-Dudek
No Time Like the Present
lead to dissociative experiences are cross-sectional, in this
study we used momentary assessments and expanded previous
results regarding momentary stress and dissociation (Stiglmayr
et al., 2008) to sleepiness and rumination. Second, we broke
apart the concepts of rumination and worry that are usually
examined in the literature as whole concepts, into their basic
thought components, and showed that each component has a
unique and significant role in predicting dissociation. Specifically,
thinking about the past, the future, and negative value of
the thoughts, are all unique predictors of state dissociative
experiences. Third, we found that thinking about the past or
the future are both related to negative mental states (current
stress, sleepiness, and dissociation), whereas thinking about the
present was associated with decreased levels of those states.
However, it is important to take into account that (a) our
data points to shared oscillations between the constructs, but
it does not identify the directionality of the associations; and
(b) these links did not exist among all participants equally,
but rather were dependent upon levels of psychopathological
symptoms.
These findings expand our knowledge on the mechanisms
involved in dissociative experiences, and they have implications
for clinical practice. Specifically, clinicians treating common
disorders such as depression, anxiety, and OCD, do not
necessarily routinely assess dissociation; however, our findings
highlight the importance of taking dissociation into account.
Dissociation is maladaptive and related to poorer prognosis
and poorer response to treatment, possibly due to detachment
from the therapeutic process (Rufer et al., 2006; Spitzer et al.,
2007; Fassino et al., 2009; Semiz et al., 2014; Arntz et al.,
2015). Thus, it is especially important to identify the mental
states that may trigger dissociation in psychotherapy. Perhaps
clinicians who observe signs of repetitive thinking about
events from the past or the future should pay attention to
possible detachment accompanying those moments. Such
dissociating may be detrimental to the therapeutic process if it
goes unnoticed and untreated. Moreover, our findings suggest
that clinicians may expect specific subtypes of dissociation
in accordance with the psychopathological pattern of the
client. Such expansion of our knowledge on the links between
dissociation and psychopathology may be helpful in early
recognition of dissociation signs, ultimately leading to better
understanding clients’ emotional states across different moments
in the session.
four times a day, resulting in 16 assessment points. This resulted
in a sufficient amount of within subjects’ variance as can be
concluded from the ICC indices and also from the strong withinsubjects associations that were found. Yet, longer study with more
days of measurment could have increased the validity of our
findings.
Another limitation is the limited number of items assessing
state ABS and DEP-DER. ABS was measured with only one
item, due to a problem with the validation of the second item.
One item is not fully sufficient to assess all the aspects of
ABS and this item indeed measured only absorption in daydreaming (and not in other mental or external experiences).
DEP-DER was measured with two items, one for DEP and
one for DER, which is also insufficient. According to Sar
et al. (2017), there are four aspects of DEP-DER: cognitiveemotional depersonalization, perceptual alterations, detachment
from reality, and bodily self-detachment. Of these four aspects,
our two items measured cognitive-emotional depersonalization
and detachment from reality, whereas the other two aspects
were not examined in our study. The nature of our study
(experience sampling) limited the amount of items, in order
to avoid overloading each administration point. In future
studies, more items may be used in order to validate and to
expand our results to additional aspects of both ABS and DEPDER.
A final limitation of our study is the fact that our study was
gender-biased toward women and was composed of non-clinical
and relatively high-functioning college students. However, the
definition of the sample as non-clinical does not mean that
none of the participants had clinical-range symptoms and
disorders. In fact, 40% of participants reported that they had,
at some point in their life, engaged in psychotherapy, and
10% of them reported that they currently take psychotropic
medication. These percentages are compatible with reports by
Hunt and Eisenberg (2010) and Stallman (2010) who claim
that psychopathology levels among college students are high
and similar to the prevalence of psychopathology in sameaged non-students. The non-clinical nature of the sample in
this study, may explain the low means of DEP-DER and ABS
state scales and the low means of depression and anxiety trait
scales. The ICC indices of DEP-DER and ABS indicate that
there was sufficient amount of within-subject variance to explore
temporal changes in these variables. The means of depression
and anxiety are completely compatible with the means of nonclinical subjects in other studies (e.g., Crawford et al., 2011 for
anxiety; and Gonzalez et al., 2013 for depression). Thus, we
may be able to generalize our results to community samples,
but future research should explore these links among clinical
samples with higher levels of dissociation, as well as depression
and anxiety.
Despite these limitations, the study also has methodological
strengths, specifically, the use of experience-sampling to
identify high-resolution contemporaneous relationships, and
the exploration of cross-level trait-state interactions which
help advance scientific knowledge beyond simple correlative
information. There are some important findings in this study.
First, whereas most studies on the mechanisms which may
Frontiers in Psychology | www.frontiersin.org
DATA AVAILABILITY STATEMENT
The raw data supporting the conclusions of this manuscript will
be made available by the authors, without undue reservation, to
any qualified researcher.
ETHICS STATEMENT
This study was carried out in accordance with the
recommendations of the BGU institutional review board
12
December 2018 | Volume 9 | Article 2465
Vannikov-Lugassi and Soffer-Dudek
No Time Like the Present
FUNDING
with written informed consent from all subjects. All
subjects gave written informed consent in accordance
with the Declaration of Helsinki. The protocol received
ethical approval beforehand by the institutional review
board.
This research was supported by the ISRAEL SCIENCE
FOUNDATION (Grant No. 539/13), and this research was also
supported in part by the ISRAEL SCIENCE FOUNDATION
grant (1895/13).
AUTHOR CONTRIBUTIONS
SUPPLEMENTARY MATERIAL
MV-L and NS-D were responsible for the conception, literature
review, data collection, data analysis, and writing of this
manuscript. This research is part of MV-L’s graduate work,
conducted under the supervision of NS-D.
The Supplementary Material for this article can be found
online at: https://www.frontiersin.org/articles/10.3389/fpsyg.
2018.02465/full#supplementary-material
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Conflict of Interest Statement: The authors declare that the research was
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