ArticleBMC psychology2026
Cognitive fusion and psychological distress as serial mediators between childhood trauma and maladaptive daydreaming.
Article in BMC psychology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMaladaptive daydreaming (MD) has been conceptualized as an immersive, compulsive form of fantasy engagement often linked to emotional avoidance. Although childhood trauma has been associated with MD, the underlying cognitive and emotional mechanisms remain insufficiently clarified. This study examined whether cognitive fusion and psychological distress function as serial mediators in the relationship between childhood trauma and MD, and whether these pathways differ by gender.
methodsA total of 366 medical students participated in this cross-sectional study. Participants completed the Childhood Trauma Questionnaire (CTQ-28), Cognitive Fusion Questionnaire (CFQ-7), Depression Anxiety Stress Scale (DASS-21), and Maladaptive Daydreaming Scale (MDS-16). Data were analyzed using partial least squares structural equation modeling (PLS-SEM) with 5,000 bootstrap resamples. Measurement invariance across gender was assessed using the MICOM procedure, followed by permutation-based multi-group analysis.
resultsChildhood trauma was positively associated with both cognitive fusion and psychological distress. Cognitive fusion showed strong associations with distress and MD, and distress was independently related to MD. The indirect effects indicated that trauma influenced MD via cognitive fusion and the sequential pathway of cognitive fusion and distress. The direct path from trauma to MD was not significant, supporting a full mediation pattern. Measurement invariance across genders was partially established. Multi-group analyses revealed no significant gender differences in the primary structural paths and total indirect associations, although certain distress-related indirect pathways showed localized gender variation.
conclusionThe association between childhood trauma and maladaptive daydreaming appears to operate primarily through cognitive and emotional mechanisms rather than direct effects. Cognitive fusion plays a central mediating role, both independently and in conjunction with psychological distress. These findings support a process-based conceptualization of MD and suggest that interventions targeting cognitive fusion and distress regulation may be clinically relevant for treating MD.
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