Abstract
Objectives
Evidence is lacking for trait mindfulness as a longitudinal protective factor following bereavement and other stressful life events. This study aimed to determine whether trait mindfulness predicted better mental health adjustment (i.e., decreased distress and greater positive states of mind) in young adults following the recent loss of a loved one. This study also examined cognitive (e.g., intrusive and deliberate thoughts) and somatic (e.g., sleep disturbance) processes as possible underlying mechanisms linking trait mindfulness to mental health consequent to bereavement.
Method
Recently-bereaved undergraduate students (n = 117) completed questionnaires evaluating multifaceted aspects of mental health adjustment following their loss at three time points (T1: baseline, T2: 3 weeks, T3: 6 weeks).
Results
Trait mindfulness significantly predicted reduced distress symptoms (i.e., anxiety, depression, and stress) and increased positive states of mind over time. Trait mindfulness significantly impacted mental health following loss indirectly through its effect on sleep disturbance, but it had no significant indirect effects through intrusive or deliberate thoughts.
Conclusions
Trait mindfulness may be a key protective factor for young adults who experience highly stressful events. Findings underscore the importance of sleep disturbance as a critical factor linking trait mindfulness and mental health adjustment consequent to bereavement. This study contributes to our understanding of risk and resilience factors following loss, which can also inform targeted mindfulness-based interventions as well as future studies to eventually establish causal pathways between trait mindfulness and mental health consequent to bereavement.
Preregistration
This study was not preregistered.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The data that support the findings of this study are available upon reasonable request from the corresponding author with regulatory board approval. The data are not publicly available due to privacy or ethical restrictions.
References
Alvaro, P. K., Roberts, R. M., & Harris, J. K. (2013). A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep, 36(7), 1059–1068. https://doi.org/10.5665/sleep.2810.
An, Y., Yuan, G., Zhang, N., Xu, W., Liu, Z., & Zhou, F. (2018). Longitudinal cross-lagged relationships between mindfulness, posttraumatic stress symptoms, and posttraumatic growth in adolescents following the Yancheng Tornado in China. Psychiatry Research, 266, 334–340. https://doi.org/10.1016/j.psychres.2018.03.034.
Ang, W. H. D., Lau, S. T., Cheng, L. J., Chew, H. S. J., Tan, J. H., Shorey, S., & Lau, Y. (2022). Effectiveness of resilience interventions for higher education students: A meta-analysis and metaregression. Journal of Educational Psychology, 114(7), 1670–1694. https://doi.org/10.1037/edu0000719.
Baddeley, J. L., Williams, J. L., Rynearson, T., Correa, F., Saindon, C., & Rheingold, A. A. (2015). Death thoughts and images in treatment-seekers after violent loss. Death Studies, 39(2), 84–91. https://doi.org/10.1080/07481187.2014.893274.
Baer, R. (2019). Assessment of mindfulness by self-report. Current Opinion in Psychology, 28, 42–48. https://doi.org/10.1016/j.copsyc.2018.10.015.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1177/1073191105283504.
Balk, D. E. (2008). Grieving: 22 to 30% of all college students. New Directions for Student Services, 2008(121), 5–14. https://doi.org/10.1002/ss.262.
Barlé, N., Wortman, C. B., & Latack, J. A. (2017). Traumatic bereavement: Basic research and clinical implications. Journal of Psychotherapy Integration, 27(2), 127–139. https://doi.org/10.1037/int0000013.
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173. https://doi.org/10.1037/0022-3514.51.6.1173.
Bergomi, C., Tschacher, W., & Kupper, Z. (2013). The assessment of mindfulness with self-report measures: Existing scales and open issues. Mindfulness, 4(3), 191–202. https://doi.org/10.1007/s12671-012-0110-9.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., & Velting, D. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077.
Boelen, P. A., Reijntjes, A., Djelantik, A. M. J., & Smid, G. E. (2016). Prolonged grief and depression after unnatural loss: Latent class analyses and cognitive correlates. Psychiatry Research, 240, 358–363. https://doi.org/10.1016/j.psychres.2016.04.012.
Breckenridge, J. N., Gallagher, D., Thompson, L. W., & Peterson, J. (1986). Characteristic depressive symptoms of bereaved elders. Journal of Gerontology, 41(2), 163–168. https://doi.org/10.1093/geronj/41.2.163.
Burton, A., Haley, W., & Small, B. (2006). Bereavement after caregiving or unexpected death: Effects on elderly spouses. Aging and Mental Health, 10(3), 319–326. https://doi.org/10.1080/13607860500410045.
Cacciatore, J., Thieleman, K., Osborn, J., & Orlowski, K. (2014). Of the soul and suffering: Mindfulness-based interventions and bereavement. Clinical Social Work Journal, 42(3), 269–281. https://doi.org/10.1007/s10615-013-0465-y.
Calhoun, L. G., Cann, A., Tedeschi, R. G., & McMillan, J. (2000). A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 13(3), 521–527. https://doi.org/10.1023/A:1007745627077.
Cann, A., Calhoun, L. G., Tedeschi, R. G., Triplett, K. N., Vishnevsky, T., & Lindstrom, C. M. (2011). Assessing posttraumatic cognitive processes: The event related rumination inventory. Anxiety Stress & Coping, 24(2), 137–156. https://doi.org/10.1080/10615806.2010.529901.
Carpenter, J. K., Conroy, K., Gomez, A. F., Curren, L. C., & Hofmann, S. G. (2019). The relationship between trait mindfulness and affective symptoms: A meta-analysis of the five Facet Mindfulness Questionnaire (FFMQ). Clinical Psychology Review, 74, 101785. https://doi.org/10.1016/j.cpr.2019.101785.
Ding, X., Wang, X., Yang, Z., Tang, R., & Tang, Y. Y. (2020). Relationship between trait mindfulness and sleep quality in college students: A conditional process model. Frontiers in Psychology, 11, 576319. https://doi.org/10.3389/fpsyg.2020.576319.
Ding, Y., Fu, X., Liu, R., Hwang, J., Hong, W., & Wang, J. (2021). The impact of different coping styles on psychological distress during the COVID-19: The mediating role of perceived stress. International Journal of Environmental Research and Public Health, 18(20), 10947. https://doi.org/10.3390/ijerph182010947.
Emerson, L. M., Heapy, C., & Garcia-Soriano, G. (2018). Which facets of mindfulness protect individuals from the negative experiences of obsessive intrusive thoughts? Mindfulness, 9(4), 1170–1180. https://doi.org/10.1007/s12671-017-0854-3.
Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. P. (2007). Mindfulness and emotion regulation: The development and initial validation of the cognitive and affective mindfulness scale-revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29(3), 177–190. https://doi.org/10.1007/s10862-006-9035-8.
Finkelstein-Fox, L., Park, C. L., & Riley, K. E. (2019). Mindfulness’ effects on stress, coping, and mood: A daily diary goodness-of-fit study. Emotion, 19(6), 1002–1013. https://doi.org/10.1037/emo0000495.
Finkelstein-Fox, L., Park, C. L., Eigsti, I. M., Awao, S., & Mancini, A. D. (2023). Disruptions in self-regulatory processes predict depression and sleep disturbance in bereaved young adults. Stress and Health. https://doi.org/10.1002/smi.3310.
Frazier, P., Nguyen-Feng, V. N., Fulco, C., Anders, S., & Shallcross, S. (2017). Mediators of the relation between sexual victimization and distress: Comparison to bereavement. Psychological Trauma, 9(1), 96–104. https://doi.org/10.1037/tra0000166.
Garland, E. L., Farb, N. A., Goldin, P. R., & Fredrickson, B. L. (2015). Mindfulness broadens awareness and builds eudaimonic meaning: A process model of mindful positive emotion regulation. Psychological Inquiry, 26, 293–314. https://doi.org/10.1080/1047840X.2015.1064294.
Gaultney, J. F. (2010). The prevalence of sleep disorders in college students: Impact on academic performance. Journal of American College Health, 59(2), 91–97. https://doi.org/10.1080/07448481.2010.483708.
Gibert, L., Hage, E., Verdonk, W., Levy, C., Falissard, B., B., & Trousselard, M. (2021). The negative association between trait mindfulness and post-traumatic stress disorder: A 4.5‐year prospective cohort study. Brain and Behavior, 11(8), e02163. https://doi.org/10.1002/brb3.2163.
Gómez-Odriozola, J., & Calvete, E. (2021). Effects of a mindfulness-based intervention on adolescents’ depression and self-concept: The moderating role of age. Journal of Child and Family Studies, 30(6), 1501–1515. https://doi.org/10.1007/210826-021-01953-z.
Han, K. S., Kim, L., & Shim, I. (2012). Stress and sleep disorder. Experimental Neurobiology, 21(4), 141–150. https://doi.org/10.5607/en.2012.21.4.141.
Hardison, H. G., Neimeyer, R. A., & Lichstein, K. L. (2005). Insomnia and complicated grief symptoms in bereaved college students. Behavioral Sleep Medicine, 3(2), 99–111. https://doi.org/10.1207/s15402010bsm0302_4.
Harper, L., Jones, A., Goodwin, L., & Steven, G. (2022). Association between trait mindfulness and symptoms of post-traumatic stress: A meta-analysis. Journal of Psychiatric Research, 152, 233–241. https://doi.org/10.1016/j.jpsychires.2022.05.027.
Horowitz, M., Adler, N., & Kegeles, S. (1988). A scale for measuring the occurrence of positive states of mind: A preliminary report. Psychosomatic Medicine, 50(5), 477–483. https://doi.org/10.1097/00006842-198809000-00004.
Howell, A. J., Digdon, N. L., Buro, K., & Sheptycki, A. R. (2008). Relations among mindfulness, well-being, and sleep. Personality and Individual Differences, 45(8), 773–777. https://doi.org/10.1016/j.paid.2008.08.005.
Huang, F., Hsu, A., Chao, Y., Shang, C. M., Tsai, J., & Wu, C. W. (2021). Mindfulness-based cognitive therapy on bereavement grief: Alterations of resting‐state network connectivity associate with changes of anxiety and mindfulness. Human Brain Mapping, 42(2), 510–520. https://doi.org/10.1002/hbm.25240.
Kalill, K. S., Treanor, M., & Roemer, L. (2014). The importance of non-reactivity to posttraumatic stress symptoms: A case for mindfulness. Mindfulness, 5(3), 314–321. https://doi.org/10.1007/s12671-012-0182-6.
Kazdin, A. E. (2009). Understand how and why psychotherapy leads to change. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 19(4–5), 418–428. https://doi.org/10.1080/10503300802448899.
Lee, Y. H., Richards, K. A. R., & Washburn, N. (2021). Mindfulness, resilience, emotional exhaustion, and turnover intention in secondary physical education teaching. European Review of Applied Psychology, 71(6), 100625. https://doi.org/10.1016/j.erap.2021.100625.
Leeuwerik, T., Cavanagh, K., & Strauss, C. (2020). The association of trait mindfulness and self-compassion with obsessive-compulsive disorder symptoms: Results from a large survey with treatment-seeking adults. Cognitive Therapy and Research, 44(1), 120–135. https://doi.org/10.1007/s10608-019-10049-4.
Lehman, D. R., Wortman, C. B., & Williams, A. F. (1987). Long-term effects of losing a spouse or child in a motor vehicle Crash. Journal of Personality and Social Psychology, 52(1), 218–231. https://doi.org/10.1037/0022-3514.52.1.218.
Lepore, S. J., Silver, R. C., Wortman, C. B., & Wayment, H. A. (1996). Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers. Journal of Personality and Social Psychology, 70(2), 271–282. https://doi.org/10.1037/0022-3514.70.2.271.
Lin, J., Massar, S. A., & Lim, J. (2020). Trait mindfulness moderates reactivity to social stress in an all-male sample. Mindfulness, 11(9), 2140–2149.
Lindsay, E. K., Young, S., Smyth, J. M., Brown, K. W., & Creswell, J. D. (2018). Acceptance lowers stress reactivity: Dismantling mindfulness training in a randomized controlled trial. Psychoneuroendocrinology, 87, 63–73. https://doi.org/10.1016/j.psyneuen.2017.09.015.
Little, R. J. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.2307/2290157.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression anxiety stress scales (DASS) with the Beck Depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-u.
Lu, J., Potts, C. A., & Allen, R. S. (2021). Homeless people’s trait mindfulness and their resilience–a mediation test on the role of inner peace and hope. Journal of Social Distress and Homelessness, 30(2), 155–163. https://doi.org/10.1080/10530789.2020.1774847.
Madley-Dowd, P., Hughes, R., Tilling, K., & Heron, J. (2019). The proportion of missing data should not be used to guide decisions on multiple imputation. Journal of Clinical Epidemiology, 110, 63–73. https://doi.org/10.1016/j.jclinepi.2019.02.016.
Martin, K. P., Blair, S. M., Clark, G. I., Rock, A. J., & Hunter, K. R. (2018). Trait mindfulness moderates the relationship between early maladaptive schemas and depressive symptoms. Mindfulness, 9(1), 140–150. https://doi.org/10.1111/ap.12390.
Mason, T. M., Tofthagen, C. S., & Buck, H. G. (2020). Complicated grief: Risk factors, protective factors, and interventions. Journal of Social Work in End-of-Life & Palliative Care, 16(2), 151–174. https://doi.org/10.1080/15524256.2020.1745726.
McBride, E. E., Chin, G. R., Clauser, K. S., & Greeson, J. M. (2022). Perceived stress mediates the relationship between trait mindfulness and physical symptoms of stress: A replication study using structural equation modeling. Mindfulness, 13(8), 1923–1930. https://doi.org/10.1007/s12671-022-01923-1.
Meichsner, F., O’Connor, M., Skritskaya, N., & Shear, M. K. (2020). Grief before and after bereavement in the elderly: An approach to care. The American Journal of Geriatric Psychiatry, 28(5), 560–569. https://doi.org/10.1016/j.jagp.2019.12.010.
Monk, T. H., Germain, A., & Reynolds, C. F. (2008). Sleep disturbance in bereavement. Psychiatric Annals, 38(10), 671–675. https://doi.org/10.3928/00485713-20081001-06.
Murphy, M. J., Mermelstein, L. C., Edwards, K. M., & Gidycz, C. A. (2012). The benefits of dispositional mindfulness in physical health: A longitudinal study of female college students. Journal of American College Health, 60(5), 341–348. https://doi.org/10.1080/07448481.2011.629260.
Onrust, S., & Cuijpers, P. (2006). Mood and anxiety disorders in widowhood: A systematic review. Aging & Mental Health, 10(4), 327–334. https://doi.org/10.1080/13607860600638529.
Parsons, E. M., Dreyer-Oren, S. E., Magee, J. C., & Clerkin, E. M. (2019). Evaluating the indirect effects of trait mindfulness facets on state tripartite components through state rumination and state experiential avoidance. The Journal of Nervous and Mental Disease, 207(6), 440–450. https://doi.org/10.1097/NMD.0000000000000993.
Polizzi, C. P., Sleight, F. G., Aksen, D. E., McDonald, C. W., & Lynn, S. J. (2023). Mindfulness and COVID-19-related stress: Staying present during uncertain times. Mindfulness, 14(5), 1135–1147. https://doi.org/10.1007/s12671-023-02132-5.
Rash, J. A., Kavanagh, V. A., & Garland, S. N. (2019). A meta-analysis of mindfulness-based therapies for insomnia and sleep disturbance: Moving towards processes of change. Sleep Medicine Clinics, 14(2), 209–233. https://doi.org/10.12701/yujm.2020.00850.
Richardson, V. E., & Balaswamy, S. (2001). Coping with bereavement among elderly widowers. OMEGA-Journal of Death and Dying, 43(2), 129–144. https://doi.org/10.2190/Y2Q6-BB75-ENM7-BBYR.
Robitzsch, A., Grund, S., & Henke, T. (2018). Miceadds: Some additional multiple imputation functions, especially for mice. R Package Version, 2–12.
Sala, M., Rochefort, C., Lui, P. P., & Baldwin, A. S. (2020). Trait mindfulness and health behaviours: A meta-analysis. Health Psychology Review, 14(3), 345–393. https://doi.org/10.1080/17437199.2019.1650290.
Sauer, S., Walach, H., Schmidt, S., Hinterberger, T., Lynch, S., Büssing, A., & Kohls, N. (2013). Assessment of mindfulness: Review on state of the art. Mindfulness, 4(1), 3–17. https://doi.org/10.1007/s12671-012-0122-5.
Schultz, D. M., & Arnau, R. C. (2019). Effects of a brief mindfulness induction on death-related anxiety. OMEGA-Journal of Death and Dying, 79(3), 313–335. https://doi.org/10.1177/0030222817721115.
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386. https://doi.org/10.1002/jclp.20237.
Shear, M. K., & Skritskaya, N. A. (2012). Bereavement and anxiety. Current Psychiatry Reports, 14(3), 169–175. https://doi.org/10.1007/s11920-012-0270-2.
Shipherd, J. C., & Fordiani, J. M. (2015). The application of mindfulness in coping with intrusive thoughts. Cognitive and Behavioral Practice, 22(4), 439–446. https://doi.org/10.1016/j.cbpra.2014.06.001.
Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), 1960–1973. https://doi.org/10.1016/S0140-6736(07)61816-9.
Tedeschi, R. G., & Blevins, C. L. (2015). From mindfulness to meaning: Implications for the theory of posttraumatic growth. Psychological Inquiry, 26(4), 373–376. https://doi.org/10.1080/1047840X.2015.107534.
Thieleman, K., Cacciatore, J., & Hill, P. W. (2014). Traumatic bereavement and mindfulness: A preliminary study of mental health outcomes using the ATTEND model. Clinical Social Work Journal, 42(3), 260–268. https://doi.org/10.1007/s10615-014-0491-4.
Tingley, D., Yamamoto, T., Hirose, K., Keele, L., & Imai, K. (2014). Mediation: R package for causal mediation analysis. Journal of Statistical Software, 59(5), 1–38. https://doi.org/10.18637/jss.v059.i05.
Vago, D. R., & Silbersweig, D. A. (2012). Self-awareness, self-regulation, and self-transcendence (S-ART): A framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Human Neuroscience, 6, 296. https://doi.org/10.3389/fnhum.2012.00296.
Van Buuren, S., & Groothuis-Oudshoorn, K. (2011). Mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45, 1–67. http://www.jstatsoft.org/v45/i03.
Vandekerckhove, M., & Cluydts, R. (2010). The emotional brain and sleep: An intimate relationship. Sleep Medicine Reviews, 14(4), 219–226. https://doi.org/10.1016/j.smrv.2010.01.002.
Vanderwerker, L. C., & Prigerson, H. G. (2004). Social support and technological connectedness as protective factors in bereavement. Journal of Loss and Trauma, 9(1), 45–57. https://doi.org/10.1080/15325020490255304.
Verhaeghen, P. (2023). Mindfulness and academic performance meta-analyses on interventions and correlations. Mindfulness, 14(6), 1305–1316. https://doi.org/10.1007/s12671-023-02138-z.
Visser, P. L., Hirsch, J. K., Brown, K. W., Ryan, R., & Moynihan, J. A. (2015). Components of sleep quality as mediators of the relation between mindfulness and subjective vitality among older adults. Mindfulness, 6(4), 723–731. https://doi.org/10.1007/s12671-014-0311-5.
Williams, H., Skalisky, J., Erickson, T. M., & Thoburn, J. (2021). Posttraumatic growth in the context of grief: Testing the mindfulness-to-meaning theory. Journal of Loss and Trauma, 26(7), 611–623. https://doi.org/10.1080/15325024.2020.1855048.
Yu, L., Buysse, D. J., Germain, A., Moul, D. E., Stover, A., Dodds, N. E., Johnston, K. L., & Pilkonis, P. A. (2012). Development of short forms from the PROMIS™ sleep disturbance and sleep-related impairment item banks. Behavioral Sleep Medicine, 10(1), 6–24. https://doi.org/10.1080/15402002.2012.636266.
Zisook, S., & Shear, K. (2009). Grief and bereavement: What psychiatrists need to know. World Psychiatry, 8(2), 67–74. https://doi.org/10.1002/j.2051-5545.2009.tb00217.x.
Acknowledgements
The authors thank Sayaka Awao, Victoria Andersen, Tyler White, Zachary Brown, & Tanvi Patel for their assistance with this study.
Funding
This work was supported by fellowships from the University of Connecticut (Jeffery D. Fisher Behavior Change Research Fellowship); Graduate School Doctoral Dissertation Fellowship and the National Cancer Institute (T32CA092203).
Use of Artificial Intelligence StatementAI was not utilized for this manuscript.
Author information
Authors and Affiliations
Contributions
Mariel Emrich: Conceptualization, Methodology, Data curation, Formal analysis, Writing – Original Draft, Writing – Review and Editing.
Crystal L. Park: Conceptualization, Methodology, Supervision, Resources, Writing – Original Draft, Writing – Review and Editing.
Adam B. David: Writing – Original Draft, Writing – Review and Editing.
Lucy Finkelstein-Fox: Conceptualization, Methodology, Investigation, Data curation, Project Administration, Funding acquisition, Writing – Original Draft, Writing – Review and Editing.
Corresponding author
Ethics declarations
Ethics Approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board at the University of Connecticut (L19-042).
Consent for publication
Informed consent was obtained from all individual participants included in the study.
Competing interest
The authors have no competing interests to declare.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Emrich, M., Park, C.L., David, A.B. et al. Cognitive and Somatic Mediators of the Effects of Trait Mindfulness on Mental Health Adjustment Following Bereavement. Mindfulness 14, 2932–2945 (2023). https://doi.org/10.1007/s12671-023-02251-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-023-02251-z