Abstract
The present prospective study tested the mediating processes between mindfulness and symptoms of depression and anxiety among Chinese emerging adults in Hong Kong. A total of 333 emerging adults between 18 and 26 years of age (male = 95; female = 238) completed a questionnaire for four times in two consecutive years, with each time point spanning 6 months apart. Findings based on multi-group path analysis and bootstrapping indicated that the longitudinal association between mindfulness and depressive symptoms was mediated by regulatory processes including awareness and acceptance of negative emotions, impulse control difficulties, and emotion regulation, regardless of gender. A marginal trend was also indicated for the mediation processes between mindfulness and anxiety symptoms. The present findings underscore the importance of mindfulness in mental health through a chain of longitudinal mediating mechanisms. In addition to enriching the mindfulness literature in diverse ecological contexts, evidence was advanced to inform prevention and intervention efforts in promoting mindfulness as an asset associated with mental health.
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References
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.
Baer, R. A., Lykins, E. L., & Peters, J. R. (2012). Mindfulness and self-compassion as predictors of psychological wellbeing in long-term meditators and matched nonmeditators. The Journal of Positive Psychology, 7(3), 230–238. https://doi.org/10.1080/17439760.2012.674548.
Bardeen, J. R., & Stevens, E. N. (2015). Sex differences in the indirect effects of cognitive processes on anxiety through emotion regulation difficulties. Personality and Individual Differences, 81, 180–187. https://doi.org/10.1016/j.paid.2014.07.009.
Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2012). An examination of the latent structure of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 34(3), 382–392. https://doi.org/10.1007/s10862-012-9280-y.
Baumeister, R. F., Vohs, K. D., & Tice, D. M. (2007). The strength model of self-control. Current Directions in Psychological Science, 16(6), 351–355. https://doi.org/10.1111/j.1467-8721.2007.00534.x.
Bender, P. K., Reinholdt-Dunne, M. L., Esbjørn, B. H., & Pons, F. (2012). Emotion dysregulation and anxiety in children and adolescents: Gender differences. Personality and Individual Differences, 53(3), 284–288. https://doi.org/10.1016/j.paid.2012.03.027.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., ... & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. doi:https://doi.org/10.1093/clipsy.bph077.
Bonn-Miller, M. O., Vujanovic, A. A., & Zvolensky, M. J. (2008). Emotional dysregulation: Association with coping-oriented marijuana use motives among current marijuana users. Substance Use & Misuse, 43(11), 1653–1665. https://doi.org/10.1080/10826080802241292.
Bowlin, S. L., & Baer, R. A. (2012). Relationships between mindfulness, self-control, and psychological functioning. Personality and Individual Differences, 52(3), 411–415. https://doi.org/10.1016/j.paid.2011.10.050.
Bränström, R., Duncan, L. G., & Moskowitz, J. T. (2011). The association between dispositional mindfulness, psychological well-being, and perceived health in a Swedish population-based sample. British Journal of Health Psychology, 16(2), 300–316. https://doi.org/10.1348/135910710X501683.
Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216. https://doi.org/10.1177/135910457000100301.
Caldwell-Harris, C. L., & Aycicegi, A. (2006). When personality and culture clash: The psychological distress of allocentrics in an individualist culture and idiocentrics in a collectivist culture. Transcultural Psychiatry, 43(3), 331–361. https://doi.org/10.1177/1363461506066982.
Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance: The Philadelphia mindfulness scale. Assessment, 15(2), 204–223. https://doi.org/10.1177/1073191107311467.
Carsley, D., Khoury, B., & Heath, N. L. (2018). Effectiveness of mindfulness interventions for mental health in schools: A comprehensive meta-analysis. Mindfulness, 9(3), 693–707. https://doi.org/10.1007/s12671-017-0839-2.
Chambers, R., Lo, B. C. Y., & Allen, N. B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Therapy and Research, 32(3), 303–322. https://doi.org/10.1007/s10608-007-9119-0.
Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29(6), 560–572. https://doi.org/10.1016/j.cpr.2009.06.005.
Chambers, R., Gullone, E., Hassed, C., Knight, W., Garvin, T., & Allen, N. (2015). Mindful emotion regulation predicts recovery in depressed youth. Mindfulness, 6(3), 523–534. https://doi.org/10.1007/s12671-014-0284-4.
Cheung, C. K., & Bagley, C. (1998). Validating an American scale in Hong Kong: The Center for Epidemiological Studies Depression Scale (CES-D). The Journal of Psychology, 132(2), 169–186. https://doi.org/10.1080/00223989809599157.
Cheung, R. Y. M., & Park, I. J. K. (2010). Anger suppression, interdependent self-construal, and depression among Asian American and European American college students. Cultural Diversity and Ethnic Minority Psychology, 16(4), 517–525. https://doi.org/10.1037/a0020655.
Cheung, R. Y. M., Leung, M. C., Chiu, H. T., Kwan, J. L. Y., Yee, T. S., & Hou, W. K. (2018). Family functioning and psychological outcomes at emerging adulthood: Savoring positive experiences as a mediating mechanism. Journal of Social and Personal Relationships, 0265407518798499. doi: https://doi.org/10.1177/0265407518798499.
Coffey, K. A., Hartman, M., & Fredrickson, B. L. (2010). Deconstructing mindfulness and constructing mental health: Understanding mindfulness and its mechanisms of action. Mindfulness, 1(4), 235–253. https://doi.org/10.1007/s12671-010-0033-2.
Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112(4), 558. https://doi.org/10.1037/0021-843X.112.4.558.
Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific construct: Methodological challenges and directions for child development research. Child Development, 75(2), 317–333. https://doi.org/10.1111/j.1467-8624.2004.00673.x.
Curtiss, J., Klemanski, D. H., Andrews, L., Ito, M., & Hofmann, S. G. (2017). The conditional process model of mindfulness and emotion regulation: An empirical test. Journal of Affective Disorders, 212, 93–100. https://doi.org/10.1016/j.jad.2017.01.027.
Deng, Y. Q., Liu, X. H., Rodriguez, M. A., & Xia, C. Y. (2011). The five facet mindfulness questionnaire: Psychometric properties of the Chinese version. Mindfulness, 2(2), 123–128. https://doi.org/10.1007/s12671-011-0050-9.
Desrosiers, A., Vine, V., Klemanski, D. H., & Nolen-Hoeksema, S. (2013). Mindfulness and emotion regulation in depression and anxiety: Common and distinct mechanisms of action. Depression and Anxiety, 30(7), 654–661. https://doi.org/10.1002/da.22124.
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. https://doi.org/10.1146/annurev-psych-113011-143750.
Garland, E. L., Gaylord, S. A., & Fredrickson, B. L. (2011). Positive reappraisal mediates the stress-reductive effects of mindfulness: An upward spiral process. Mindfulness, 2(1), 59–67. https://doi.org/10.1007/s12671-011-0043-8.
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(4), 293–314. https://doi.org/10.1080/1047840X.2015.1064294.
Garland, E. L., Hanley, A. W., Goldin, P. R., & Gross, J. J. (2017). Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data. PLoS One, 12(12), e0187727. https://doi.org/10.1371/journal.pone.0187727.
Garnefski, N., Van Den Kommer, T., Kraaij, V., Teerds, J., Legerstee, J., & Onstein, E. (2002). The relationship between cognitive emotion regulation strategies and emotional problems: Comparison between a clinical and a non-clinical sample. European Journal of Personality, 16(5), 403–420. https://doi.org/10.1002/per.458.
Germer, C., Siegel, R. D., & Fulton, P. R. (Eds.). (2016). Mindfulness and psychotherapy. New York: Guilford Press..
Giromini, L., Velotti, P., de Campora, G., Bonalume, L., & Zavattini, G. C. (2012). Cultural adaptation of the difficulties in emotion regulation scale: Reliability and validity of an Italian version. Journal of Clinical Psychology, 68(9), 989–1007. https://doi.org/10.1002/jclp.21876.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271.
Hall, G. C., Hong, J. J., Zane, N. W., & Meyer, O. L. (2011). Culturally competent treatments for Asian Americans: The relevance of mindfulness and acceptance-based psychotherapies. Clinical Psychology: Science and Practice, 18(3), 215–231. https://doi.org/10.1111/j.1468-2850.2011.01253.x.
He, X., Li, C., Qian, J., Cui, H., & Wu, W. (2010). Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients. Shanghai Archives of Psychiatry, 22(4), 200–203. https://doi.org/10.3969/j.issn.1002-0829.2010.04.002.
Hill, C. L., & Updegraff, J. A. (2012). Mindfulness and its relationship to emotional regulation. Emotion, 12(1), 81. https://doi.org/10.1037/a0026355.
Ho, D. Y. F. (1976). On the concept of face. American Journal of Sociology, 81(4), 867–884. https://doi.org/10.1086/226145.
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169. https://doi.org/10.1037/a0018555.
Hollis-Walker, L., & Colosimo, K. (2011). Mindfulness, self-compassion, and happiness in non-meditators: A theoretical and empirical examination. Personality and Individual Differences, 50(2), 222–227. https://doi.org/10.1016/j.paid.2010.09.033.
Hou, J., Wong, S. Y. S., Lo, H. H. M., Mak, W. W. S., & Ma, H. S. W. (2014). Validation of a Chinese version of the five facet mindfulness questionnaire in Hong Kong and development of a short form. Assessment, 21(3), 363–371. https://doi.org/10.1177/1073191113485121.
Hu, T., Zhang, D., Wang, J., Mistry, R., Ran, G., & Wang, X. (2014). Relation between emotion regulation and mental health: A meta-analysis review. Psychological Reports, 114(2), 341–362. https://doi.org/10.2466/03.20.PR0.114k22w4.
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11–21. https://doi.org/10.1207/s15324796abm3301_2.
Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective, & Behavioral Neuroscience, 7(2), 109–119. https://doi.org/10.3758/CABN.7.2.109.
Jimenez, S. S., Niles, B. L., & Park, C. L. (2010). A mindfulness model of affect regulation and depressive symptoms: Positive emotions, mood regulation expectancies, and self-acceptance as regulatory mechanisms. Personality and Individual Differences, 49(6), 645–650. https://doi.org/10.1016/j.paid.2010.05.041.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your mind to face stress, pain and illness. New York: Dell.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056. https://doi.org/10.1016/j.cpr.2011.04.006.
Kiken, L. G., Lundberg, K. B., & Fredrickson, B. L. (2017). Being present and enjoying it: Dispositional mindfulness and savoring the moment are distinct, interactive predictors of positive emotions and psychological health. Mindfulness, 8(5), 1280–1290. https://doi.org/10.1007/s12671-017-0704-3.
Klemanski, D. H., Curtiss, J., McLaughlin, K. A., & Nolen-Hoeksema, S. (2017). Emotion regulation and the transdiagnostic role of repetitive negative thinking in adolescents with social anxiety and depression. Cognitive Therapy and Research, 41(2), 206–219. https://doi.org/10.1007/s10608-016-9817-6.
Lattimore, P., Fisher, N., & Malinowski, P. (2011). A cross-sectional investigation of trait disinhibition and its association with mindfulness and impulsivity. Appetite, 56(2), 241–248. https://doi.org/10.1016/j.appet.2010.12.007.
Lau, N. S., & Hue, M. T. (2011). Preliminary outcomes of a mindfulness-based programme for Hong Kong adolescents in schools: Well-being, stress and depressive symptoms. International Journal of Children's Spirituality, 16(4), 315–330. https://doi.org/10.1080/1364436X.2011.639747.
Leung, K., Koch, P. T., & Lu, L. (2002). A dualistic model of harmony and its implications for conflict management in Asia. Asia Pacific Journal of Management, 19(2–3), 201–220. https://doi.org/10.1023/A:1016287501806.
Lindsay, E. K., & Creswell, J. D. (2017). Mechanisms of mindfulness training: Monitor and acceptance theory (MAT). Clinical Psychology Review, 51, 48–59. https://doi.org/10.1016/j.cpr.2016.10.011.
Lo, H. H., Ng, S. M., & Chan, C. L. (2015). Evaluating compassion–mindfulness therapy for recurrent anxiety and depression: A randomized control trial. Research on Social Work Practice, 25(6), 715–725. https://doi.org/10.1177/1049731514537686.
Lyvers, M., Makin, C., Toms, E., Thorberg, F. A., & Samios, C. (2014). Trait mindfulness in relation to emotional self-regulation and executive function. Mindfulness, 5(6), 619–625. https://doi.org/10.1007/s12671-013-0213-y.
Mandal, S. P., Arya, Y. K., & Pandey, R. (2017). Mindfulness, emotion regulation, and subjective well-being: Exploring the link. SIS Journal of Projective Psychology & Mental Health, 24(1). Retrieved March 5, 2018, from: https://www.researchgate.net/publication/312233871_Mindfulness_Emotion_Regulation_and_Subjective_Well-Being_Exploring_the_Link.
Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98(2), 224. https://doi.org/10.1037/0033-295X.98.2.224.
Matsumoto, D., Yoo, S.H., Nakagawa, S., Alexandre, J., Anguas-Wong, A. M., Arriola, M … Zengeya, A.(2008). Culture, emotion regulation, and adjustment. Journal of Personality and Social Psychology, 94(6), 925–937. doi:https://doi.org/10.1037/0022-3514.94.6.925.
Merwin, R. M., Zucker, N. L., Lacy, J. L., & Elliott, C. A. (2010). Interoceptive awareness in eating disorders: Distinguishing lack of clarity from non-acceptance of internal experience. Cognition and Emotion, 24(5), 892–902. https://doi.org/10.1080/02699930902985845.
Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49–100. https://doi.org/10.1006/cogp.1999.0734.
Moore, A., & Malinowski, P. (2009). Meditation, mindfulness and cognitive flexibility. Consciousness and Cognition, 18(1), 176–186. https://doi.org/10.1016/j.concog.2008.12.008.
Murphy, C., & MacKillop, J. (2012). Living in the here and now: Interrelationships between impulsivity, mindfulness, and alcohol misuse. Psychopharmacology, 219(2), 527–536. https://doi.org/10.1007/s00213-011-2573-0.
Muthén, L. K., & Muthén, B. O. (2012). MPLUS Version 7 user’s guide. Los Angeles: Muthén & Muthén.
Oberle, E., Schonert-Reichl, K. A., Lawlor, M. S., & Thomson, K. C. (2012). Mindfulness and inhibitory control in early adolescence. The Journal of Early Adolescence, 32(4), 565–588. https://doi.org/10.1177/0272431611403741.
Peters, J. R., Erisman, S. M., Upton, B. T., Baer, R. A., & Roemer, L. (2011). A preliminary investigation of the relationships between dispositional mindfulness and impulsivity. Mindfulness, 2(4), 228–235. https://doi.org/10.1007/s12671-011-0065-2.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306.
Rodriguez, C. M., Tucker, M. C., & Palmer, K. (2016). Emotion regulation in relation to emerging adults’ mental health and delinquency: A multi-informant approach. Journal of Child and Family Studies, 25(6), 1916–1925.
Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9(1), 54–68. https://doi.org/10.1093/clipsy.9.1.54.
Roemer, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Orsillo, S. M., & Mennin, D. S. (2009). Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions. Behavior Therapy, 40(2), 142–154. https://doi.org/10.1016/j.beth.2008.04.001.
Roemer, L., Williston, S. K., & Rollins, L. G. (2015). Mindfulness and emotion regulation. Current Opinion in Psychology, 3, 52–57. https://doi.org/10.1016/j.copsyc.2015.02.006.
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422–445. https://doi.org/10.1037/1082-989X.7.4.422.
Smith, P. B. (2010). On the distinctiveness of Chinese psychology; or: Are we all Chinese? In M. H. Bond (Ed.), The Oxford handbook of Chinese psychology (pp. 699–710). New York: Oxford University Press.
Soto, J. A., Perez, C. R., Kim, Y. H., Lee, E. A., & Minnick, M. R. (2011). Is expressive suppression always associated with poorer psychological functioning? A cross-cultural comparison between European Americans and Hong Kong Chinese. Emotion, 11(6), 1450–1455. https://doi.org/10.1037/a0023340.
Soysa, C. K., & Wilcomb, C. J. (2015). Mindfulness, self-compassion, self-efficacy, and gender as predictors of depression, anxiety, stress, and well-being. Mindfulness, 6(2), 217–226. https://doi.org/10.1007/s12671-013-0247-1.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.
Teper, R., Segal, Z. V., & Inzlicht, M. (2013). Inside the mindful mind: How mindfulness enhances emotion regulation through improvements in executive control. Current Directions in Psychological Science, 22(6), 449–454. https://doi.org/10.1177/0963721413495869.
Thompson, B. L., & Waltz, J. A. (2008). Mindfulness, self-esteem, and unconditional self-acceptance. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26(2), 119–126. https://doi.org/10.1007/s10942-007-0059-0.
Tong, X., An, D., McGonigal, A., Park, S. P., & Zhou, D. (2016). Validation of the generalized anxiety Disorder-7 (GAD-7) among Chinese people with epilepsy. Epilepsy Research, 120, 31–36. https://doi.org/10.1016/j.eplepsyres.2015.11.019.
Tsai, W., Nguyen, D. J., Weiss, B., Ngo, V., & Lau, A. S. (2017). Cultural differences in the reciprocal relations between emotion suppression coping, depressive symptoms and interpersonal functioning among adolescents. Journal of Abnormal Child Psychology, 45(4), 657–669. https://doi.org/10.1007/s10802-016-0192-2.
Wang, L., Liu, H., Du, W., & Li, Z. (2007). Test of difficulties in emotion regulation scale in Chinese people. China Journal of Health Psychology, 15, 336–340.
Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616. https://doi.org/10.1037/a0016669.
Wong, S. Y. S., Yip, B. H. K., Mak, W. W. S., Mercer, S., Cheung, E. Y. L., Ling, C. Y. M., … & Lee, T. M. C. (2016). Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: Randomised controlled trial, The British Journal of Psychiatry, 209(1), 68–75. doi:https://doi.org/10.1192/bjp.bp.115.166124.
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This study was funded by The Education University of Hong Kong (RG 60/2014-2015R and RG 90/2015-2016).
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RYMC: conceived, designed and executed the study, conducted data analyses, and wrote the manuscript. MCYN: collaborated in the writing and editing of the final manuscript. Both authors approved the final version of the manuscript for submission.
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Cheung, R.Y.M., Ng, M.C.Y. Mindfulness and Symptoms of Depression and Anxiety: the Underlying Roles of Awareness, Acceptance, Impulse Control, and Emotion Regulation. Mindfulness 10, 1124–1135 (2019). https://doi.org/10.1007/s12671-018-1069-y
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DOI: https://doi.org/10.1007/s12671-018-1069-y