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Associations between Psychological Distress and Facets of Mindfulness: Implications for Campus-Based University Wellness Services

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Title: Associations between Psychological Distress and Facets of Mindfulness: Implications for Campus-Based University Wellness Services
Language: English
Authors: Burger, James W. (ORCID 0000-0003-2388-5019), Bantjes, Jason (ORCID 0000-0002-3626-9883), Derman, Wayne (ORCID 0000-0002-8879-177X), Whitesman, Simon (ORCID 0000-0001-7763-8748), Gomez-Ezeiza, Josu (ORCID 0000-0003-0437-2226)
Source: Journal of American College Health. 2023 71(4):1074-1083.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 10
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: College Students, Foreign Countries, Psychological Patterns, Student Behavior, Knowledge Level, Well Being, Mental Health, Fatigue (Biology), Anxiety, Depression (Psychology), Metacognition
Geographic Terms: South Africa
DOI: 10.1080/07448481.2021.1920601
ISSN: 0744-8481
1940-3208
Abstract: Objectives: To investigate associations between components of psychological distress and five facets of mindfulness (i.e. "observing"; "describing"; "acting with awareness"; "non-reactivity"; "non-judging"). Participants: Students from a university in South Africa (n = 174). Methods: This cross-sectional study assessed psychological distress and mindfulness using the K10 and Five Facet Mindfulness Questionnaire. Multivariate regression analysis identified associations between psychological distress and facets of mindfulness, controlling for demographics. Results: Prevalence of psychological distress was 56.9% (95% CI 49.2%-64.4%). "Acting with awareness," "non-reactivity," and "non-judging" predicted significantly lower psychological distress, whereas "observing" and "describing" did not. "Acting with awareness" was the only facet of mindfulness that consistently predicted lower levels of negative affect, fatigue, nervousness, and agitation. Conclusions: Acting with awareness appears to be a key component of psychological wellbeing. To advance theory and practice, future research should consider why and how various facets of mindfulness predict lower psychological distress and its components among university students.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1389734
Database: ERIC
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  Value: <anid>AN0164011003;acl01may.23;2023Jun02.06:31;v2.2.500</anid> <title id="AN0164011003-1">Associations between psychological distress and facets of mindfulness: Implications for campus-based university wellness services </title> <p>To investigate associations between components of psychological distress and five facets of mindfulness (i.e. observing; describing; acting with awareness; non-reactivity; non-judging). Students from a university in South Africa (n = 174). This cross-sectional study assessed psychological distress and mindfulness using the K10 and Five Facet Mindfulness Questionnaire. Multivariate regression analysis identified associations between psychological distress and facets of mindfulness, controlling for demographics. Prevalence of psychological distress was 56.9% (95% CI 49.2%–64.4%). Acting with awareness, non-reactivity, and non-judging predicted significantly lower psychological distress, whereas observing and describing did not. Acting with awareness was the only facet of mindfulness that consistently predicted lower levels of negative affect, fatigue, nervousness, and agitation. Acting with awareness appears to be a key component of psychological wellbeing. To advance theory and practice, future research should consider why and how various facets of mindfulness predict lower psychological distress and its components among university students.</p> <p>Keywords: Mental health; mindfulness; psychological distress; South Africa; university students</p> <hd id="AN0164011003-2">Introduction</hd> <p>There is a marked prevalence of psychological distress among college students,[[<reflink idref="bib1" id="ref1">1</reflink>], [<reflink idref="bib3" id="ref2">3</reflink>]] with rates of psychopathology in this population typically higher than those observed in the general population. It is estimated that the 12-month prevalence of common mental disorders among university students globally is as high as 31%.[<reflink idref="bib2" id="ref3">2</reflink>] While most studies on student mental health have been conducted in high-income countries,[<reflink idref="bib4" id="ref4">4</reflink>] there is evidence to show that students in South Africa (SA) experience high rates of depressive, anxiety and posttraumatic stress disorders,[<reflink idref="bib5" id="ref5">5</reflink>],[<reflink idref="bib6" id="ref6">6</reflink>] as well as elevated rates of non-fatal suicidal behavior.[<reflink idref="bib7" id="ref7">7</reflink>] However, treatment rates are low with less than a quarter of SA students who require mental healthcare receiving treatment.[<reflink idref="bib8" id="ref8">8</reflink>] Mental health problems have a deleterious impact on students' psychosocial and academic functioning, and are associated with role impairment,[<reflink idref="bib9" id="ref9">9</reflink>] time away from university,[<reflink idref="bib10" id="ref10">10</reflink>] suicidal behavior,[<reflink idref="bib11" id="ref11">11</reflink>] and poor academic performance.[<reflink idref="bib12" id="ref12">12</reflink>] There is a need for mental healthcare services, including primary prevention and stress reduction programs, to be an integral component of campus-based wellness services for students. Understanding the prevalence of psychological distress and its risk and protective factors is the cornerstone of planning empirically supported campus-based wellness services. It is, however, equally important to identify potentially effective novel interventions to address the high level of need in this population. Mindfulness has been identified as a protective factor against psychological distress, with growing evidence to support the benefits of mindfulness-based interventions (MBIs) in university settings,[<reflink idref="bib13" id="ref13">13</reflink>],[<reflink idref="bib14" id="ref14">14</reflink>] where they have a moderate effect size in reducing distress,[<reflink idref="bib15" id="ref15">15</reflink>],[<reflink idref="bib16" id="ref16">16</reflink>] promoting wellbeing, and improving student retention.[<reflink idref="bib17" id="ref17">17</reflink>] These data suggest MBIs might be an effective component of campus-based wellness programs.[<reflink idref="bib16" id="ref18">16</reflink>]</p> <p>Dispositional mindfulness, or the tendency to be mindful, is considered a stable intrinsic trait which is present in all individuals to varying degrees,[<reflink idref="bib18" id="ref19">18</reflink>],[<reflink idref="bib19" id="ref20">19</reflink>] although this trait is more developed in experienced meditators.[<reflink idref="bib20" id="ref21">20</reflink>] Mindfulness can be developed intentionally through training, as is the case in MBIs.[<reflink idref="bib18" id="ref22">18</reflink>],[<reflink idref="bib20" id="ref23">20</reflink>],[<reflink idref="bib21" id="ref24">21</reflink>] Several psychological interventions utilize the principles of mindfulness and involve formal training to develop mindfulness skills, including Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Dialectical Behavior Therapy, and Acceptance and Commitment Therapy. Increases in mindfulness through these MBIs are associated with reductions in stress and mood disturbances,[<reflink idref="bib18" id="ref25">18</reflink>] as well as reductions in rumination[<reflink idref="bib22" id="ref26">22</reflink>],[<reflink idref="bib23" id="ref27">23</reflink>] and negative automatic thoughts,[<reflink idref="bib23" id="ref28">23</reflink>] suggesting that MBIs may improve the psychological[[<reflink idref="bib24" id="ref29">24</reflink>], [<reflink idref="bib26" id="ref30">26</reflink>]] and physical wellbeing[[<reflink idref="bib28" id="ref31">28</reflink>], [<reflink idref="bib30" id="ref32">30</reflink>]] of university students. The Koru mindfulness training program for students is effective for reducing stress, alleviating sleep problems and improving self-compassion.[<reflink idref="bib32" id="ref33">32</reflink>] Similarly, guided mindfulness practices promote the psycho-social adjustment of first-year students to university.[<reflink idref="bib33" id="ref34">33</reflink>] There are, however, also studies which suggest that simply adding mindfulness to interventions does not necessarily make them more effective[<reflink idref="bib34" id="ref35">34</reflink>] and that sustained mindfulness interventions are needed to significantly reduce college students' psychological distress.[<reflink idref="bib35" id="ref36">35</reflink>] Efforts to advance evidence-based practice in the area of MBIs requires the development of theory to understand <emph>if</emph>, <emph>when</emph>, and <emph>how</emph> mindfulness improves university students' psychological functioning. However, much of the empirical work in this area has focused on global measures of mindfulness rather than attempting to understand its various facets.</p> <p>Critics of MBIs have noted that the term "mindfulness" is ill-defined with no shared understanding of what exactly constitutes mindfulness.[<reflink idref="bib36" id="ref37">36</reflink>],[<reflink idref="bib37" id="ref38">37</reflink>] One way to define mindfulness is as the awareness that arises through attending to present experience without judgment,[<reflink idref="bib19" id="ref39">19</reflink>],[<reflink idref="bib21" id="ref40">21</reflink>],[<reflink idref="bib23" id="ref41">23</reflink>],[<reflink idref="bib38" id="ref42">38</reflink>] implying that there are mindfulness skills which entail the ability to observe and attend to experiences without attachment or judgment.[<reflink idref="bib39" id="ref43">39</reflink>] Mindfulness is not a unidimensional construct,[[<reflink idref="bib40" id="ref44">40</reflink>], [<reflink idref="bib42" id="ref45">42</reflink>]] and scholars have described various pillars,[<reflink idref="bib19" id="ref46">19</reflink>] characteristics,[<reflink idref="bib44" id="ref47">44</reflink>] dimensions,[<reflink idref="bib40" id="ref48">40</reflink>] and facets[<reflink idref="bib42" id="ref49">42</reflink>] of mindfulness. Although these elements of mindfulness may have overlapping features, it is clear that different schools of thought emphasize particular facets of mindfulness.[<reflink idref="bib44" id="ref50">44</reflink>] A factor analysis of five self-reported mindfulness questionnaires identified five discrete facets of mindfulness, namely: (i) <emph>Observing</emph>: noticing or attending to internal and external experiences, (ii) <emph>Describing</emph>: labeling internal experiences with words, (iii) <emph>Acting with awareness</emph>: attending to one's activities of the moment, (iv) <emph>Non-reactivity to inner experience</emph>: allowing thoughts and feelings to come and go, without getting caught up in or carried away by them, and (v) <emph>Non-judging of experience</emph>: taking a non-evaluative stance toward thoughts and feelings.[<reflink idref="bib42" id="ref51">42</reflink>] These five facets of mindfulness have been codified into the Five Facet Mindfulness Questionnaire (FFMQ).[<reflink idref="bib45" id="ref52">45</reflink>]</p> <p>There is some evidence that different facets of mindfulness influence different psychological processes.[<reflink idref="bib41" id="ref53">41</reflink>],[<reflink idref="bib46" id="ref54">46</reflink>],[<reflink idref="bib47" id="ref55">47</reflink>] For example, Iani et al.[<reflink idref="bib41" id="ref56">41</reflink>] found that <emph>observing, describing</emph>, and <emph>acting with awareness</emph> (sometimes called the "<emph>what</emph>" skills of mindfulness) are associated with key eudaimonic components of psychological well-being, including autonomy, personal growth, and life purpose.[<reflink idref="bib41" id="ref57">41</reflink>] By comparison, <emph>non-reactivity</emph> and <emph>non-judging</emph> (the "<emph>how</emph>" skills of mindfulness) are associated with less neuroticism, withdrawal, and volatility.[<reflink idref="bib41" id="ref58">41</reflink>]</p> <p>Although the various facets of mindfulness can be thought of as separate, some authors assert that these component mechanisms work synergistically, making it artificial and meaningless to learn or practice one facet of mindfulness in isolation from others.[<reflink idref="bib48" id="ref59">48</reflink>] Nonetheless, learning more about how particular facets of mindfulness may be associated with different components of psychological distress could guide future theoretical research and may have practical implications for how MBIs are structured, what skills are taught, and the order in which these skills are presented in order to make campus-based interventions as effective and streamline as possible.[<reflink idref="bib48" id="ref60">48</reflink>] It is within this context, that we investigated associations between mindfulness and psychological distress among a sample of students from a university in SA.</p> <hd id="AN0164011003-3">Study aim</hd> <p>Our aim was to explore associations between the particular facets of mindfulness and the components of psychological distress, in order to consider the implications of this for campus-based wellness services. The objectives of this cross-sectional study were to:</p> <p></p> <ulist> <item> Investigate if dispositional mindfulness is associated with psychological distress (total score, depression subscale score and anxiety subscale score), when controlling for demographic factors.</item> <p></p> <item> Investigate if the five facets of dispositional mindfulness (i.e., <emph>observing</emph>; <emph>describing</emph>; <emph>acting with awareness</emph>; <emph>non-reactivity to inner experience</emph>; and <emph>non-judging of experience</emph>) are associated with psychological distress (total score, depression subscale score and anxiety subscale score), when controlling for demographic factors.</item> </ulist> <hd id="AN0164011003-4">Materials and methods</hd> <p></p> <hd id="AN0164011003-5">Study design</hd> <p>The study utilized a cross-sectional study design using a self-selected sample of university students.</p> <hd id="AN0164011003-6">Study setting and population</hd> <p>174 students from Stellenbosch University, SA, were recruited from the Department of Sport Science and through the Campus Health Services. The university is a publicly-funded institution with a total enrollment of approximately 32600 students registered across 10 faculties, which include medicine and health sciences, science, engineering, economic and management sciences, arts and social sciences, agriculture, and others. The university is among SA's leading tertiary institutions based on research output, student pass rates, and rated scientists. As is common at many universities in SA, there is a student counseling center on campus which provides free crisis and counseling services. However, the student counseling center is over-subscribed and frequently has a waiting list. While this indicates many students' willingness to access psychological services, there is still stigma associated with seeking professional health for mental health problems among students. The data for this study were collected in the first phase of the initiation of a campus-wide surveillance system on health, wellbeing, and non-communicable disease risk factors, the MaRooN Health Passport. This study focusses on the psychological measures of that study, particularly looking at associations between mindfulness and psychological distress. Data were collected between March and August 2019. All staff and students from the Department of Sport Science and students accessing Campus Health Services were invited to participate in the study. For the purposes of this study, participants who identified as staff members were excluded from our analysis. Incentives for participants included a Safe ID bracelet with a one-year subscription to the emergency-response technology company, Safe ID, as well as a R25 airtime voucher, and an entry into a lucky draw for ZAR500 (equivalent to ∼36 US$ at the time of the study).</p> <hd id="AN0164011003-7">Data collection</hd> <p>The following data were collected via a self-report Web-based survey in English using REDCap, Research Electronic Data Capture:[<reflink idref="bib49" id="ref61">49</reflink>],[<reflink idref="bib50" id="ref62">50</reflink>]</p> <p></p> <ulist> <item> <emph>Demographic information:</emph> Participants were asked their age, gender, marital status, and whether they were registered as an undergraduate or postgraduate student.</item> <p></p> <item> <emph>Mindfulness:</emph> Dispositional Mindfulness was assessed using the Five Facet Mindfulness Questionnaire – Short Form (FFMQ-SF), which consists of 24 questions each assessed on a Likert scale from 1 ("never or very rarely true") to 5 ("very often or always true").[<reflink idref="bib45" id="ref63">45</reflink>] The FFMQ-SF determines the extent to which one is mindful (i.e. dispositional mindfulness) and five facets of mindfulness (i.e. <emph>observing; describing; acting with awareness</emph>; <emph>non</emph>-<emph>reactivity to inner experience; and non-judging of experience</emph>).[<reflink idref="bib42" id="ref64">42</reflink>],[<reflink idref="bib45" id="ref65">45</reflink>] The FFMQ has been previously used within SA student populations.[<reflink idref="bib51" id="ref66">51</reflink>] The FFMQ-SF Cronbach's alpha for this study showed the FFMQ-SF to have good internal consistency for the total score (<emph>α</emph> = 0.83) and acceptable to good internal consistency for the individual facets: <emph>observing</emph> (<emph>α</emph> = 0.75)<emph>, describing</emph> (<emph>α</emph> = 0.80)<emph>, acting with awareness</emph> (<emph>α</emph> = 0.78), <emph>non</emph>-<emph>reactivity</emph> (<emph>α</emph> = 0.71)<emph>, and non-judging</emph> (<emph>α</emph> = 0.74).</item> <p></p> <item> <emph>Psychological distress:</emph> The 30-day prevalence of psychological distress was measured using the 10-item K10 questionnaire,[<reflink idref="bib52" id="ref67">52</reflink>] which has been previously used and validated in SA.[[<reflink idref="bib53" id="ref68">53</reflink>], [<reflink idref="bib55" id="ref69">55</reflink>]] Participants were asked about how often they felt depressed, hopeless, worthless, restless, or nervous in the preceding 30-day period. Each item on the K10 is assessed using a five-point ordinal scale, ranging from 0 ("none of the time") to 4 ("all of the time"). The item scores are summed, to yield a total score, with higher scores indicating higher levels of psychological distress. A previous screening cutoff of 16 was established in the SA general population for differentiating Composite International Diagnostic Interview-defined depression and anxiety cases from non-cases, with a sensitivity of 70% and a specificity of 67%.[<reflink idref="bib53" id="ref70">53</reflink>] Furthermore the K10 total score can be categorized into low (0–15), moderate (16–21), high (22–29), and very high levels of distress (30–50), as in previous studies.[<reflink idref="bib10" id="ref71">10</reflink>] Factor analysis of the K10 has identified four distinct components of psychological distress (i.e. <emph>negative affect</emph>, <emph>fatigue</emph>, <emph>nervousness</emph>, and <emph>agitation</emph>) which fall under two second-order factors (i.e. depression subscale and anxiety subscale).[<reflink idref="bib56" id="ref72">56</reflink>] Cronbach's alpha for this study showed the K10 to have good internal consistency (<emph>α</emph> = 0.92), with the depression subscale being more reliable (<emph>α</emph> = 0.92) than the anxiety subscale (<emph>α</emph> = 0.79).</item> </ulist> <hd id="AN0164011003-8">Data analysis</hd> <p>Statistical analysis was performed using IBM SPSS Statistics (IBM Corporation, Armok, USA; Version 27). Encoded data were imported and cleaned. Descriptive statistics were used to describe the sample characteristics and the 30-day prevalence of psychological distress. Continuous variables were summarized as means (standard deviation [SD]) or medians (interquartile range [IQR]), while categorical variables were summarized as counts (percentages). We used bivariate and multivariate linear regression analysis to explore associations between psychological distress (K10 global scores and each of its four components) and demographic variables. Finally, we used bivariate and multivariate linear regression models to explore associations between psychological distress (K10 global score and each of its four components) and dispositional mindfulness (FFMQ-SF global scores and scores for each of the five facets), controlling for demographic factors identified as significant in the preceding step of the analysis. Results of all regression analyses are presented as standardized beta-coefficients. The level of statistical significance was set at <emph>p</emph> = 0.05.</p> <hd id="AN0164011003-9">Ethical considerations</hd> <p>Ethical clearance for the study was obtained from the Research Ethics Committee: Social, Behavioral and Education Research at Stellenbosch University (REC-2019-0793). The protocol conformed to the recommendations of the Declaration of Helsinki and was approved by the Institutional Research Office. Written informed consent was obtained from all participants prior to data collection. All identifiable patient information were stored in password protected electronic files. The data were anonymized and deidentified data were used for analysis. Participants who reported very high levels of psychological distress were referred to campus health for free consultation.</p> <hd id="AN0164011003-10">Results</hd> <p></p> <hd id="AN0164011003-11">Sample characteristics</hd> <p>As shown in Table 1, the sample consisted primarily of individuals who identified as female (56.4%), undergraduate students (72.4%), and unmarried (94.3%). The mean age of the sample was 21.8 years (Range = 18 to 50 years, SD = 3.5). The FFMQ scores were normally distributed with a mean score of 78.9 (SD = 10.7). K10 scores were predictably right skewed, with a median of 18 (IQR = 14 to 24). Using the cutoff of 16 on the K10, 56.9% of the sample reported significant psychological distress (95% CI 49.2%–64.4%). High distress (K10, 22 to 29) and very high distress (K10, ≥30) were reported in 21.3% and 13.2% of participants, respectively.</p> <p>Table 1. Participant descriptive characteristics, dispositional mindfulness scores, and 30-day prevalence of psychological distress.</p> <p> <ephtml> <table><thead><tr><td /><td>Participants (<italic>n</italic> = 174)</td></tr></thead><tbody valign="top"><tr><td><bold>Age (years)</bold></td><td char=".">21.8</td><td>(±3.5)</td></tr><tr><td><bold>Gender</bold></td><td /><td /></tr><tr><td>Male</td><td char=".">75</td><td char=".">43.6%</td></tr><tr><td>Female</td><td char=".">97</td><td char=".">56.4%</td></tr><tr><td>Unanswered</td><td char=".">2</td><td char=".">1.1%</td></tr><tr><td><bold>Student level</bold></td><td /><td /></tr><tr><td>Undergraduates</td><td char=".">126</td><td char=".">72.4%</td></tr><tr><td>Postgraduates</td><td char=".">39</td><td char=".">22.4%</td></tr><tr><td>Unanswered</td><td char=".">9</td><td char=".">5.2%</td></tr><tr><td><bold>Marital status</bold></td><td /><td /></tr><tr><td>Unmarried</td><td char=".">164</td><td char=".">94.3%</td></tr><tr><td>Married</td><td char=".">7</td><td char=".">4.0%</td></tr><tr><td>Unanswered</td><td char=".">3</td><td char=".">1.7%</td></tr><tr><td><bold>Dispositional mindfulness</bold></td><td /><td /></tr><tr><td>Total score</td><td char=".">78.9</td><td>(±10.7)</td></tr><tr><td><italic>Describing</italic></td><td char=".">16.7</td><td>(±3.8)</td></tr><tr><td><italic>Acting with awareness</italic></td><td char=".">17.0</td><td>(±3.9)</td></tr><tr><td><italic>Non-judging</italic></td><td char=".">14.3</td><td>(±3.5)</td></tr><tr><td><italic>Non-reactivity</italic></td><td char=".">16.7</td><td>(±3.2)</td></tr><tr><td><italic>Observing</italic></td><td char=".">14.1</td><td>(±3.0)</td></tr><tr><td><bold>Psychological distress</bold></td><td /><td /></tr><tr><td>Total K10 score</td><td char=".">18</td><td>(14 to 24)</td></tr><tr><td char=".">Low (10–15)</td><td char=".">64</td><td char=".">36.8%</td></tr><tr><td char=".">Moderate (16–21)</td><td char=".">50</td><td char=".">28.7%</td></tr><tr><td char=".">High (22–29)</td><td char=".">37</td><td char=".">21.3%</td></tr><tr><td char=".">Very High (30–50)</td><td char=".">23</td><td char=".">13.2%</td></tr><tr><td><italic>Depression</italic> Subscale</td><td char=".">10</td><td>(8 to 15)</td></tr><tr><td><italic>Anxiety</italic> subscale</td><td char=".">8</td><td>(6 to 10)</td></tr><tr><td><italic>Negative affect</italic></td><td char=".">6</td><td>(4 to 9)</td></tr><tr><td><italic>Fatigue</italic></td><td char=".">4</td><td>(3 to 6)</td></tr><tr><td><italic>Nervous</italic></td><td char=".">4</td><td>(3 to 5)</td></tr><tr><td><italic>Agitation</italic></td><td char=".">4</td><td>(2 to 5)</td></tr><tr><td>Above 16</td><td char=".">99</td><td char=".">56.9%</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164011003-12">Associations between demographic factors and psychological distress</hd> <p>Bivariate and multivariate regression analysis identified demographic variables associated with psychological distress (Table 2). In bivariate analysis, higher psychological distress was independently associated with being younger (<emph>p</emph> < 0.01), female (<emph>p</emph> = 0.045), an undergraduate student (<emph>p</emph> < 0.01), and unmarried (<emph>p</emph> < 0.01). However, in multivariate models controlling for all demographic factors, gender was the only variable that was consistently associated with psychological distress (<emph>β</emph> = 0.25, <emph>p</emph> < 0.1). This regression equation accounted for 6.5% of the variance in psychological distress scores (F[<reflink idref="bib4" id="ref73">4</reflink>,<reflink idref="bib165" id="ref74">165</reflink>] = 3.93, <emph>p</emph> < 0.01). As seen in Table 2, a similar pattern was observed for three of the four components of psychological distress, with gender being significantly associated with fatigue, negative affect, and nervousness, but not with agitation, in multivariate models controlling for the effects of all demographic factors.</p> <p>Table 2. Bivariate and multivariate analysis of demographic variables as predictors of psychological distress.</p> <p> <ephtml> <table><thead><tr><td /><td>Psychological distress</td><td>Depressive symptoms subscales</td><td>Anxiety symptoms subscales</td></tr><tr><td>Fatigue</td><td>Negative affect</td><td>Nervous</td><td>Agitated</td></tr><tr><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td></tr><tr><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td></tr></thead><tbody valign="top"><tr><td><bold>Age</bold></td><td char=".">−0.26</td><td char=".">0.00*</td><td char=".">−0.05</td><td char=".">0.67</td><td char=".">−0.15</td><td char=".">0.02*</td><td char=".">−0.08</td><td char=".">0.49</td><td char=".">−0.19</td><td char=".">0.00*</td><td char=".">−0.04</td><td char=".">0.72</td><td char=".">−0.28</td><td char=".">0.00*</td><td char=".">−0.01</td><td char=".">0.92</td><td char=".">−0.30</td><td char=".">0.00*</td><td char=".">−0.25</td><td char=".">0.80</td></tr><tr><td><bold>Gender</bold></td><td char=".">0.13</td><td char=".">0.05*</td><td char=".">0.25</td><td char=".">0.00*</td><td char=".">0.16</td><td char=".">0.01*</td><td char=".">0.24</td><td char=".">0.00*</td><td char=".">0.14</td><td char=".">0.03*</td><td char=".">0.26</td><td char=".">0.00*</td><td char=".">0.14</td><td char=".">0.03*</td><td char=".">0.24</td><td char=".">0.00*</td><td char=".">−0.04</td><td char=".">0.55</td><td char=".">0.77</td><td char=".">0.44</td></tr><tr><td><bold>Undergraduate student</bold></td><td char=".">0.21</td><td char=".">0.00*</td><td char=".">0.09</td><td char=".">0.39</td><td char=".">0.14</td><td char=".">0.03*</td><td char=".">0.09</td><td char=".">0.38</td><td char=".">0.13</td><td char=".">0.04*</td><td char=".">0.01</td><td char=".">0.89</td><td char=".">0.24</td><td char=".">0.00*</td><td char=".">0.13</td><td char=".">0.21</td><td char=".">0.29</td><td char=".">0.00*</td><td char=".">1.36</td><td char=".">0.18</td></tr><tr><td><bold>Marital status</bold></td><td char=".">0.18</td><td char=".">0.01*</td><td char=".">0.08</td><td char=".">0.42</td><td char=".">0.04</td><td char=".">0.51</td><td char=".">0.03</td><td char=".">0.79</td><td char=".">0.15</td><td char=".">0.02*</td><td char=".">0.04</td><td char=".">0.66</td><td char=".">0.20</td><td char=".">0.00*</td><td char=".">0.14</td><td char=".">0.14</td><td char=".">0.23</td><td char=".">0.00*</td><td char=".">0.96</td><td char=".">0.34</td></tr><tr><td /><td /><td>F[4,165] = 3.93</td><td /><td>F[4,165] = 3.572</td><td /><td>F[4,165] = 3.42</td><td /><td>F[4,165] = 4.51</td><td /><td>F[4,165] = 2.05</td></tr><tr><td /><td /><td><italic>p</italic> = 0.00*</td><td><italic>p</italic> = 0.01*</td><td><italic>p</italic> = 0.01*</td><td><italic>p</italic> = 0.00*</td><td><italic>p</italic> = 0.09</td></tr><tr><td /><td /><td><italic>R</italic><sup>2</sup>=0.07</td><td><italic>R</italic><sup>2</sup>=0.06</td><td><italic>R</italic><sup>2</sup>=0.05</td><td><italic>R</italic><sup>2</sup>=0.08</td><td><italic>R</italic><sup>2</sup>=0.02</td></tr></tbody></table> </ephtml> </p> <p>1 <bold>*</bold><emph>p</emph> < 0.05.</p> <hd id="AN0164011003-13">Associations between mindfulness and psychological distress</hd> <p>Bivariate and multivariate regression analysis of dispositional mindfulness and each of its facets was performed to investigate their associations with psychological distress (Table 3). In bivariate analysis, dispositional mindfulness was inversely associated with psychological distress (<emph>β</emph>= −0.51, <emph>p</emph> < 0.01) and each of its four components (fatigue, negative affect, nervousness, and agitation). Multivariate regression analysis showed that the facets of mindfulness explained 28.5% of the variance in psychological distress (<emph>p</emph> < 0.001). <emph>Describing</emph>, <emph>acting with awareness</emph>, <emph>non-reactivity to inner experience</emph>, and <emph>non-judging of experience</emph> showed a significant inverse association with psychological distress. The <emph>observing</emph> facet, however, was not associated with psychological distress or any of its components.</p> <p>Table 3. Bivariate and multivariate regression analysis of dispositional mindfulness (and each of its five facets) as predictors of psychological distress.</p> <p> <ephtml> <table><thead><tr><td /><td>Psychological distress</td><td>Depressive symptoms subscales</td><td>Anxiety symptoms subscales</td></tr><tr><td>Fatigue</td><td>Negative affect</td><td>Nervous</td><td>Agitated</td></tr><tr><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td><td>Bivariate associations</td><td>Multivariate associations</td></tr><tr><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>P</italic></td><td><italic>β</italic></td><td><italic>P</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td></tr></thead><tbody valign="top"><tr><td><bold>Dispositional mindfulness</bold></td><td char=".">−0.51</td><td char=".">0.00*</td><td /><td /><td char=".">−0.42</td><td char=".">0.00*</td><td /><td /><td char=".">−0.47</td><td char=".">0.00*</td><td /><td /><td char=".">−0.41</td><td char=".">0.00*</td><td /><td /><td char=".">−0.41</td><td char=".">0.00*</td><td /><td /></tr><tr><td><bold>Observing</bold></td><td char=".">−0.12</td><td char=".">0.05</td><td char=".">0.018</td><td char=".">0.79</td><td char=".">−0.10</td><td char=".">0.12</td><td char=".">−0.02</td><td char=".">0.77</td><td char=".">−0.13</td><td char=".">0.05</td><td char=".">0.01</td><td char=".">0.88</td><td char=".">−0.11</td><td char=".">0.09</td><td char=".">0.00</td><td char=".">1.00</td><td char=".">−0.07</td><td char=".">0.26</td><td char=".">0.08</td><td char=".">0.29</td></tr><tr><td><bold>Describing</bold></td><td char=".">−0.41</td><td char=".">0.00*</td><td char=".">−0.160</td><td char=".">0.04*</td><td char=".">−0.34</td><td char=".">0.00*</td><td char=".">−0.18</td><td char=".">0.04*</td><td char=".">−0.38</td><td char=".">0.00*</td><td char=".">−0.17</td><td char=".">0.04*</td><td char=".">−0.26</td><td char=".">0.00*</td><td char=".">0.00</td><td char=".">0.98</td><td char=".">−0.37</td><td char=".">0.00*</td><td char=".">−0.14</td><td char=".">0.10</td></tr><tr><td><bold>Acting with awareness</bold></td><td char=".">−0.38</td><td char=".">0.00*</td><td char=".">−0.223</td><td char=".">0.00*</td><td char=".">−0.33</td><td char=".">0.00*</td><td char=".">−0.17</td><td char=".">0.04*</td><td char=".">−0.33</td><td char=".">0.00*</td><td char=".">−0.19</td><td char=".">0.02*</td><td char=".">−0.29</td><td char=".">0.00*</td><td char=".">−0.17</td><td char=".">0.03*</td><td char=".">−0.32</td><td char=".">0.00*</td><td char=".">−0.24</td><td char=".">0.00*</td></tr><tr><td><bold>Non-reactivity to inner experience</bold></td><td char=".">−0.31</td><td char=".">0.00*</td><td char=".">−0.307</td><td char=".">0.00*</td><td char=".">−0.25</td><td char=".">0.00*</td><td char=".">−0.21</td><td char=".">0.01*</td><td char=".">−0.27</td><td char=".">0.00*</td><td char=".">−0.25</td><td char=".">0.00*</td><td char=".">−0.30</td><td char=".">0.00*</td><td char=".">−0.38</td><td char=".">0.00*</td><td char=".">−0.25</td><td char=".">0.00*</td><td char=".">−0.25</td><td char=".">0.00*</td></tr><tr><td><bold>Non-judging of experience</bold></td><td char=".">−0.28</td><td char=".">0.00*</td><td char=".">−0.154</td><td char=".">0.03*</td><td char=".">−0.22</td><td char=".">0.00*</td><td char=".">−0.14</td><td char=".">0.06</td><td char=".">−0.26</td><td char=".">0.00*</td><td char=".">−0.18</td><td char=".">0.02*</td><td char=".">−0.26</td><td char=".">0.00*</td><td char=".">−0.16</td><td char=".">0.03*</td><td char=".">−0.18</td><td char=".">0.00*</td><td char=".">−0.01</td><td char=".">0.95</td></tr><tr><td /><td>F[5,168] = 14.82</td><td /><td>F[5,168] = 9.25</td><td /><td>F[5,168] = 11.71</td><td /><td>F[5,168] = 10.06</td><td /><td>F[5,168] = 8.44</td></tr><tr><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td></tr><tr><td><italic>R</italic><sup>2</sup>=0.29</td><td><italic>R</italic><sup>2</sup>=0.19</td><td><italic>R</italic><sup>2</sup>=0.24</td><td><italic>R</italic><sup>2</sup>=0.21</td><td><italic>R</italic><sup>2</sup>=0.18</td></tr></tbody></table> </ephtml> </p> <p>2 <bold>*</bold><emph>p</emph> < 0.05.</p> <p>In multivariate regression models, controlling for gender, dispositional mindfulness remained inversely associated with global measures of psychological distress as well as all its components (Table 4). Female gender remained significantly associated with global measures of psychological distress (<emph>β</emph> = 0.19, <emph>p</emph> < 0.01), fatigue (<emph>β</emph> = 0.19, <emph>p</emph> = 0.01), negative affect (<emph>β</emph> = 0.22, <emph>p</emph> < 0.01) and nervousness (<emph>β</emph> = 0.18, <emph>p</emph> = 0.01), but not agitation (<emph>p</emph> = 0.96).</p> <p>Table 4. Multivariate regression analysis of dispositional mindfulness as a predictor of psychological distress, controlling for gender.</p> <p> <ephtml> <table><thead><tr><td /><td>Psychological distress</td><td>Depressive symptoms subscales</td><td>Anxiety symptoms subscales</td></tr><tr><td>Fatigue</td><td>Negative affect</td><td>Nervous</td><td>Agitated</td></tr><tr><td><italic>Β</italic></td><td><italic>P</italic></td><td><italic>Β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td></tr></thead><tbody valign="top"><tr><td><bold>Gender</bold></td><td char=".">0.19</td><td char=".">0.00*</td><td char=".">0.19</td><td char=".">0.01*</td><td char=".">0.22</td><td char=".">0.00*</td><td char=".">0.18</td><td char=".">0.01*</td><td char=".">0.00</td><td char=".">0.96</td></tr><tr><td><bold>Dispositional mindfulness</bold></td><td char=".">−0.51</td><td char=".">0.00*</td><td char=".">−0.44</td><td char=".">0.00*</td><td char=".">−0.47</td><td char=".">0.00*</td><td char=".">−0.42</td><td char=".">0.00*</td><td char=".">−0.38</td><td char=".">0.00*</td></tr><tr><td /><td>F[2,169] = 37.58</td><td>F[2,169] = 26.19</td><td>F[2,169] = 33.20</td><td>F[2,169] = 23.12</td><td>F[2,169] = 14.47</td></tr><tr><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td></tr><tr><td><italic>R</italic><sup>2</sup>=0.30</td><td><italic>R</italic><sup>2</sup>=0.23</td><td><italic>R</italic><sup>2</sup>=0.27</td><td><italic>R</italic><sup>2</sup>=0.21</td><td><italic>R</italic><sup>2</sup>=0.14</td></tr></tbody></table> </ephtml> </p> <p>3 <bold>*</bold><emph>p</emph> < 0.05.</p> <p>In the final step of the analysis, we used multivariate models to explore associations between the various facets of mindfulness and the components of psychological distress, controlling for gender (Table 5). In this regression model, the facets of mindfulness explained 30.2% of the variance in psychological distress (F[<reflink idref="bib6" id="ref75">6</reflink>,<reflink idref="bib242" id="ref76">242</reflink>] = 13.32, <emph>p</emph> < 0.001). Global measures of psychological distress were inversely associated with <emph>acting with awareness</emph> (<emph>β</emph>= −0.23, <emph>p</emph> < 0.01)<emph>, non-reactivity to inner experience</emph> (<emph>β</emph>= −0.26, <emph>p</emph> < 0.01) and <emph>non-judging of experience</emph> (<emph>β</emph>= −0.16 <emph>p</emph> = 0.03). No association was found between <emph>observing</emph> and psychological distress (<emph>p</emph> = 0.84) or any of its components (all <emph>p</emph> > 0.2). Similarly, associations between <emph>describing</emph> and psychological distress did not reach significance (<emph>p</emph> = 0.07), nor with any of its components (<emph>p</emph> ≥ 0.05). As seen in Table 5, <emph>acting with awareness</emph> predicted lower reporting of all components of psychological distress (fatigue, negative affect, nervousness, and agitation). <emph>Non-reactivity to inner experience</emph> predicted lower negative affect (<emph>p</emph> = 0.02), nervousness (<emph>p</emph> < 0.01), and agitation (<emph>p</emph> < 0.01), but not fatigue (<emph>p</emph> = 0.07). <emph>Non-reactivity</emph> was the facet which most strongly predicted lower scores in the anxiety components, nervousness (<emph>β</emph>= −0.34, <emph>p</emph> < 0.01) and agitation (<emph>β</emph>= −0.27, <emph>p</emph> < 0.01). <emph>Non-judging</emph> predicted lower negative affect (<emph>p</emph> = 0.01), and nervousness (<emph>p</emph> = 0.03), but not fatigue (<emph>p</emph> = 0.05) or agitation (<emph>p</emph> = 0.97). These models accounted for 17.3% to 26.7% of the variance in each dimension of psychological distress, with the largest effect being on negative affect.</p> <p>Table 5. Multivariate regression analysis of dimensions of mindfulness as predictors of psychological distress, controlling for gender.</p> <p> <ephtml> <table><thead><tr><td /><td>Psychological distress</td><td>Depressive symptoms subscales</td><td>Anxiety symptoms subscales</td></tr><tr><td>Fatigue</td><td>Negative affect</td><td>Nervous</td><td>Agitated</td></tr><tr><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td><td><italic>β</italic></td><td><italic>p</italic></td></tr></thead><tbody valign="top"><tr><td><bold>Gender</bold></td><td char=".">0.16</td><td char=".">0.02*</td><td char=".">0.18</td><td char=".">0.01*</td><td char=".">0.20</td><td char=".">0.00*</td><td char=".">0.15</td><td char=".">0.03*</td><td char=".">−0.05</td><td char=".">0.48</td></tr><tr><td><bold>Observing</bold></td><td char=".">−0.01</td><td char=".">0.84</td><td char=".">−0.06</td><td char=".">0.42</td><td char=".">−0.03</td><td char=".">0.69</td><td char=".">−0.03</td><td char=".">0.68</td><td char=".">0.09</td><td char=".">0.25</td></tr><tr><td><bold>Describing</bold></td><td char=".">−0.15</td><td char=".">0.07</td><td char=".">−0.16</td><td char=".">0.06</td><td char=".">−0.16</td><td char=".">0.05</td><td char=".">0.02</td><td char=".">0.86</td><td char=".">−0.14</td><td char=".">0.10</td></tr><tr><td><bold>Acting with awareness</bold></td><td char=".">−0.23</td><td char=".">0.00*</td><td char=".">−0.19</td><td char=".">0.02*</td><td char=".">−0.20</td><td char=".">0.01*</td><td char=".">−0.18</td><td char=".">0.02*</td><td char=".">−0.24</td><td char=".">0.01*</td></tr><tr><td><bold>Non-reactivity to inner experience</bold></td><td char=".">−0.26</td><td char=".">0.00*</td><td char=".">−0.16</td><td char=".">0.07</td><td char=".">−0.19</td><td char=".">0.02*</td><td char=".">−0.34</td><td char=".">0.00*</td><td char=".">−0.27</td><td char=".">0.00*</td></tr><tr><td><bold>Non-judging of experience</bold></td><td char=".">−0.16</td><td char=".">0.03*</td><td char=".">−0.15</td><td char=".">0.05</td><td char=".">−0.18</td><td char=".">0.01*</td><td char=".">−0.17</td><td char=".">0.03*</td><td char=".">0.00</td><td char=".">0.97</td></tr><tr><td /><td>F[6, 165 ] = 13.32</td><td>F[6, 165 ] = 8.72</td><td>F[6, 165 ] = 11.40</td><td>F[6, 165 ] = 9.18</td><td>F[6, 165 ] = 6.97</td></tr><tr><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td><td><italic>p</italic> < 0.001*</td></tr><tr><td><italic>R</italic><sup>2</sup>=0.30</td><td><italic>R</italic><sup>2</sup>=0.21</td><td><italic>R</italic><sup>2</sup>=0.27</td><td><italic>R</italic><sup>2</sup>=0.22</td><td><italic>R</italic><sup>2</sup>=0.17</td></tr></tbody></table> </ephtml> </p> <p>4 <bold>*</bold><emph>p</emph> < 0.05.</p> <hd id="AN0164011003-14">Discussion</hd> <p>Our findings add to the literature describing high rates of psychological distress among university students, and highlighting the need for targeted campus based interventions.[<reflink idref="bib1" id="ref77">1</reflink>],[<reflink idref="bib2" id="ref78">2</reflink>],[<reflink idref="bib5" id="ref79">5</reflink>] Furthermore, our data are congruent with studies showing higher risk of psychological distress in female students,[<reflink idref="bib2" id="ref80">2</reflink>],[<reflink idref="bib4" id="ref81">4</reflink>],[<reflink idref="bib5" id="ref82">5</reflink>] suggesting that they should be a particular focus of targeted interventions in SA universities. Crucially, our data are congruent with previous findings that higher levels of mindfulness predict lower levels of psychological distress.[<reflink idref="bib15" id="ref83">15</reflink>],[<reflink idref="bib16" id="ref84">16</reflink>] Dispositional mindfulness was inversely associated with psychological distress, as well as all of the components of depressive and anxiety subscales. Dispositional mindfulness was most strongly associated with lower scores on the depressive symptom subscales, supporting literature that describes the role of mindfulness in ameliorating depressive symptomatology.[<reflink idref="bib13" id="ref85">13</reflink>] The evidence supporting the use of MBIs[<reflink idref="bib13" id="ref86">13</reflink>],[<reflink idref="bib15" id="ref87">15</reflink>],[<reflink idref="bib16" id="ref88">16</reflink>],[<reflink idref="bib57" id="ref89">57</reflink>] suggests that teaching mindfulness may improve psychological functioning, highlighting the potential to explore this mode of intervention on university campuses.</p> <p>At many universities, funding for large-scale interventions is limited and finding optimal ways to deliver interventions is imperative. MBIs may be an effective and sustainable form of intervention in low-resource environments, particularly if they can be cost-effectively implemented on a large scale, such as through group interventions, e-interventions (such as mobile apps or online interventions) or included in the curriculum. Indeed, mindfulness practices have been effectively taught in academic seminars[<reflink idref="bib58" id="ref90">58</reflink>] and online interventions are effective in promoting students' psychological wellbeing,[<reflink idref="bib59" id="ref91">59</reflink>] suggesting that both of these mediums may be effective for campus-based MBIs, provided these are culturally appropriate, feasible and acceptable to students. Mobile applications, such as the mindfulness meditation app, <emph>Headspace</emph>, have shown the potential to improve distress among students,[<reflink idref="bib60" id="ref92">60</reflink>] suggesting the potential to use app-based MBIs.</p> <p>Developing streamlined and effective large-scale MBIs for students requires that we elucidate the theoretical basis of how mindfulness is beneficial in reducing particular kinds of distress.[<reflink idref="bib41" id="ref93">41</reflink>] Furthermore, exploring the roles of the facets of mindfulness in psychological distress could help to guide the development of these interventions. Our study identifies that there are three facets of mindfulness (i.e., <emph>acting with awareness</emph>, <emph>non-judging</emph>, and <emph>non-reactivity</emph>) which were associated with lower levels of psychological distress, while <emph>observing</emph> and <emph>describing</emph> were not. These findings are congruent with other exploratory studies suggesting that particular facets of mindfulness underpin the psychological benefits of MBIs[<reflink idref="bib22" id="ref94">22</reflink>],[<reflink idref="bib38" id="ref95">38</reflink>],[<reflink idref="bib61" id="ref96">61</reflink>] and could have important practical implications for how MBIs are structured and whether particular skills should be frontloaded to bring more immediate symptom relief.</p> <p>Although our findings prompt questions about whether mindfulness can be taught as a set of discrete skills or whether mindfulness is developed as a coherent practice consisting of inter-related components that cannot be practically disentangled from each other,[<reflink idref="bib19" id="ref97">19</reflink>] the science of MBIs is too nascent to resolve this question. The mechanisms of how mindfulness improves psychological functioning still need to be fully established,[<reflink idref="bib43" id="ref98">43</reflink>] nonetheless our findings lay the groundwork for future studies to advance theoretical insights into the mechanisms of mindfulness and the pragmatic implications for campus-based wellness services. In this regard, we offer four observations from our data and hypothesize about the causal mechanisms underpinning the observed associations:</p> <p></p> <ulist> <item> <emph>Acting with awareness</emph> was negatively associated with all components of psychological distress, consistently predicting lower fatigue, negative affect, nervousness, and agitation. This finding is congruent with studies purporting that mindfulness training improves psychological functioning through increasing one's tendency to sustain self-focused attention, internal observation and staying with the present moment.[<reflink idref="bib43" id="ref99">43</reflink>] A recent study[<reflink idref="bib62" id="ref100">62</reflink>] found that <emph>acting with awareness</emph> accounted for the most variance in distress scores. Studies consistently show <emph>acting with awareness</emph> is associated with better perceived health,[<reflink idref="bib38" id="ref101">38</reflink>] lower depressive[<reflink idref="bib22" id="ref102">22</reflink>],[<reflink idref="bib38" id="ref103">38</reflink>],[<reflink idref="bib41" id="ref104">41</reflink>] and anxiety symptoms,[<reflink idref="bib38" id="ref105">38</reflink>] better psychological well-being,[<reflink idref="bib61" id="ref106">61</reflink>] and fewer incidents of non-suicidal self-injury.[<reflink idref="bib63" id="ref107">63</reflink>] Although the reasons for these associations are not clear, it is possible that focused attention on the task at hand, through <emph>acting with awareness</emph>, may protect against negative automatic thoughts and reduce rumination, resulting in improved affect. <emph>Acting with awareness</emph> may also protect against fatigue through greater awareness of self and improved internal monitoring, which would allow for more accurate assessment of physical and emotional needs, more purposeful use of energy, and reduced cognitive load of rumination, all of which may protect against fatigue. <emph>Acting with awareness</emph> and consolidating tasks could reduce the stress burden of simultaneous competing tasks and thoughts, thereby helping to reduce arousal and agitation. <emph>Acting with awareness</emph> entails a focus on the present rather than anxiously anticipating what is to come, which may help regulate nervousness.</item> <p></p> <item> <emph>Non-reactivity to internal experiences</emph> was associated with lower levels of negative affect, nervousness, and agitation, consistent with previous studies reporting <emph>non-reactivity</emph> is negatively associated with anxiety symptoms,[<reflink idref="bib38" id="ref108">38</reflink>] as well as lower stress[<reflink idref="bib46" id="ref109">46</reflink>] and depressive symptoms.[<reflink idref="bib22" id="ref110">22</reflink>],[<reflink idref="bib38" id="ref111">38</reflink>] One possible explanation is that <emph>non-reactivity</emph> enables individuals to notice feelings and automatic thoughts without reflexively reacting, thus promoting adaptive responses that protect against negative affect[<reflink idref="bib22" id="ref112">22</reflink>],[<reflink idref="bib40" id="ref113">40</reflink>] and curbing rumination.[<reflink idref="bib64" id="ref114">64</reflink>] Sustaining attention to inner experience, without reacting to thoughts and emotions through avoidance or other defenses, may facilitate desensitization[<reflink idref="bib43" id="ref115">43</reflink>] and over-come avoidance, which is known to perpetuate anxiety. <emph>Non-reactive</emph> individuals can allow thoughts and feelings to come and go, potentially allowing for situations of high arousal to be noticed, but allowed to pass, which may protect against the restlessness associated with high agitation scores.</item> <p></p> <item> <emph>Non-judging of experience</emph> was associated with lower negative affect and nervousness, a finding which is consistent with a recent network-analysis demonstrating the importance of <emph>non-judging</emph> for reducing negative affect.[<reflink idref="bib65" id="ref116">65</reflink>]<emph>Non-judging</emph> has previously been associated with reduced stress[<reflink idref="bib46" id="ref117">46</reflink>] and lower levels of anxiety,[<reflink idref="bib38" id="ref118">38</reflink>] although we only observed an association with the nervousness component, and not in the more somatic 'agitation' component of the anxiety subscale. Self-focused attention can be either non-judgmental and adaptive, or ruminative and maladaptive.[<reflink idref="bib43" id="ref119">43</reflink>]<emph>Non-judging</emph> requires "bare attention" (i.e. the ability to attend to experiences without evaluating, elaborating or labeling them) and the capacity to suspend disapproval of one's thoughts and feelings.[<reflink idref="bib40" id="ref120">40</reflink>] Some of the benefits of mindfulness may arise from a non-judgmental framing of thoughts and emotions as merely mental events rather than truths.[<reflink idref="bib43" id="ref121">43</reflink>]<emph>Non-judging of experience</emph> may thus guard against categorizing thoughts, emotions, and experiences as 'good' or 'bad', which precipitates and maintains cognitive distortions, depression and anxiety.</item> <p></p> <item> <emph>Observing</emph> and <emph>describing</emph> were not associated with psychological distress or any of its components. This finding is congruent with studies noting that <emph>observing</emph> alone is inadequate[<reflink idref="bib65" id="ref122">65</reflink>] and that high levels of <emph>observing</emph> may be maladaptive when used in isolation,[<reflink idref="bib20" id="ref123">20</reflink>] suggesting that this aspect of mindfulness may be less effective in promoting psychological functioning. Similarly, <emph>describing</emph> did not predict lower psychological distress or its components. These facets may give students the language and the ability to watch and describe their thoughts, feelings, and experiences, but this alone may not result in lower psychological distress.</item> </ulist> <p>Implicit in these observations are six implications for developing MBIs for students, all of which need to be empirically tested in subsequent research:</p> <p></p> <ulist> <item> MBIs should emphasize a<emph>cting with awareness</emph> early in interventions. Providing many opportunities to practice this key skill may bring about greater and/or faster symptom relief.</item> <p></p> <item> Focusing on <emph>acting with awareness</emph> will be important in transdiagnostic interventions.</item> <p></p> <item> MBIs for students with anxiety may benefit from focusing more on <emph>non-reactivity</emph> early in the intervention.</item> <p></p> <item> Students with higher anxiety levels may find it particularly challenging to remain <emph>non-reactive</emph> and may benefit from more guidance and opportunities to practice this skill.</item> <p></p> <item> <emph>Non-judging of experience</emph> may be less helpful for students who somaticize, but effective for those with negative cognitions or affect.</item> <p></p> <item> Interventions that focus narrowly on <emph>observing</emph> and <emph>describing</emph> are unlikely to bring symptom relief to students with anxiety and depression symptoms.</item> </ulist> <p>Given the cross-sectional nature of our data, it is not possible to infer a causal link between mindfulness and psychological distress, as is assumed in our preceding discussion of findings. Indeed, the relationship between mindfulness and psychological distress may be bidirectional, as non-evaluative attentional control through mindfulness may allow the capacity to process complex emotions, while open acceptance and appropriate thought patterns would allow for the cultivation of mindfulness and bare attention.[<reflink idref="bib40" id="ref124">40</reflink>] In turn, the burden of significant psychological distress could affect the capacity to be mindful. Baer[<reflink idref="bib43" id="ref125">43</reflink>] highlighted the limitations of cross-sectional data in excluding whether improvements in psychological functioning improve mindfulness, but the preliminary research had not yet found significant mediators in this direction. Carefully-designed longitudinal studies of the relationships between facets of mindfulness and components of psychological functioning may help us to better understand this causality.</p> <p>Future research could help to explore our observations and hypotheses, thus further illuminating the mechanism through which the various facets of mindfulness may promote psychological functioning. Larger longitudinal and experimental studies could enhance these findings and structural equation modeling may provide additional insights into potential mechanisms and the direction of causality. Well-designed randomized controlled trials with long follow-up periods will be needed to establish definitively if MBIs can be effectively utilized on university campuses. However, it is, first important to determine if MBIs are culturally appropriate and acceptable to university students, before investing in expensive prospective studies.</p> <p>The preceding discussion is premised on the assumption that mindfulness practices can and should be dissected and studied scientifically. Conventional scientific methods may, however, struggle to meaningfully explore mindfulness. As the Bhikkhu[<reflink idref="bib66" id="ref126">66</reflink>] asserted: "Western psychology mandates that constructs must be explicated and operationalized to be accurately assessed," which may not be possible with mindfulness. Traditions in Buddhism maintain that mindfulness is challenging to analyze in isolation from other inherently interdependent, synergistic, and mutually reinforcing processes.[<reflink idref="bib66" id="ref127">66</reflink>] If this is indeed true then attempting to investigate discrete facets of mindfulness, as we have done in this study, may be unproductive.</p> <hd id="AN0164011003-15">Limitations</hd> <p>The limitations of our study include our reliance on self-report data and the use of a cross-sectional study design. Sample size and nonrandom sampling within one university may also have biased the sample and hence limit the generalizability of findings. Nonetheless, this is, to our knowledge, the first study of this kind among university students in Africa, and the findings add to the limited body of literature on the role of the facets of mindfulness in regulating psychological functioning.</p> <hd id="AN0164011003-16">Conclusion</hd> <p>Dispositional mindfulness was inversely associated with psychological distress and its components, suggesting that MBIs may help inoculate students against psychological distress. Most importantly, our data show that different facets of mindfulness are associated with distinct components of psychological distress, which could help advance theories about <emph>if</emph>, <emph>when</emph>, and <emph>how</emph> mindfulness practices improve psychological wellbeing and the potential implications of these associations for campus-based wellness services. Future studies should investigate the acceptability of MBIs and the feasibility of implementing MBIs on university campuses before experimental trials are used to establish the effectiveness of MBIs in this setting.</p> <hd id="AN0164011003-17">Author contributions</hd> <p>JWB was the principal investigator of this project as part of his Master's in Science in Sport and Exercise Medicine. WD conceptualized and designed the MaRooN Health Passport and the larger study of non-communicable disease risk factors. JWB developed the initial proposal for this study with WD and JG as supervisors. JB, JWB, and JG analyzed the data. JWB, JB, JG, SW, and WD all contributed to the interpretation of the data and writing the manuscript. All authors approved the final version.</p> <hd id="AN0164011003-18">Data availability</hd> <p>Data from the current study are available from the corresponding author on reasonable request.</p> <hd id="AN0164011003-19">Disclaimer</hd> <p>The authors declare that the results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The views expressed in this article are the authors own views and not an official position of their institutions.</p> <hd id="AN0164011003-20">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of South Africa and received approval from the Research Ethics Committee: Social, Behavioral and Education Research at Stellenbosch University.</p> <hd id="AN0164011003-21">Funding</hd> <p>The authors received no specific grant or financial support for thisresearch. JB receives financial support from the South African Medical Research Council (SAMRC) through its Division of Research CapacityDevelopment under the Mid-Career Scientist Program. The contenthereof is the sole responsibility of the authors and does not necessarilyrepresent the official views of the SAMRC.</p> <ref id="AN0164011003-22"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Larcombe W, Finch S, Sore R, et al. Prevalence and socio-demographic correlates of psychological distress among students at an Australian university. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Associations between Psychological Distress and Facets of Mindfulness: Implications for Campus-Based University Wellness Services
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Burger%2C+James+W%2E%22">Burger, James W.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-2388-5019">0000-0003-2388-5019</externalLink>)<br /><searchLink fieldCode="AR" term="%22Bantjes%2C+Jason%22">Bantjes, Jason</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-3626-9883">0000-0002-3626-9883</externalLink>)<br /><searchLink fieldCode="AR" term="%22Derman%2C+Wayne%22">Derman, Wayne</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-8879-177X">0000-0002-8879-177X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Whitesman%2C+Simon%22">Whitesman, Simon</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-7763-8748">0000-0001-7763-8748</externalLink>)<br /><searchLink fieldCode="AR" term="%22Gomez-Ezeiza%2C+Josu%22">Gomez-Ezeiza, Josu</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-0437-2226">0000-0003-0437-2226</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2023 71(4):1074-1083.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+Patterns%22">Psychological Patterns</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Behavior%22">Student Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Knowledge+Level%22">Knowledge Level</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Fatigue+%28Biology%29%22">Fatigue (Biology)</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Metacognition%22">Metacognition</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22South+Africa%22">South Africa</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2021.1920601
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: To investigate associations between components of psychological distress and five facets of mindfulness (i.e. "observing"; "describing"; "acting with awareness"; "non-reactivity"; "non-judging"). Participants: Students from a university in South Africa (n = 174). Methods: This cross-sectional study assessed psychological distress and mindfulness using the K10 and Five Facet Mindfulness Questionnaire. Multivariate regression analysis identified associations between psychological distress and facets of mindfulness, controlling for demographics. Results: Prevalence of psychological distress was 56.9% (95% CI 49.2%-64.4%). "Acting with awareness," "non-reactivity," and "non-judging" predicted significantly lower psychological distress, whereas "observing" and "describing" did not. "Acting with awareness" was the only facet of mindfulness that consistently predicted lower levels of negative affect, fatigue, nervousness, and agitation. Conclusions: Acting with awareness appears to be a key component of psychological wellbeing. To advance theory and practice, future research should consider why and how various facets of mindfulness predict lower psychological distress and its components among university students.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1389734
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1389734
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        Value: 10.1080/07448481.2021.1920601
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 1074
    Subjects:
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Psychological Patterns
        Type: general
      – SubjectFull: Student Behavior
        Type: general
      – SubjectFull: Knowledge Level
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      – SubjectFull: Well Being
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      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Fatigue (Biology)
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Metacognition
        Type: general
      – SubjectFull: South Africa
        Type: general
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      – TitleFull: Associations between Psychological Distress and Facets of Mindfulness: Implications for Campus-Based University Wellness Services
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