Mental Health and Mindfulness: Mediational Role of Positive and Negative Affect

Transcription

1 SIS J. Proj. Psy. & Ment. Health (2012) 19 : Mental Health and Mindfulness: Mediational Role of Positive and Negative Affect Sachit Prasun Mandal, Yogesh Kumar Arya and Rakesh Pandey A consensus is emerging among the researchers that mindfulness is associated with better physical health and psychological well-being. The present study attempts to explore the posstible role of positive and negative affectivity in explaining the relationship between mindfulness and health. One hundred undergraduate and post-graduate students (52 male and 48 female) were assessed on selfreport measures of mindfulness, positive/negative affectivity and mental illness/distress. Analysis revealed that most of the dimensions of mindfulness as well as the total score of mindfulness were correlated positively with positive affect and negatively with different dimensions of mental illness/ distress and negative affect. Further, positive affect correlated significantly and negatively with the dimensions mental illness/distress whereas negative affect correlated positively with the same. Though, most of the dimensions of mindfulness correlated significantly with mental illness/distress as well as positive/negative affect, the findings of stepwise multiple regression analysis revealed that acting with awareness dimension of mindfulness emerged as the best predictor of mental illness/distress. Further, in predicting negative affect describe dimension of mindfulness emerged as best predictor followed by non-judgment of inner experiences. Positive affect was best predicted by describe dimension of mindfulness followed by reactivity to inner experiences. To examine the mediational role of positive/negative affect in mindfulness-mental illness relationship a mediation analysis was carried out. Findings revealed that the negative affect and not the positive affect significantly mediated the relationship between mindfulness and mental illness/distress. The results have been discussed in the light of available empirical researches. Mental health, well-being and happiness have been a major concern for human beings from very initial days of their existence. In recent years, this issue has drawn attention and interest of researchers to explore modifiable psychosocial factors that promote optimal mental health and well-being of an individual. Researches on well-being have produced a plethora of scientific literatures on different correlates and mechanisms of overall health and well-being. But as far as the modern wellbeing research trend is concerned, researchers focus more on those correlates which can be modified and/or developed within an individual through practices and efforts. The construct of mindfulness is of great interest in this regard, because oriental meditation practices particularly Buddhism provides methods of cultivating it, which are now being adopted in the western research world also in order to elevate health and well-being. Mindfulness connotes non-judgmental and nonreactive acceptance of emotional states. According to Ellen Langer (1989), it refers to a flexible state of mind, openness to novelty, a process of actively drawing novel distinctions. It plays a big role in making human being free from automatic thoughts, habits and unhealthy behaviors and enhances self-regulated behavior which is related to enhancement of well-being (Ryan and Deci, 2001). The psychometric approach to study mindfulness as a trait has resulted in better operationalization and psychometric measures of the construct and one of the most widely studies and validated operationalization and measure of mindfulness and its mechanism has been given by Baer et al (2006). They proposed a five element structure of mindfulness namely observing, describing, acting with awareness, non-judgment of inner experiences and nonreactivity to inner experiences. Satchit P. Mandal, Research Scholar, Yogesh K. Arya, Ph.D. Assistant Professor, and Rakesh Pandey, Ph.D., FSIS (Corresponding author), Professor, Dept. of Psychology, Banaras Hindu University, Varanasi , rpan_in@yahoo.com Key Words: Mental health, Well-being, Positive and Negative Affect, Mindfulness

2 Mental Health and Mindfulness: Mediational role of Positive and Negative Affect 151 According to Baer and colleagues (2006), observing refers to flexible awareness over internal and external experiences, such as sensations, cognitions, emotions, sights, sounds, and smells. Describing refers to labeling internal experiences with words. Acting with awareness denotes doing activities of the present moment with being conscious of them. Non-judging of inner experience refers to the attitude of not evaluating the emotions and thoughts. Non-reactivity to inner experience is the tendency to take a detached position towards cognitive and affective experiences without getting involved in them and exerting any responses. Based on the aforesaid operationalization of the construct of mindfulness and its various domains they developed the Five Facet Mindfulness Questionnaire (FFMQ) that has been widely used in the area of health research. The effectiveness of mindfulness in reducing negative health outcomes and a wide range of mental and physical health symptoms has been observed in serveral studies. For instance, Speca, et al. (2000) observed that a mindfulness-based stress reduction program on mood disturbance and symptoms of stress in Cancer patients resulted in reduced mood disturbances and stress symptoms in both male and female patients with a wide variety of cancer diagnoses. Similar effectiveness of mindfulness based stress reduction program in reducing symptoms associated with physical, psychosomatic and psychiatric disorders has been reported (Grossman, et al. 2004). Several other studies demonstrate that mindfulness trait as well as training programs have been found to be very successful in the reduction of symptoms related to chronic pain (Kabat-Zinn, 1982; Kabat-Zinn et al, 1985), generalized anxiety and panic disorders (Kabat-Zinn and Massion, 1992), fibromyalgia (Kaplan et al 1993), and cancer (Speca and Carlson, 2000). Apart from reduction of symptoms and distress, the mindfulness trait and related practices have also been found to be associated with positive mental health, positive affect and life satisfaction (Micheal and Graham, 2010). The foregoing studies, though, suggest that mindfulness as a trait as well as a practice is associated with better mental health and wellbeing, the exact mechanism through which it brings beneficial health effect is little known. Several potential mediating mechanisms may be put forward to explain the mindfulnesshealth relationship. For instance, it is likely that mindfulness increases positive affective experiences and also decreases negative affective experiences which in turn exert a long term beneficial effects on human health and well-being. Interestingly, existing literature follows this theoretical lining as mindfulness indeed positively relates with positive affect and negatively with negative affect. Brown and Ryan (2003) in an experience-sampling study found that mindfulness induces self-regulatory behaviors and frequent experiences of positive emotional states. Cherie and Dianne (2010) demonstrated that mindfulness increases positive affectivity and life satisfaction. Jacob, et al, (2004) conducted a survey on mindfulness, spirituality and subjective wellbeing and observed that mindfulness leads to pro-social values, decreases negative affective experiences, increases positive affective experiences and life satisfaction. The trait positive affect (PA) has been found to be related with low rates of stroke among non-institutionalized elderly (Ostir et al 2001), low rates of hospitalization for coronary problems (Middleton and Byrd, 1996), fewer injuries (Koivumaa-Honkanen et al., 2000) and improved pregnancy outcomes among women undergoing assisted fertilization (Klonoff- Cohen et al 2001). On the other hand, negative affect has been found to be inversely related with health and wellness. Numerous studies suggest that prevalence of negative affect leads to high greater levels of stress, depression, poor psychological health, well-being and low self-esteem (Cohen et al, 2003). It is evident from the review that mindfulness is associated with enhanced positive emotions and reduced negative emotions and greater positive and lower negative affect is linked with better health and well-being. This observation lends indirect support to our speculation that the beneficial health effect of mindfulness

3 152 Mandal, et al may be mediated by the positive/negative emotional experiences. However, there is dearth of literature in this area and most of the earlier studies on mindfulness-mental illness were conducted on clinical population that presents a lot of confound difficulty to control experimentally. The present study is a modest attempt to reexamines the mindfulness-mental illness/ distress relationship in general population using psychometric measure of mental health and explores the relative significance of various domains of mindfulness in predicting mental health. It will also explore the potential mediating role of positive/negative affectivity in mindfulness-mental health relationship. Method: Sample: The present study was conducted on a sample of 100 adult students belonging to different colleges and universities of the Varanasi city. They ranged from 20 to 33 years (mean age = years and S.D= 2.84 years) and all of them belonged to middle class. It was an incidental sampling with almost equal number of both sexes (Males = 52, Females = 48). None had reported any history of chronic illness. Tools: The Hindi adaptation of Five Facet Mindfulness Questionnaire (FFMQ; Baer, et al., 2004) made by Mandal, Arya and Pandey, 2011 was used to assess the trait mindfulness of the participants. It consists of 39 items and assesses five facets of mindfulness viz., observing (8 items), describing (8 items), acting with awareness (8 items), non-judgment of inner experiences (8 items) and non-reactivity to inner experiences (7 items). It has demonstrated good internal consistency with alpha coefficients ranging from.75 to.91 and satisfactory validity of the factor structure (Baer et al., 2004). Positive and negative affectivity was assessed using the Hindi adaptation of Positive Negative Affect Schedule (PANAS; Watson, Clark and Tellegan, 1988) developed by Pandey and Srivastava (2008). It consists of 20 mood related adjectives (10 positive and 10 negative) that assesses two global dimensions of affect: positive and negative (Watson et al, 1988). Respondents are required to mark the level to which these moods were experienced by them during a specified period on a 5-point scale. The Hindi adaptation of the Ninety-item Revised Symptom Checklist (SCL-90-R; Derogatis, 1973) adopted by Dubey and Pandey (2011) was used to assess mental health and general level of mental distress. It is designed to evaluate a broad range of psychological problems and nine primary symptom dimensions viz., Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychoticism and three global indices of distress. It also indicates three global indices viz: 1) Global Severity Index (GSI) (which reflects the average score of the 90 items of the questionnaire), 2) Positive Symptom Distress Index (PSDI) (refers to the mean score of the items scored above zero) and 3) Positive Symptoms Total (PST) (is simply the number of items scored above zero) (Derogatis, 1983). According to Holi (1999) The global indices provide a means of communicating an individual s pathology with a single number. Procedure: The participants were contacted either individually or in small groups consisting of 3 to 4 persons and explained the purpose of study. After getting their consent of the participants the aforesaid questionnaires were administered as per the standard instructions of each questionnaire. All participants were requested to ensure that they have responded to each items of every questionnaire/scale. The obtained data were analysed by using bivariate correlation, stepwise regression analyses and mediation analysis. Results and Discussion: To examine the relationship of mindfulness with mental health bivariate correlations were computed and the obtained results have been displayed in Table 1.

4 Mental Health and Mindfulness: Mediational role of Positive and Negative Affect 153 Table1 Correlation of Various Dimensions of Mindfulness with Various Symptom Dimensions of SCL-90 R ** p < 0.01; ** p < 0.05 It is evident from Table 1 that mindfulness total score as well as all the dimensions of mindfulness except observing and nonreactivity to inner experience correlated negatively and significantly with all the symptom dimensions of mental health as assessed by the SCL-90-R. The observing dimension of mindfulness correlated positively to only two symptom dimensions viz., hostility and paranoid ideation and the non-reactivity to inner experience failed to correlate with any Table 2 symptom dimension of mental health. Only two significant correlations (with mild effect size) obtained between observing dimension of mindfulness and nine dimensions of mental health suggest that the association of this dimension of mindfulness with mental health is statistically unreliable if family-wise type-i error is taken into account. In fact, this speculation is supported by its non-significant correlations observed with the various global indices of the SCL-90-R (Table 2). Correlation of Different Dimensions of Mindfulness with Three Global Distress Indices ** p < 0.01, * p < 0.05

5 154 Mandal, et al It is evident from Table 2 that a similar pattern of correlations was also obtained between various dimensions of mindfulness and three global indices of distress namely positive symptom total, positive distress index, global severity index. Again only the aforesaid 3 dimensions of mindfulness correlated significantly and negatively with the three global indices of mental distress and psychopathology and the two dimensions viz. observing and non-reactivity to inner experiences failed to correlate with any of the said indices. The observed pattern of correlation between mindfulness and mental health and general mental distress suggests that higher level of mindfulness trait is associated with fewer symptoms of various types of mental health problems as well as global mental distress. Table 3 Further, it also suggests that though, total score of mindfulness correlated significantly with all the symptom dimensions of mental health and various global indices of psychopathology and mental distress, only three dimensions of mindfulness (Describing, Acting with awareness and Non-judgment of inner experience) significantly contribute to the observed association between mindfulness and mental health. However, as relative significance of various dimensions of mindfulness in predicting mental health cannot be determined by simple bivariate correlation, a series of stepwise regression analyses was conducted using different dimensions of mindfulness as predictors and various symptom dimensions of SCL 90 R as criterion variables. The result has been shown in Table 3. Results of Step Wise Multiple Regression Analysis using Dimensions of Mindfulness as Predictor Variables and Symptom Dimensions of SCL 90 R as Criterion

6 Mental Health and Mindfulness: Mediational role of Positive and Negative Affect 155 The results revealed that acting with awareness emerged as the best predictor of all dimensions of mental illness except depression. It also emerged as the single best predictor of global mental distress or level of psychopathology. This dimension of mindfulness explained approximately 12.4% to 24.6% of the total variance of the various symptom domains of mental illness/distress. Depression was best predicted by describing and observing dimensions of mindfulness and these predictors explained 10.3 and 4.6 percent of the total variance in depression. The describing dimension of mindfulness was found to be the second best predictor of obsessive compulsive and phobic anxiety symptoms. The nonjudgment of inner experience was the second best predictor of paranoid ideation, positive symptom total and interpersonal sensitivity and the observing dimension of mindfulness was the second best predictor of symptoms of hostility and depression. Overall, the findings suggests that acting with awareness is such dimension of mindfulness that plays important role in ameliorating mental health and alleviating various symptoms of mental illness and global mental distress. However, for alleviation of symptoms of depression the describing and observing dimensions of mindfulness play a pivotal role. This finding corroborates the earlier observations that mindfulness is associated with reduction in the symptoms of psychopathology (Kingston, et al., 2007), mood disturbances and stress (Brown and Ryan, 2003). The relationship of mindfulness with positive and negative emotional experiences was also examined and the obtained pattern of correlation between the two constructs (Table 4) indicates that though, mindfulness total score correlated significantly and positively with positive affect and negatively with negative affect, not all dimensions of mindfulness correlate significantly with positive/negative affect. It is evident that describing, acting with awareness and non-judgment to inner experiences correlated significantly and negatively with negative affect. However, the positive affect was found to be positively correlated with only two dimensions of mindfulness- describing and non-reactivity to inner experiences. Table 4 Correlation of Various Dimensions of Mindfulness with Positive/Negative Affectivity ** p < 0.01, * p < 0.05 Overall, the obtained pattern of correlation between mindfulness and its various dimensions on one hand and positive/negative affect on the other suggest that higher level of mindfulness trait is associated with reduced negative emotional experiences and enhanced positive experiences. However, in reduction of negativity and enhancement of positivity different aspects of mindfulness have been found to be significant. In reduction of negative emotions the same three dimensions of mindfulness (Describing, Acting with awareness, Non-judgment of inner experience) were found significant that were found to be important in reduction of symptoms of psychopathology and general mental distress. However, for enhancement of happiness and positive affect non-reactivity to inner experience was found significant in addition to the describing dimension of mindfulness. The present observation provide additional support to the earlier observations that selfreported mindfulness is positively related to positive affect and negatively related to negative affect and that mindfulness training leads to increase in positive affect as well

7 156 Mandal, et al as decrease in negative affect (Schroevers and Brandsma, 2010). The present findings point out the possibility that not all domains of mindfulness are equally important in predicting level of positive and negative affect. To test this speculation we conducted two sets of stepwise regression analyses using different dimensions of mindfulness as predictors and positive/negative affect as criterion variables. The results are shown in Table 5. Table 5 Results of Step wise Multiple Regression Analysis using Dimensions of Mindfulness as Predictor Variables and Positive/Negative Affect as Criterion It is evident from Table 5 that the describing dimension of mindfulness emerged as the best predictor of both positive and negative affect and accounts for around 16.6 and 20.8 percent of the total variance in these constructs, respectively. However, the second best predictor for positive affect was nonreactivity to inner experience and for negative affect it was non-judgment of inner experience. Thus, the findings imply that though, describing is such a dimension of mindfulness that is common to both enhancement of positive affect and reduction of negative affect, the nonjudgment of inner experience is a factor that helps in reduction of negative affect but not in the enhancement of positive affect. Similarly, non-reactivity to inner experience leads to enhancement of positive affect but it has not been found important in reducing negative affect. The finding that non-reactivity to inner experience leads to reduction in negative affect is theoretically congruent with conceptual definition of this dimension of mindfulness. This dimension of mindfulness reflects an individual s ability to stay back and watch the emotions including the negative ones without reacting to them. Some example items of this dimensions are, When I have distressing thoughts or images, I just notice them and let them go and When I have distressing thoughts or images, I feel calm soon after. Thus, just noticing the negative emotions and letting it go or feeling calm soon after reflects such traits and behavior pattern that will gradually reduce the potential of negative events/thoughts to further generate negativity and thereby reducing the overall negative affect. On the other hand, the non-judgment of inner experience domain of mindfulness reflect such behavioral tendencies as to not to disapprove oneself in presence of irrational ideas, not evaluating one s emotions or thoughts as bad. It is apparent from the description of this domain of mindfulness that it emphasizes acceptance of self and negative events and not giving a value judgment of bad to such events and thoughts. Naturally, such tendency will enhance positive affect even in face of negative and/or adverse situations of the life. Further, the finding that describing dimension of mindfulness is associated with enhanced positive affect and reduced negative affect also appears to be theoretically congruent with description of this dimension of mindfulness. The describing domain of

8 Mental Health and Mindfulness: Mediational role of Positive and Negative Affect 157 mindfulness is defined by the ability to notice and verbally describe the emotions or putting the emotional experiences into words and thus it is not only likely to facilitate emotional catharsis but also social sharing of emotions. And a bulk of researches evidences available, which demonstrate that social sharing of emotions not only reduce negative emotions but may also enhance positive ones (Pandey and Choubey, 2010). The foregoing findings suggest that mindfulness and some of its dimensions do not only help to reduce symptoms of mental ill-health and general mental distress but it also help to reduce negative emotions in one s life and to enhance the positive affects such as happiness and joy. However, before testing this mediated effect of mindfulness on mental health through positive/negative affect, it is essential to establish that a relationship exists between mental health and positive/negative affect. Thus, bivariate correlation was computed between the measures of positive/negative affect and mental health and the findings have been presented in Table 6. Table 6 Correlation of Dimensions and Mental Illness/Distress Indices of SCL-90 R with Positive/Negative Affectivity. ** p < 0.01, * p < 0.05 It is evident from the table that positive affect correlated significantly and negatively with all the symptom domains of mental health (except hostility) and the negative affect correlated positively with various symptom domains of psychopathology. This pattern of correlation suggests that positive affect is associated with fewer symptoms of psychopathology and general mental distress whereas the negative affect is associated with more symptoms of psychopathology. This finding is congruent with the findings of various earlier studies (e.g., Gruber and Hu, 2008; Salovey and Birnbaum, 1989). Taken together, the preceding findings of the present study suggest that mindfulness is associated with fewer symptoms of mental illness and general mental distress as well as with a higher level of positive affective experience and lower level of negative affective experience. Further, it is also evident from the findings of the present study that higher level of positive affect is associated with fewer symptoms of psychopathology or mental illness and higher negative emotional experience is linked with more symptoms of mental illness and general mental distress. This pattern of relationship among mindfulness, mental health and positive/negative affect clearly support our speculation that the beneficial health effect of mindfulness is likely to be mediated by the resulting positive and negative affect. However, we have tried to empirically test this positive/ negative affect mediated relationship between mindfulness and mental health. The mediation analysis was conducted by running a series of hierarchical regression analyses using the SPSS script developed by Hayes (2009) the mediational effect of positive and negative affect was tested independently. For this analysis the total score on mindfulness questionnaire was considered as predictor and the global distress index SCL-90-R was taken as criterion variable. The mediated relationship of mindfulness and mental health via positive affect has been presented in Fig. 1 along with the path coefficients.

9 158 Mandal, et al Fig. 1: The meditational effect of positive affect on mindfulness-mental illness relationship It is evident from the above figure that the total effect of mindfulness on mental illness/distress represented by path C = and the total effect of mindfulness on positive affect represented by path a= The effect of positive affect on Mental illness/distress represented by path b= The dashed line (path C ) between mindfulness and mental illness/distress represents the direct effect of mindfulness on mental illness/distress. The direct effect is the effect of predictor on criterion after controlling the effects of mediator. Here it can be seen that the direct effect of mindfulness on mental illness/distress is C` = , which is smaller in magnitude than the total effect. Any mediator can be declared as a significant mediator only when the indirect effect of predictor through the mediating variable on criterion is found to be statistically significant. Indirect effect is the product of path coefficients a and b (.1384 and respectively) which is However, the conventional test of significance as well as the Sobel test both indicated that this indirect effect of mindfulness through positive affect is non-significant (P>.05). This finding suggests that positive affect does not mediate the relationship of mindfulness and mental illness/ distress. A similar test of mediational effect of negative affect on mindfulness mental health relationship was also conducted. The path diagram and path coefficients of direct and total effects have been displayed in Fig. 2. It is evident from Fig. 2 that the total effect of mindfulness on mental illness/distress (path coefficient C = ) reduced substantially after controlling the indirect (mediated) effect of negative affect resulting in a nonsignificant direct effect of mindfulness on mental health (direct effect is represented by path C = ). The product of the effect of mindfulness on negative affect (path a= ) and effect of negative affect on mental illness/ distress (path b =.0486) was computed to determine the mediated (indirect) effect of mindfulness on mental illness/distress through negative affect. The indirect effect was found to be which was statistically significant (z = , p<.05, Confidence interval of Sobel test ranged from to -.005). The observed significant mediational effect of mindfulness through negative affect implies that mindfulness promotes mental health by reducing negative emotional experiences. Conclusion: The findings of the present study suggest that mindfulness in general and three of its components in particular (viz. verbally describing emotions, acting with awareness, and non-judgment of inner experience) are not only helpful in reducing the symptoms of mental illness and thereby promoting mental health but also in reducing the negative affect and enhancing positive emotional experience. The results also indicate that mindfulness exerts its beneficial mental health effect largely by reducing the negative affect and not by its positive emotion enhancing effect. Thus, it can be concluded that mindfulness alleviates symptoms of mental illness and distress by regulating the emotional balance of an individual. However, it will be premature to generalize such conclusions before rigorous experimental verification on larger group.in future. References: Fig. 2.: The meditational effects of negative effect on mindfulness-mental illness relationship Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J. and Toney, L. (2006).Using self-report assessment methods

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