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Mindful Coping Mindful Coping by Kjersti B. Tharaldsen Thesis submitted in fulfilment of the requirements for the degree of PHILOSOPHIAE DOCTOR (PhD) Faculty of Social Sciences University of Stavanger 2012 University of Stavanger N-4036 Stavanger NORWAY www.uis.no © 2012 Kjersti B. Tharaldsen ISBN: 978-82-7644-508-4 ISSN: 1890-1387 PhD thesis no. 174 To my Albertine iii iv Acknowledgments Sincere thanks go to the patients, students, and schools who took part in this project; this work would be impossible without your willingness to participate! Main supervisor, Professor Edvin Bru at the University of Stavanger, has been an invaluable source of knowledge, support and guidance; thanks! Co-supervisor, Professor Ingvard Wilhelmsen at the University of Bergen, has provided helpful advices, and has been a genuine source of inspiration; thanks! I thank Dalane DPS (SUS) for funding the work and UiS for practical arrangements. Sincere thanks go to my colleagues and fellow PhD- candidates at both institutions for support and encouraging discussions. Special thanks go to Møyfrid Løvbrekke, Hanna Pettersen, Henk Otten, Aslaug Mikkelsen, Knud Knudsen, Bjørn-Tore Blindheim, and Turid Rødne. Thanks to Svein Gran for valuable comments on the material. I thank my closest friends and family for their love and support during ups and downs of this journey; we made it! Finally, I send a thought of gratitude to my Amish friends who taught me what being in the present moment was all about before I knew there was a name for it. Stavanger, May 2012 Kjersti B. Tharaldsen v vi Summary The main objective of this thesis was to investigate the relation between mindfulness and coping. Building on a definition of mindfulness as a way of being in the present moment, appraisal theory was linked to coping with distress. The reason was to inquire whether mindfulness may be related to a coping process that entails appraising and to suggest how it is associated. “Mindful coping” is presented as a way to link these two traditions. This aim was developed based on years of working with both clinical and non-clinical populations who have expressed interest in and benefitted from practicing mindfulness as a door-opener to more adequate coping with general stress- and emotion- related life problems. Beginning with a look into coping strategies that may play a central role in mindful coping, these strategies were related to mental health indicators to provide information on how mindful coping strategies may affect mental health. Mindful coping strategies were then investigated empirically within a non-clinical adolescent sample and a sample of psychiatric outpatients. Two interventions believed to enhance mindful coping were evaluated with the main goal of learning more about how mindful coping skills may be developed, as well as their capability to stimulate mindful coping and improve mental health. vii Using a pragmatic approach within a critical realist framework, and by mixing quantitative and qualitative methods, four studies contributed to the current research. Findings showed that mindfulness may play a part in coping (i.e., mindful coping). Strategies for promoting mindful coping have been suggested. Furthermore, the results revealed that mindful coping strategies do seem to affect mental health in different ways for different populations. Within the adolescent sample, tendencies reflected that some strategies were more beneficial than others, whereas the strategies seem to affect symptoms of poor mental health in promising ways within the patient sample. In response to the findings, suggestions have been made to moderate interventions that enhance mindful coping to increase the use of such strategies and promote mental health. Finally, challenges in developing and executing mindfulness-based interventions for adolescents and for psychiatric outpatients have been suggested. The study provides important knowledge on how mindfulness can be linked to coping theories and how interventions integrating mindfulness practices and coping skills may be carried out. viii Abbreviations APA – American Psychiatric Association ACT – Acceptance and Commitment Therapy CC – Conscious Coping CFA – Confirmatory Factor Analysis BC – Brief Cope DBT – Dialectical Behavior Therapy DPS – District Psychiatric Outpatient Service (community mental health center) EFA – Exploratory Factor Analysis GAF – Global Assessment of Functioning GP – General Practitioner GSI – Global Severity Index MABI – Mindfulness- and Acceptance-Based Interventions MBC – Mindfulness-Based Coping MBCT – Mindfulness-Based Cognitive Therapy MBI – Mindfulness-Based Interventions MBSR – Mindfulness-Based Stress Reduction MC – Mindful Coping MCS – Mindful Coping Scale NSD – Personal Data Registers Act § 9 (Norwegian abbreviation) PLS – Perceived Life Strain PS – Psychological Symptoms ix REK Vest – Regional Ethical Committee (Norwegian abbreviation) S-GAF – Global Assesment of Functioning – split version SCL-90-R – Symptom Checklist-90-Revised SWLS – Satisfaction with Life Scale TAU – Treatment as Usual x xi Contents Acknowledgments ................................................................................. v Summary ............................................................................................. vii Abbreviations ....................................................................................... ix Contents .............................................................................................. xiii 1 Introduction .............................................................................. 1 1.1 Background ................................................................................ 4 1.2 Research aims ............................................................................. 8 1.3 Structure of the thesis ................................................................. 9 2 Theoretical framework .......................................................... 11 2.1 The concept of mindfulness ..................................................... 11 2.1.1 Defining mindfulness ......................................................................... 13 2.1.2 Mindfulness as a multifaceted construct ............................................ 15 2.2 Stress and coping ...................................................................... 16 2.2.1 Stress as activating affects ................................................................. 17 2.2.2 The role of coping .............................................................................. 18 2.2.3 Appraisal theory ................................................................................ 20 2.3 Mindful coping ......................................................................... 21 2.3.1 The mindful coping process ............................................................... 22 2.3.2 Mindful coping and mental health ..................................................... 27 xiii 3 Enhancing mindful coping ..................................................... 31 3.1 Mindfulness-Based Coping ...................................................... 31 4 Methodology ........................................................................... 35 4.1 Introduction .............................................................................. 35 4.2 Philosophical and theoretical perspectives ............................... 36 4.2.1 Mental models and pragmatic thinking ............................................. 36 4.2.2 Mixed methods – a research cocktail?............................................... 39 4.2.3 Mixing methods in the current study .................................................. 41 4.3 Research design ........................................................................ 43 4.3.1 The quantitative and qualitative strands............................................ 44 4.4 Data collection .......................................................................... 46 4.4.1 Procedure .......................................................................................... 47 4.4.2 Measurements .................................................................................... 48 4.5 Data analyses ............................................................................ 52 4.6 Samples .................................................................................... 54 4.6.1 Mapping sample ................................................................................. 54 4.6.2 Student sample ................................................................................... 55 4.6.3 Patient sample ................................................................................... 57 4.7 Methodological challenges ....................................................... 60 4.7.1 Internal validity ................................................................................. 61 4.7.2 Construct, conclusion, and external validity ..................................... 65 4.7.3 Enhancing quality of findings ............................................................ 68 4.8 Ethical considerations .............................................................. 69 xiv 5 Results ..................................................................................... 73 5.1 Results in Article I .................................................................... 73 5.2 Results in Article II .................................................................. 74 5.3 Results in Article III ................................................................
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