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Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK
The Journal of Sex Research
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http://www.tandfonline.com/loi/hjsr20
Development of the Sexual Five-Facet Mindfulness
Questionnaire (FFMQ-S): Validation Among a
Community Sample of French-Speaking Women
Françoise Adam a , Alexandre Heeren a b , James Day a & Pascal de Sutter a
a Psychological Sciences Research Institute , Université catholique de Louvain
b Fonds National de la Recherche Scientifique
Published online: 17 Apr 2014.
To cite this article: Françoise Adam , Alexandre Heeren , James Day & Pascal de Sutter (2014): Development of the Sexual
Five-Facet Mindfulness Questionnaire (FFMQ-S): Validation Among a Community Sample of French-Speaking Women, The
Journal of Sex Research
To link to this article: http://dx.doi.org/10.1080/00224499.2014.894490
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Development of the Sexual Five-Facet Mindfulness Questionnaire (FFMQ-S):
Validation Among a Community Sample of French-Speaking Women
Franc
¸oise Adam
Psychological Sciences Research Institute, Universite
´catholique de Louvain
Alexandre Heeren
Psychological Sciences Research Institute, Universite
´catholique de Louvain and Fonds
National de la Recherche Scientifique
James Day and Pascal de Sutter
Psychological Sciences Research Institute, Universite
´catholique de Louvain
It has been recently demonstrated that mindfulness-based intervention may be particularly
suitable for addressing sexual difficulties in women. Although the Five-Facet Mindfulness
Questionnaire (FFMQ) is currently one of the most widely used scales to assess mindfulness,
no adaptation and validation of the FFMQ to measure female sexual functioning has been
published. The main aim of this study was to develop and validate a sexual version of the Five
Facets Mindfulness Questionnaire (FFMQ-S) to specifically measure mindfulness in the con-
text of sexual encounters. A total of 251 healthy, French-speaking female volunteers were
administered the FFMQ-S, the original FFMQ, and the Female Sexual Distress Scale
(FSDS-R). Confirmatory factor analyses indicated that the FFMQ-S exhibits a five-factor
model, as implied by the original FFMQ. Good scale reliability was observed. The FFMQ-S
showed significant correlations with the FSDS-R and the usual FFMQ. Scores on the
FFMQ-S correlated significantly more negatively with the total FSDS-R score than with
the total score of the original version of the FFMQ. These findings clearly support the rel-
evance of developing a version of the FFMQ tailored to sexual functioning.
As pointed by Brotto and colleagues (2012), since the
approval of sildenafil citrate (Viagra) for men’s sexual
dysfunction in the 1990s, there has been an intense
research effort to develop sexual pharmaceuticals for
women. Although there are currently no Food and Drug
Administration–approved pharmaceuticals for women,
several drugs specifically designed to improve female sex-
ual arousal (and not libido) are currently under study
(e.g., phosphodiesterase inhibitor; van der Made et al.,
2009). However, as evidenced by Krapf and Simon
(2009), to date, no treatments have been shown to signifi-
cantly increase low libido. One potential explanation
could be that psychological processes, such as intrusive
thoughts or attentional focus, may play an important
role in women’s libido (e.g., for a review, see Ge
´onet,
De Sutter, & Zech, 2013). In contrast to pharmaceuticals,
it is now widely documented that psychological interven-
tions result in increased relationship satisfaction,
resumption of sexual activity, and improved control of
vaginal dilatation among women suffering from hypoac-
tive sexual desire disorder or orgasmic disorder (Berry &
Berry, 2013; Fru
¨hauf, Gerger, Schmidt, Munder, &
Barth, 2013).
Mindfulness-based interventions (MBIs), often com-
bined with the sex therapy or patient education, have
been demonstrated to be particularly suitable for
addressing sexual difficulties in women (Brotto, Basson,
& Luria, 2008; Brotto & Heiman, 2007; Brotto et al.,
2012). Mindfulness is defined as the ability to bring
one’s attention to experiences in the present moment
in a nonjudgmental way (Kabat-Zinn, 1990).
In recent years, several meta-analyses examining the
efficacy of MBIs (e.g., Baer, 2003; Grossman, Niemann,
Schmidt, & Walach, 2004; Khoury et al., 2013) have
concluded that these interventions may help alleviate a
variety of mental health problems, including anxiety,
depression, and stress disorders, and improve overall
psychological functioning. Recent research suggests that
mindfulness training might promote effective emotion
Authors Adam and Heeren contributed equally to this article.
Correspondence should be addressed to Alexandre Heeren or
Franc
¸oise Adam, Universite
´catholique de Louvain, Psychological
Sciences Research Institute, Place du Cardinal Mercier, 10, B-1348
Louvain-la-Neuve, Belgium. E-mail: alexandre.heeren@uclouvain.be
or francoise.adam@gmail.com
JOURNAL OF SEX RESEARCH, 0(0), 1–10, 2014
Copyright #The Society for the Scientific Study of Sexuality
ISSN: 0022-4499 print=1559-8519 online
DOI: 10.1080/00224499.2014.894490
Downloaded by [Alexandre Heeren] at 10:53 17 April 2014
regulation through a disengagement from intrusive
thoughts and ruminations (e.g., Heeren & Philippot,
2011; Heeren, Van Broeck, & Philippot, 2009; Kingston,
Dooley, Bates, Lawlor, & Malone, 2007; Ramel,
Goldin, Carmona, & McQuaid, 2004).
Regarding sexual difficulties, a pilot study by Brotto
and colleagues (2008) found that a structured three-
session MBI (combined with patient education and sex
therapy) both significantly improved self-reported sex-
ual desire, arousal, orgasm, and satisfaction and signifi-
cantly reduced sexual distress and depression among
women with cervical or endometrial cancer exhibiting
sexual difficulties. More recently, Brotto and colleagues
(2012) reported that a three-session MBI (combined
with patient education and sex therapy) led to significant
improvements in all domains of sexual responses,
including increased perception of genital arousal during
an erotic film, as compared to a wait-list control group.
Nevertheless, uncertainty still remains regarding
whether these benefits can be unambiguously attributed
to a change in mindfulness resulting from the inter-
vention. To demonstrate the successful induction of
psychological change, changes in the process of interest
must be established by a reliable measure (e.g.,
MacLeod, Koster, & Fox, 2009). This point is particu-
larly relevant, as MBIs in the field of sex therapy often
contain patient education and=or sex therapy, thus mak-
ing it impossible to say with absolute certainty that the
observed changes are a direct result of the mindfulness
intervention.
In addition, to strengthen the conclusion that symp-
tom change resulted directly from change in the process
of interest (i.e., the mediating processes) elicited by the
training, it must be demonstrated that the magnitude
of symptom change is related to the magnitude of the
change in the mediating processes (e.g., Heeren, Reese,
McNally, & Philippot, 2012; MacLeod et al., 2009).
As a consequence, in the present case, it must be
demonstrated that changes in mindfulness do indeed
mediate the impact of MBIs on improvement in sexual
functioning. Hence, one challenge for studies in this field
will be to prove that improvement in sexual functioning
after MBIs is a direct result from a change in the process
of interest (i.e., mindfulness) elicited by the training. To
assess these changes, measures assessing mindfulness
skills applied to sexual functioning must be developed.
Recently, several questionnaires have been proposed
for assessing general mindfulness skills (e.g., Baer,
Smith, & Allen, 2004; Brown & Ryan, 2003; Buchheld,
Grossman, & Walach, 2001). As argued by Baer, Smith,
Hopkins, Krietemeyer, and Toney (2006), although all
these self-reports assess a general tendency to be mindful
in daily life, show potentially good psychometric proper-
ties, and are significantly correlated with one another,
differences in their content and structural construct
clearly indicate a lack of consensus about the conceptua-
lization of mindfulness. Further, these differences in
content and structure suggest some disagreement about
how mindfulness should be defined and operationalized.
In particular, the number of facets of mindfulness varies
widely across instruments.
To overcome this limitation, Baer and colleagues
(2006) conducted an exploratory factor analysis on the
combined item pool from all available mindfulness
questionnaires. They found that a five-factor structure
captures several distinct but related underlying dimen-
sions. Items with the highest loadings on each of the five
factors (and low loadings on all other factors) were
combined to form a scale. This procedure resulted in a
39-item questionnaire, called the Five Facet Mindful-
ness Questionnaire (FFMQ; Baer et al., 2006, 2008),
which assesses five elements of mindfulness. These facets
include Observing (attending to or noticing internal and
external stimuli, such as sensations, emotions, cogni-
tions, sights, sounds, and smells), Describing (noting or
mentally labeling these stimuli with words), Acting with
awareness (attending to one’s current actions, as
opposed to behaving automatically or absentmindedly),
Nonjudging of inner experience (refraining from evalu-
ation of one’s sensations, cognitions, and emotions),
and Nonreactivity to inner experience (allowing thoughts
and feelings to come and go without getting caught up in
them).
The FFMQ has shown good internal consistency,
structural validity (i.e., using confirmatory factor analy-
ses; Baer et al., 2008), and correlations in the expected
directions with variables predicted to be related to
mindfulness (e.g., well-being, experiential avoidance;
Baer et al., 2006). Baer and colleagues (2006) also repor-
ted elevated FFMQ scores among long-term meditation
practitioners.
In addition, the FFMQ has shown good cross-
cultural reliability, corroborating the five-factored
solution as a basic model of mindfulness. Indeed, the
structural validity of the FFMQ remains consistent
across different languages. For instance, Heeren,
Douilliez, Peschard, Debrauwere, and Philippot (2011)
have adapted and validated the FFMQ in French. Using
confirmatory factor analyses, they found that the
French version of the FFMQ has good psychometric
properties and that it replicates the structural model
proposed by Baer and colleagues (2006). Similar results
were found in Italian (Romanelli & di Berardino, 2010)
and in Chinese (Deng, Liu, Rodriguez, & Xia, 2011)
translations.
To our knowledge, no adaptation and validation of a
sexual version of the FFMQ has been published. This
development is critical, as clinical measurement clearly
benefits from being tailored to the treatments and con-
structed to ensure an ideographic approach to clinical
change (e.g., Christensen & Mendoza, 1986; Jacobson
& Truax, 1991; Heeren, Maurage, et al., 2012). The
present study was thus designed to develop and validate
a sexual version of the FFMQ, called the FFMQ-S, that
ADAM, HEEREN, DAY, AND DE SUTTER
2
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can be used in future research examining the effect of
mindfulness in the treatment of sexual difficulties among
women. The main goal of the present study was to
answer two major questions: Does the five-factor struc-
ture proposed by previous research (e.g., Baer et al.,
2008) best capture items’ covariance of the FFMQ-S?
Do the facets of the FFMQ-S significantly correlate
more negatively with sexual distress among women than
the usual version of the FFMQ?
Method
The FFMQ was adapted to measure women’s sexual
functioning. Next, the structural validity of the FFMQ-S
was tested with confirmatory factor analyses. We then
assessed the new scale’s criterion validity, examining
its relation with mindfulness and sexual functioning.
Adaptation of the Scale
We followed the steps for the adaptation of psy-
chometric instruments detailed by the International
Test Commission’s guidelines for test adaptation
(Hambleton et al., 2004). Two experts in clinical sexol-
ogy selected and=or generated items (i.e., they combined
two=three different items of a same facet) based on the
original FFMQ. For each facet, they had to obtain four
distinct items that they considered relevant for sexual
functioning. The core criterion was that the final items
had to be applicable to female sexual encounters. The
French version of the scale is provided in Appendix A.
Two bilingual colleagues also translated the scale into
English, which is available in Appendix B.
Structural Validation
Participants. A total of 251 French-speaking
female volunteers were administered the FFMQ-S.
Their age ranged from 18 to 67 years (M¼31.81,
SD ¼11.60). They had no prior training in mindfulness
or other forms of meditation. They were recruited from
the Universite
´catholique de Louvain community
(Belgium). The first step involved sending e-mails to
potential participants (e.g., acquaintances and French-
speaking international colleagues) requesting partici-
pation in a study on a voluntary basis. Participants were
also invited to circulate this invitational e-mail to others
(i.e., snowball principle e-mailing). Participants were
predominantly university graduates (48%, n¼121). Of
the remaining sample, 33.3% (n¼84) of the participants
had an undergraduate degree, 10.3% (n¼26) a high
school degree, 3.2% (n¼8) a middle school degree,
and 0.4% (n¼1) an elementary school degree. Regard-
ing their sexual functioning, their number of sexual
activities per month (alone or with their partners) ran-
ged from 2 to 90 (M¼14.45, SD ¼8.81). The majority
of participants had heterosexual relations (88.5%,
n¼223). Of the remaining sample, 2% (n¼5) of the
participants had homosexual relations and 9.1%
(n¼23) had bisexual relations. Only native French
speakers were invited to take part in the study. The
study was approved by the Ethics Committee of the
Psychological Sciences Research Institute.
Measures and procedure. Participants completed
the FFMQ-S, the FFMQ (Baer et al., 2006; Baer et al.,
2008), and the Female Sexual Distress Scale–Revised
(FSDS-R; Derogatis et al., 2002). As described, the
FFMQ (Baer et al., 2006; Baer et al., 2008) is a vali-
dated, 39-item self-report measure assessing the level
of mindfulness in daily life. It includes five facets of
mindfulness: Observing, Describing, Acting with aware-
ness, Nonjudging of inner experience, and Nonreactivity
to inner experience. Items are rated on a 5-point scale
ranging from 1 (Never or very rarely true) to 5 (Very
often or always true).
Cronbach’s alpha in the current sample was .88 for
the global scale score, indicating good scale score
reliability. Good scale score reliabilities were also
observed for each of the five facets (for Observing,
Cronbach’s alpha ¼.80; for Describing, .88; for Acting
with awareness, .87; for Nonjudging of inner experience,
.86; for Nonreactivity to inner experience, .78).
The FSDS-R (DeRogatis et al., 2008) is a 13-item
self-report measure assessing women’s personal distress
related to sex. Items are rated on a 5-point scale ranging
from 0 (Never true) to 5 (Always true). This measure has
shown good scale score reliability and structural validity
(Derogatis et al., 2008). Cronbach’s alpha in the current
sample was .94, indicating good scale score reliability. In
the present sample, the mean score was 10.72 (SD ¼
9.38; min ¼1; max ¼44).
Data Analysis
Confirmatory factor analysis, using AMOS 16
software (Arbuckle, 2007), was used to test the factorial
validity of the FFMQ-S. Before performing the analysis,
we conducted the Kolmogorov-Smirnov test on each
item of the French version of the FFMQ-S. These analy-
ses revealed that normality was achieved for all items
(all ps>.05).
For the confirmatory factor analyses, goodness of fit
was tested with a v
2
test. In v
2
tests, a statistically non-
significant value corresponds to an acceptable fit. How-
ever, the v
2
test is sensitive to sample size, which may
pose a problem in statistical analyses. Byrne (1994)
noted that it is unusual to obtain a statistically nonsigni-
ficant v
2
when performing confirmatory factor analyses,
even if the discrepancy between the observed and the
implied data is trivial. Thus, we used a derived fit stat-
istic, the normed v
2
, which is less dependent on sample
size. The normed v
2
is achieved by computing the ratio
SEXUAL FIVE-FACET MINDFULNESS QUESTIONNAIRE (FFMQ-S)
3
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of the model v
2
and the degrees of freedom (Wheaton,
Muthe
´n, Alwin, & Summers, 1977). A normed v
2
below
2 usually suggests good model fit and below 3 suggests
acceptable fit (Bollen, 1989).
Many different fit indices proposing to solve this
problem of dependency on sample size are available.
As recommended by Schweizer (2010), we decided to
report the standardized root mean square residual
(SRMR), the root mean square error of approximation
(RMSEA), and the comparative fit index (CFI). SRMR
and RMSEA are both residuals-based absolute fit mea-
sures. CFI is an incremental relative fit measure. As
argued by Hu and Bentler (1998), the combination of
RMSEA and SRMR is useful because the SRMR is
sensitive to the misspecification of the factor covarian-
ces, and the RMSEA is sensitive to the misspecification
of factor loadings. Thus, if both indices are acceptable,
then the latent and the measurement models would be
considered well specified. Furthermore, the RMSEA
has the advantage of usually being associated with
a confidence interval. RMSEA values less than .05
indicate a good model fit (Browne & Cudeck, 1993).
SRMR values are expected to stay below .05 (Kline,
2005). The CFI indicates a good model fit for values
between .95 and 1.0, whereas values in the range of .90
and .95 signify acceptable fit (Bentler 1990; Hu &
Bentler, 1999).
We also reported goodness of fit index (GFI).
Developed by Jo
¨reskog and So
¨rbom (1984), the GFI is
an absolute fit index analogous to R
2
. The GFI performs
better than any other absolute fit index regarding the
absolute fit of the data (Hoyle & Panter, 1995; Marsh,
Balla, & McDonald, 1988). GFI values are between 0
and 1, with 1 indicating a perfect fit. As suggested by
Cole (1987), a value of .80 has usually been considered
as a minimum for model acceptability.
The present context requires comparing fit across
models that are not necessarily nested (i.e., one model
is not simply a constrained version of the other). There-
fore, we also reported the Akaike information criterion
(AIC; Akaike, 1987), the Browne-Cudeck criterion
(BCC; Browne & Cudeck, 1989), and the expected cross-
validation index (ECVI; Browne & Cudeck, 1989),
which are the most suited for comparison of nonnested
models (Blunch, 2008). AIC, BCC, and ECVI are fit
measures based on information theory. These indices
are not used for judging the fit of a single model but
are used in situations where there are several realistic
but different models from which to choose. These indi-
ces are a function of both model complexity and good-
ness of fit: Low scores refer to simple, well-fitting
models, whereas high scores refer to complex, poor-
fitting models. Therefore, in a comparison-model
approach, the model with the lower score is preferred.
Results
Structural Validity
Based on previous research (e.g., Baer et al., 2008),
three structural models were tested using confirmatory
factor analyses: (a) a model including only the five facets
as latent variables (Model A); (b) a model with a single
principal factor (Model B); and (c) a hierarchical model
with the five facets as latent variables and mindfulness as
a second-order factor (Model C).
Table 1 displays the fit indices of the three models.
The three models exhibited very good fit indices.
However, the analyses indicated that Model A fit signifi-
cantly better than both Model B (Dv
2
¼63.731,
Ddf ¼10, p<.001) and Model C (Dv
2
¼21.667, Ddf ¼5,
p<.001). In addition, the AIC, BCC, and ECVI of
Model A were most favorable (i.e., lowest; see Table 1).
However, because all standardized factor loadings of
Model C were statistically significant (p<.001) except
for item 20 (p¼.966; factor loading ¼".003), we also
reran the analyses without this item (Model A
bis
; Model
B
bis
; Model C
bis
, respectively).
These three new models also exhibited very good fit
indices (Table 1). However, the analyses indicated that
Model A
bis
fit significantly better than both Model B
bis
(Dv
2
¼81.754, Ddf ¼10, p<.001) and Model C
bis
(Dv
2
¼20.856, Ddf ¼5, p<.005). Moreover, the analyses
also revealed that Model A
bis
fit significantly better than
Model A (Dv
2
¼35.318, Ddf ¼18, p<.01), Model B
(Dv
2
¼99.049, Ddf ¼28, p<.001), and Model C (Dv
2
¼
56.985, Ddf ¼23, p<.001). In addition, the AIC, BCC,
Table 1. Fit Index Values for the Different Models Tested
Models v
2
df Normed v
2
SRMR RMSEA RMSEA 90% CI GFI CFI AIC BCC ECVI
A 273.584 160 1.710 .020 .053 .042–.064 .891 .557 373.584 382.754 1.494
B 337.315 170 1.984 .026 .063 .053–.073 .865 .348 417.315 424.651 1.669
C 295.251 165 1.789 .026 .056 .046–.066 .882 .492 385.251 393.505 1.541
A
bis
238.266 142 1.678 .020 .052 .040–.063 .900 .597 334.266 342.614 1.337
B
bis
301.020 152 1.980 .026 .063 .052–.073 .873 .334 377.020 383.629 1.508
C
bis
259.122 147 1.763 .023 .055 .044–.066 .891 .531 345.122 352.600 1.380
Note. Model A
bis
(in bold) is the best-fitting model. df ¼degrees of freedom; SRMR ¼standardized root mean square residual; RMSEA ¼root
mean square error of approximation; GFI ¼goodness of fit index; CFI ¼comparative fit index; AIC ¼Akaike information criterion; BCC ¼
Browne-Cudeck criterion; ECVI ¼expected cross-validation index.
ADAM, HEEREN, DAY, AND DE SUTTER
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and ECVI of Model A
bis
were most favorable (i.e.,
lowest; see Table 1). Factor loadings of Model A
bis
are
depicted in Table 2.
Descriptive Statistics, Internal Consistency, and
Reliability
Table 3 displays the descriptive statistics and scale
score reliability indices of the FFMQ-S and its sub-
scales. In addition, we also reported the 95% confidence
intervals of Cronbach’s alpha coefficients. These confi-
dence intervals were computed using the procedure of
Koning and Franses (2003). Although both Nonreactiv-
ity to inner experience and Nonjudging of inner experi-
ence subscales exhibited less than ideal Cronbach’s
alphas, the alphas suggested overall good scale and sub-
scale score reliabilities. Within each of the subscales,
Cronbach’s alpha coefficients decreased if any of the
items was deleted (with the exception of item 20, as
previously noted). The correlations between the first-
order and second-order factors are displayed in Table 3.
These findings clearly support the relevance of measur-
ing factors separately.
Correlations Between the FFMQ-S and Other
Constructs
Table 4 displays the correlations between the FFMQ-S
and the other scales included in the present study.
Fisher’s r-to-ztransformation, with the formula for
comparing correlations measured on the same subjects
taken from Steiger (1980), was used to assess the differ-
ence in Pearson rvalues. The total FSDS-R score was
significantly more negatively correlated with the total
score of the FFMQ-S than with the total score of the
FFMQ (Z¼8.97, p<.001). The same pattern of results
was observed for all subscales: the FSDS-R score corre-
lated significantly more negatively with any facet of the
Table 2. Standardized Factor Loadings of Each Item After the Analysis of Model A
bis
Items Latent Facets Loadings
1. I can easily identify when I’m sexually aroused. Observing .725
2. It’s difficult for me to perceive physical sensations when my partner kisses me or caresses me. Observing .808
3. I don’t pay attention to my physiological change when I’m aroused (e.g., vaginal lubrication,
heat).
Observing .340
4. I realize how the gestures of my partner impact on my emotions and my sexual arousal. Observing .608
5. I can easily help my partner to understand what makes me feel good or what my sexual
needs are.
Describing .750
6. It’s difficult to express to my partner what I feel during intercourse. Describing .686
7. I easily feel my emotions during sexual intercourse. Describing .688
8. I’m unable to say if I like or dislike a specific sexual activity. Describing .637
9. I cannot reach orgasm because I’m quite often absent-minded. Acting with awareness .677
10. I usually feel quite available and present during sexual intercourse. Acting with awareness .848
11. I have the feeling I have sex in an automatic way without being able to let go. Acting with awareness .813
12. I have the feeling that all my sexual activities are consensual. Acting with awareness .635
13. I don’t criticize myself when I have sexual fantasies that I consider to be ‘‘taboo.’’ Nonjudging of inner experience .307
14. I think I should reach orgasm more quickly. Nonjudging of inner experience .559
15. I don’t judge myself when I don’t reach orgasm. Nonjudging of inner experience .569
16. I think that some of my emotions are bad and I should not feel them. Nonjudging of inner experience .601
17. When I don’t experience enough satisfaction during sexual activities I can take some
distance and get perspective on that.
Nonreactivity to inner experience .819
18. When I have negative thoughts I feel them and let them go. Nonreactivity to inner experience .611
19. When I have negative emotions I let them take over. Nonreactivity to inner experience .482
Note. Items 2, 3, 6, 8, 9, 14, 15, and 19 should be reversed before scoring.
Table 3. Descriptive Statistics and Cronbach’s Alphas of the Sexual FFMQ
Dimensions Items Minimum Maximum M SD aa95% CI
Observing 4 7 20 16.889 2.625 .67 .65–.69
Describing 4 6 20 14.837 3.039 .71 .70–.71
Acting with awareness 4 7 20 16.064 3.291 .79 .77–.81
Nonjudging of inner experience 4 6 20 14.900 3.136 .51 .50–.53
Nonreactivity to inner experience 4 5 20 12.904 2.810 .47 .46–.48
Nonreactivity to inner experience (without item 20) 3 3 15 9.697 2.520 .63 .61–.65
Global scale 20 40 97 74.892 11.216 .86 .84–.88
Global scale (without item 20) 19 38 95 71.685 11.151 .87 .85–.89
Sexual distress 13 1 44 10.720 9.308 .94 .91–.97
SEXUAL FIVE-FACET MINDFULNESS QUESTIONNAIRE (FFMQ-S)
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FFMQ-S than with any facet of the original version of
the FFMQ (all ps<.05). Moreover, to control the
potential overlap in content between the two versions
of the FFMQ, we also computed the correlation
between each facet of the FFMQ-S and the total
FSDS-R score, while controlling for the corresponding
facet on the original version of the FFMQ. We found
that all the correlations remained significant at p<.01
[for FFMQ-S total score, r(251) ¼".67; for Sexual
observing, r (251) ¼".47; for Sexual describing, r (251) ¼
".59 ; for Sexual acting with awareness, r (251) ¼".64;
for Sexual nonjudging of inner experience, r (251) ¼
".39; for Sexual nonreactivity to inner experience,
r(251) ¼".45]. All together, these findings clearly sup-
port the relevance of developing a version of the FFMQ
tailored for sexual functioning.
Regarding the facets of the FFMQ-S, both the
Describing and Acting with awareness facets were signifi-
cantly more negatively correlated with the FSDS-R
score than any other facet of the FFMQ-S (all
ps<.05). Furthermore, the Acting with awareness facet
of the FFMQ-S correlated significantly more negatively
with the FSDS-R score than with the Describing facet of
the FFMQ-S (Z¼2.00, p<.05). These findings clearly
support the relevance of measuring factors separately.
Discussion
The main goal of the present study was to answer two
major questions: Does the five-factor structure proposed
by previous research (e.g., Baer et al., 2008) best capture
the covariance of the items of the FFMQ-S? Compared
to the facets of the original version of the FFMQ, are
those of the FFMQ-S significantly more negatively
correlated with sexual distress among women?
Regarding the factor structure, we investigated
whether the five-factor structure found by previous
researchers on the FFMQ could be replicated in a sexual
adaptation of the scale. Confirmatory factor analyses
revealed a five-factor solution including Observing
(attending to or noticing internal and external stimuli
during sex, such as sensations, emotions, cognitions,
sights, sounds, and smells), Describing (noting or men-
tally labeling these stimuli with words), Acting with
awareness (attending to one’s current sexual actions, as
opposed to behaving automatically or absentmindedly),
Nonjudging of inner experience (refraining from evalu-
ation of one’s sensations, cognitions, and emotions dur-
ing sex), and Nonreactivity to inner experience (allowing
thoughts and feelings to come and go during sex, with-
out attention getting caught up in them). These first-
order factors clearly replicate the structure found by
previous studies (e.g., Baer et al., 2006; Baer et al., 2008)
and extend it to mindfulness skills in sexual functioning.
It should be noted that although the hierarchical model
with the five facets as latent variables and mindfulness as
a second-order factor also exhibited very good fit indi-
ces, the present data suggest that a model including only
the five facets as latent variables—and thus with no
overarching mindfulness construct—fit best. Neverthe-
less, although they tended to be of moderate strength,
good score reliabilities were observed, especially for
the global scale. Both these findings suggest that there
is good reason to interpret scale and subscale scores of
the FFMQ-S according to the scoring of the original
FFMQ. To score the FFMQ, the items of each subscale
(Observing, Describing, Acting with awareness, Nonjud-
ging of inner experience, and Nonreactivity to inner experi-
ence) are summed together. These subscale scores are then
added together to obtain a global mindfulness score.
Regarding the score scale and subscales reliabilities, it
should be noted that both Nonjudging of inner experi-
ence and Nonreactivity to inner experience (without item
20) of the FFMQ-S exhibit less than ideal Cronbach’s
alphas (.51 and .63, respectively). It is possible that the
wide range of and lack of specificity in the situations
evoked in this measure may have negatively affected
the intercorrelations of these items, resulting in a
decrease in Cronbach’s alphas. Future studies should
examine whether the inclusion of more specific situation-
based items overcomes this limitation.
Table 4. Correlations Between the First-Order Factors, the Second-Order Factors, and Other Psychological Constructs
Facets Act-S Nonjudging-S NonReact-S FFMQ-S Obs Describ Act Nonjudging NonReact FFMQ FSDS-R
Obs-S .59#.37#.64#.73#.21#.24#.35#.31#.13 40#".47#
Describ-S .67#.43#.36#.80#.15#.33#.31#.27#.17#.40#".61#
Act-S — .50#.52#.85#.18#.27#.41#.31#.15#43#".69#
Nonjudging-S — .52#.75#.24#.27#.21#.43#.19#.43#".47
NonReact-S — .66#.15#.18#.24#.41#.45#.43#".47#
FFMQ-S — .24#.34#.40#.45#.28#.55#".72#
FSDS-R ".03#".21#.34#".33#".15 ".34#
Note. Obs-S ¼Observing facet of FFMQ-S; Describ-S ¼Describing facet of FFMQ-S; Act-S ¼Acting facet of FFMQ-S; Nonjudging-S ¼
Nonjudging facet of FFMQ-S; NonReact-S ¼Nonreactivity facet of FFMQ-S; FFMQ-S ¼total score of FFMQ-S; Obs ¼Observing facet of original
FFMQ; Describ¼Describing facet of FFMQ; Act ¼Acting facet of FFMQ; NonReact ¼Nonreactivity facet of FFMQ; Nonjudging ¼Nonjudging
facet of FFMQ; FSDS-R ¼Female Sexual Distress Scale–Revised.
All correlations were significant at p<.05. Correlations that were significant at p<.01 are denoted with an asterisk (#).
ADAM, HEEREN, DAY, AND DE SUTTER
6
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With respect to convergent validity, we found that
the FFMQ-S score was significantly more negatively
correlated with the total sexual distress score than with
the total score of the original version of the FFMQ.
Similarly, each facet of the FFMQ-S was significantly
more negatively correlated with sexual distress than with
the corresponding facet on the original FFMQ. This
suggests that the FFMQ-S taps skills that are more
related to the sexual distress among women than does
the FFMQ, which clearly supports the relevance of
developing a version of the FFMQ tailored for sexual
functioning. Moreover, at an applied level, the present
findings suggest that the global score of the FFMQ-S
would be more useful in clinical practice than the scores
on the individual facets. Indeed, the global score showed
better psychometric properties (e.g., Cronbach’s alpha)
and exhibited a significantly stronger correlation with
sexual distress compared to the subscales.
Of the subscales of the FFMQ-S, the facets Describ-
ing and Acting with awareness were significantly more
negatively correlated with sexual distress than were
any of the other facets. In addition, Acting with aware-
ness correlated significantly more negatively with sexual
distress than Describing. These differential relationships
with outcome measures support the relevance of mea-
suring facets separately. The Describing facet’s strong
negative association with sexual distress suggests that
noting or mentally labeling emotions, cognitions, and
sensations during sexual activities might be related to
decreased sexual distress. This result is consistent with
neuroscience findings demonstrating that the conscious
labeling of affect modulates the brain’s responses to
emotional stimuli (e.g., Lieberman et al., 2007), as
well as with other studies that show describing the
details of an emotional experience reduces general
psychological distress (e.g., Vrielynck, Philippot, &
Rime
´, 2010).
Despite the behavioral features of the items of the
Acting with awareness facet, the general tendency to be
focused on one’s bodily sensations during sex evoked
by these items may explain its strong association with
self-reported sexual distress. Indeed, previous research
has found that a lack of focus on sensations during
sex may make individuals more vulnerable to the devel-
opment and maintenance of sexual dysfunctions (e.g.,
for a review, see Ge
´onet et al., 2013). Previous psycho-
logical interventions aimed at reducing female sexual
dysfunction target constructs that are very similar to
the Acting with awareness facet. For instance, sensate
focus, introduced by Masters and Johnson (1970),
shares strong similarities with the Acting with awareness
construct as depicted in the FFMQ-S. In this practice,
patients are encouraged to focus on the sensations they
experience during sex, rather than seeing orgasm as the
sole goal of sex. It is thus not surprising that this facet
exhibits the strongest negative association with self-
reported sexual distress.
At a clinical level, by offering the first adaptation of a
mindfulness scale to measure women’s sexual function-
ing, future clinical MBI studies among women suffering
from sexual difficulties will now be able to explore how
such treatment may work. Indeed, recent studies have
suggested that MBIs may be particularly suitable for
addressing sexual difficulties in women (e.g., Brotto
et al., 2012). Hence, for the mechanisms behind the effi-
cacy of MBIs to be identified, a reliable instrument that
captures the process of interest, such as the FFMQ-S,
will be of great use in future studies.
Moreover, even if the present results suggest that the
global score of the FFMQ-S exhibits better psychometric
properties, the five facets of this measure appear to be
statistically related to distinct processes underlying a
more global mindfulness skill. Hence, it would be highly
relevant to explore how these facets change as a result of
MBIs and whether they are differentially related to treat-
ment outcomes. Future studies should also explore
whether different sexual dysfunctions differ on their facet
scores, resulting in different profiles of mindfulness facets
as a function of the sexual dysfunction. At the thera-
peutic level, this rationale underlines the need to develop
treatments that are focused on the specific facets causing
problems for patients. Indeed, several effective MBI pro-
grams have been recently proposed for women suffering
from sexual dysfunction (e.g., Brotto et al., 2012). Never-
theless, these programs propose only a global mindful-
ness training intervention. In view of the present
perspective, these interventions should be adapted to
focus treatment on the problematic facet, as improving
the preserved ones appears to be of little utility.
The present study suffers from several limitations.
First, our sample comprised only nonclinical parti-
cipants. Future studies should assess the structural val-
idity of FFMQ-S among a clinical sample of women
suffering from hypoactive sexual desire disorder and
orgasmic disorder. Second, we assessed the construct
validity only with self-report measures. Future studies
should examine the correlation between this scale and
behavioral as well as psychophysiological (e.g., skin con-
ductance, vaginal dilation, hormonal release) responses
to stimuli such as erotic films. Third, we did not assess
the test-retest reliability of the scale, thereby limiting
its use in clinical research applications. Indeed, when
assessing change in pharmacological and psychothera-
peutic treatments, some researchers recommend weight-
ing each individual clinical change by the test-retest
reliability (e.g., Jacobson & Truax, 1991; Heeren,
Maurage, et al., 2012). This approach ensures that the
clinical changes observed reflect more than the simple
fluctuation of an imprecise measuring instrument.
Fourth, none of the models reported in Table 1 appear
to provide an optimal fit. Specifically, the CFI values
were below .90. However, the CFI depends in large part
on the average size of the correlations in the data. If the
average correlation between variables is not high, then
SEXUAL FIVE-FACET MINDFULNESS QUESTIONNAIRE (FFMQ-S)
7
Downloaded by [Alexandre Heeren] at 10:53 17 April 2014
the CFI will not be very high. Fifth, some of the factor
loadings reported in Table 2 were very high. We cannot
eliminate the possibility that overextraction may be an
issue. However, as observed by Frazier and Youngstrom
(2007), although CFI and v
2
may lead to overextraction,
AIC and RMSEA are more useful to derived factor
structures examined with confirmatory factor analyses.
To more adequately measure additional factors and thus
structural validity, researchers may increase the length
of the scale by including additional items. In that way,
our scale development strategy was less than ideal, as
we did not adapt all items of the FFMQ to sexual func-
tioning. Instead, our scale was composed of items which
were either adapted from the original FFMQ or which
were a result of combining two or more items. Hence,
future studies may increase the length of the scale by
merely adapting all of the original FFMQ to sexual
functioning. Furthermore, to best approach the con-
struct validity of each factor, the use of multitrait-
multimethod matrix strategies might be useful
(Campbell & Fiske, 1959). Future studies should inves-
tigate this question.
In conclusion, this preliminary adaptation of the
FFMQ to measure women’s sexual functioning provides
a valid measure of patients’ sexual mindfulness skills for
French-speaking clinicians as well for as researchers.
Regarding its structural validity, confirmatory factor
analyses replicated the previous model, suggesting a
five-factor solution. These facets include the skills of
Observing (attending to or noticing internal and external
stimuli during sex, such as sensations, emotions, cogni-
tions, sights, sounds, and smells), Describing (noting or
mentally labeling these stimuli with words), Acting with
awareness (attending to one’s current sexual actions, as
opposed to behaving automatically or absent-mindedly),
Nonjudging of inner experience (refraining from evalu-
ation of one’s sensations, cognitions, and emotions dur-
ing sex), and Nonreactivity to inner experience (allowing
thoughts and feelings to come and go during sex, without
attention getting caught up in them) as separate factors.
Furthermore, it correlates with other constructs, such as
sexual distress, in the expected directions. These findings
have critical clinical consequences for the evaluation of
sex-related mindfulness skills before and after the use
of MBIs in the treatment of female sexual dysfunction.
Funding
Alexandre Heeren (postdoctoral research fellow) is
funded by the Belgian Fund for Scientific Research
(F.R.S.-FNRS, Belgium). The writing of this article
was also supported by the Bourse d’Excellence Scientifi-
que de la Fe
´de
´ration Wallonie-Bruxelles-International
(awarded to Alexandre Heeren). However, these funds
did not exert any editorial direction or censorship on
any part of this article.
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APPENDIX A: French Version of the FFMQ-S
Veuillez e
´valuer chacun des e
´nonce
´s suivant au moyen de l’e
´chelle fournie. Cochez dans la zone de re
´ponse le chiffre qui correspond le mieux a
`ce qui
est ge
´ne
´ralement vrai pour vous lors des relations sexuelles avec votre partenaire.
1 2 3 4 5
jamais ou rarement vrai rarement vrai parfois vrai souvent vrai tre
`s souvent ou toujours vrai
1 2 3 4 5
1. Je peux facilement identifier quand je suis excite
´e. & & & & &
2. Quand mon=ma partenaire me caresse ou m’embrasse, il m’est difficile de percevoir les sensations corporelles
que cela me procure.
& & & & &
3. Je ne fais pas attention aux changements physiques quand je suis excite
´e (lubrification du vagin, chaleur, etc.) & & & & &
4. Je remarque comment les gestes de mon=ma partenaire influencent mes e
´motions et mon excitation sexuelle. & & & & &
5. Je peux facilement faire comprendre a
`mon=ma partenaire ce qui me ferait du bien ou ce dont j’ai envie sexuellement. & & & & &
6. Il m’est difficile d’exprimer a
`mon=ma partenaire ce que je ressens lors des activite
´s sexuelles. & & & & &
7. Je perc
¸ois facilement les e
´motions qui me traversent durant l’activite
´sexuelle. & & & & &
8. Je n’arrive pas a
`dire si une pratique sexuelle me plaı
ˆt ou pas. & & & & &
9. Je suis incapable d’atteindre l’orgasme car je suis souvent distraite ! & & & & &
10. J’ai le sentiment d’e
ˆtre vraiment disponible et pre
´sente lors des activite
´s sexuelles. & & & & &
11. J’ai l’impression de faire l’amour en mode «automatique »sans vraiment «la
ˆcher-prise »ou me «laisser aller ’’. & & & & &
12. J’ai le sentiment de toujours avoir des activite
´s sexuelles consenties. & & & & &
13. Je ne me critique pas quand j’ai des fantasmes que je juge trop «tabous ’’. & & & & &
14. Je me dis souvent que je devrais atteindre l’orgasme plus rapidement. & & & & &
15. Je pense que certaines de mes e
´motions sont mauvaises et que je ne devrais pas les ressentir. & & & & &
16. Je ne me juge pas quand je n’atteins pas l’orgasme. & & & & &
17. Quand je suis peu satisfaite de l’activite
´sexuelle, je peux prendre du recul et relativiser. & & & & &
18. Quand j’ai des pense
´es ne
´gatives, je les remarque et les laisse passer. & & & & &
19. Quand j’ai des e
´motions ne
´gatives, je me laisse envahir par elles. & & & & &
APPENDIX B: English Version of the FFMQ-S
Please rate each of the following statements using the scale provided. For each statement, select the number that best describes your own opinion of
what is generally true for you during sexual encounters with your partner.
1 2 3 4 5
never or very rarely true rarely true sometimes true often true very often or always true
1 2 3 4 5
1. I can easily identify when I’m sexually aroused. & & & & &
2. It’s difficult for me to perceive physical sensations when my partner kisses me or caresses me. & & & & &
3. I don’t pay attention to my physiological change when I’m aroused (e.g., vaginal lubrication, heat). & & & & &
4. I realize how the gestures of my partner impact on my emotions and my sexual arousal. & & & & &
5. I can easily help my partner to understand what makes me feel good or what my sexual needs are. & & & & &
6. It’s difficult to express to my partner what I feel during intercourse. & & & & &
7. I easily feel my emotions during sexual intercourse. & & & & &
8. I’m unable to say if I like or dislike a specific sexual activity. & & & & &
9. I cannot reach orgasm because I’m quite often absent-minded. & & & & &
10. I usually feel quite available and present during sexual intercourse. & & & & &
11. I have the feeling I have sex in an automatic way without being able to let go. & & & & &
12. I have the feeling that all my sexual activities are consensual. & & & & &
13. I don’t criticize myself when I have sexual fantasies that I consider to «taboo ’’. & & & & &
14. I think I should reach orgasm more quickly. & & & & &
15. I don’t judge myself when I don’t reach orgasm. & & & & &
16. I think that some of my emotions are bad and I should not feel them. & & & & &
17. When I don’t experience enough satisfaction during sexual activities I can take some distance and
get perspective on that.
& & & & &
18. When I have negative thoughts I feel them and let them go. & & & & &
19. When I have negative emotions I let them take over. & & & & &
ADAM, HEEREN, DAY, AND DE SUTTER
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