Mindfulness and Coping with Stress: Do Levels of Perceived Stress Matter?

Abstract

Few studies have explored whether mindfulness facilitates more adaptive coping with stress, and the evidence for this is mixed. It may be that mindfulness influences coping responses only among relatively stressed individuals, but this has not been tested. Two randomized controlled experiments (Study 1, N = 204; Study 2, N = 202) tested whether a brief mindfulness induction enhances coping among adults and whether perceived stress moderates these effects. In Study 1, we found that a mindfulness induction produced less self-reported avoidance coping but only among relatively stressed individuals. In Study 2, a mindful acceptance induction produced more approach and less avoidance coping than relaxation and self-affirmation controls, and these effects were strongest among individuals reporting high levels of perceived stress. These findings suggest that perceived stress is an important moderator of the influence of mindfulness upon coping responses.

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ORIGINAL PAPER
Mindfulness and Coping with Stress: Do Levels of Perceived
Stress Matter?
James N. Donald
1
&Paul W. B. Atkins
1
#Springer Science+Business Media New York 2016
Abstract Few studies have explored whether mindfulness
facilitates more adaptive coping with stress, and the evidence
for this is mixed. It may be that mindfulness influences coping
responses only among relatively stressed individuals, but this
has not been tested. Two randomized controlled experiments
(Study 1, N= 204; Study 2, N= 202) tested whether a brief
mindfulness induction enhances coping among adults and
whether perceived stress moderates these effects. In Study 1,
we found that a mindfulness induction produced less self-
reported avoidance coping but only among relatively stressed
individuals. In Study 2, a mindful acceptance induction pro-
duced more approach and less avoidance coping than relaxa-
tion and self-affirmation controls, and these effects were stron-
gest among individuals reporting high levels of perceived
stress. These findings suggest that perceived stress is an im-
portant moderator of the influence of mindfulness upon cop-
ing responses.
Keywords Mindfulness .Perceived stress .Approach
coping .Avoidan c e c opin g .Acceptance .Randomized
controlled trial
Mindfulness-based theories claim that mindfulness enhances
individuals’capacity to willingly experience the thoughts and
feelings elicited by difficult or stressful experiences (Brown
et al. 2007; Hayes et al. 2006; Shapiro et al. 2006). In turn,
enhanced engagement with stress-related thoughts and feel-
ings is said to produce less reactive and more autonomously
motivated responses to such experiences (Brown et al. 2007,
Shapiro et al. 2006). Despite these clear theoretical predic-
tions, the majority of social and clinical psychology research
on mindfulness in stressful settings has explored its influence
on affective outcomes, such as in reducing stress and anxiety
and enhancing well-being among clinical (Keng et al. 2011;
Khoury et al. 2013) and non-clinical populations (Chiesa, and
Serretti, 2009;Khouryetal.2015). Much less research has
examined the influence of mindfulness on behavioral
responses to stress, such as coping responses (Josefsson
et al. 2014).
Coping has been defined as Befforts to prevent or diminish
threat, harm, and loss, or to reduce associated distress^follow-
ing a threatening experience (Carver and Connor-Smith 2010,
p. 685). Although dozens of classifications of coping re-
sponses have been offered (for reviews, see Carver and
Connor-Smith 2010;andSkinneretal.2003), the distinction
between avoidance and approach coping is one of the most
widely used and has been used in previous studies of mind-
fulness and coping (e.g., Sears and; Kraus 2009; Weinstein
et al. 2009). Approach and avoidance coping have been de-
scribed as being, respectively, Bcognitive and emotional acti-
vity that is oriented either toward or away from threat^(Roth
and Cohen 1986, p. 813). Approach coping involves reducing
distress by taking steps to directly remove the stressor or re-
duce its impact, while avoidance coping reduces distress by
taking actions to avoid direct contact with the stressor (Carver
and Connor-Smith 2010). Examples of approach coping in-
clude seeking to learn from a stressful experience, planning a
response and positively reframing the experience, while ex-
amples of avoidance coping are denial, distraction, and mental
disengagement (Weinstein et al. 2009).
Although avoidant coping responses often serve short-term
adaptive functions (Sherman and Cohen 2006), they come at
the cost of not learning from the stressful experience or
*James N. Donald
james.n.donald@gmail.com
1
Institute for Positive Psychology and Education, Australian Catholic
University, 25A Barker Road, Strathfield, Sydney, Australia
Mindfulness
DOI 10.1007/s12671-016-0584-y

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missing out on important information (Brown and Locker
2009). Avoidance coping has been associated with significant-
ly worse psychological well-being (Penley et al. 2002;
Rayburn et al. 2005; Roesch et al. 2005) whereas approach
coping has been associated with greater well-being
(Duangdao and Roesch 2008;Penleyetal.2002; Roesch
et al. 2005), including among undergraduate student samples
(Mosley et al. 1994; Weinstein et al. 2009).
Perhaps the most widely used definition of mindfulness is
Bpaying attention in a particular way: on purpose, in the
present-moment and non-judgmentally^(Kabat-Zinn 1990).
This definition operationalizes mindfulness as a unitary con-
struct (i.e., paying attention with a particular attitude), and
there is evidence that the major measures of mindfulness used
in the literature do indeed tap into a singular construct, rein-
forcing this approach to defining and studying mindfulness
(Siegling and Petrides 2014).
Mindfulness as an individual-difference trait has been
found to be associated with more approach and less
avoidance coping. For example, Weinstein et al. (2009)found
that among a student sample, higher trait mindfulness predict-
ed less avoidance and more approach coping with laboratory-
induced and naturally occurring stress. Further, Palmer and
Rodger (2009) found that higher trait mindfulness was asso-
ciated with more adaptive (rational and detached) coping and
less avoidance coping among a student sample. Trait mindful-
ness has also been associated with less avoidance of unavoid-
able distressing experiences (such as being criticized, humili-
ated or having one’s weaknesses exposed) among a commu-
nity sample (Bergomi et al. 2013). Consistent with these find-
ings, studies of mindfulness and behavioral responses to stress
more generally have found that mindfulness is associated with
less avoidance and reactivity across domains as varied as gam-
bling (Lakey et al. 2007), inter-personal communication
(Heppner et al. 2008), physical activity (Chatzisarantis and
Hagger 2007), and exposure to unpleasant images (Arch and
Craske 2006).
In addition to examining mindfulness as a unitary phenom-
enon, the construct has also been operationalized as compris-
ing several components (e.g., Baer et al. 2006; Bishop et al.
2004; Hayes et al. 2006; Shapiro et al. 2006). The psycholog-
ical flexibility framework of acceptance and commitment
therapy (ACT; Hayes et al. 2006) provides a useful way of
doing this. This approach identifies four conceptually distinct
but inter-related behaviors: present-centered awareness, ac-
ceptance, cognitive defusion, and self-as-context (Hayes
et al. 2006). Present-moment awareness describes the regula-
tion of attention so that it is focused on experiences occurring
in the present moment such as physical sensations, thoughts,
and emotions (Bishop et al. 2004); acceptance is the behavior
of Bactively embracing the private events evoked in the mo-
ment without unnecessary attempts to change their frequency
or form^(Hayes and Fletcher 2005, p. 7); cognitive defusion
describes the process of distancing from thoughts, so that they
exert less control over a person’s behavior (Gillanders et al.
2014), while self-as-context describes experiencing oneself as
the observer of one’s experiences, and therefore as distinct
from them (Hayes and Fletcher 2005). Because each of these
components is a distinct behavior, each can be directly manip-
ulated (Hayes et al. 2006). This is arguably a key advantage of
the ACT conceptualisation of mindfulness as compared with
operationalizing mindfulness as a relatively stable personality
construct (Hayes and Shenk 2004).
In the context of coping with stress, acceptance and cogni-
tive defusion are particularly likely to enhance coping re-
sponses. By accepting difficult or aversive thoughts, feelings,
and sensations, an individual is more likely to willingly en-
gage with these, and this, in turn, enhances the likelihood that
their behavior is less avoidant and more approach-focused
(Hayes et al. 2006; Shapiro et al. 2006). There is evidence
for this from a number of sources. For example, experiential
avoidance, which is the tendency to psychologically avoid
unwanted thoughts and feelings and the opposite of accep-
tance, has been shown to predict less approach coping (i.e.,
positive reframing) and more avoidance coping (i.e., denial,
self-distraction and behavioral disengagement) with stressful
events (Karekla and Panayiotou 2011). Moreover, brief accep-
tance interventions have been found to consistently reduce
behavioral avoidance of an aversive stimulus, relative to inter-
ventions that target cognitive control over stressful experi-
ences (Eifert and Heffner 2003; Gutiérrez et al. 2004;Levitt
et al. 2004). Further, a study of self-compassion (a construct
that includes acceptance) found that following academic fail-
ure, self-compassion was negatively associated with avoidant
coping responses among university students (Neff et al. 2005).
Greater cognitive defusion in relation to stress-related
thoughts is also likely to result in less avoidance of situa-
tions in which such thoughts are experienced and greater
engagement with these situations in constructive ways
(Gillanders et al. 2014). Support for this comes from sever-
al studies which reported reductions in emotional discom-
fort and negative thought believability among non-clinical
samples, following brief cognitive defusion manipulations
(Masuda et al. 2010a;Masudaetal.2004;Masudaetal.
2010b;Watsonetal.2010). Another study found that a brief
cognitive defusion induction prior to a cold-pressor task
(i.e., inducing physical pain) resulted in significantly more
pain tolerance than those in pain-control and attention-
placebo control conditions (Teasdale et al. 2002). This ev-
idence suggests that, by creating psychological distance
from one’s stress-related cognitions (i.e., cognitive
defusion), individuals are less likely to be governed by such
cognitions, meaning the person becomes less avoidant and
more likely to engage in approach coping behaviors.
On the other hand, there is less evidence that present-
moment awareness and self-as-context, as mindfulness sub-
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processes, predict increased approach and reduced avoidance
coping (Levin et al. 2012). For example, a study of the effects
of a brief mindfulness intervention that focused on present-
moment awareness did not find significant effects on approach
or avoidance coping over time (Sears and Kraus 2009), while
the self-as-context component of mindfulness is yet to be test-
ed in a randomized controlled laboratory study (Levin et al.
2012).
To our knowledge, there have been five studies of the ef-
fects of multi-session mindfulness interventions (as opposed
to brief inductions) on coping with stress among adults. Two
studies found that the Mindfulness-Based Stress Reduction
(MBSR; Kabat-Zinn et al. 1992) resulted in greater approach
(Walach et al. 2007) and less avoidance coping (Tacón et al.
2003) relative to controls, while two studies of multi-session
mindfulness interventions did not find significant effects rel-
ative to controls (Josefsson et al. 2014; Sears and Kraus 2009).
Most recently, Halland et al. (2015) found that a truncated
MBSR program resulted in greater approach and less avoid-
ance coping as a function of individual differences in neurot-
icism, among undergraduate students.
Of these studies, those that reported significant effects of
mindfulness on coping were with populations likely to be
experiencing relatively high levels of stress, namely women
living with heart disease (Tacón et al. 2003) and workers from
a high-stress telesales center (Walach et al. 2007). In addition,
Halland et al. (2015) found that a mindfulness intervention
interacted with neuroticism in predicting less avoidance cop-
ing. Neuroticism has been shown to be consistently correlated
with perceived stress and negative affect, providing further
support for the possibility that perceived stress may moderate
the effects of mindfulness upon coping responses
(Mohiyeddini et al. 2015). Finally, acceptance and defusion
induction studies that found reductions in avoidance behaviors
involved relatively stressful contexts, such as breathing CO
2
enriched air (Eifert and Heffner 2003; Levitt et al. 2004),
receiving an electric shock (Gutiérrez et al. 2004), and expo-
sure negative self-referential thoughts (Masuda et al. 2010a;
Masuda et al. 2004;Masudaetal.2010b). It may be, therefore,
that mindfulness interventions enhance coping responses
among relatively highly stressed (but not low stressed) indi-
viduals, in turn, explaining the mixed findings of studies of
mindfulness interventions and coping to date.
The present studies sought to examine the effects of brief
mindfulness inductions (a general mindfulness induction in
Study 1 and acceptance and cognitive defusion inductions in
Study 2) on coping responses, in a controlled laboratory set-
ting. Our first hypothesis was that a mindfulness induction
will result in more approach and less avoidance coping fol-
lowing a stressful experience. Our second hypothesis was that
perceived stress will moderate the effect of a mindfulness
induction upon coping with a stressful experience, resulting
in more approach and less avoidance coping among
individuals reporting relatively high (but not low) levels of
perceived stress.
Study 1
This study was a laboratory experiment in which we manipu-
lated mindfulness and measured self-reported coping out-
comes. We compared the effects of a 15-min mindfulness
induction, a relaxation induction and a filler task, on how
individuals reported coping with stress following an interven-
ing problem solving task. It may be that mindfulness has its
effects on coping by triggering the relaxation response and
reducing stress levels and, in this sense, has effects on coping
that are no different from a relaxation induction. Indeed, re-
laxation interventions have been shown to result in less de-
pression, anxiety, and distress (Jorm et al. 2008; Manzoni et al.
2008). In this study, we therefore included a relaxation induc-
tion to control for the relaxation effects of mindfulness, con-
sistent with other mindfulness studies to have done this (Jain
et al. 2007; Manocha et al. 2011). The filler task was included
as a no-treatment control intervention, following Reb and
Narayanan (2014) and Weinstein et al. (2009). We expected
that the mindfulness induction would result in increased ap-
proach and reduced avoidance coping relative to the relaxation
and filler task controls and that these effects would occur
particularly among individuals reporting relatively high levels
of stress.
Method
Participants
Undergraduate students (N= 204; 71 % female; mean
age = 21; age range = 19–27) from a Dutch university
volunteeredinanhour’s lab session for which they were paid
9 euros. This study was approved by the Human Ethics
Committee at the Australian National University. Upon arrival
at the research site, subjects were randomly allocated into one
of three experimental conditions (mindfulness, n= 69; relaxa-
tion, n= 67; filler task, n= 68) and then took part in one of the
three 15-min inductions.
Procedure
The mindfulness induction was a mindful candy eating exer-
cise in which participants were directed to touch, smell, feel,
and taste a piece of candy (an M&M) in a slow and deliberate
way, noticing thoughts, feelings, and sensations. This induc-
tion was based on the Braisin eating^exercise, commonly used
in mindfulness research (e.g., Heppner et al. 2008; Reb and
Narayanan 2014). The relaxation induction was the
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progressive muscle relaxation protocol, where individuals
were directed to tense various parts of their body (e.g., feet,
legs, hands, etc) and then gradually relax them (McCallie et al.
2006). The filler task was a mildly challenging task, designed
to prevent subjects from becoming bored, but without induc-
ing anxiety or distress (Reb and Narayanan 2014; Weinstein
et al. 2009). The task involved typing onto a screen a series of
the same letters in a specified pattern, starting from Ba.^For
example, Baaa aaa aaa^then Bbbb bbb bbb^up to Bk^.All
inductions were pre-recorded by appropriately qualified in-
structors to ensure consistency and accuracy.
Following the inductions, subjects undertook a problem
solving task that involved working in groups of nine people
to generate as many uses for a brick as possible within a 15-
min time-frame. This task was included as part of another
study but for the purposes of this study, served to create an
interval between the inductions and the subsequent data col-
lection, to test whether any effects of the brief mindfulness
induction on self-reported coping were sustained through a
challenging intervening problem solving task. After this task,
subjects completed the self-report measures described in the
following section.
Measures
Trait mi ndful nes s was measured using the 15-item Mindful
Attention and Awareness Scale (MAAS; Brown and Ryan
2003;α= .84). Sample items included BI rush through activ-
ities without being really attentive to them^and BIfindmyself
preoccupied with the future or the past.^Participants were
asked to rate each item using a five-point Likert scale
(1 = strongly disagree,5=strongly agree). A higher score on
this scale indicates lower trait mindfulness (Brown and Ryan
2003). Several subsequent studies have confirmed the validity
and reliability of this scale (e.g., Black et al. 2012; Siegling
and Petrides 2014; Van Dam et al. 2010).
A four-item measure of state mindfulness was adapted from
Reb and Narayan (2014;α= .75) as a manipulation check of
the effect ofthe inductions on state mindfulness. Sample items
were BI noticed the sensations of my body^and BI was aware
of my thoughts without getting lost in them.^Items were
ranked on a 1 (strongly disagree)to5(strongly agree)Likert
scale, with a higher scale score indicating higher levels of state
mindfulness.
General perceived stress wasmeasuredwiththefour-item
version of the Perceived Stress Scale (PSS; Cohen et al. 1983;
α= .76). Items were ranked on a 1 (never)to5(very often)
Likert scale and sample items were: BIn the last month how
often have you felt that you were unable to control the impor-
tant things in your life?^and BIn the last month how often have
you felt that things were going your way?^The four-item ver-
sion of the PSS generally has been found to have more limited
psychometric properties than the 10-item version (Lee 2012),
though for the present sample, the internal consistency of this
scale was acceptable (Tabachnick and Fidell 2013).
Self-reported coping behavior was measured using the
Brief COPE Inventory (Carver 1997) from which approach
and avoidance coping subscales were derived, following sim-
ilar approaches elsewhere (e.g., Doron et al. 2014;Lyneand
Roger 2000; Stowell et al. 2001; Weinstein et al. 2009).
Approach coping (6 items; α= .69) comprised measures of
active coping, acceptance, and positive reinterpretation and
growth, each comprised of two items. Avoidance coping (6
items; α= .72) comprised measures of behavioral and mental
disengagement coping, also two items each. Subjects were
asked to think of the stress associated with their most recent
university exams and rate how they would respond to that
stress if they were experiencing it right now. Both subscales
were rated on a 1 (I do not do this at all)to5(I do this a lot)
Likert scale, with higher scores reflecting more approach and
avoidance coping, respectively. Although the use of two-item
measures from the Brief COPE Inventory have been shown to
weaken the psychometric properties of each subscale, this is
one of the most widely used coping scales in the literature
(Kato 2013).
Data Analyses
Statistical power for this study (assuming a medium effect size
(f= .25); a total sample size of 204; and n= 67 in the smallest
condition) was .90. Experimental effects were assessed using
linear regression analyses with ordinary least squares estima-
tion. For moderation analyses (Hypothesis 2), perceived
stress, the moderator, was mean-centered. All statistical anal-
yses in this study were conducted using the R software (R
Core Team 2015).
Results
Descriptive statistics and bivariate correlations for Study 1
variables appear in Table 1. We did not find significant differ-
ences between the three experimental conditions on trait
mindfulness (F(2, 201) = 2.37, p= .096) or monthly perceived
stress (F(2, 201) = 2.60, p= .077). As a manipulation check,
we compared the three conditions on state mindfulness after
the inductions. We found a significant overall difference in
state mindfulness between conditions (F(2, 201) = 16.40;
p< .001) with post hoc analysis (Tukey’s HSD) indicating
significant differences between the mindfulness and filler task
conditions (MD = .41; p< .001) and between the relaxation
and the filler task conditions (MD =.39; p< .001) but not
between the mindfulness and the relaxation conditions
(MD =.01;p=.984).
We next tested main effects of the inductions on self-
reported coping (our first hypothesis). However, we did not
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find significant differences between the mindfulness condition
and either of the two control conditions on approach coping
(mindfulness vs. relaxation: b= .50 (.41), t=1.23, p=.220;
mindfulness vs. filler: b= .23 (.42), t=.54,p= .590) or avoid-
ance coping (mindfulness vs. relaxation: b=−.41 (.25),
t=−1.66, p= .099; mindfulness vs. filler: b=−.03 (.26),
t=−.10, p=.917).
We next tested our second hypothesis that perceived stress
would moderate the impact of the mindfulness induction upon
coping. Consistent with this hypothesis, we found a signifi-
cant interaction between monthly perceived stress and the
mindfulness induction in predicting less avoidance coping,
relative to the relaxation induction (b=−.18 (.08), t=−2.18,
p= .030) but not between the mindfulness and filler induc-
tions (b=−.11 (.10), t=−1.18, p= .240), as illustrated in
Fig. 1. Significant interaction or conditional effects were not
found for the mindfulness condition compared to either con-
trol condition, on approach coping.
Discussion
Consistent with our second hypothesis, we found that monthly
perceived stress moderated the effects of a mindfulness induc-
tion in predicting less avoidance coping, relative to a relaxa-
tion control. Specifically, we found that there were significant
differences between the mindfulness and relaxation inductions
on avoidance coping, but only as a function of increases in
perceived stress between individuals. This provides the first
direct evidence that mindfulness may have particular benefits,
in terms of enhanced coping, among individuals experiencing
relatively high levels of stress. Notably, there were no differ-
ences in self-reported awareness of present-moment bodily
sensations (i.e., the measure of state mindfulness) between
the mindfulness and relaxation conditions following the in-
ductions in this study (consistent with previous research;
Agee et al. 2009); yet a moderation effect was found. This
suggests that mindfulness has its effects on coping responses
not simply via being more attentive to bodily sensations in the
present-moment or by being more relaxed in general. Rather,
it may be the self-regulatory function of mindfulness that is
the difference between it and relaxation, in terms of enhancing
coping responses. Participants in the mindfulness induction
were asked to redirect their attention back to the exercise each
time it wandered off, while those in the relaxation condition
did not receive any such self-regulatory instruction. It may
have been this self-regulatory element of the mindfulness in-
duction that explains the present finding, althoughthis was not
directly tested in this study.
In addition, the lack of support for main effects of the
mindfulness induction upon coping responses (our first hy-
pothesis) may have been because coping was measured in a
relatively non-threatening context (i.e., self-reported coping
with the stress of one’s most recent university exams).
Consistent with other research (e.g., Eifert and Heffner
2003; Levitt et al. 2004), a more threatening context may be
needed for main effects of a mindfulness induction upon cop-
ing responses to be observed. Also, this study used self-report
Fig. 1 Experimental conditions interacting with monthly perceived
stress to predict avoidance coping
Tabl e 1 Group means, standard deviations, and bivariate correlations for study variables
Mindfulness Relaxation Filler Bivariate correlations
(n= 69) (n=71) (n=64)
M SD M SD M SD 1234
Female (%) 70 % –68 % –75 % –
Age 20.70 0.46 21.10 0.47 20.86 0.44
1. Monthly stress 9.18 2.60 10.16 3.09 9.34 2.41
2. Trait mindfulness 3.03 0.68 3.27 0.68 3.19 0.64 −.300**
3. State mindfulness 13.81 2.55 13.76 2.53 11.56 2.58 −.014 .140*
4. Approach coping 15.91 4.31 15.42 4.73 15.70 4.34 −.272** .260** .145*
5. Avoidance coping 4.32 2.41 4.73 2.50 4.34 2.36 .364** −.316** −.066 −.351**
*p<.05;**p<.01
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measures of coping, which bring with them problems of recall
bias (Shikai et al. 2014). Lastly, in the present study, we mea-
sured trait mindfulness after the experimental manipulation,
meaning that individuals’assessment of this may have been
influenced by the experimental manipulation. In Study 2, we
sought to address these issues.
Study 2
This study replicated and extended Study 1 by exploring the
effects of specific mindfulness sub-processes (acceptance and
cognitive defusion) on coping responses relative to a relaxa-
tion control, in an effort to highlight the potential Bactive in-
gredients^of more general mindfulness inductions, in enhanc-
ing coping responses. Recall that acceptance involves actively
embracing present-moment thoughts and feelings, without
seeking to change their form or frequency (Hayes and
Fletcher 2005), while cognitive defusion describes the process
of distancing from thoughts, so that they exert less control
over a person’s behavior (Gillanders et al. 2014). As
discussed, there is evidence that manipulations of both accep-
tance and cognitive defusion (as used in ACT, Hayes et al.
2006) should have a particularly strong influence on coping
responses. We expected to find that manipulations of these
mindfulness sub-processes enhance coping responses relative
to a relaxation induction, with these effects strengthening
among relatively more stressed individuals, consistent with
Study 1.
Also, to strengthen the approach taken in Study 1, we ad-
ministered behavioral measures of coping in this study to
avoid the recall biases of self-report coping scales (Shikai
et al. 2014) and sought to more directly induce stress via a
social-comparison stress manipulation (adapted from Dweck
and Elliott-Moskwa 2010). There is evidence that negative
social comparisons are highly stress inducing (Klein et al.
2001; Nussbaum and Dweck 2008). In the present study, we
administered a Bcognitive ability^test and artificially lowering
all students’scores relative to the student mean (adapted from
Mueller and Dweck 1998, and Nussbaum and Dweck 2008).
Students were then asked to share their (deflated) scores with
the class and discuss their performance with peers. This was
used to measure approach and avoidance coping behaviorally,
as described below.
Lastly, to strengthen the controls against which weassessed
the effects of the two mindfulness-based inductions, we re-
placed the filler task in Study 1 with a self-affirmation induc-
tion in this study. Self-affirmation theory and empirical evi-
dence suggest that following a stressful encounter, affirmation
of one’s self-concept (e.g., writing about an important life
value), even via a brief induction, dampens defensive threat
responses in general (Good and Abraham 2007; McQueen
and Klein 2006) and avoidance coping in particular
(Creswell et al. 2007). In this sense, self-affirmation was
included in this study as a Btreatment as usual^comparison
against which to more robustly compare the effects of the two
mindfulness-related interventions. Self-affirmations target the
content of thoughts (i.e., replacing negative self-evaluations
with positive ones), while mindfulness-based approaches tar-
get one’srelationship to thoughts (i.e., bringing acceptance
and psychological distance to them) (Bond et al. 2011;
Hayes et al. 2006).
Method
Participants
Participants were 202 undergraduate students (57 % female;
mean age = 22; age range = 20–26) in a management course at
an Australian university. This study was approved by the
Human Ethics Committee at the Australian National
University.
Procedure
First, the 12 tutorial groups in the course were each randomly
allocated to one of four experimental conditions, described
below. Second, all participants completed baseline measures
of self-compassion (the focus of the acceptance induction),
cognitive fusion (the focus of the defusion induction), and
general perceived stress, to control for baseline differences
between individuals on these variables. This was followed
by a 10 question Bcognitive ability test.^The cognitive ability
test was an unofficial test developed by the researchers using
Mensa problem solving questions. Piloting (N= 15) indicated
that students cared more having a favorable cognitive ability
score than receiving positive evaluations on measures of so-
cial skill, future income earning capacity, cultural intelligence,
and writing about recent failures. On completion of the test,
students received an automated email message reporting their
score (a number between 0 and 10), the fact that they had
failed the test (reported as being out of 20), and were informed
that the global student average for the test was 12/20.
Third, students attended their tutorial class and were in-
formed that they would be asked to share their test score with
their peers after completing the experimental inductions. In
the acceptance induction, participants received guided instruc-
tion (adapted from Neff et al. 2007) in reflecting on the forth-
coming class activity, noticing and naming the emotions they
experienced in response to this, and cultivating an attitude of
self-acceptance and self-compassion to oneself inthe presence
of these emotions. The cognitive defusion induction was the
Bleaves on a stream^protocol (see Hayes et al. 1999,p.158–
161), which has been used in other studies to induce defusion
(e.g., Tapper et al. 2009). Participants were instructed to visu-
alize placing thoughts on leaves in a stream, as a way of
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creating psychological space between themselves and their
thoughts. The relaxationinduction was the progressive muscle
relaxation exercise described in Study 1. Lastly, in the self-
affirmation induction, students were asked to rank a list of
values and then write about their highest ranked value for
10 min (following Crocker et al. 2008 and Sherman et al.
2000). Although this was a writing task (as opposed to listen-
ing in the other inductions), this manipulation was used in the
present research as it is a far more commonly used manipula-
tion of self-affirmation than non-written self-affirmations
(McQueen and Klein 2006), meaning the results of the present
study could be compared with a wide range of self-affirmation
studies. All inductions were 10 min long and were delivered
by the same instructor using standard scripts.
Fourth, after the inductions, students were invited to share
their test score with the class via an online learning tool, with
scores projected on a screen. Following Mueller and Dweck
(1998), students were told that they could anonymously report
a false score if they wished but that this would undermine the
value of the subsequent peer review exercise. This was a mea-
sure of avoidance coping (i.e., whether students chose to in-
flate their score). Having reported their score, students re-
ceived a copy of the test questions and discussed their perfor-
mance on it with peers. Finally, measures of approach coping,
event stress, manipulation checks, and items on suspicion and
diffusion were administered. Students were then fully
debriefed.
Measures
Cognitive fusion was measured with the 7-item Cognitive
Fusion Questionnaire (CFQ), rated on a 1 (never true)to7
(always true) Likert scale (Gillanders et al. 2014;α= .77;
ICC
1
= .003), meaning higher scores on this scale represent
increased cognitive fusion. The CFQ measures cognitive
fusion/defusion as a unidimensional construct and has shown
acceptable psychometric properties across seven separate
samples (Cronbach’sα=.88–.92; test-retest reliability r=.71
across a 4-week period; Gillanders et al. 2014).
Self-compassion (ICC
1
= .008) was measured with the 12-
item Short Form of the Self-Compassion scale (Raes 2011;
α= .88), on a 1 (almost never)to5(almost always)Likert
scale. This scale contains six negatively worded items, which
are reverse-scored and items summed to create a total self-
compassions core, with a higher score representing greater
self-compassion (Raes et al. 2011). This scale has shown ac-
ceptable psychometric properties (Cronbach’sα=.84–.87,
Raes et al. 2011, Raes 2011; test-retest reliability r= .71 across
a 5-month period, Raes 2011).
Perceived stress over the past month was measured with
the same scale as in Study 1 (Cohen et al. 1983;α= .73;
ICC
1
= .023). Event-related stress (ICC
1
= .007) was measured
using a single item: BBeing told that I will have to reveal my
cognitive ability test score to the rest of the class made me feel
stressed and anxious,^rated on a 1 (strongly disagree)to5
(strongly a gree) Likert scale.
Avoidance coping (ICC
1
= .027) was measured behavioral-
ly by whether a student reported an inflated cognitive ability
test score to the class (coded as 0 = no inflation; 1 = inflation),
adapted from Mueller and Dweck (1998). Instances of score
inflation were recorded as instances of avoidance coping.
Approach coping (ICC
1
= .012) was measured by asking
students to rate their willingness to engage in a remedial tuto-
rial as a means of improving on their cognitive abilities, on a
single item adapted from Hong et al. (1999) and Nussbaum
and Dweck (2008): BResearch has shown that with training,
you can significantly increase your cognitive ability. How
interested are you in signing up for a remedial tutorial (sepa-
rate to this class), to strengthen your cognitive abilities?^The
item was rated on a 1 (not at all)to5(very much)Likertscale,
with higher scores indicating greater approach coping.
Distraction (ICC
1
= .012): Two items measured distraction
during the inductions as a manipulation check, on a 1 (not at
all)to5(very much) Likert scale: BI was finding it difficult to
stay focused on what was happening^and BI was preoccupied
with the future or the past.^
Data Analyses
This study had statistical power of .73 (assuming p=.05; an
intraclass correlation coefficient of ρ= .01 and an anticipated
medium effect size of f= .25). Following tests for differences
between conditions on baseline variables and covariates, we
tested our hypotheses using linear mixed models, given the
nested nature of these data (i.e., individuals within classrooms
within experimental conditions). In all models, classroom was
included as a random factor (as a random intercept term) and
condition was treated as a fixed factor. All statistical analyses
were conducted in the R program (R Core Team 2015), using
the Blme4^package.
Results
We first compared the four conditions on baseline measures
but did not find significant differences between them on trait
cognitive defusion (t=−.51 (.60), t=−.85, p= .395), self-
compassion (t=.11(.27),t= .41, p= .681), monthly perceived
stress (b=−.17 (.24), t=−.74, p= .478), and gender (b=.02
(.03), t= .58, p= .574). Nor did we find significant differences
between conditions on cognitive ability test score (b=.08
(.15), t=.50, p= .626). Bivariate correlations between study
variables are in Table 2.
We next tested for the possibility that a person’sscoreon
the cognitive ability test would predict their coping behavior
and therefore warranted inclusion in our analyses as a
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FOR APPROVAL
covariate. As cognitive ability test scores did not predict nei-
ther approach (b= .05 (.03), t=1.51, p= .133) or avoidance
coping (b=−.03 (.02), t=−1.85, p=.065),wedidnotinclude
this variable in subsequent analyses. As a manipulation check,
we tested how distracted students were during the experimen-
tal inductions. Those in the defusion condition reported sig-
nificantly higher distraction than the relaxation condition,
(b=1.68(.55),t=3.06,p= .010) and marginally significantly
more distraction than those in the acceptance (b=1.10 (.52),
t= 2.11, p= .055) and self-affirmation inductions (b= 1.11
(.55), t=2.00,p= .082). We also found that distraction during
the inductions predicted significantly less approach (b=−.08
(.03), t=−2.86, p= .005) and nearly significantly more avoid-
ance coping (b= .02 (.01), t=1.85,p= .067) and so included
distraction as a covariate in subsequent analyses. Group
means and standard deviations for study variables appear in
Tab le 3.
Next, we tested Hypothesis 1 that both mindfulness induc-
tions would produce more approach and less avoidance
coping than the self-affirmation and relaxation inductions
and found partial support for this. With approach coping as
an outcome variable, statistically significant differences be-
tween the acceptance condition and the self-affirmation and
relaxation conditions were obtained, in the expected direction
(acceptance vs. self-affirmation: b= .49 (.16), t=3.05,
p= .023; acceptance vs. relaxation: b= .60 (.16), t= 3.77,
p= .004). With avoidance coping as an outcome variable, we
also found statistically significant differences between the ac-
ceptance condition and the self-affirmation and relaxation
conditions in the expected direction (acceptance vs. self-affir-
mation: b=−.18 (.08), t=−2.27, p= .025; acceptance vs. re-
laxation: b=−.17 (.08), t=−2.06, p=.041).However,similar
differences between the defusion condition and the self-
affirmation and relaxation conditions were not found for either
approach or avoidance coping.
We next tested Hypothesis 2 that perceived stress
would moderate the influence of both mindfulness induc-
tions (acceptance and defusion) upon coping, resulting in
Tabl e 3 Group means and
standard deviations for each study
variable
Defusion Acceptance Self-affirmation Relaxation
(n=43) (n=62) (n=48) (n=49)
M SD M SD M SD M SD
Female (%) 63 % –59 % –44 % –61 % –
Age 21.61 2.48 22.43 2.16 22.62 2.51 21.28 2.89
Monthly stress 12.19 3.20 11.90 3.39 12.04 2.90 11.55 2.68
Event-related stress 2.93 1.08 2.66 1.23 3.17 1.12 2.90 1.18
Self-compassion 17.21 3.89 17.58 3.73 17.63 4.48 17.59 4.49
Cognitive fusion 36.44 9.37 35.77 8.13 35.15 9.71 34.94 9.71
Distraction 7.16 2.28 6.06 2.61 6.04 2.79 5.49 2.47
Test score 4.81 1.93 4.95 1.75 4.71 2.14 5.11 1.45
Approach coping 3.02 0.83 3.35 0.60 2.88 0.89 2.80 0.87
Avoidance coping 0.26 0.44 0.13 0.34 0.31 0.47 0.29 0.46
Tabl e 2 Bivariate correlations
between study variables 12345678
1. Event stress
2. Monthly stress .184**
3. Trait self-
compassion
−.341** −.410**
4. Trait cognitive
fusion
.342** .390** −.629**
5. Distraction .100 .223** −.175* .255**
6. Test score −.021 −.016 .001 .043 −.083
7. Approach coping −.306** −.267** .199** −.240** −.171* .127
8. Avoidance coping .352** .208** −.183** .194** .116 −.125 −.231**
9. Gender (female) .172* .097 −.082 −.011 −.117 −.112 −.075 .089
*p< .05; **p<.01
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greater approach and less avoidance coping relative to
controls. We tested this hypothesis using two measures
of perceived stress described above: monthly and event-
specific perceived stress.
The trend lines for the four conditions on approach
coping, moderated by monthly perceived stress, appear
in Fig. 2a. Linear mixed effects analysis indicated that
the acceptance induction interacted with monthly per-
ceived stress to predict significantly more approach cop-
ing than the self-affirmation (b= .12 (.05), t= 2.23,
p= .027) and relaxation inductions (b= .13 (.05),
t=2.40, p= .017). However, we did not find a similar
moderation effect for the defusion induction with monthly
stress, compared to either the self-affirmation or relaxa-
tion conditions.
We next examined how the four conditions differed on
avoidance coping, moderated by monthly perceived
stress. As shown in Fig. 2b, as perceived stress increased,
those in the acceptance condition reported less of an in-
crease in avoidance coping, compared with the other three
conditions; however, these differences were not statistical-
ly significant. Together, these results suggest that as
monthly stress increases between individuals, receiving
an acceptance induction facilitates more approach coping
responses, though not less avoidance coping, relative to
receiving a self-affirmation or relaxation induction.
Figure 3a shows the approach coping scores for the
four experimental conditions, moderated by event-
related perceived stress. Consistent with Hypothesis 2
and the above results with monthly stress as a moderator,
we found that the acceptance induction interacted with
event-related stress to predict significantly more ap-
proach coping than the self-affirmation (b= .31 (.14),
t= 2.22, p= .028) and relaxation inductions (b=.27
(.13), t=2.03, p= .044). However, we did not find sim-
ilar effects for the defusion induction compared with the
control conditions.
Finally, we tested for the moderating effects of event-
related stress with avoidance coping as the outcome var-
iable. Figure 3b shows the results for the four conditions.
The acceptance induction interacted with event-related
stress to predict significantly less avoidance coping, com-
pared with the relaxation induction (b=−.13 (.06),
t=−2.15, p= .033), and nearly significantly less avoidance
coping than the self-affirmation induction (b=−.13 (.07),
t=−1.847, p=.067).
b
Fig. 2 Experimental conditions interacting with monthly perceived
stress to predict approach coping (a) and avoidance coping (b)
b
Fig. 3 Experimental conditions interacting with event-related stress to
predict approach coping (a) and avoidance coping (b)
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Discussion
In this study, we found partial support for our first hy-
pothesis. The acceptance induction resulted in significant-
ly more approach and less avoidance coping following a
stressful experience, relative to relaxation and self-
affirmation controls. This significant main effect may
have been because the acceptance component of mindful-
ness has a stronger effect on coping responses than a
general mindfulness induction (used in Study 1). The ma-
nipulation of acceptance in this study involved cultivating
self-acceptance and self-kindness in the face of difficulty,
and this has in turn been shown to reduce avoidance be-
haviors and increase engagement with stressful stimuli
(Eifert and Heffner 2003; Hayes et al. 2006;Levittetal.
2004), whereas there is less evidence for this from manip-
ulations of general mindful awareness (Levin et al. 2012).
In this study, we also found support for our second hypoth-
esis, replicating the finding in Study 1 that perceived stress
moderates the impact of a brief mindfulness induction on cop-
ing responses. Specifically, we found that as stress levels in-
creased between individuals, avoidance coping diminished
and approach coping increased among those in the acceptance
condition relative to those in the relaxation condition, adding
to the findings of Study 1 which only found moderation ef-
fects on avoidance coping. This finding suggests that for rel-
atively stressed individuals, the acceptance component of
mindfulness is particularly important in facilitating more ap-
proach and less avoidance coping, controlling for its relaxa-
tion effects.
In addition, we found a significant interaction between
perceived stress and the acceptance induction, relative to
the self-affirmation induction, resulting in less avoidance
and more approach coping. Self-affirmation inductions
have been shown to reduce avoidant behavior in the face
of stressful experiences (Creswell et al. 2007). However,
there is growing evidence that interventions targeting ac-
ceptance have a bigger influence on healthy behaviors and
well-being than those that seek to control stress-related
cognitions (Eifert and Heffner 2003; Gutiérrez et al.
2004; Hayes et al. 2006;Levittetal.2004). The findings
from this study are consistent with the latter evidence and
suggest that changing one’s relationship to stress-related
cognitions (i.e., via acceptance) has a larger impact on
coping responses than seeking to change the content of
such cognitions (i.e., via self-affirmation).
Lastly, it is notable that we did not observe significant
main or interaction effects of the cognitive defusion in-
duction relative to relaxation and self-affirmation controls.
It is possible that these non-significant effects were because
the cognitive defusion induction was more difficult for par-
ticipants to engage with than the other inductions in this
study. Participants reported more distraction during the
cognitive defusion induction than the other inductions, as
reported above. It is possible that the instructions to
Bunhook^from thoughts may have been too complex or
difficult to engage with for relatively young participants
situated in a classroom environment. For some participants
at least, the cognitive defusion induction may have para-
doxically drawn participants further into their thoughts,
rather than distancing from them, thereby undermining the
impact of the induction on coping behaviors.
General Discussion
Theoretically, mindfulness is claimed to enhance self-
regulation in the presence of stressful or threatening ex-
periences (Brown et al. 2007; Hayes et al. 2006;Shapiro
et al. 2006). However, the evidence for this in relation to
coping responses is inconclusive. One explanation for the
mixed findings of studies of mindfulness interventions
and coping responses is that mindfulness enhances coping
only among relatively stressed individuals (Josefsson
et al. 2014). In the present studies, we sought to test this
possibility, which has not yet been done. In Study 1, we
tested whether a general mindfulness induction enhanced
approach and undermined avoidance coping relative to
controls and whether these effects were a function of per-
ceived stress. In Study 2, we tested whether two mindful-
ness sub-processes (acceptance and cognitive defusion)
have particular effects on coping, relative to controls.
We tested these hypotheses using self-report (Study 1)
and behavioral (Study 2) measures of coping.
The main finding from both studies was that as levels
of perceived stress increased between individuals, mind-
fulness resulted in less avoidance coping, controlling for
its relaxation effects. This suggests that for individuals
who are relatively unstressed, the effects of mindfulness
are no different to those of relaxation in terms of how
individuals cope. However, as stress levels increase bet-
ween individuals, mindfulness has increasingly differen-
tial effects on avoidance coping behavior, relative to re-
laxation, suggesting that for relatively highly stressed
individuals, the relaxation effects of mindfulness (which
are well supported, see Keng et al. 2011; Khoury et al.
2013; Khoury, et al. 2015) become less important; and,
although we did not test this, we expect that self-
regulatory effects of mindfulness become increasingly
important.
A central element of mindfulness, and arguably what
separates it from relaxation, is the behavior of noticing
and choosing to willingly engage with difficult or un-
pleasant experiences (Hayes et al. 2006;Shapiro,etal.
2006;Teasdaleetal.2002). This process involves the
regulation of emotions and a choiceful engagement in
Mindfulness

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present-moment experience, even when doing so unpleas-
ant or difficult (Shapiro et al. 2006). This is arguably a
core process of mindfulness that distinguishes it from re-
laxation (Brown and Ryan 2003). Indeed, this self-
regulatory process was central to both the mindfulness
(Study 1) and acceptance (Study 2) protocols: in both,
participants were directed to attend to an aspect of
present-moment experience, with an attitude of openness
and curiosity. Whenever they noticed their minds becom-
ing fixated on a particular thought, they were encouraged
to gently redirect their attention to the object of focus.
There were no such self-regulation instructions in the re-
laxation protocols.
However, we found more consistent effects on coping
for the acceptance induction (Study 2) than the general
mindfulness induction (Study 1), relative to relaxation.
Specifically, we found that acceptance resulted in less
avoidance and greater approach coping than relaxation,
as a function of perceived stress; whereas the general
mindfulness induction only produced significant effects
on avoidance coping. As discussed, we expect that this
was because the acceptance manipulation (Study 2) di-
rected participants to bring feelings of self-kindness and
acceptance to the thoughts and feelings associated with a
stressful personal issue and so directly targeted greater
engagement with stress than the general mindfulness ma-
nipulation (Study 1) which targeted curiosity and interest
directed toward a relatively pleasant object (i.e., a candy).
These studies have several limitations. First, both stud-
ies were with undergraduate samples and a laboratory set-
ting. Subsequent research could test our hypotheses in a
more naturalistic setting, for example, with a high-stress
working sample. A replication with a working sample
would be particularly worthwhile, given the growing costs
of stress-related illness in modern workplaces and the as-
sociated increasing interest in workplace mindfulness.
A second limitation was that in both studies, we used
the randomization process to control for baseline differ-
ences in previous meditation or mindfulness experience.
We did not collect this information directly from partici-
pants, representing a limitation of the present studies that
could be addressed in subsequent experimental studies of
mindfulness.
Third, we did not measure mechanisms of change in
either study. Based on mindfulness theory and previous
research, we expect that the mindfulness inductions pro-
duced differences in coping responses via increases in
perspective-taking and the self-regulation of affect.
However, we were unable to test this possibility in the
present studies. The focus of this study was instead on
whether and when brief mindfulness inductions enhance
coping responses relative to controls, including the mod-
erating effect of perceived stress. Subsequent research
could usefully examine possible mediators of the changes
we found in the present research.
Fourth, the self-report copingmeasureinStudy1asked
subjects to recall the stress associated with their most
recent set of university exams. The short-comings of ret-
rospective measures of coping have been well document-
ed (Shikai et al. 2014). Future research into mindfulness
and coping should ideally use alternative approaches to
measuring coping such as ecological momentary assess-
ment methods to avoid recall biases associated with retro-
spective measures (see Shikai et al. 2014) or, ideally, be-
havioral measures as was used in Study 2.
Fifth, the self-affirmation manipulation in Study 2 involved
a different format (writing versus listening) to the other three
manipulations in that study. The manipulations were selected
to be consistent with the most commonly used manipulations
of each phenomenon, including self-affirmation (McQueen
and Klein 2006); however, we acknowledge that this differ-
ence is an inconsistency in the induction format between the
four conditions in Study 2.
Sixth, as discussed, in Study 2, the defusion induction
may have paradoxically drawn students further into their
thoughts rather than creating psychological distance from
them. Although the defusion protocol, known as the
Bleaves on a stream^exercise, has been successfully used
in other studies of mindfulness and behavior change (e.g.,
Tapper et al. 2009), as have similar defusion exercises in
other studies (e.g., Metzler et al. 2000), it may have been
difficult for participants to engage with outside the con-
text of a broader intervention. Future studies testing the
influence of a cognitive defusion induction on outcomes
such as coping responses could seek to better contextual-
ize the induction, so as to minimize this risk.
Finally, future research could test whether our results are
replicable following a longer mindfulness intervention and
whether effects are sustained over time. Evidence for
sustained impacts of a mindfulness intervention on coping
responses would add greatly to the existing evidence regard-
ing mindfulness and coping responses.
Despite these limitations, the present studies make a
valuable contribution to our understanding of whether
and when mindfulness influences how individuals cope
with stress. Our findings suggest that mindfulness has
particular benefits for coping among individuals
experiencing relatively high levels of stress, and further,
that the acceptance element of mindfulness may be a key
Bactive ingredient^of mindfulness interventions in terms
of their influence on coping responses. In the context of
the growing costs of stress-related illness for individuals
and organizations, these studies provide preliminary evi-
dence that acceptance-based mindfulness interventions
may have a useful role to play in enhancing coping
behaviors.
Mindfulness

FOR APPROVAL
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
Ethical Approval All procedures performed in studies involving hu-
man participants were in accordance with the ethical standards of the
institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical stan-
dards. This article does not contain any studies with animals performed by
any of the authors.
Informed Consent Informed consent was obtained from all individual
participants included in the study.
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