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Mindfulness Based Flourishing Program: A Cross-Cultural Study of Hong Kong Chinese and British Participants


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The Mindfulness Based Flourishing Program (MBFP) is an online 8-week intervention developed for enhancing wellbeing with the use of mindfulness practices, through targeting a range of positive variables. The efficacy of the MBFP has been demonstrated in a randomized controlled trial, and in order to further establish it as an intervention with widespread application, cross-cultural validation is warranted. The current study was conducted with the primary aim of testing the validity of the MBFP with a Hong Kong Chinese population, as well as verifying its positive effects. A randomized wait-list controlled design was adopted with 115 participants (92 females, mean age = 31.50). Intervention outcomes were compared between Hong Kong Chinese and British participants. Five positive variables were examined (self-compassion, meaning in life, positive and negative emotions, gratitude, and mindfulness), and measures were taken pre- and post-intervention. Significant gains in wellbeing measures were observed in both the Hong Kong Chinese and the British experimental groups. Levels of wellbeing post-intervention were also higher for the two experimental groups as compared to their control counterparts. The current study provides preliminary evidence for the MBFP’s cross-cultural validity, and strengthens previous claims for its efficacy as a new, accessible alternative for enhancing wellbeing.
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1 23
Journal of Happiness Studies
An Interdisciplinary Forum on
Subjective Well-Being
ISSN 1389-4978
J Happiness Stud
DOI 10.1007/s10902-017-9919-1
Mindfulness Based Flourishing Program:
A Cross-Cultural Study of Hong Kong
Chinese and British Participants
Itai Ivtzan, Tarli Young, Hoi Ching Lee,
Tim Lomas, Daiva Daukantaitė & Oscar
1 23
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Mindfulness Based Flourishing Program: A Cross-
Cultural Study of Hong Kong Chinese and British
Itai Ivtzan
Tarli Young
Hoi Ching Lee
Tim Lomas
Daiva Daukantait_
Oscar N. E. Kjell
Springer Science+Business Media B.V. 2017
Abstract The Mindfulness Based Flourishing Program (MBFP) is an online 8-week
intervention developed for enhancing wellbeing with the use of mindfulness practices,
through targeting a range of positive variables. The efficacy of the MBFP has been
demonstrated in a randomized controlled trial, and in order to further establish it as an
intervention with widespread application, cross-cultural validation is warranted. The cur-
rent study was conducted with the primary aim of testing the validity of the MBFP with a
Hong Kong Chinese population, as well as verifying its positive effects. A randomized
wait-list controlled design was adopted with 115 participants (92 females, mean
age =31.50). Intervention outcomes were compared between Hong Kong Chinese and
British participants. Five positive variables were examined (self-compassion, meaning in
life, positive and negative emotions, gratitude, and mindfulness), and measures were taken
pre- and post-intervention. Significant gains in wellbeing measures were observed in both
the Hong Kong Chinese and the British experimental groups. Levels of wellbeing post-
intervention were also higher for the two experimental groups as compared to their control
counterparts. The current study provides preliminary evidence for the MBFP’s cross-
cultural validity, and strengthens previous claims for its efficacy as a new, accessible
alternative for enhancing wellbeing.
Keywords Positive psychology Mindfulness Cross-cultural Wellbeing Randomized
controlled trial
Electronic supplementary material The online version of this article (doi:10.1007/s10902-017-9919-1)
contains supplementary material, which is available to authorized users.
&Itai Ivtzan
Department of Psychology, The University of East London UEL, Stratford Campus,
London E15 4LZ, UK
Department of Psychology, Lund University, Paradisgatan 5P, 22350 Lund, Sweden
J Happiness Stud
DOI 10.1007/s10902-017-9919-1
Author's personal copy
1 Introduction
Mindfulness can be broadly defined as a state of sustained awareness of the present
moment with an attitude of non-judgmental acceptance of what is happening in one’s own
mind and body, as well as in the immediate environment (Grossman et al. 2004). Mind-
fulness is most commonly cultivated through meditation but can be enhanced through any
activity which involves focusing on the present with the appropriate attitude (Kabat-Zinn
1990). In a state of mindfulness, internal and external stimuli are non-judgmentally
observed, and habitual reactions to them are reduced. This deliberate dissociation between
perception and response enables an individual to be reflective, rather than reflexive (Bishop
et al. 2004).
Mindfulness has its roots in Buddhist meditative practices, in which it is believed to be
important for the mind, as well as the body, through the understanding of human expe-
rience (Mikulas 2011). Within Buddhism, mindfulness has historically been regarded as an
innate capacity which people possess to varying extents. The purpose of Buddhist mind-
fulness practices is to elicit this innate capacity, and develop it for spiritual growth (Kabat-
Zinn 2003) and psychological wellbeing (Shapiro 2009) including positive psychological
experiences such as joy, awareness and compassion (Garland et al. 2015).
Traditional Mindfulness practices have been adapted by Western Psychology, in which
the primary purpose has been altered towards clinical interventions for psychological
distress and maladaptive behaviour (Shapiro 2009). For instance, Mindfulness Based Stress
Reduction (MBSR), which is an approach that integrates meditation and yoga, was
developed to assist with chronic pain (Kabat-Zinn 1982). Other Western programs include
the Mindfulness Based Cognitive Therapy (MBCT; Segal et al. 2002), Dialectical Behavior
Therapy (DBT; Linehan 1993), and Mode Deactivation Therapy (MDT; Swart et al. 2014).
These programs have been widely applied to a range of psychological difficulties, such as
anxiety disorders (Grossman et al. 2004) and suicidal behavior (Linehan 1993). There is
considerable evidence for the effectiveness of mindfulness practices in treating symptoms
of mental illnesses, preventing relapse, and alleviating psychological distress associated
with long-term health problems (e.g. Teasdale et al. 2000; Zainal et al. 2013). But there
have been few mindfulness programs targeting positive variables such as wellbeing.
In recent years, Mindfulness has become increasingly influential in the field of positive
psychology (Ivtzan and Lomas 2016); a relatively recent branch of psychology that
investigates the facilitation of flourishing lives (Lomas et al. 2014). Positive psychology
focuses research on positive variables such as wellbeing. Shapiro et al. (2002) suggest the
field can offer perspectives in better alignment with the original Buddhist aims of mind-
fulness. In line with this suggestion, the Mindfulness Based Flourishing Program (MBFP)
was developed by Ivtzan et al. (2016) to integrate mindfulness practices with positive
psychology into an 8-week online program, designed to enhance wellbeing. In addition to
targeting overall wellbeing, each of the 8 weeks focuses on a positive variable. For
example, five of the positive variables are based on the Psychological Wellbeing model
(Ryff and Keyes 1995): autonomy, meaning in life, self-compassion, positive relations
with others, and self-efficacy. These are all considered important dimensions of Eudai-
monic wellbeing, which emphasises the wellbeing that comes from living in a meaningful
and deeply satisfying manner (Ryan and Deci 2001). In addition, two variables, gratitude
and engagement, were included in the MBFP to enhance Hedonic wellbeing, which
emphasises the attainment of pleasure and pain avoidance (Deci and Ryan 2008).
The MBFP is one of the few existing mindfulness programs developed with the
intention of enhancing positive variables. In the context of mindfulness, intentions are an
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individual’s goals in practicing mindfulness, and it is argued that they significantly
influence the outcomes of the practice (Shapiro et al. 2006). Shapiro et al. (2006)
emphasize this in their IAA model of mindfulness, which posits intention as a key aspect
which connects practitioners with their goals, visions and aspirations. Intention is similarly
an important component of positive psychology interventions (PPIs) which focus, by
definition, on the goal of increasing positive variables (Sin and Lyubomirsky 2009; Parks
and Biswas-Diener 2013). The MBFP incorporates mindfulness with PPIs and positive
psychology theory with the explicit intention of increasing wellbeing and positive vari-
ables. Both Mindfulness and PPIs enhance positive variables in their own right, and the
MBFP is designed so they mutually enhance each other, leading to improvements in
Hedonic and Eudaimonic well-being. The mutually supportive relationship between PPIs
and Mindfulness is described in the ‘positive Mindfulness cycle’ which forms the theo-
retical basis for the MBFP (Ivtzan et al. 2016).
The positive Mindfulness cycle suggests that PPIs shape the intention for mindfulness
practice. While existing Mindfulness programs (e.g. MBSR and the MBCT) aim to
decrease negative variables; the MBFP utilizes PPIs to set positive intentions. As part of
the MBFP, each PPI includes a talk on the positive variable targeted and an invitation to
increase this variable through an evidence-based activity. The focus on positive intentions
aligns with Positive Psychology’s focus on flourishing, which goes beyond the mere
elimination of psychological distress and can be achieved only if positive variables are
involved (Keyes 2002). Thus the PPIs in the MBFP set positive intentions for the mind-
fulness component of the program and support increases in wellbeing.
In turn, the ‘positive Mindfulness cycle’ proposes that mindfulness supports the use of
PPIs through the process of savouring. Savouring relates to generating and prolonging
enjoyment and appreciation (Bryant and Veroff 2007) and has been identified as a potential
pathway through which mindfulness enhances positive variables (Garland et al. 2015).
Mindfulness is a key dimension of savouring (Ritchie and Bryant 2012) and allows
practitioners increased awareness of positive emotions and outcomes triggered by PPIs.
While PPIs often lead to the experience of positive events or emotions, without savouring,
the practitioner may not be able to appreciate or prolong these positive outcomes. Mind-
fulness promotes savouring, which is required to fully utilise the benefits of PPIs. Thus,
through the positive mindfulness cycle, Mindfulness and PPIs, in the MBFP, continuously
enhance each other, leading to greater increases in wellbeing than their impact as separate
The efficacy of the MBFP is promising as demonstrated through a recent randomized
controlled trial with a non-clinical population (Ivtzan et al. 2016). While the wait-listed
control group showed no significant changes, the experimental group showed significant
increases in a range of positive variables, including gratitude, self-compassion, meaning,
and strengths. In addition, experimental group participants showed significant decreases in
depression and perceived stress, indicating the MBFP is also effective in reducing psy-
chological distress.
The MBFP was developed in the UK by researchers from Western backgrounds. In the
original study of the MBFP, participants came from 20 countries, with the majority from
Western cultures including the United Kingdom (29.8%), Canada (27.8%), United States
(12.6%) and Australia (10.6%). It is therefore important to test the efficacy of the program
cross-culturally, to examine whether or not similar effects would be found, since the
experience of mindfulness differs across cultures.
Cross-cultural studies show that people with distinct cultural backgrounds might have
different conceptualizations or experiences of mindfulness. For example, a cross-cultural
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mindfulness study by O
¨zyesil (2012) found that American students had greater psycho-
logical needs and were more mindful than Turkish students. In a separate study of
mindfulness measures, Christopher et al. (2009b) found that Thai students had greater
ability to focus with undivided attention, while American students appeared to be more
accepting of events that occurred around them. The same study also identified that these
populations had different conceptualizations of mindfulness, as the predominantly Bud-
dhist Thai population sees mindfulness as only one component of a larger system of
teachings; whereas Western secular mindfulness is not necessarily connected to a wider
system of wisdom and morality (Christopher et al. 2009a,b). More broadly, O
¨zyesil (2012)
proposed that collectivist cultures might hamper attempts to be more mindful due to
cultural norms that put much emphasis on the society’s approval or disapproval, and thus
hinder the adoption of a non-judgmental life view.
These studies exemplify how Mindfulness can vary among cultures and it is also
important to note that Western Mindfulness interventions and scales have adapted mind-
fulness to fit with Western ideals and tastes (Kabat-Zinn 2003). As such, it is important that
Western mindfulness interventions are culturally validated before being put to use else-
where. Systematically assessing a mindfulness program in a target culture facilitates the
identification of areas that need to be adjusted (e.g. mode of delivery, format) for the
purpose of proper adaptation, and is therefore a vital step before the test or program can be
implemented with the population concerned (e.g. Woods-Giscombe
´and Gaylord 2014).
There have been a number of such cross-cultural studies on mindfulness interventions; for
instance research on the MBSR (Roth and Robbins 2004) which suggest the intervention
can be used successfully in different cultures, but as yet, there is no cross-cultural study on
the MBFP.
Despite the research suggesting the MBFP is a viable new alternative to enhance
wellbeing, the breadth and width of its reach could remain limited without an assessment
of its cross-cultural validity. The primary aim of the current study is to test the effec-
tiveness of the program in the context of an Eastern culture. Specifically, the MBFP will be
tested with a sample of Hong Kong Chinese, and their intervention outcomes will be
compared to those of a British sample.
Hong Kong was chosen as a comparison culture as it is distinct from the Western
cultures tested in the original study (Ivtzan et al. 2016). While Hong Kong was previously
under British rule, the two cultures are very different. Approximately 94% of Hong Kong’s
population are ethnically Chinese and 96% speak Cantonese (Census and Statistics
Department 2011). Most people in Hong Kong follow Buddhist, Taoist or Confucian faiths
(Hong Kong Yearbook 2015) and align with traditional Chinese culture and customs
(Ralston et al. 1993). These demographics have led researchers to treat Hong Kong as a
representative of Eastern culture (e.g., Go
¨kc¸en et al. 2014; Maxwell et al. 2005; Ralston
et al. 1993). A variety of studies highlight the differences between the UK and Hong Kong;
for example Hofstede (2001) found Hong Kong has a more pragmatic and collectivist
culture than Britain: while British citizens tend to score higher in terms of indulgence,
Hong Kong adults scored lower on extraversion and higher on social desirability and
Psychoticism than British adults (Eysenck and Chan 1982) and higher on anger rumination
(Maxwell et al. 2005). In addition to the cultural differences the two populations are
situated in vastly different geographical regions and were chosen to represent Western and
Eastern cultures as per previous research (e.g., Go
¨kc¸en et al. 2014; Maxwell et al. 2005).
While there are many studies on the differences between Hong Kong and Britain, there
is no documented research that directly compares Hong Kong and Britain in terms of
mindfulness. As such, while this study aims to test the MBFP across the two cultures, it
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may also shed light on any differences or similarities in the two populations regarding
mindfulness in general. Another motivation for the current study is the lack of interven-
tions designed to enhance wellbeing available for Eastern populations. Mindfulness pro-
grams tested on Asian populations (e.g. Chien and Thompson 2014; Lee et al. 2011), have
generally focused on reduction of negative variables (e.g. stress, schizophrenic symptoms).
Mindfulness-based interventions for improving positive variables have not yet been
empirically tested in an Eastern culture. This study aims to test the MBFP as a potential
evidence-based approach for achieving flourishing in an Eastern culture.
The main objective of this study is to assess the cross-cultural validity of the MBFP.
This is done in two ways; firstly, by assessing whether the MBFP was successful with the
Hong Kong experimental group compared to the Hong Kong control group; and secondly
by comparing the results of Hong Kong participants and British participants to ascertain
whether the MBFP was equally effective in both populations. Specifically, two related
hypotheses were tested. The primary hypothesis was that participation in the MBFP, as
compared with participating in the waitlist condition, leads to significant improvements
from pre-test to post-test in six dependent variables (mindfulness, gratitude, self-com-
passion, meaning in life, positive and negative effects) in both countries. The secondary
hypothesis was that the MBFP is equally effective in improving the six dependent variables
when comparing results of the experimental groups from Hong Kong and the UK.
2 Method
2.1 Design
The study used a randomized wait-list control trial. Balanced randomization was executed
by means of a predefined list (115 numbers, range 1–2, balanced) created automatically by
the study’s online platform. The between-subjects independent variables were 1) condition
(allocation to either the control, waitlist group, or the MBFP, experimental group, and 2)
country (Great Britain or Hong Kong). The within-subject independent variable was time
(pre- and post-intervention measurements). The dependent variables were: mindfulness,
gratitude, self-compassion, meaning in life, positive affect and negative affect. Dependent
variables were measured through quantitative, self-report scales completed online.
2.2 Participants
Participants were recruited through health-related online forums and social networks, as
well as from meditation centres in Great Britain and Hong Kong. Participation was
completely voluntary and no compensation of any kind was offered. Participants were only
eligible if: (1) they were permanent citizens of either Hong Kong or Great Britain, and (2)
they had resided in either place for no less than 5 years. All Hong Kong participants had to
confirm that they were ethnically Chinese. These inclusion criteria were set to ensure that
participants adequately represented the two cultures under study.
A total of 222 participants signed up for the study and were assessed for eligibility. Nine
of the recruited participants were disqualified for severe signs of depression, as there is
evidence that meditation can negatively affect individuals with high levels of depression
(Shapiro 1992). Out of these 213 participants, 107 did not start the study. The remaining
115 participants (47% male; 53% female), with the age range from 18 to 70 (M=31.50,
Mindfulness Based Flourishing Program: A Cross-Cultural
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SD 13.50) years, commenced the study by completing at least the pre-intervention ques-
tionnaires, while 79 participants of 115 (43% male; 57% female) completed the entire
study (see Fig. 1for more details).
2.3 Procedure
Ethics approval was obtained from the Research Ethics Committee of the University of
East London. Before commencing the program, all recruited individuals were emailed an
invitation letter, which briefly outlined the study. Participants within each culture group
were randomly allocated into either the experimental or the control group. They were then
emailed a link to an online platform which hosted the questionnaires and MBFP. Partic-
ipants were asked to complete the consent form and screened for depression using the
Patient Health Questionnaire-2 (Kroenke et al. 2003) a 2-item validated scale with a score
range of 0-6. A cut-off score of 5 was chosen as this provides a positive predictive value of
84.6% regarding depressive disorders (Kroenke et al. 2003). Participants who passed
screening completed the pre-test questionnaires; comprised of demographic questions and
five questionnaires to provide pre-intervention measures (see measurements).
After completing pre-tests, the procedure differed for the experimental and control
groups. Participants in the control groups (from both Great Britain and Hong Kong) were
wait-listed for 8 weeks. After this time, they were asked to complete the same five
questionnaires to provide post-test results. They were then able to begin the MBFP. The
Figure 1. Participant flow diagram
Assessed for eligibility
(British: n=112; HK: n=110)
Screened for depression
(British: n=7; HK: n=2)
Completed post assessment
(British: n=22; HK: n=19)
Allocated to experimental group
(British: n=56; HK: n=55)
Did not complete any pre-test scales
(British: n=23; HK: n=28)
(British: n=105; HK: n=108)
Fig. 1 Participant flow diagram
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MBFP was presented in English as it is one of the official languages of Hong Kong (Bolton
Participants in the experimental groups were immediately allowed to start the 8-week
MBFP following the pre-tests. The MBFP lasted 8 weeks, and each week focused on a
different theme: (1) self-awareness, (2) positive emotions, (3) self-compassion, (4)
autonomy, (5) self-efficacy, (6) meaning in life, (7) positive relations with others, and (8)
engagement. Each week, participants were provided with a short video (approximately
10 min) that explained the theory of the topic that week and invited them to undertake
activities to increase the relevant positive variable. They were also provided with an audio
file (12-15 min) which contained a guided meditation and a daily practice. The daily
activity was related to the week’s topic, and was to be performed outside of meditation
sessions. A written transcript of the audio file and the daily activity was also available for
download. Participants were asked to watch each video once and complete the meditation
and daily activity each day for the following week. Table 1summarizes the program
throughout the 8 weeks.
At the end of each week, participants received an email with a link to the following
week. They were also sent reminder emails 3 days into each week to encourage adherence.
Upon starting each subsequent week, they were asked to report the number of times they
had meditated and completed the daily activity during the past week. The above procedure
was repeated for 8 weeks.
Upon completion of the MBFP, participants were asked to complete the same five
questionnaires to provide post-intervention measures. All experimental and control par-
ticipants were given a debrief letter that concluded the program. Figure 1shows a flow
chart of the procedure and participant numbers.
2.4 Measures
Depression was screened by using the Patient Health Questionnaire-2 (PHQ-2; Kroenke
et al. 2003), which comprises two questions about the frequency of anhedonia and
depressive mood over the last 2 weeks. The two items are answered with rating scales
ranging from 0 (‘‘not at all’’) to 3 (‘‘nearly every day’’); where a score of C5 is considered
a severe depression screening cut-point (Kroenke et al. 2003; Yu et al. 2011). The PHQ-2
has also been found valid and reliable using the Chinese version of the PHQ-2 in a Hong
Kong sample (Yu et al. 2011). The internal reliability for the PHQ-2 was (alpha =.66,
omega =.67) for the UK sample and (alpha =.32, omega =.32) for the Hong Kong
Chinese sample.
Mindfulness was measured using the Freiburg Mindfulness Inventory, Short Form
(FMI), which has 14 items scored on a 4-point Likert scale and good internal reliability
(Walach et al. 2006). The FMI has been tested cross-culturally and a translated version was
validated with a Chinese population (Chen and Zhou 2014). The internal reliability for the
FMI was good in both the UK (pre-test: alpha =.88, omega =.88; post-test: alpha =.93,
omega =.93) and Hong Kong (pre-test: alpha =.84, omega =.84; post-test:
alpha =.81, omega =.81) samples.
Positive Affect and Negative Affect were assessed with the Positive and Negative Affect
Schedule (PANAS), which contains two 10-item mood scales, both with high internal
consistency (Watson et al. 1988). The PANAS has been validated cross-culturally with a
Chinese population using a translated version (Weidong et al. 2004). The internal relia-
bility for the positive affect scale was good in both the UK (pre-test: alpha =.90,
omega =.91; post-test: alpha =.91, omega =.91) and Hong Kong (pre-test:
Mindfulness Based Flourishing Program: A Cross-Cultural
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alpha =.89, omega =.90; post-test: alpha =.90, omega =.91) samples. The internal
reliability for the negative affect scale was also good in both the UK (pre-test: alpha =.92,
omega =.92; post-test: alpha =.91, omega =.91) and Hong Kong (pre-test:
alpha =.91, omega =.92; post-test: alpha =.92, omega =.92) samples.
Gratitude was assessed with the Gratitude Questionnaire-6-Item Form (GQ-6) which
has six items on a 7-point Likert scale and good internal reliability (McCullough et al.
2002). The GQ-6 has been noted as valid and reliable in a study with the Hong Kong
Table 1 Topics, materials and activities each week of the MBFP
Week Target
Content of video Meditation Daily activity
1 Self-
Introduction to
mindfulness, self-
awareness, positive
psychology and
Introductory meditation
focused on awareness
of breath, body and
Being aware of thoughts
and reactions throughout
the day and returning to
the breath
2 Positive
Explanation of the benefits
of positive emotions and
Gratitude meditation
focused on who or
what one appreciates
Expressing gratitude for
positive situations
3 Self-
Explanation of self-
compassion concept and
research; and methods to
increase self-compassion
Adaption of Loving-
Kindness meditation
focused on self-
compassion (Neff and
Germer 2013)
Replacing internal
criticism with statements
of kindness
4 Self-efficacy Introduction to character
strengths and self-
efficacy including
enhancement methods
Meditation focused on a
time when participant
was at their best and
using character
Completing the VIA
character strengths
questionnaire (Peterson
and Seligman 2004) and
using strengths
5 Autonomy Introduction to autonomy
and connection with
Meditation on authentic
self and action
Taking authentic action
and noticing external
pressure on choices
6 Meaning Talk on meaning and
wellbeing. Completion
of writing exercise,
‘Best Possible Legacy’
adapted from the
Obituary Exercise
(Seligman et al. 2006)
Meditation on future
vision of self, living
one’s best possible
Acting according to best
possible legacy.
Choosing meaningful
7 Positive
with others
Talk on benefits of
positive relationships
and methods for
Bringing feelings of
loving-kindness into
8 Engagement Introduction to
engagement and
savouring and their
connection to positive
Savouring meditation
focused on food
Using savouring to engage
with experiences
Conclusion Summary of the program.
Discussion of personal
growth and invitation to
continue meditations
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Chinese population (Chan 2010). The internal reliability for the GQ-6 was mostly good in
both the UK (pre-test: alpha =.76, omega =.74; post-test: alpha =.73, omega =.71)
and Hong Kong (pre-test: alpha =.80, omega =.83; post-test: alpha =.68,
omega =.65) samples.
Self-Compassion was measured with the Self-Compassion Scale, Short Version (SCS;
Raes et al. 2011). The SCS has 12 items on a 5-point Likert scale and good internal
reliability (Raes et al. 2011). The SCS (translated) were used in a cross-cultural study in
Taiwan, Thailand and United States, and were found to have good internal consistency in
all three populations (Neff et al. 2008). The internal reliability for the SCS was good in
both the UK (pre-test: alpha =.90, omega =.91; post-test: alpha =.92, omega =.92)
and Hong Kong (pre-test: alpha =.84, omega =.84; post-test: alpha =.87,
omega =.88) samples.
Meaning in Life was assessed using the Meaning in Life Questionnaire-Presence Sub-
scale (MLQ-P) which has 5 items scored on a 7-point Likert scale and good internal
reliability (Steger et al. 2006). A translated MLQ was used within a sample of Hong Kong
Chinese caregivers and found to have the same factor structure as the original version of
MLQ (Chan 2014). The internal reliability for the MLQ-P was good in both the UK (pre-
test: alpha =.91, omega =.92; post-test: alpha =.86, omega =.87) and Hong Kong
(pre-test: alpha =.94, omega =.95; post-test: alpha =.93, omega =.94) samples.
Demographic questions encompassed asking for gender, age, household income in US
dollars, and highest level of education.
2.5 Statistical Analyses
Chi square and t-tests were used to compare the experimental and the control groups within
each cultural stratum as well as between the two countries on demographic variables. To
assess the program efficacy in the two countries, we used mixed 2 9292 design
ANOVAs (Between Countries: Great Britain and Hong Kong) 9(Between Groups:
Experimental and Control) 9(Within Group Repeated Measures: Pre-intervention, Post-
intervention). We included partial eta squared as an indicator of effect size whenever
possible to reflect the proportion of variance that the independent variable accounted for.
We used values of .010, .059, and .138 as indicators of small, medium, and large effect
sizes (these are approximately equivalent to Cohen’s ds of 0.2, 0.5, and 0.8, respectively).
A significant two-way interaction (Condition 9Time) was interpreted as evidence for a
differential intervention effect irrespective of country, while a significant three-way
interaction (Country 9Condition 9Time) was interpreted as evidence for a differential
intervention effect between the two samples from different countries. The six dependent
variables were the outcome measures. The preliminary analyses are based on all partici-
pants that completed the interventions; but intention-to-treat with last values carried for-
ward was also examined as an alternative, more conservative analysis approach. All
analyses were completed with alpha set at .05.
3 Results
There were significant demographic differences between the Great Britain and Hong Kong
samples in terms of gender, household income, level of education as well as age. There
were no significant differences between the experimental and control groups in either
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Table 2 Baseline demographics and tests on differences between countries and the experimental and the control groups for participants completing pre- and post-tests
(N =79)
Demographics British (n =43)
n (%)
Hong Kong Chinese (n =36) n (%) Difference tests
Comparison between countries
Gender (male) 12 (27.9) 22 (61.1) v
(1) =8.81, p=.003
Household income (less than $25 k per year) 14 (32.6) 19 (52.8) v
(7) =18.39, p=.010
Level of education (bachelor’s degree) 15 (34.9) 24 (66.7) v
(4) =14.91, p=.005
Age 39.79 (15.24) 24.33 (8.46) t(77) =5.42,
(n =33)
(n =29)
Difference tests Experimental
(n =27)
(n =26)
Difference tests
N(%) N(%) N(%) N(%)
Comparison between experiment and control groups within countries
Gender (male) 5 (22.7) 7 (33.3) v
(1) =0.60, p=.438 13 (68.4) 9 (52.9) v
(1) =0.91, p=. 342
Household income (less than $25 k per year) 7 (31.8) 7 (33.3) v
(5) =1.68, p=.892 12 (63.2) 7 (41.2) v
(5) =8.10, p=.151
Level of education (bachelor’s degree) 7 (31.8) 8 (38.1) v
(4) =2.71, p=.607 11 (57.9) 13 (76.5) v
(4) =9.42, p=.051
Age 39.86 (17.30) 39.71 (13.18) t(41) =0.03, p=.975 23.37 (4.78) 25.41 (11.34) t(34) =-0.719, p=.477
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country (see Table 2). These results were similar when also including those participants
that started but did not complete the study (See Table S1 in the supplementary material).
There were no significant differences among the examined demographic variables
between participants completing and those not completing the study. (See Table S2 in the
supplementary material) However, at the pre-test, those completing the study reported
significantly less self-compassion and presence of meaning in life as well as significantly
more positive and negative affect than those not completing the study. The correlations
among the six dependent variables are presented in Table 3.
Overall, the MBFP had a significant and considerable large effect on the outcome
measures (see Table 4and Fig. 2for more details). The interactions between Condition
(MBFP or waitlist) and Time (pre- and post-intervention) in the mixed three-way ANO-
VAs for the six dependent variables, revealed significant (p\.001) increases in mind-
fulness, gratitude, self-compassion, and presence of meaning in life, and decrease in
negative affect. Positive affect did not change significantly (p=.571). All effect sizes
were large: for mindfulness (g2
p=.147), self-compassion (g2
p=.432), negative affect
p=.379), meaning in life (g2
p=.303) and gratitude (g2
p=.276). The intention-to-treat
analyses yielded similar results, with medium effect size for mindfulness and large
(although somewhat smaller) effect sizes for the other four constructs (See Table S3 in
Supplementary Material).
No significant three-way interaction (Country 9Condition 9Time) effects were found
for the six dependent variables. This indicates that the MBFP tends to have a similar effect
in both countries. Large effect sizes were found for experimental groups within both Great
Britain and Hong Kong for mindfulness, self-compassion, meaning in life and negative
affect; whereas the effect sizes for gratitude were large in Hong Kong and moderate
(almost strong) in Great Britain. For gratitude, there was a tendency (p=.057) for a
significant interaction effect with a small effect size (g2
p=.047). However, it is also worth
noting that the experimental group in Hong Kong reported considerably lower levels of
gratitude than all other groups at pre-test, which is likely to influence the interaction rather
than cross-cultural differences in the effects of the MBFP. The intention-to-treat analyses
yielded similar statistically non-significant results. In addition, controlling for age, gender,
household income and level of education did not change any of the reported interactions
considerably (See Table S4 in supplementary material).
Table 3 Pearson correlations among dependent variables pre-intervention for the Hong Kong Chinese
(lower triangle) and the British (upper triangle) samples
Measure 123456
1. Mindfulness (FMI) .29* .70*** .47*** .21 -.40**
2. Gratitude (GQ-6) .47*** .32* .36** .26* -.05
3. Self-compassion (SCS) .57*** .49*** .69*** -.05 -.52***
4. Meaning in life (MLQ-P) .47*** .70*** .52*** .17 -.32*
5. Positive affect (PANAS) .29* .18 -.03 .13 – .07
6. Negative affect (PANAS) -.28* -.32* -.55*** -.28* .34* –
Hong Kong Chinese
=53; N
=62; * =p\.05; ** =p\.01; *** =p\.001
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Table 4 Mean (SD) for dependent variables and the relevant interactions from the mixed three-way ANOVAs with time (within-subjects), condition (between-subjects) and
country (between-subjects) (N =79)
Dependent Variable Country Condition Pre-score
M (SD)
M (SD)
2-way interaction:
Time * Condition
3-way interaction:
Time * Condition * Country
Cohen’s d for within-country
pre-post scores in exp. groups
Mindfulness (FMI) F(1,75) =12.88,
p=.001, g2
F(1,75) =0.27,
p=.607, g2
Great Britain Exp. 31.6 (8.6) 40.8 (6.0) -1.25
Cont. 31.0 (7.1) 32.8 (7.8)
Hong Kong Exp. 32.0 (6.7) 37.8 (5.5) -0.95
Cont. 36.6 (6.9) 36.9 (6.3)
F(1,75) =28.56,
p\.001, g2
F(1,75) =3.81,
p=.055, g2
Great Britain Exp. 32.7 (5.6) 36.3 (3.8) -0.76
Cont. 34.0 (3.8) 33.1 (5.0)
Hong Kong Exp. 24.6 (7.8) 33.3 (4.5) -1.41
Cont. 31.2 (3.9) 30.3 (5.0)
Self-compassion (SCS) F(1,75) =57.02,
p\.001, g2
F(1,75) =1.37,
p=.245, g2
Great Britain Exp. 30.9 (8.5) 45.6 (5.2) -2.17
Cont. 35.2 (10.0) 33.3 (9.4)
Hong Kong Exp. 32.9 (7.9) 45.2 (4.9) -1.93
Cont. 37.5 (5.8) 37.6 (7.9)
Meaning in life (MLQ-P) F(1,75) =32.59,
p\.001, g2
F(1,75) =0.70,
p=.406, g2
Great Britain Exp. 21.4 (7.6) 29.8 (3.0) -1.59
Cont. 24.3 (6.2) 22.4 (5.6)
Hong Kong Exp. 17.7 (9.4) 25.0 (6.0) -0.95
Cont. 24.7 (5.5) 24.4 (6.0)
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Table 4 continued
Dependent Variable Country Condition Pre-score
M (SD)
M (SD)
2-way interaction:
Time * Condition
3-way interaction:
Time * Condition * Country
Cohen’s d for within-country
pre-post scores in exp. groups
Positive affect (PANAS) F(1,75) =.32,
p=.571, g2
F(1,75) =1.13,
p=.292, g2
Great Britain Exp. 30.2 (7.6) 32.4 (7.2) -0.30
Cont. 28.5 (7.8) 27.4 (6.8)
Hong Kong Exp. 25.7 (6.4) 24.3 (7.3) 0.22
Cont. 31.0 (7.9) 30.5 (7.3)
Negative affect (PANAS) F(1,75) =45.82,
p\.001, g2
F(1,75) =.97,
p=.328, g2
Great Britain Exp. 23.1 (9.7) 15.9 (5.9) 0.94
Cont. 17.3 (5.5) 21.7 (8.1)
Hong Kong Exp. 28.4 (7.6) 14.6 (4.9) 2.19
Cont. 21.6 (7.8) 23.4 (9.0)
(GB, Experiment)
=22, n
(GB, Control)
=21, n
(HK, Experiment)
=19, n
(HK, Control)
Box’s Tests of Equality of Covariance Matrices were significant for gratitude, self-compassion, presence of meaning in life and negative affect, therefore Pillai’s Trace is
presented for all tests
Exp. =Experiment; Cont. =Control
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4 Discussion
The current study was conducted with a key objective: to test whether the MBFP is cross-
culturally valid. This was represented by two hypotheses: the first was that participation in
the MBFP would lead to significant improvements in six dependent variables for the
experimental groups from both countries, and significantly improve scores in all dependent
variables at post-test when compared to the control groups. The second hypothesis pro-
claimed that the MBFP would be equally effective when comparing results of the exper-
imental group from Hong Kong to the experimental group of Great Britain. Results appear
promising with regards to both cross-cultural validity and program efficacy.
Examining intervention outcomes independently within each cultural stratum, the
MBFP remains effective. Both the British and the Hong Kong Chinese experimental
gr. = Group
T1 T2
T1 T2
T1 T2
Meaning in life
T1 T2
T1 T2
Posive affect
T1 T2
Negave affect
Fig. 2 The mean score for the outcome measures at pre- and post-tests for the experimental and control
groups in the Great Britain and the Hong Kong samples
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groups showed significant improvements, with large effect sizes, in mindfulness, gratitude,
self-compassion, meaning, and negative affect, but no significant improvement in positive
affect. The intention to treat analyses offers the same conclusions, with medium to large
effect sizes. These results support the first hypothesis and provide preliminary support
regarding the efficacy of the MBFP in the context of an Eastern culture.
Similar conclusions could be drawn from the three way interaction (Country 9Con-
dition 9Time) where no significant effects were found for the six dependent variables.
When comparing effect sizes for experimental groups from Britain versus those of Hong
Kong Chinese participants, the results indicate a great similarity: large effect sizes were
found for mindfulness, self-compassion, meaning, and negative affect, for both countries.
For gratitude, there was a minor difference, whereas the effect size in Hong Kong was
large versus a moderate one in Great Britain. These results clearly indicate that the MBFP
had a similar effect in both countries. It could be concluded that the MBFP is associated
with a cross-cultural pattern of benefits, and is valid within a Hong Kong Chinese
It is important to consider these results in the context of the cross-cultural literature
relating to mindfulness. Past studies indicated there might be cultural differences in
relation to the understanding and conceptualization of Mindfulness (e.g., O
¨zyesil 2012;
Christopher et al. 2009a,b). However, MBSR cross-cultural studies found no difference in
the program’s influence when cultures were compared (e.g., Roth and Robbins 2004). The
results of the current study support the MBSR studies’ results and indicate that structured
programs lead to similar results even when the initial understanding of mindfulness might
be different. This would have to be further investigated by future studies, and yet these
results suggest that a structured and balanced program could overcome cultural theoretical
gaps and lead to similar results.
Response analyses indicated that completers differed from non-completers in their pre-
test scores of the wellbeing measures. For example, completers reported lower meaning
and self-compassion, in the pre-test, compared with non-completers. It might be that
participants with greater need for the program found it more relevant and thereby expe-
rienced an increased motivation to complete it. These results are in line with Ivtzan et al.
(2016), where participants with greater need (lower scores of positive variables and higher
scores of negative variables) were more consistent with the practice and gained more from
the program. A similar point of convergence between the studies is the program’s impact
on negative affect. Although the MBFP’s intention is to increase positive variables, it still
influences variables such as stress and depression (Ivtzan et al. 2016). Similarly, the current
study found significant reductions in negative affect. These are important results as they
indicate that a program’s intention focusing on flourishing does not mean that dysphoria is
being neglected. These results are in line with other positive psychology studies where it
has been shown that PPIs are highly effective for depression treatment (Sin and Lyubo-
mirsky 2009).
In summary, not only is the MBFP a program with significant efficacies, but also one
that shows potential for targeting heterogeneous populations. Its validity in the context of
the Hong Kong Chinese culture implies that it is feasible to put the MBFP into practical use
in Eastern cultures, after making appropriate adaptations. For example, the program could
be translated into Chinese in order to reach the proportion of the Chinese population that is
not proficient in English. The MBFP has many practical advantages that will promote easy
implementation. For example, due to the online nature of the MBFP, participants from
across different geographical locations can access it with ease. The incurred cost is also
relatively low as trained personnel are not required for the delivery of the program, nor are
Mindfulness Based Flourishing Program: A Cross-Cultural
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physical materials, such as paper notes or booklets. It is thus concluded that the MBFP is a
promising wellbeing program with a high level of practicality and the potential for cross-
cultural application.
Furthermore, the MBFP can be taken as a convenient tool for future research on the
relationships between mindfulness and wellbeing. Since the MBFP is explicitly designed
with a positive-oriented intention, it would be suitable for investigating the links between
mindfulness and positive variables. Because of the multi-faceted nature of the MBFP,
many different wellbeing variables can be studied in relation to mindfulness. The MBFP’s
cross-cultural validity also makes it possible to apply the program for the study of
mindfulness in other cultures, or to identify intercultural differences in mindfulness.
Although the current study was carried out with the practical intention of testing a
mindfulness-based wellbeing program, it does also serve to strengthen the existing evi-
dence base for the positive effects of mindfulness on wellbeing measures (e.g., Brown and
Ryan 2003; Carson et al. 2004). A host of positive variables were examined, and they all
demonstrated responsiveness to this mindfulness-based program. The versatility of
mindfulness appears encouragingly high in that in addition to its established role in alle-
viating mental distress (e.g. Grossman et al. 2004; Teasdale et al. 2000), it also appears
very useful for human flourishing.
More importantly, findings from this study suggest the benefits of mindfulness practices
are cross-cultural to an extent. While differences exist between cultures in terms of the
definition, practice, and measurement of Mindfulness (e.g. Christopher et al. 2009a,b;
Grossman 2011), it is increasingly evident that regardless of the conceptual fluidity of
mindfulness, the positive effects of mindfulness can transcend cultural boundaries.
A limitation with the sample of this study is its potential lack of generalizability.
Participants were predominantly recruited from health-related settings (i.e. mental health
forums and meditation centres). It is thus possible that participants had a higher than
average awareness of mental health, or greater interest in improving wellbeing. There was
also notable attrition in both countries, across both the experimental and the control groups.
However, the largest portion of the attrition was by participants that did not even complete
the pre-intervention measures, whereas 68.7% of those that completed the pre-intervention
measures also completed the post-intervention measures (which is comparable with Ivtzan
et al. 2016 study).
In addition, a methodological shortcoming of the current study is its reliance on sub-
jective, self-report measures. To assess the MBFP’s efficacy from a more objective per-
spective, future attempts to test the program could incorporate physiological and
behavioural measures that are linked to mindfulness (e.g., Campbell et al. 2012). Lastly,
while the internal consistency of the dependent measures tended to be good across time and
countries, the two-items measure used to screen for depression (the PHQ-2) yielded
unexpectedly poor internal consistency, especially in the Hong Kong sample. This low
reliability may indicate that the screening for depression was not as accurate as anticipated.
Another possible limitation is that the MBFP is delivered in English. Although English
is an official and common language in Hong Kong (Bolton 2000); research indicates it is
favoured by the middle class while those from lower socio-economic groups favour
Cantonese (Lai 2001). This may help explain the high education levels of participants from
Hong Kong. To counter this issue, future research should make the MBFP available in
multiple languages. This will also make it available to a wider audience.
Future research should also focus on the underlying mechanisms of the MBFP, by
measuring savouring and the incremental benefits provided by each element of the inter-
vention. Additional future research should aim to replicate the cross-cultural findings from
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the current study with a larger sample size. To present the MBFP as a truly cross-cultural
intervention, research is needed in other distinctive cultures with the program delivered in
the local language. A plausible starting point would be to test the program in other
primarily Buddhist cultures, such as Thailand and Vietnam.
Compliance with Ethical Standards
Ethical Approval This study received ethical approval from the Research Ethics Committee of the
University of East London, Water Lane, London E15 4LZ.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A
proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241.
Bolton, K. (2000). The sociolinguistics of Hong Kong and the space for Hong Kong English. World
Englishes, 19(3), 265–285.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psycho-
logical well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
Bryant, F. B., & Veroff, J. (2007). Savoring: A new model of positive experience. Mahwah: Lawrence
Erlbaum Associates Inc.
Campbell, T. S., Labelle, L. E., Bacon, S. L., Faris, P., & Carlson, L. E. (2012). Impact of mindfulness-based
stress reduction (MBSR) on attention, rumination and resting blood pressure in women with cancer: A
waitlist-controlled study. Journal of Behavioral Medicine, 35(3), 262–271.
Carson, J. W., Carson, K. M., Gil, K. M., & Baucom, D. H. (2004). Mindfulness-based relationship
enhancement. Behavior Therapy, 35, 471–494.
Census and Statistics Department. (2011). 2011 Population census: Summary results, Hong Kong Special
Administrative Region, People’s Republic of China.
Chan, D. W. (2010). Gratitude, gratitude intervention and subjective well-being among Chinese school
teachers in Hong Kong. Educational Psychology, 30, 139–153.
Chan, W. C. H. (2014). Factor structure of the Chinese version of the meaning in life questionnaire among
Hong Kong Chinese caregivers. Health and Social Work, 39(3), 135–143.
Chen, S. Y., & Zhou, R. L. (2014). Validation of a Chinese version of the freiburg mindfulness inventory-
short version. Mindfulness, 5(5), 529–535.
Chien, W. T., & Thompson, D. R. (2014). Effects of a mindfulness-based psychoeducation programme for
Chinese patients with schizophrenia: 2-year follow-up. The British Journal of Psychiatry, 205(1),
Christopher, M. S., Charoensuk, S., Gilbert, B. D., Neary, T. J., & Pearce, K. L. (2009a). Mindfulness in
Thailand and the United States: A case of apples versus oranges? Journal of Clinical Psychology,
65(6), 590–612.
Christopher, M. S., Christopher, V., & Charoensuk, S. (2009b). Assessing ‘‘Western’’ mindfulness among
Thai Therava¯ da Buddhist monks. Mental Health, Religion and Culture, 12(3), 303–314.
Deci, E. L., & Ryan, R. M. (2008). Hedonia, eudaimonia, and well-being: An introduction. Journal of
Happiness Studies, 9(1), 1–11.
Eysenck, S. B. G., & Chan, J. (1982). A comparative study of personality in adults and children: Hong Kong
vs. England. Personality and Individual Differences, 3(2), 153–160.
Garland, E. L., Farb, N. A., Goldin, P., & Fredrickson, B. L. (2015). Mindfulness broadens awareness and
builds eudaimonic meaning at the attention-appraisal-emotion interface: A process model of mindful
positive emotion regulation. Psychological Inquiry, 26(4), 293–314.
¨kc¸ en, E., Furnham, A., Mavroveli, S., & Petrides, K. V. (2014). A cross-cultural investigation of trait
emotional intelligence in Hong Kong and the UK. Personality and Individual Differences, 65, 30–35.
Grossman, P. (2011). Defining mindfulness by how poorly I think I pay attention during everyday awareness
and other intractable problems for psychology’s (re)invention of mindfulness: Comment on Brown
et al. (2011). Psychological Assessment, 23(4), 1034–1040.
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and
health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35–43.
Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions and organizations
across nations (2nd ed.). Thousand Oaks CA: Sage Publications.
Mindfulness Based Flourishing Program: A Cross-Cultural
Author's personal copy
Hong Kong Yearbook. (2015). Chapter 20: Religion and custom. Hong Kong Government. Retrieved from
Ivtzan, I., & Lomas, T. (2016). Mindfulness in positive psychology: The science of meditation and wellbeing.
London: Routledge.
Ivtzan, I., Young, T., Martman, J., Jeffrey, A., Lomas, T., Hart, R., et al. (2016). Integrating mindfulness into
positive psychology: A randomised controlled trial of an online positive mindfulness program.
Mindfulness, 7(6), 1396–1407.
Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the
practice of mindfulness meditation: Theoretical considerations and preliminary results. General
Hospital Psychiatry, 4(1), 33–47.
Kabat-Zinn, J. (1990). Full catastrophe living: The program of the stress reduction clinic at the University
of Massachusetts Medical Center. New York: Delta.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psy-
chology: Science and Practice, 10(2), 144–156.
Keyes, C. L. (2002). The mental health continuum: from languishing to flourishing in life. Journal of Health
and Social Behavior, 43(2), 207–222.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: Validity of a two-
item depression screener. Medical Care, 41(11), 1284–1292.
Lai, M. L. (2001). Hong Kong students’ attitudes towards Cantonese, Putonghua and English after the
change of sovereignty. Journal of Multilingual and Multicultural Development, 22(2), 112–133.
Lee, K. H., Bowen, S., & Bai, A. F. (2011). Psychosocial outcomes of mindfulness-based relapse prevention
in incarcerated substance abusers in Taiwan: A preliminary study. Journal of Substance Use, 16(6),
Linehan, M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford
Lomas, T., Hefferon, K., & Ivtzan, I. (2014). Applied positive psychology: Integrated positive practice.
London: Sage Publications.
Maxwell, J. P., Sukhodolsky, D. G., Chow, C. C. F., & Wong, C. F. C. (2005). Anger rumination in Hong
Kong and Great Britain: Validation of the scale and a cross-cultural comparison. Personality and
Individual Differences, 39, 1147–1157.
McCullough, M. E., Emmons, R. A., & Tsang, J. (2002). The grateful disposition: A conceptual and
empirical topography. Journal of Personality and Social Psychology, 82, 112–127.
Mikulas, W. L. (2011). Mindfulness: Significant common confusions. Mindfulness, 2, 1–7.
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-
compassion program. Journal of Clinical Psychology, 69(1), 28–44.
Neff, K. D., Pisitsungkagarn, K., & Hsieh, Y.-P. (2008). Self-compassion and self-construal in the United
States, Thailand, and Taiwan. Journal of Cross-Cultural Psychology, 39(3), 267–285.
¨zyesil, Z. (2012). Mindfulness and psychological needs: A cross-cultural comparison. Elementary Edu-
cation Online, 11(1), 151–160.
Parks, A. C., & Biswas-Diener, R. (2013). Positive interventions: Past, present and future. In T. Kashdan &
J. Ciarrochi (Eds.), Mindfulness, acceptance and positive psychology: The seven foundations of
wellbeing (pp. 140–165). Oakland: Context Press.
Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A classification and handbook.
New York: Oxford University Press.
Raes, F., Pommier, E. A., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a
short form of the self-compassion scale. Clinical Psychology and Psychotherapy, 18(3), 250–255.
Ralston, D. A., Gustafson, D. J., Cheung, F. M., & Terpstra, R. H. (1993). Differences in managerial values:
A study of US, Hong Kong and PRC managers. Journal of International Business Studies, 24(2),
Ritchie, T. D., & Bryant, F. B. (2012). Positive state mindfulness: A multidimensional model of mindfulness
in relation to positive experience. International Journal of Wellbeing, 2(3), 150–181.
Roth, B., & Robbins, D. (2004). Mindfulness based stress reduction and health related quality of life:
Finding from a bilingual inner-city patient population. Psychosomatic Medicine, 66(1), 112–123.
Ryan, R. M., & Deci, E. L. (2001). On happiness and human potentials: A review of research on hedonic and
eudaimonic well-being. Annual Review of Psychology, 52(1), 141–166.
Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of
Personality and Social Psychology, 69(4), 719.
Segal, Z. V., Williams, M., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression: A
new approach to preventing relapse. New York: Guilford Press.
I. Ivtzan et al.
Author's personal copy
Seligman, M. E. P., Rashid, T., & Parks, A. C. (2006). Positive psychotherapy. American Psychologist, 61,
Shapiro, D. H. (1992). Adverse effects of meditation: A preliminary investigation of long- term meditators.
International Journal of Psychosomatics, 39(1), 62–67.
Shapiro, S. L. (2009). The integration of mindfulness and psychology. Journal of Clinical Psychology,
65(6), 555–560.
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of
Clinical Psychology, 62(3), 373–386.
Shapiro, S. L., Schwartz, G. E., & Santerre, C. (2002). Meditation and positive psychology. Handbook of
Positive Psychology, 2, 632–645.
Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-be ing and alleviating depressive symptoms with
positive psychology interventions: Apractice-friendly meta-analysis. Journal of Clinical Psychology,
65(5), 467–487.
Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The Meaning in Life Questionnaire: Assessing the
presence of and search for meaning in life. Journal of Counseling Psychology, 53, 80–93.
Swart, J., Winters, D., & Apsche, J. (2014). Mindfulness-based Mode Deactivation Therapy for adolescents
with behavioral problems and complex comorbidity: Concepts in a nutshell and cost-benefit analysis.
Journal of Psychology and Clinical Psychiatry,1(5), 1–31.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000).
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal
of Consulting and Clinical Psychology, 68(4), 615.
Walach, H., Buchheld, N., Buttenmu
¨ller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring mindful-
ness—The Freiburg mindfulness inventory (FMI). Personality and Individual Differences, 40(8),
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive
and negative affect: The PANAS Scales. Journal of Personality and Social Psychology, 47,
Weidong, Z., Jing, D., & Schick, C. (2004). The cross-cultural measurement of positive and negative affect
examining the dimensionality of PANAS. Psychological Science (China), 27, 77–79.
´, C., & Gaylord, S. (2014). The cultural relevance of mindfulness meditation as a health
intervention for African Americans. Journal of Holistic Nursing, 32, 3.
Yu, X., Stewart, S. M., Wong, P. T., & Lam, T. H. (2011). Screening for depression with the Patient Health
Questionnaire-2 (PHQ-2) among the general population in Hong Kong. Journal of Affective Disorders,
134(1), 444–447.
Zainal, N. Z., Booth, S., & Huppert, F. A. (2013). The efficacy of mindfulness-based stress reduction on
mental health of breast cancer patients: A metal-analysis. Psychooncology, 22(7), 1457–1465.
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... Additionally, a study indicated that MBIs could be influenced by cultural practices (Solomon & Esmaeili, 2021). To date, cross-cultural MBIs for Chinese participants have only been studied in Hong Kong (Ivtzan et al., 2018). Accordingly, more MBI-related studies are needed to guide the establishment of culturally relevant psychological interventions that can effectively protect cancer patients' mental well-being in China. ...
... Meanwhile, Tian et al. (2021) reported that cross-culture research on social mindfulness is necessary, and they built a psychological structure of social mindfulness according to Chinese culture. To the best of our knowledge, only one RCT has compared MBIs' effects between Chinese and British participants, documenting the validity of cross-culture differences (Ivtzan et al., 2018). Although our findings also demonstrated MBIs' positive effect, further research on MBIs in Chinese culture is necessary to confirm our findings. ...
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In this study, we sought to evaluate the efficacy of mindfulness-based interventions (MBIs) for anxiety, depression, and quality of life (QoL) among cancer patients in China. Two independent researchers systematically searched major databases for randomized controlled trials (RCTs) examining MBIs’ effectiveness regarding anxiety, depression, and QoL among cancer patients in China. The reviewed databases included CNKI, the WanFang database, VIP Database, PubMed, Embase, Cochrane Library, PsycInfo, and Web of Science. We used the Cochrane risk-of-bias tool to assess the risk of bias, and we used Stata 15.1 for our meta-analysis. In total, 1,796 patients were included in the 18 RCTs we selected and reviewed. Our meta-analysis showed that compared to usual care, MBI can effectively improve anxiety (SMD = − 1.32, 95% CI [− 1.69, − 0.94], p < 0.001), depression (SMD = − 1.21, 95% CI [− 1.52, − 0.89], p < 0.001), and QoL (SMD = 1.09, 95% CI [0.73, 1.44], p < 0.001). Current evidence indicates that MBIs can effectively manage anxiety, depression, and QoL among cancer patients in China. Hence, MBIs should be included as part of the multidisciplinary treatment approach to treat cancer patients in China in order to protect their psychological well-being and QoL.
... Mindfulness Therapy (C-MT: Lo et al., 2015) were excluded. Although compassion integrated interventions have shown to increase self-compassion and/or compassion for others (e.g., Anuwatgasem et al., 2020;Asano et al., 2017;Centeno & Fernandez, 2020;Finlay-Jones et al., 2018;Guo et al., 2020;Ivtzan et al., 2018;Joseph & Bance, 2019), the problem with using an integrated intervention is that in the absence of a comparator control group to assess the impact of the compassion-integrated approach (e.g., mindfulness in C-MT, and CBT in the GCBT with compassion training), it is difficult to differentiate the impact of compassion from the impact caused from the other integrated approaches . Therefore, incorporating studies with a compassionenhancing focus only was a strength of this meta-analysis, as it provided a more precise estimate of the true impact of the compassion intervention on increasing compassion. ...
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The concept and benefits of practicing compassion have been recognised and discussed in the contemplative traditions for thousands of years. However, it is within the last two to three decades, that research and psychotherapy have shown an increased interest in integrating compassion for addressing mental health difficulties and increased well-being. Although heavily influenced by Buddhist philosophy and Eastern traditions, compassion related studies and interventions are mostly developed and applied in the Western communities. In fact, compassion-based studies are particularly scarce in the Asian context. Therefore, whilst briefly outlining the theories and existing compassion-based interventions, this thesis explored the cross-cultural applicability of compassion-based interventions in the Asian communities. A rigorous qualitative investigation discussed that compassion is a culturally embraced concept in Sri Lanka, a Buddhist influenced, collectivistic Asian community, and discussed the challenges Sri Lankan participants (n = 10) experience when practicing compassion. Participants discussed that showing compassion to others was easier than showing compassion to themselves, whilst religion, society, and upbringing influenced these experiences. To understand whether these compassionate experiences are similar across cultures, a cross-sectional quantitative study was conducted among Sri Lankan (n = 149) and UK (n = 300) participants. This study indicated that some similarities (e.g., compassion to and from others, depression, anxiety) and some differences (e.g., self-compassion and self-reassurance, fears of compassion and external shame were higher in the Sri Lankan group, and social safeness was higher in the UK group) existed in the levels of compassion, and facilitators and inhibitors of compassion across the two samples. Therefore, it was important to note that the impact of compassion-based interventions might have cross-cultural differences. To test this, a longitudinal Compassionate Mind Training was implemented among Sri Lankan (n = 21) and UK participants (n = 73), which produced promising results towards increasing compassion for the self and others, along with significant reductions in distress and improvements in well-being in participants across both countries. Thus, this thesis suggests that although research is limited in exploring the cross-cultural applicability of compassion, compassion-based interventions can be used effectively in the Asian communities.
... 2011) to indicate their self-compassion. This scale has been translated into different languages and has shown good reliability in adult samples in different cultures, such as Chinese, British, and Canadian (e.g., Ivtzan et al., 2018;Liu & Hu, 2020;Sbarra et al., 2012). Although the positive and negative components of self-compassion are measured by this scale, a total self-compassion score has typically been used in past research (MacBeth & Gumley, 2012) and is recommended for this scale (Neff, 2016). ...
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In this research, we aimed to investigate the role of trait self-compassion in moderating ostracism’s effect on perceived meaningful existence and perceptual judgments of the environment. Specifically, we conducted two studies to test whether ostracism thwarts meaningful existence, thereby increasing darkness judgment (i.e., judge one’s surrounding lighting as darker). Moreover, we examined whether trait self-compassion moderates the proposed mediation effect such that the effect of ostracism is attenuated among participants with high trait self-compassion. The results showed that participants in the ostracism condition reported less meaningful existence and more darkness judgment than participants in the control conditions did (Studies 1 and 2). Moreover, meaningful existence mediated the effect of ostracism on darkness judgment (Studies 1 and 2). In addition, trait self-compassion moderated the indirect effect such that the mediation effect was observed only among participants with low trait self-compassion (Study 2). The current findings show that trait self-compassion is a potential resource for people to quell the adverse effects of ostracism on psychological well-being and perceptual judgments of the environment.
... It combines mindfulness training with didactic content on self-awareness, positive emotions, self-compassion, self-efficacy, autonomy, relationships, and savoring. Research suggests the program significantly improves mindfulness, well-being, gratitude, compassion, self-efficacy, autonomy, meaning, and savoring compared to waitlist controls (Ivtzan et al., 2016b(Ivtzan et al., , 2018, as well as work-based meaning, authenticity, flow, self-efficacy, and athletic motivation and training satisfaction (Young & Ivtzan, 2019). The Mindfulness-Based Flourishing Program is a promising PP intervention that requires further validation in studies with active control comparators. ...
... There were also inconsistencies when two or more cultures were compared. Ivtzan et al. (2018) tested an 8-week mindfulness program to promote flourishing via mindfulness in the United Kingdom and Hong Kong. Compared to the respective control groups, Hong Kong participants showed a decrease in the positive affect post-intervention, while UK participants demonstrated an increase. ...
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This short opinion piece raises an important point about the universality of mindfulness-based programs. The currently established mindfulness programs delivered worldwide are modeled mainly on the original Mindfulness-Based Stress Reduction program structure. Taken out from its original Buddhist context and developed in the West originally for Western practitioners, mindfulness techniques and definitions are now re-exporting back to Asia, gaining popularity in Asia. Studies in self-construal have pointed out the cultural differences between the West and the East. Hence the suitability of Western-developed programs would need to be re-examined. And there could be significant implications for the design and adaptation of mindfulness-based programs delivered across cultures.
... Individuals having higher levels of mindfulness have higher levels of flourishing. There is a wealth of evidence in the literature that supports the contribution of mindfulness to flourishing [38,39]. In a longitudinal mediation analysis, Duan and Ho (2018) reported that mindfulness improves flourishing [40]. ...
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Introduction: An important research avenue on flourishing is to understand the predictors and mechanisms associated with flourishing. Most evidence has been reported from western countries. However, little is known about whether the relationship between self-compassion and flourishing could be explained through mindfulness in a non-western country. Therefore, this study aimed to examine the mediating role of mindfulness in the association between self-compassion and flourishing in a sample of Arabic speaking adults. Methods: A cross-sectional research design was used to collect data from 396 (50% females) Arab adults recruited from the general public. Participants ranged in age fro 19 and 59 years with a mean age of 30.7 years (SD = 10.3). Participants completed online versions of the Self-Compassion Scale – Short Form, the Freiburg Mindfulness Inventory, and the Flourishing Scale. Results: The results of correlation analysis indicated significant positive correlations among self-compassion, mindfulness, and flourishing. The results of mediation analysis showed that self-compassion significantly predicted mindfulness and flourishing. Mindfulness also significantly predicted flourishing. Mediation analysis supported the hypothesis that mindfulness played a mediating role between self-compassion and flourishing. Discussion: The results suggest the importance of mindfulness in understanding the association between self-compassion and flourishing. Intervention efforts aimed at improving flourishing may benefit from increased mindfulness and self-compassion. Take-home message: In this study, individuals with high levels of self-compassion experienced more mindfulness and flourishing in their lives.
... It combines mindfulness training with didactic content on self-awareness, positive emotions, self-compassion, self-efficacy, autonomy, relationships, and savoring. Research suggests the program significantly improves mindfulness, well-being, gratitude, compassion, self-efficacy, autonomy, meaning, and savoring compared to waitlist controls(Ivtzan et al., 2016b;Ivtzan et al., 2018), as well as work-based meaning, authenticity, flow, self-efficacy, and athletic motivation and training satisfaction(Young & Ivtzan, 2019). The Mindfulness-Based Flourishing Program is a promising PP intervention that requires further validation in studies with active control comparators. ...
... Therefore, it is necessary to have measures that can be used to assess changes in mindfulness in different cultures (Raphiphatthana et al., 2019). Cross-cultural studies have shown that people with different cultural backgrounds differ in the conceptualization and experiences of mindfulness (Ivtzan et al., 2018). For example, it has been reported that U.S. students had greater psychological needs and were more aware than Turkish students (Özyeşil, 2012). ...
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The Spanish version of the 5-item Mindful Attention Awareness Scale (MAAS-5) is a brief measure of the general tendency to be attentive and aware of experiences in the present moment during daily life. The MAAS-5 has been used in different countries; however, an assessment of its cross-cultural measurement invariance (MI) has not been conducted. Therefore, the study aimed to evaluate the cross-cultural measurement invariance of the MAAS-5 in university students from two countries: Peru and Mexico. A total of 1144 university students from Peru ( N = 822) and Mexico ( N = 322) responded online to the Spanish version of the 5-item Mindful Attention Awareness Scale (MAAS-5). A multigroup confirmatory factor analysis was performed. Measurement invariance tests the hypothesis that the model behind a set of scores is comparable between groups. The results showed that the unidimensional structure of the MAAS-5 is the same between Peruvian and Mexican university students. Therefore, it is suggested that university students from both countries conceptualize the mindfulness in a similar way. As a result, the MAAS-5 can be used to compare differences between countries. No significant differences were observed in the MAAS-5 score between Peruvian and Mexican university students. The present study contributes to a better understanding of the psychometric properties of the MAAS-5 by presenting MI results in two Latin American countries. Implications of the findings are discussed, which will facilitate a more solid and reliable use of the MAAS-5 in future cross-cultural studies.
Objectives The COVID-19 pandemic has had negative mental health impacts. Online psychological interventions can facilitate rapid access to mental health resources. This study examined the outcomes of a 4-lesson, self-help online mindfulness course during the early months of the pandemic in Australia. Methods 5058 adults commenced the Introduction to Mindfulness course and completed measures of psychological distress (Kessler-10) and wellbeing (Short Warwick-Edinburgh Mental Well-being Scale). 3696 individuals commenced their course between 2016 and 2019 (“pre-COVID” group), while 1362 started their course between 12 March 2020 and 31 July 2020 (“during-COVID” group). Results Participants in the during-COVID-pandemic group reported slightly lower levels of psychological distress and higher levels of wellbeing compared to the pre-COVID group. In both groups, the mindfulness course was associated with medium effect size reductions in psychological distress (g = .49-.55) and small effect size improvements in wellbeing (g = .27-.41). Conclusions The mindfulness course was associated with reduced psychological distress before and during the pandemic. Results underscore the generalisability of online mindfulness interventions to pandemic situations. KEY POINTS What is already known about this topic: • The mental health impacts associated with the COVID-19 pandemic have been substantial. • Mental health service provision has adapted to meet community health needs in the wake of the pandemic. • It is unclear if the effectiveness of online mental health interventions will generalise to pandemic conditions. What this paper adds: • The outcomes of an online mindfulness course were explored. • The course was associated with improved psychological distress and wellbeing both before and during the COVID-19 pandemic in Australia. • Results highlight the utility of digital mental health services during COVID-19.
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In four studies, the authors examined the correlates of the disposition toward gratitude. Study 1 revealed that self-ratings and observer ratings of the grateful disposition are associated with positive affect and well-being prosocial behaviors and traits, and religiousness/spirituality. Study 2 replicated these findings in a large nonstudent sample. Study 3 yielded similar results to Studies 1 and 2 and provided evidence that gratitude is negatively associated with envy and materialistic attitudes. Study 4 yielded evidence that these associations persist after controlling for Extraversion/positive affectivity, Neuroticism/negative affectivity, and Agreeableness. The development of the Gratitude Questionnaire, a unidimensional measure with good psychometric properties, is also described.
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The purpose of the present study was to test the efficacy of an 8-week online intervention-based Positive Mindfulness Program (PMP) that integrated mindfulness with a series of positive psychology variables, with a view to improving well-being scores measured in these variables. The positive mindfulness cycle, based on positive intentions and savouring, provides the theoretical foundation for the PMP. The study was based on a randomised wait-list controlled trial, and 168 participants (128 females, mean age = 40.82) completed the intervention which included daily videos, meditations and activities. The variables tested included well-being measures, such as gratitude, self-compassion, self-efficacy, meaning and autonomy. Pre- and post-intervention data, including 1 month after the end of the intervention, were collected from both experimental and control groups. The posttest measurements of the experimental participants showed a significant improvement in all the dependent variables compared with the pre-test ones and were also significantly higher than those of the control group. One month after the intervention, the experimental group participants retained their improvement in 10 out of the 11 measurements. These positive results indicate that PMP may be effective in enhancing wellbeing and other positive variables in adult, non-clinical populations.
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Contemporary scholarship on mindfulness casts it as a form of purely nonevaluative engagement with experience. Yet, traditionally mindfulness was not intended to operate in a vacuum of dispassionate observation, but was seen as facilitative of eudaimonic mental states. In spite of this historical context, modern psychological research has neglected to ask the question of how the practice of mindfulness affects downstream emotion regulatory processes to impact the sense of meaning in life. To fill this lacuna, here we describe the mindfulness-to-meaning theory, from which we derive a novel process model of mindful positive emotion regulation informed by affective science, in which mindfulness is proposed to introduce flexibility in the generation of cognitive appraisals by enhancing interoceptive attention, thereby expanding the scope of cognition to facilitate reappraisal of adversity and savoring of positive experience. This process is proposed to culminate in a deepened capacity for meaning-making and greater engagement with life.
Mindfulness in Positive Psychology brings together the latest thinking in these two important disciplines. Positive psychology, the science of wellbeing and strengths, is the fastest growing branch of psychology, offering an optimal home for the research and application of mindfulness. As we contemplate mindfulness in the context of positive psychology, meaningful insights are being revealed in relation to our mental and physical health. The book features chapters from leading figures from mindfulness and positive psychology, offering an exciting combination of topics. Mindfulness is explored in relation to flow, meaning, parenthood, performance, sports, obesity, depression, pregnancy, spirituality, happiness, mortality, and many other ground-breaking topics. This is an invitation to rethink about mindfulness in ways that truly expands our understanding of wellbeing. Mindfulness in Positive Psychology will appeal to a readership of students and practitioners, as well as those interested in mindfulness, positive psychology, or other relevant areas such as education, healthcare, clinical psychology, counselling psychology, occupational psychology, and coaching. The book explores cutting edge theories, research, and practical exercises, which will be relevant to all people interested in this area, and particularly those who wish to enhance their wellbeing via mindfulness