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Applications of mindfulness toward promoting psychosocial health in diverse communities

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Applications of mindfulness toward promoting psychosocial health in diverse communities

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Applications of Mindfulness toward Promoting Psychosocial Health
in Diverse Communities
__________________________________________
Dissertation for the PhD Program
in Health Behavior Research, Preventive Medicine
For degree conferral on August 8, 2017
__________________________________________
By
Michael Jonathan Li, PhD(c), MPH

Division of Health Behavior Research
Department of Preventive Medicine
Faculty of the USC Graduate School
Keck School of Medicine
University of Southern California

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Table of Contents
Acknowledgements ..........................................................................................................................4
Introduction ......................................................................................................................................5
Introduction to the dissertation studies ..........................................................................6
Specific aims ..................................................................................................................9
Operational definitions.................................................................................................10
Chapter
1. Seeking refuge from minority stress: A grounded theory analysis of dispositional
mindfulness in Latino/a sexual minorities and their families ............................................12
Background ..................................................................................................................13
Methods........................................................................................................................19
Results ..........................................................................................................................23
Discussion ....................................................................................................................42
2. Dispositional mindfulness in Latino/a parents: Interactions with parent histories of
potentially traumatic events and psychosocial health in their children .............................48
Background ..................................................................................................................49
Methods........................................................................................................................51
Results ..........................................................................................................................55
Discussion ....................................................................................................................59
3. Using the Applied Mindfulness Process Scale (AMPS) to evaluate daily life application
of mindfulness skills in Mindful USC participants: Effects on within-person changes in
dispositional mindfulness, distress, wellbeing, and concentration ....................................63
Background ..................................................................................................................64
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Methods........................................................................................................................66
Results ..........................................................................................................................74
Discussion ....................................................................................................................82
Conclusions ....................................................................................................................................87
Appendix I .....................................................................................................................................91
Appendix II ....................................................................................................................................93
References ......................................................................................................................................96
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Acknowledgements
I would like to thank my dissertation committee members, Dr. Ricky Bluthenthal, Dr. David
Black, Dr. Anthony DiStefano, Dr. Jennifer Unger, Dr. Chih-Ping Chou, and Dr. Joel Milam, for
their invaluable guidance, wisdom, and knowledge. I would also like to thank Marny Barovich
and the Health Behavior Research Program for providing a welcoming and supportive
environment for my education. I would like to acknowledge the Scientific and Community
Advisory Boards of Partners for Strong, Healthy Families, Bienestar Human Services, Karina
Dominguez, and Kelsey Simpson for their contributions to these studies. This dissertation was
supported by the USC Russell Endowed Fellowship and the American Mindfulness Research
Association Professional Development Award. Lastly, thank you to my husband, Robert, for
believing in me and supporting me through my journey into public health research.
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Introduction

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Introduction to the dissertation studies
The construct of mindfulness refers to a metacognitive state or trait characterized by
attention and self-regulation in the present moment, free of preoccupations and judgment (Kabat-
Zinn, 2003). There is growing scientific interest in mindfulness because of its protective benefits
against various mental and physical ailments including stress, mood disorders, anxiety,
addiction, and pain (Black, 2012, 2014; Brown & Ryan, 2003; Brown, Ryan, & Creswell, 2007;
Chiesa & Serretti, 2009; Day, Jensen, Ehde, & Thorn, 2014). Mindfulness also is recognized for
its salutogenic qualities, particularly its association with psychological wellbeing, quality of life,
and improved immune functioning (Black & Slavich, 2016; Brown & Ryan, 2003; Garland,
Farb, Goldin, & Fredrickson, 2015). Mindfulness-based interventions (MBIs) include various
mind-body practices aimed toward cultivating mindfulness and improving symptomology
(Chiesa, Anselmi, & Serretti, 2014), with particular effectiveness against stress-related ailments
(Chiesa & Serretti, 2009).
Although researchers have shown increasing interest in MBIs and mindfulness-based
research (Chiesa, 2013; Chiesa et al., 2014), there are still questions about the how mindfulness
can be used in vulnerable populations and the mechanisms of action by which mindfulness can
bring about desired health outcomes in these populations. Considering that many minority
groups in including are The body of research around how mindfulness can benefit minority
populations is in its nascent stages (Black & Fernando, 2014; Hinton, Ojserkis, Jalal, Peou, &
Hofmann, 2013; Liehr & Diaz, 2010; Lyons, 2016). Even more unclear is how mindfulness can
prevent negative health outcomes that result from minority-related stress, but some evidence
suggests a buffering effect against minority stress outcomes (Lyons, 2016). Research is needed
to explore the modes by which dispositional mindfulness or the lack to dispositional mindfulness
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may come into play in the context of experiences of minority stress and related health behaviors
and psychosocial health outcomes.
Furthermore, a growing body of research suggests that the benefits of dispositional
mindfulness extend to the interpersonal level, such as between family members. In particular,
dispositional mindfulness has shown to be associated with positive parenting styles, positive
perceptions of the parent-child relationship (Coatsworth, Duncan, Greenberg, & Nix, 2010;
Duncan, Coatsworth, & Greenberg, 2009; Parent, McKee, Anton, et al., 2016; Parent, McKee, N.
Rough, & Forehand, 2016), and in turn, lower levels of psychological problems (Bögels,
Hoogstad, van Dun, de Schutter, & Restifo, 2008; Parent et al., 2010) and greater levels of
wellbeing in children (Medeiros, Gouveia, Canavarro, & Moreira, 2016).
Some uncertainty remains about how MBIs in general work—that is, whether the
reported benefits of MBIs are due to changes in mindfulness and mindfulness practice itself, or
exposure to other ‘non-specific’ content in the MBI (Chiesa et al., 2014). Some studies have
attempted to parse out the specific benefits of MBIs by testing MBIs in randomized control trials
against “active” comparison groups. Still, it may be unclear whether the differing benefits
between an MBI and another intervention are due to the mindfulness-content itself or other
characteristics of the MBI. In order to clarify which MBI components are best suited and most
helpful for participants, researchers recommend evaluating which practices are most often are
employed by MBI participants in everyday circumstances, as well as the degree to which those
practices improve desired health outcomes and behaviors (Chiesa et al., 2014; Dimidjian &
Linehan, 2003).
In three dissertation studies, I examined: (a) the relevance of dispositional mindfulness as
a stress-ameliorating factor in the context of the minority experience; (b) the interpersonal effects
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of dispositional mindfulness in parents on improvements in psychosocial health in their children;
and (c) the importance of mindfulness practice in cultivating mindfulness as a construct in
relation to health outcomes and health behaviors.

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Specific aims
In order to elucidate the potential applications of mindfulness towards promoting
psychosocial minority communities and mechanisms of action of MBIs, three dissertation studies
addressed the following specific aims:
Chapter 1 aim: To explore how dispositional mindfulness can manifest (or be absent) in
Latino/a sexual minority young adults, and how mindfulness domains based on the Five
Facet Mindfulness Questionnaire (FFMQ) (Baer, Smith, Hopkins, Krietemeyer, & Toney,
2006) affect the experience of minority stress and related health outcomes.
Chapter 2 aim: To test whether dispositional mindfulness in parents was associated with
psychosocial health outcomes in their children at baseline and 3-month follow-up.
Chapter 3 aim: To test the effects of mindfulness practice in daily life situations on
changes in dispositional mindfulness and measures of distress, psychological wellbeing,
and concentration, and whether changes in trait mindfulness mediates the effects of
mindfulness process on these study outcomes.
Figure 0.1 displays the overarching conceptual framework for these three dissertation studies and
their corresponding aims, as well as the intersection of these study aims.

Figure 0.1. Conceptual framework for the three dissertation studies

Note: 1 = Chapter 1 aim; 2 = Chapter 2 aim; 3 = Chapter 3 aim
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Operational definitions
Dispositional mindfulness
Dispositional mindfulness refers to the trait or characteristic of having attention and
awareness of the present, free of judgements and preoccupations (Brown & Ryan, 2003). The
construct of dispositional mindfulness is a secular scientific interpretation of concepts derived
from Buddhism including the dharma, the laws of reality, or tao, referring to reality as is (Brown
& Ryan, 2003). Therefore, the essence mindfulness is insight, in particular, an objective
perspective look at one’s thoughts, feelings, and circumstances.
Applied mindfulness
The term mindfulness practice is often used in mindfulness research to refer to the array
of formal meditative practices used to achieve or cultivate states or traits of mindfulness
(Dimidjian & Linehan, 2003; Kabat-Zinn, 2003). However, Dimidjian and Linehan (2003) and
Kabat-Zinn (2003) emphasize that informal mindfulness practices nested in daily life situations
(e.g., mindful eating, mindful waiting, mindful working) are equally valuable in cultivating
moment to moment, nonreactive and nonjudgmental awareness, especially for purposes of
adapting to difficult situations. Therefore, in this dissertation, we employ the term applied
mindfulness to refer to any formal and informal applications of mindfulness skills in the context
of daily living, and measure practice using a process measure that encapsulates many of these
applications (Li, Black, & Garland, 2016). Alongside applied mindfulness, we operationalize the
dispositional mindfulness measure, the Mindful Attention Awareness Scale (Brown & Ryan,
2003), to elucidate mechanisms of change.

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Minority stress
Minority stress was originally coined by Meyer (1995) to describe the social and internal
burden of gay men, due to experiences of discrimination, rejection, and prejudice. Eventually,
the concept of minority stress evolved into a theory illustrating the excess stress of being of any
minority status or intersection of minority statuses (e.g., racial, ethnic, religious, gender-identity,
sexuality-based, etc.) and the impact of that stress on health (Meyer, 2003). Meyer (2003)
differentiates between two types of minority stress: (a) distal minority stress refers to external
experiences or social forces that oppress those of minority status, including overt discrimination,
indirect discrimination, violence, or societal disadvantage; (b) proximal minority stress refers to
internal experiences of minority stress (e.g., internalized prejudice, fear of rejection, shame,
repression of one’s identity, etc.) and is often associated with prior or current by experiences of
distal minority stress (Meyer, 2003). Using in-depth semi-structured interviewing, we
qualitatively captured experiences of minority stress in Latino/a sexual minorities.
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Chapter 1

Seeking refuge from minority stress: A grounded theory analysis of dispositional

mindfulness in Latino/a sexual minorities and their families

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Background
Among sexual minorities—people whose sexual identities, orientations, or behaviors
differ from the heterosexual majority—the excess stress resulting from social and environmental
prejudice and disadvantage has been described as minority stress (Meyer, 1995, 2003). The term
minority stress may also pertain to social stress in other minority populations, such the
experiences of racism among Latino/a, Black, and other racial minorities, the experiences of
transphobia in transgender persons, or any combination of minority statuses. The Minority Stress
Model explains minority stress processes in two levels. First, distal minority stress processes
refer to interpersonal and societal forces in the form of prejudice, hostility, isolation, and other
forms of disadvantage (Meyer, 2003), whether intentionally or unintentionally imposed by others
(Nadal et al., 2011). Second, proximal minority stress refers to intrapersonal struggles with one’s
sexual minority status, including repression, fear of rejection, and internalized homonegativity
(Meyer, 2003). Among sexual minorities, minority stress is linked to a myriad of mental health
problems and health-risk behaviors, including depression, suicidality, substance abuse, and
sexual risk behaviors (Li, Distefano, Mouttapa, & Gill, 2014; Mereish, O'Cleirigh, & Bradford,
2014; Meyer, 1995, 2003; Mustanski & Liu, 2013; O'Donnell, Meyer, & Schwartz, 2011;
Russell, Ryan, Toomey, Diaz, & Sanchez, 2011).
The Minority Stress Model also acknowledges stress-ameliorating processes that
reduce/buffer minority stress (Meyer, 2003). These include personal-level factors such as
resilience and individual coping styles (Kosciw, Palmer, & Kull, 2015; Kuper, Coleman, &
Mustanski, 2014; Smith & Gray, 2009), and group-level factors such as social support,
institutional support, and community resources (Gray, Mendelsohn, & Omoto, 2015; McConnell,
Birkett, & Mustanski, 2015; Snapp, Watson, Russell, Diaz, & Ryan, 2015). Researchers have
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expressed growing interest in exploring various ways to integrate resilience and positive
psychology research in the Model of Minority Stress towards improving adaptation and health
outcomes (Meyer, 2014; Vaughan et al., 2014; Vaughan & Rodriguez, 2014).
Minority stress processes in Latino/a sexual minorities
It is important to consider how the dual minority status of Latino/a sexual minorities can
shape minorities stress processes and in turn, how those processes can affect their health
outcomes. As with other sexual minorities, experiences of homophobic victimization in
Latinos/as exacerbate their risk of mental health problems, substance use, and sexual risk
behaviors (Ryan, Huebner, Diaz, & Sanchez, 2009). Prejudice can also take on indirect forms,
also termed microaggessions, which have also been reported as distressing and even threatening
experience among Latino/a sexual minorities (Li, Thing, Galvan, Gonzalez, & Bluthenthal,
2017). Latino/a sexual minorities have been found to be at greater risk of suicidal behaviors than
other sexual minorities despite reporting similar levels of depression as other sexual minorities
(with the exception of African Americans) (O'Donnell et al., 2011). Extant literature provides
mixed evidence for differences in stigmatizing experiences between Latino/a sexual minorities
and their non-Latino peers. For example, some studies have found that Latino/a sexual minorities
experience more internalized homonegativity (Barnes & Meyer, 2012), social stress (Meyer,
Schwartz, & Frost, 2008), and family rejection (only in Latino men) (Ryan et al., 2009) than
non-Latinos/a sexual minorities. In contrast, findings from the Human Rights Campaign (HRC)
Youth Survey Report of sexual minority youth show similar rates of family acceptance and
rejection in Latinos/as (Human Rights Campaign, 2013b) compared to the general sample
participants (Human Rights Campaign, 2013a). Meyer et al. (2008) found that Latino/a sexual
minorities experienced greater racial prejudice but not greater sexual minority prejudice than
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their White peers, and Velez, Moradi, and DeBlaere (2015) further explained that some of the
excess social stress in Latino/a sexual minorities can be attributed to the additive and interactive
effects of racial bias and sexual minority stigma.
Mindfulness and minority stress
Pachankis (2014) has called for the integration of a minority stress framework into
mental health care for sexual minorities in order to provide affirming care that validates their
experiences and burdens in society. Integration of mindfulness—which is characterized by
having present-centered nonjudgmental awareness and attention (Brown et al., 2007)—into the
Minority Stress Model may elucidate salient modes of adaptation against minority-specific stress
for Latino/a and sexual minorities. In general, mindfulness has been found to be a protective trait
against stress, mood and anxiety disorders (Brown & Ryan, 2003; Brown et al., 2007; Chiesa &
Serretti, 2009), addiction (Black, 2012, 2014), and pain (Day et al., 2014) and a positive correlate
of self-control (Black, Semple, Pokhrel, & Grenard, 2011), psychological and subjective
wellbeing (Hanley, Warner, & Garland, 2015), and eudaimonic happiness (wellbeing around
sense of self and functioning) (Garland et al., 2015).
Research into the utility of mindfulness within the context of the minority experience is
sparse but growing (Black & Fernando, 2014; Brown-Iannuzzi, Adair, Payne, Richman, &
Fredrickson, 2014). Cross-sectional analyses of a sample of 605 adults indicated that
dispositional mindfulness attenuated the effect of perceived discrimination on depressive
symptoms (Brown-Iannuzzi et al., 2014). However, implications are somewhat limited by the
small proportion racial minorities in the sample (n = 127) and the absence of stratification by
racial minority status (Brown-Iannuzzi et al., 2014). Womack and Sloan (2017) identified a link
between past exposure to affirming racial socialization messages, greater dispositional
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mindfulness, and greater adaptive coping strategies in African American adults, though future
research is needed to explore these implications for other minority communities. Furthermore,
among Latino/a youth specifically, dispositional mindfulness appears to be protective against
perceived stress and depression while promoting self-compassion (Edwards, Adams, Waldo,
Hadfield, & Biegel, 2014). In cross-sectional studies, reported past experiences of
discrimination were associated with negative psychological outcomes in Latino/a sexual minority
youth (Toomey & Anhalt, 2016) and older gay men (Lyons, 2016) with low dispositional
mindfulness, while those with high mindfulness were protected against this association. In
longitudinal research of HIV-positive gay men, increases in mindfulness appeared to coincide
with improvement in positive affect and reductions in avoidance and depression (Gayner et al.,
2012).
However, there remains some uncertainty around the which facets of mindfulness shape
how racial/sexual minorities adapt to stressful experiences from their minority status, as well as
how those facets function in this context. Further research is necessary to elucidate how various
facets and processes of mindfulness (Baer et al., 2006; Chiesa et al., 2014) manifest and inform
adaptive strategies in the face of minority stress in Latino/a sexual minorities.
Mindfulness in the family
Research into the interpersonal benefits of dispositional mindfulness show evidence that
dispositional mindfulness in family members is linked to improved perceptions of family
relations, especially in parent-child relationships (Coatsworth et al., 2010; Duncan et al., 2009;
Parent, McKee, Anton, et al., 2016; Parent, McKee, N. Rough, et al., 2016). Dispositional
mindfulness may be a particularly important determinant of supportive social environments in
families with sexual minority family members. A few studies have shown that mindfulness levels
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appear to coincide with lower levels of self-reported prejudices (Hunsinger, Livingston, & Isbell,
2014) and positive behavioral intentions towards others of different racial or ethnic backgrounds
(Lillis & Hayes, 2007). Pachankis, Skinta, and Curtin (2016) have proposed that mindfulness
may be a promising mode for fostering acceptance of sexual minority family members. Still
there is a dearth of literature elucidating the link between mindfulness and acceptance of sexual
minorities within families.
Alternative theoretical perspectives
As previously mentioned, in the Minority Stress Model, the construct of resilience is
acknowledged as a mode of protection against experiences of minority stress (Li et al., 2017;
Meyer, 2003, 2014). Levitt et al. (2016) used grounded theory to expand upon the resilience
component of the Minority Stress Model. The authors theorized that resilience against minority
stress is a costly process for sexual minorities, and involves continual risk evaluation and
adaptive “choices” between authenticity (e.g., coming out, being in a same-sex relationship) and
self-determination (e.g., maintaining one’s reputation, avoiding backlash). In other words, among
sexual minorities, resilience is a calculated decision-making process to minimize conflict and
suffering.
The “resilience as choice” model offers a compelling explanation of how sexual
minorities consciously adapt to heteronormative social environments. However, integration of
dispositional mindfulness into the Minority Stress Model may elucidate traits in sexual
minorities that optimize their success in evaluating their circumstances and adapting to those
circumstances with awareness. Moreover, dispositional mindfulness offers modes of adaptation
that do not require decisive action—such as comfort in simply “being” (Brown & Ryan, 2003)—
which may be particularly value in circumstances that are beyond one’s control. For example, a
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person often cannot control whether their racial identity is known to others, nor can they control
others’ biased opinions regarding race.
Purpose of the study
Figure 1.1 displays the preliminary conceptual framework for Chapter 1. The deductive
aims of Chapter 1 are to use qualitative investigation to determine whether different facets of
dispositional mindfulness in Latino/a sexual minority young adults can have protective benefits
against minority stress, and to determine whether different facets of dispositional mindfulness in
family members foster positive and/or supportive behavior towards of Latino/a sexual minority
young adults. The inductive aims of Chapter 1 are to use grounded theory to explore and
describe in detail how various facets of dispositional mindfulness manifest and operate in the
context of minority stress among Latino/a sexual minority young adults, and to explore and
describe in detail how various facets of dispositional mindfulness manifest and operate in the
family members’ relationships with Latino/a sexual minority young adults.

Figure 1. Proposed integrated conceptual model of mindfulness and minority stress in Latino/a
sexual minority young adults and family members
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Methods
Participants and procedures
We recruited at total of 60 participants consisting of 21 lesbian, gay, bisexual, and other
sexual minority young adults of Latino/a heritage, as well as 15 family members of Latino/a
heritage with family members of sexual minority status for semi-structured qualitative
interviews. Sexual minority participants were screened for the following eligibility criteria prior
to participation: (1) 18 to 29 years of age; (2) Latino/a or mixed-Latino/a heritage; (3) residence,
school attendance, or employment in the East Los Angeles area; (4) identify as cisgender (of the
same gender identity as assigned at birth) male or female; and (5) identify with a non-
heterosexual orientation. Family member participants were eligible for the study if they reported:
(1) being a family member of a sexual minority via consanguinity (blood relation), affinity, or
legal guardianship; (2) Latino/a or mixed-Latino/a heritage; (3) school attendance, or
employment in the East Los Angeles area. We recruited participants through local community-
based organizations, colleges, and snowball sampling through participant referrals. We formed a
community-advisory board of Latino/a sexual minority youth and adults from school
organizations and community-based organizations in the East Los Angeles area to assist with
recruiting, development of interview guide and domains, and interpretation of findings.
Interviewers read aloud the informed consent, provided explanation in lay-person language, and
provided a written copy of the study description. Participants provided their verbal consent prior
to being interviewed. All interviews were audio recorded and transcribed by a third party
professional. We remunerated participants with a $50 gift card upon completion of their
interviews. All research procedures for the present study are approved by the Institutional
Review Board of the University of Southern California and the Los Angeles County Department
of Public Health.
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Interview domains
The interviews used a life history format to explore the chronological experiences of
sexual identity development, minority stress, and mindfulness in Latino/a sexual minority young
adults and family participants as they shared recollections from childhood to present day. Use of
a life history approach to interviewing was helpful for subsequent ground theory analysis, as it
allows researchers to chronologically capture past patterns of experiences, thoughts, feelings, and
behavior, and how those patterns may have influenced subsequent decisions later in life
(Hagemaster, 1992). Our interview guide integrated domains from Minority Stress Theory and
mindfulness research (Baer et al., 2006; Baer et al., 2008; Li et al., 2016), including (a) distal
minority stress processes, (b) proximal minority stress processes, (c) the five facets of
mindfulness, (d) coping behaviors, (e) minority identification, and (f) health outcomes as
illustrated in our proposed conceptual model shown in Figure 1. Appendix I lists questions used
to explore minority stress and dispositional mindfulness in the interviews.
Experiences of distal minority stress process were explored with questions such as “What
was it like being a Latino/a in your school/workplace?”, “How did people treat you when they
suspected you were [sexual identity]? (sexual minority participants only),” “How were you
treated compared to your heterosexual peers in school? (sexual minority participants only),” and
“How safe was your neighborhood for [sexual identity] people?”. Experiences of proximal
minority stress processes were explored with questions such as “How did you feel about your
cultural identity when you started attending school in the U.S.?” (immigrant participants only),
“How did you feel about being Latino/a and U.S. born?” (U.S. born only), and “How
comfortable were you sharing your sexual identity with other people?” (sexual minority
participants only). We asked family members about their internal and external experiences
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having a sexual minority family member. Examples of questions included “How did you respond
when s/he came out to you?” and “How do you feel about having a [sexual orientation] family
member?”
The five facets of trait mindfulness—describe, act with awareness, non-judge, non-react,
and observe—are traditionally assessed using the quantitative Five-Facet Mindfulness
Questionnaire (FFMQ) (Baer et al., 2006; Baer et al., 2008). For the present study, we adapted
the FFMQ to develop open-ended questions and probes for qualitative inquiry geared toward
non-practitioner sexual minorities. The following are examples of mindfulness-related interview
questions included in our interview guide: “How well have you been able to focus on your
tasks/responsibilities?” to explore act with awareness; “What did you do when you felt that
way?” to explore non-react; “What was it like putting those feelings/thoughts into words?” to
explore describe; “What sensations did you notice during that experience?” to explore observe;
and “How did you feel about yourself when you were thinking those things?” to explore non-
judge.
Analysis
We conducted both deductive content analysis and grounded theory analysis (Glaser,
1978) using ATLAS.ti Version 7 (Scientific Software Development, 2014). Two researchers
performed coding and cross-checked assignment of codes to quotes to ensure consistency and
discussed any coding discrepancies until reaching consensus. The researchers discussed
emerging themes, development of appropriate nomenclature to describe themes and patterns
around multiple mindfulness facets in the context of minority stress, and well as cross-checking
assignment of themes to quotes. The community advisory board participated in discussion and
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interpretation of patterns and new themes. Participants were assigned pseudonyms to accompany
any quotations reported in the study results.
Several steps were involved in using content analysis to deductively determine whether
various facets of dispositional mindfulness appeared to benefit adaptation to minority stress and
family member relationships. Firstly, we identified and coded instances of minority stress as well
as any of the five facets of mindfulness previously defined by the FFMQ (Baer et al., 2006; Baer
et al., 2008) that emerged within the transcripts. We also coded instances of “mindlessness,” or
absence of mindfulness facets in the interviews. Next, guided by our conceptual model shown in
Figure 1, we generated memos within transcripts to identify positive cases of dispositional
mindfulness in sexual minorities and adaptation to minority stress, as well as positive cases of
dispositional mindfulness in family members and supportive behavior toward sexual minorities.
We also generated memos to identify negative cases (i.e., mindlessness and maladaptive coping)
in sexual minorities and family members. To facilitate analysis of dispositional mindfulness
facets within and between participants, we tabulated a matrix of both positive and negative cases
across all participants reported in our results. Positive cases of dispositional mindfulness facets
referred to emergence of one or more of the following at qualities of mindfulness as defined by
Baer et al. (2006): acting with awareness, non-react, non-judge, describe, and observe. Negative
cases encompassed any deficiencies of dispositional mindfulness facets—act without awareness,
reactivity, judge, difficulties describing, and difficulties observing—that emerged in the
transcripts.
In the present study, we used grounded theory to explore how various dispositional
mindfulness facets “appeared” and operated in the context of minority stress and family
relationships, as well as how mindfulness facets interacted with or influenced each other.
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Grounded theory—which involves identifying patterns, themes, and a theoretical model that
inductively emerges from the data (Glaser, 1978, 1992)—has been used to in extant qualitative
research to evolve the original Minority Stress Model (Meyer, 2003), such as elucidating the
distal and proximal minority stress processes in Latino/a sexual minorities (Holloway, Padilla,
Willner, & Guilamo-Ramos, 2015) and the process of resilience in lesbian, gay, and bisexual
(LGB) adults (Levitt et al., 2016). We generated memos to capture emerging themes or
theoretical pathways between different facets of mindfulness, minority stress experiences, and
outcomes. We also generated memos to capture any patterns of minority stress in the absence of
mindfulness among negative cases. Overall findings from grounded theory analysis were
summarized in a comprehensive ground theory model of dispositional mindfulness and minority
stress (shown in Figure 1.2) that expanded upon our preliminary conceptual model (shown in
Figure 1.1)
Results
Mindfulness and minority stress in Latino/a sexual minorities
The lesbian, gay, and bisexual Latino/a young adults who shared their life histories
described how they have responded to minority stress and other life challenges, and the aspects
of dispositional mindfulness that were present or absent during their life events. All five facets of
dispositional mindfulness (Baer et al., 2006; Baer et al., 2008) emerged among positive cases of
sexual minority participants. As shown in Table 1.1, multiple facets of dispositional mindfulness
appeared to coincide within participants. Some facets of dispositional mindfulness appeared to
function together in the face of minority stress, and the manifestation of one or more mindfulness
facets appeared to foster other mindfulness facets in each participant’s experience. Our final
grounded theory model is displayed in Figure 1.2 and denotes these coinciding facets of
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mindfulness with curved arrows. Pathways denoted “a” in Figure 1.2 correspond to relationships
between dispositional mindfulness facets and minority stress constructs that emerged in themes
among positive cases.
Non-reacting facilitates aware action and self-observation
Latino/a LGB young adults shared how non-reacting—the ability to stop in difficult
moments and not act on impulse or emotion—allowed them to make informed decisions. Non-
reacting affected their abilities to consciously regulate their emotions, and in turn, act with
awareness of the present moment and observe—or examine—themselves in a constructive
manner.
Camila (aged 28), who identifies as a queer Chicana, describes how she decided not to
react with excessive anger to the betrayal of her first same-sex partner. Same-sex relationship
problems have been identified as a symptom of minority stress in prior research of LGB persons
(Mohr & Daly, 2008). However, Camila adapted to this stressful experience by consciously
acknowledging her heartbreak while focusing on her own development:
When we broke up it was kind of big for me, like it was a big transition and I realized
that I was heartbroken, but I wasn’t as heartbroken as I had been in the past. And I think
that had to do more with the way I was approaching the breakup. I kind of let her take
control of the wheel and I kind of stopped doing […] the things that I enjoyed in this
relationship. So when we broke up, I decided that I wasn’t going to focus all my anger
towards her, because she cheated. So I wasn’t going to like focus my energy on that. I
was going to take this as an opportunity for my own growth and transition into who I
wanted to be, the strong woman that I envision for myself, right […] I decided to make it
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about me and not about her. And I think that really, that really helped me heal faster and
also feel more empowered.
Through non-reacting, Camila managed to attenuate feelings of anger toward her former partner.
This allowed her to act with awareness through self-care and objective observation of self,
which aided her in processing feelings of hurt, self-improvement, and self-empowerment.
Non-judgmental observation facilitates acting with awareness
Some participants displayed the ability to non-judgmentally observe their own sexual
development and their social needs. These two facets of dispositional mindfulness better enabled
them to accept their feelings, identity, and desires, and in turn, act with awareness to fulfill their
social needs. Ruben, a 26-year-old Latino gay male, witnessed his friends defending him from
peers who bullied him due to suspicions that he was gay. However, Ruben observed within
himself a strong yearning to be authentic about his sexual identity to his friends and did not
judge himself for simply being himself. This emboldened him to come out to his friends:
Because I felt like I needed an echo, I needed support. I needed someone to listen to me,
yeah. But they were all like weird about it, like my friend Evelyn was like oh no, no.
Because again, I was being bullied before I came out as “Oh he is gay,” […] so my
friends would stick up for me and say “No he is not.” So they were defending an image
of me as a heterosexual male, when inside I was like “Uh, I need to come out.” So when
I came out to them, it was like, what I just defended. Yeah, it was that kind of sentiment
[…] I felt normal like I was just like this is who I am, I felt liberated, I was just like I am
transparent. And I made an oath from that day onward that I would always be transparent
like “Why hide anything?” […] I want to just be myself at all times.
Li | 26

Coming out to his friends was an intentional effort for Ruben to fulfill his desires to be authentic
and feel supported, unhindered by feelings of self-judgment.
Observing liberates from self-judgment and proximal minority stress
This theme captures to the importance of Latino/a sexual minority young adults
observing the relationship between their sexual identities and “reality as it is”. By objectively
observing how their sexual minority status impacted their relationships with others, participants
recognized that they were not directly responsible for others negative reactions to their sexual
identities. Therefore, mindful observing prevented participants from judging themselves and
internalizing feelings of homophobic stigma when others judged them.
Marco (aged 30) simply recognized that by being and existing as a young gay Latino
male, he was not engaging in any destructive or harmful behavior towards others that would
merit their disapproval. He refrains from judging himself in spite of others’ judgments.
If somebody does have an issue, I am going to be like, “What am I hurting your feelings?
Am I physically threatening you? Is my presence like making you sick? If they say “No,
no, […] I just have a problem.” Like what am I doing to you? If they can’t prove that I
am physically making them sick or hurting them, it is like “Well you know what? I am
not […] doing anything to you.”
Marco recognized that others’ disapproval of his sexual orientation was unfounded. His
observations revealed that he was not acting or behaving in any harmful way towards them and
that they were responsible for their own negative reactions. Through objective observation and
non-judgment towards himself, Marco was able to liberate himself from internalizing any
homophobic stigma from others, concluding that their judgment of him was a reflection of their
own problems rather than his own.
Li | 27

Observing and describing foster empowerment
Latino/a sexual minority young adults shared how being able to observe their experiences
and describe their feelings, thoughts, and emotions helped them acknowledge their strengths,
abilities, and sense of self-worth.
Esteban a 22-year-old queer-identified Latino male, shares how studying and informal
meditation helped him to simply acknowledge his complex articulate his identities more
objectively:
I hard core was meditating. I had no formal instruction. […] But I just listened and I
knew what to do and it all starts with me conceptualizing my experience and saying,
“Okay, I am a queer, once undocumented Mexican immigrant who is now living in the
United States, growing up in Inglewood, who isn’t deemed a citizen, even though I have
lived here all my life, who like is in college, because of sheer luck that I got
documentation. So I don’t know, I got to a point where I was like “These are my
identities, this is who I am and it is an intersection and I am that intersection.” I am like
“But am I going to carry the weight of all of those identities and all of those expectations
and all those, etc.? No I cannot.” So I found a way to liberate myself going to Japan for
almost a year helped me a lot because I had distance from people. […] And I was taking
that comparative philosophy class, so I learned about Daoism, Buddhism, religiously,
philosophically and then compared to western ideals. And so I had a lot of exposure to
like the right kind of work and that just like crossed me.
In turn, Esteban was able to grasp alternative interpretations and feelings about his complex
identity. In fact, he began to consider the intersection of his identities as a gift, a vector for
connection to others, and a call to action:
Li | 28

I was just like, “Oh my god, I am so much more than these identities. I am so much more
than this eccentric like life that I have constructed for myself. […] I am a person
connected to you, to everyone around me and I have a duty. I have a responsibility to
nurture and take care of. So because of my experiences, I learned that the way to liberate
myself and to be free is not to forget who I am or where I come from, but in order to
construct a better future and decolonize my immigration and say okay I want to envision
a new world and create programs and help youth and let them see themselves beyond
these limitations, like I am going […] connect spiritually.
Academic concerns are among the minority stressors experienced by Latino/a college
students (Arbona & Jimenez, 2014). Carla, a 27-year-old Latina lesbian, described how she
previously did not appreciate her progress in throughout college. Eventually learning to observe
and acknowledge her accomplishments as they happened instilled her with feelings of triumph
and confidence.
I've for sure grown into my own skin, like I am confident […] in a lot of things. Like my
school work […] I'm proud of myself whenever I accomplish things, you know? Before I
was just kind of like, “Yeah, whatever.” Like I passed, or I didn't pass, or whatever. Now
I'm proud of the work I do, you know.
Furthermore, celebrating small successes has helped her to better appreciate her life in the
present moment. She explains:
I just kind of like try to make like short-term goals and once I reach that goal I'll make a
new one. That way […] I feel like I have my little victories along the way.
Deficiencies in mindfulness and minority stress Latino/a sexual minorities
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Latino/a sexual minority young adults who appeared to lack various facets of
dispositional mindfulness appeared to suffer more greatly or engage in maladaptive coping
behavior when experiencing minority stress. While positive cases tended to exhibit multiple
facets of mindfulness, negative cases tended to lack multiple facets of mindfulness. Participants
who reported report growing up in homophobic or unsupportive social environments also tended
to report deficiencies in dispositional mindfulness and proximal minority stress (e.g., internalized
homonegativity, repressed/concealed sexual identities). Pathways denoted “b” our final grounded
theory model (shown in Figure 1.2) corresponded to relationships between deficiencies in
mindfulness facets and minority stress constructs that emerged in themes among positive cases.
Coinciding deficiencies in mindfulness captured by participant interviews are denoted with
curved arrows in Figure 1.2.
Proximal minority stress, reactivity, and acting without awareness
Reactivity exacerbated Latino/a sexual minorities’ experiences of proximal minority
stress and hindered their abilities to act with awareness in the face of minority stress. Diego
(aged 28), a gay Latino male, portrayed how his brother responded to his coming out to him, and
how he reflects on his externalizing behavior over the years prior to his coming out:
He was, like laughing and I was just standing there looking at him go crazy, like, around
the living room. And then he stopped and then he was just, like, “Is this why you’re such
an [expletive]? Do you feel like you need to be, like, this [expletive] and tough person
because you’re gay?” I guess, looking back, I was. I guess, that’s why, but at the time, I
was, like, “No, I don’t think so. I think this is just who I am.”
Diego admits that he was confrontational and fabricated an aggressive façade to conceal his
sexual identity. However, he recalls that he was previously unaware of the link between
Li | 30

insecurities around his sexual identity and his aggressive reactions, and that he remained in
denial of this even sometime after his brother inferred that his belligerent behavior was because
of his own coming out frustrations Diego described a lack of control and awareness around the
motivations and emotions behind his aggressive behavior. As a result, he often acted out his
insecurities with repression and hostility against the people in his life, including family members.
Problems observing and acting without awareness
Participants who failed to observe how their emotions, thoughts, and experiences affected
their behaviors engaged in patterns of acting without awareness, such as avoidant coping. Omar
(aged 28), a gay man of mixed Mexican-Jewish heritage, described how he avoided
acknowledging how the many traumas throughout his life—his immigration to the U.S., his
surviving a sexual assault prior to coming out, the death of his grandmother, and the murder of
this boyfriend—deeply affected him and caused him suffering:
I never believed in dealing with things like [my boyfriend’s] death, never dealing with
my grandma’s death, never realizing leaving [my country] probably was a traumatic thing
for me, not dealing with what happened to me in the locker room. I kind of just swept that
away. Not really dealing with coming out in high school, not realizing that I was actually
forced into this, like I didn’t want to do it, not dealing with that [ …] I came to the
realization that I didn’t, I don’t deal with shit.
Omar described how his tendency to not act with awareness hindered his life and ability to grow.
He then proceeded to lament how not mourning with the many losses in his life preventing him
from managing his life and his interpersonal relationships:
That is why my life is out of control. That is why I can’t maintain a good relationship.
[…] So I went to [my boyfriend’s] grave, and I yelled at it. I said “You left me. You
Li | 31

promised me you would never leave me. You left me like my grandmother did. You
killed my opportunity to love anybody ever again.” I vented everything, and it didn’t
change the way I felt about him.
Prejudiced social environments, self-judgment, and proximal minority stress
Latino/a sexual minority participants who were subjected to homophobia in their youth
reported negatively judging their newly developing sexual feelings and thoughts. In turn, self-
judgment in the form of internalized homonegativity exacerbated their fears of public discovery
and perceptions around their sexual orientations. Diego (aged 28), whom we introduced
previously, described how he was distressed by the realization that he was attracted to other men:
And then I stopped hanging around with kids that much. I think when I was in fifth
grade, I stopped. I think it was because we were moving around so much and also being
gay was starting to, you know, I started to realize I was gay and it was not a good
experience. Like, I didn’t want to be gay. We were really religious so I prayed for that to
go away and it made me really, really shy because I felt like I was going to say or do
something that was going to give it away […] So, I was always really, really scared
wherever I was.
Diego’s rejection of his own sexual orientation exacerbated his fear about being a gay male in
public and had a negative toll on his own self-esteem. Judging himself for being attracted to
other males compounded his wariness of other with shame and internalized stigma, preventing
him from connecting with his peers.
Unsupportive social environments, difficulties describing, and proximal minority stress
Sexual minority participants who reported growing up in emotionally unavailable
families and unsupportive peer environments reported barriers to describing or comprehending
Li | 32

their developing sexualities. For these participants, difficulties describing prevented them from
processing their feelings and resulted in distress around their sexualities.
Omar (aged 28, previously introduced), struggled to articulate how his attraction to other
males was at the core of his sexuality. As a result, he experienced his sexual development as
confusing, disconcerting, and alienating. He explains:
I was starting to become very sexualized and I noticed my sexuality was not where I
[thought] it was supposed to be. I was seeing boys, not girls […] The only problem was I
didn’t know how to convey it. […] Especially the sexuality part, I had no idea. I had no
idea, because […] sexuality is not something you discuss in the Mexican household […] I
know I am not fitting the social norm and here I am trying to take another step, you know
what I am saying. You know you aren’t talking to me about sexuality to begin with, now
how am I going to tell you that I like boys.
Omar continues to explain how suffocating it felt to not be a social environment conductive to
identifying (describing) and validating those feelings and aspects of his sexuality. He continues:
Trying to figure out living in a Mexican—like I am drowning here, I don’t know. And I
went to high school that was predominantly Mexican.
Positive cases of mindfulness in family members
Four facets of dispositional mindfulness—act with awareness, non-react, non-judge, and
observe—emerged in themes in family members of sexual minority participants. Multiple facets
of mindfulness emerged within some family member interviews, though no apparent deficiencies
in mindfulness were evident in the overall data for family members. Table 1.2 displays the facets
of mindfulness that emerged within and across each family member reported in these results. In
Figure 1.2, the pathway denoted “c” corresponds to the effects of dispositional mindfulness
Li | 33

facets in family members and positive outcomes regarding their interpersonal relationships with
their sexual minority family members.
Observing elicits compassion and acting with awareness
Several family members explained how their observations of the emotional and social
challenges facing sexual minorities elicited feelings of compassion toward sexual minority
family members. This enabled family members to act with awareness—awareness of life
challenges in sexual minorities and awareness of their own benevolent intentions—by providing
their sexual minority family members with love, validation, and support.
Veronica, a 50-year-old mother of a gay son, shared how she observed how sexual
minorities struggle with coming out and feelings of repression, which provoked feelings of
compassion for her son. She did not want her son to have the added hardship of not feeling
accepted because of this sexual orientation:
I don’t understand how other people can be locked up, that they don’t speak up or
anything, and how they suffer. I mean, I don’t know because I haven’t experienced it, but
their life is already difficult, and I’m still going to live it squashed up? No. Not more
difficult.
Veronica explained that she strived to validate and support her son, motivated by her desires to
make her son’s life easier and to be remembered for her kind deeds.
I make my son’s life as pleasant as I can, because the only thing I’m going to leave him is
the love I had for him and I want him to remember me as the mother that was there when
he needed me. I don’t have anything to leave him, not money or anything, but I want him
to remember me. “My mother was always there for me, my mother always came when I
needed her…” That yes, I do want that […] he is really proud of me, although I’ve never
Li | 34

done anything with my life, I don’t care. I had my kids, I raised them, er…I’m proud of
them, none has ever had any problems, not with the law or…anything, nothing.
Although Veronica appeared to harbor some lingering feelings of inadequacy for not having
been a successful financial provider for her children, she transcended those feelings with
confidence that she did her very best to be available to her gay son and other children.
Samantha (aged 26) recalls when her mother was struggling with her sister coming out as
a lesbian. Samantha observed and sympathized with both the challenges of sexual minorities and
her mother’s relationship with the Catholic Church. Rather than taking an adversarial stance, she
embraced compassion for both her mother and her sister by initiating a meaningful discussion
with her mother about shifts in social and religious perspectives on lesbian, gay, bisexual,
transgender, and queer (LGBTQ) issues.
At some point we started talking about I think religion came up that first conversation.
And since I don’t really believe, and I know she does, I was like “Well you know, Mom,
the one thing that I will say is that I am glad.” We started talking about homosexuality
through the eyes of the church, and I was like “Okay, I know that about Pope Francis, I
know he is like a little bit more progressive than other popes.” So I used that to my
advantage in talking with her about, “Well, you know the pope recently came out and
said that he is very progressive on homosexuality and LGBTQ (lesbian, gay, bisexual,
transgender, and queer) rights, you know especially through the church.”
Although Samantha was not religious, she was aware that the shift in religious stances on
sexuality and gender-based minority rights would be a means to appeal to her mother and find
common ground. She continued:
Li | 35

So you know that is one good thing I would say about the church, and we had this
discussion, and I wanted to frame it in that way […] I knew that through religion, she
would maybe see it, and also I brought up the church is losing people because of their
stance on this issue. It is not something that is just coming up now. It has been
happening, people have been identified this way or felt this way or you know lived their
lives this way for decades. It is just like because of systems of discrimination, the
government, and communities themselves and families, unfortunately […]
Samantha’s awareness of her mother’s spiritual conflict helped her support her mother, offer a
new perspective, and ultimately support her sister. She shared the positive outcome of their
exchange:
And then she kind of went quiet and then was kind of like, “Okay, I understand that
makes sense. You know I have seen that.”
Non-reacting facilitates emotional intimacy
Parents described how non-reacting helped them process initial feelings of discomfort
when they learned that their children were gay or were introduced to way of living. Parents who
were not reactive to this new reality for their children reported arriving at a place of acceptance
and renewed appreciation for their children.
Lucia, a mother of a gay son, described how she avoided reacting impulsively to her
son’s coming out to him. When he came out to her, she said to him:
“I can’t say anything. Let me take it in, let me think about it and then afterwards we’ll
talk.” […]
Non-reacting enabled her to process her feelings and beliefs before ultimately concluding that
she would accept him as is.
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My daughter thought I was going to be against it, but as I say, I’ve always been very
close to [my son], and the same love that binds me to him, and I don’t…don’t…I felt that
I couldn’t reject him.
Lucia recalled another instance where she experienced initial feelings of discomfort around her
son’s sexual orientation. When she first met her son’s boyfriend, she deferred to non-reacting to
her discomfort. As she explains, this allowed her to grow acquainted with and appreciate her
son’s boyfriend:
I have no reason to be mean to his partner, do I? […] It was a bit hard for me to feel
affection for him […] Now he’s…I have taken to him like my son, because well, he’s my
son’s partner. I say, if he is happy with him, I’m happy. “I’ve no reason to interfere,” I
say. He’s my son, I should accept him as he is.
Lucia reflects on her decision to not be reactive as ultimately rewarding, as she has come to love
her son’s partner as her own after seeing how much he means to her son.
Non-judging fosters dialectical acceptance
Family members who were non-judging about themselves or their feelings were better
able to accept some of their paradoxical feelings and stances on their relationships. Alma, a wife
and mother of two queer-identified daughters, shared how non-judgment has helped her deeply
appreciate both the good and the challenges in her relationships with her husband and daughters:
Well my husband, we’ve been married 22 years now, and with […] good things and with
bumps in the road, but we are together. We have a healthy relationship […] I’m always
there to support them, I’ve always told them…well that I’m never going to judge them
for what they do, and well you make mistakes, don’t you? And that’s how you learn.
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Sometimes, well it’s hard, you know. But […] there are bad horrible mistakes that change
your life, but well, it’s part of life, isn’t it?
Lucia, whom we introduced earlier, explains how she resolved not to internalize judgment from
others in the family who might disapprove of her gay son:
That’s what was hard thinking about what people would say or what my family would
say. My mother, my brothers, what are they going to say when they find out my son is
like that. But it was hard thinking about that until in the end, I said, “What do I care?
What matters to me…I don’t care what my mother says, or my brothers. What matters to
me is how I feel and my son. Here my closest family are my children and me. And
now…I love my mother very much, but in the end, if my mother doesn’t accept him, just
because my mother doesn’t accept him doesn’t mean I won’t accept him either, he’s my
son.”
By refraining from self-judgment for supporting her son, she was able to accept that she can love
both her son and her family in spite of any biases that her family may hold.
Observing facilitates engenders gratitude in difficult situations
Family members who were adept at observing were better able to recognize the positive
aspects alongside the negative aspects of being a minority and being related to a sexual minority.
By recognizing the positives sides rather than just the drawbacks of situation, family members
were able to experience some gratitude in the face of life challenges.
Gina, a 26-year-old Latina who has a gay brother, described how observing parallels
between her own challenges with cultural identity and hardship experienced by those of sexuality
or gender-based minority has instilled her with appreciation of those from the LGBT community.
She expressed her feelings of solidarity:
Li | 38

I love to support the LGBT community, just because I know what it feels like growing
up, not being understood because of the cultural difference. I think that is what draws me
to them, knowing that people might not understand their choices in life or you know if
they are born feeling biologically female, but they were born with a different kind of sex
or gender […] I feel that I can connect with them.
She admitted that there are differences between her experiences and those of sexual minority
status, but expressed an appreciation for those differences.
Maybe I am not going through the same thing, but I like supporting them, like being there
for them.
Gina continued to express appreciation for her brother and other LGBT persons, not just for the
challenges they share, but because of sense of family they can foster:
What I love about it is that it is so small and it is so close, it feels like home to me,
because I have such a tight family that whenever I hang out with anybody from the
LGBT community, they take me in and like with open arms and I love that. It feels home
and I embrace it.
Alma, whom we quoted earlier, expressed how observing and listening to her daughters
with openness has instilled her with gratitude for her daughters’ wisdoms and strengths:
But my daughters are special. […] I sometimes say, “Wow, who are these girls like?”
[…] The way they think, the way they see things. I have learned a lot from them, from
them both, and well for me, I thank God because my daughters are two young women
with very good thinking [...]
Furthermore, witnessing their positive qualities and behaviors has allowed her to appreciate both
how she raised them and their individual, inherent merits:
Li | 39

You sometimes think, “Oh, well it’s what was instilled in them at home.” Yes, but it also
has a lot to do with what you’re born with.
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Table 1.1. Presence and absence of dispositional mindfulness facets within and between Latino/a sexual minority young adults
presented in study results

Positive cases Negative cases
Participants Act with
awareness
Non-react Non-judge Describe Observe Act without
awareness
Reactivity Judge Difficulty
describing
Difficulty
observing
Sexual minorities
Camila   
Ruben   
Diego    
Omar   
Marco  
Esteban   
Carla  
Family members
a

Veronica  
Samantha  
Lucia  
Alma 
Gina 

a
No negative cases (deficiencies in mindfulness) emerged in family member interviews.

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Figure 1.2. Grounded theory of dispositional mindfulness and minority stress

Note: a = positive case pathways among sexual minorities; b = negative case pathways among sexual minorities; c = positive case
pathways among family members. Curved arrows represent mindfulness facets that co-occurred in themes. No negative cases
(deficiencies in mindfulness) emerged in family member interviews.

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Discussion
Our qualitative interviews of Latino/a sexual minority young adults showed how the five
facets of mindfulness—act with awareness, describe, non-react, non-judge, and observe (Baer et
al., 2006; Baer et al., 2008)—aided them in adapting to personal struggles with their cultural and
sexual identities. By contrast, those who appeared to lack mindfulness qualities appeared to
struggle the most with their cultural and sexual identities, as well as with other life challenges,
such as handling interpersonal relationships, emotional problems, and isolation. Family members
of Latino/a sexual minorities revealed in their narratives how the five facets of mindfulness
appeared to influence how they respond and adapt to learning that someone in their family is a
sexual minority. Ultimately, those who demonstrated some aspects of mindfulness seemed both
more willing and better able to provide support for sexual minority family members by showing
them acceptance and encouraging them to be authentic. Together, these findings culminated into
our comprehensive ground theory (see Figure 1.2) illustrating the effects dispositional
mindfulness (and deficiencies of dispositional mindfulness) on family relationships and health
outcomes.
Mindfulness and minority stress in Latino/a sexual minority young adults
Sexual minority participants who acted with awareness were better able to identify their
feelings, circumstances, and motivations driving their major life choices. As a result, participants
who mindfully acted in the face of stress or opportunity often recalled their decisions with
gladness. Mindful action, such as avoiding blame, introspection, being authentic about one’s
sexual identity, or simply honoring healthy desires often resulted in their overcoming challenges,
building resilience, or cultivating meaningful relationships. Non-reacting appeared to be
protective against externalizing problems (i.e., acting out anger) and often appeared to be a
Li | 43

“necessary condition” for participants to act with awareness during distressing or challenging
life events. Observing and acting with awareness appeared to have reciprocal functions in sexual
minorities. In some participants, observing their own thoughts, emotions, and behaviors
engendered them with the awareness necessary to act mindfully, while in other participants, self-
observation was a goal of acting with awareness. In their narratives, participants who
consciously or instinctively observed their situations “as is” were better positioned to recognize
the positive aspects in their lives, even under difficult circumstances. Some participants reported
observing their own positive qualities, accomplishments, and social blessings even in the midst
of personal struggles. Their stories illustrate how the mindfulness facet of observing appears to
promote optimism and positive emotion regulation (Jacobs, Wollny, Sim, & Horsch, 2016; Li et
al., 2016). Those who reported non-judging were more accepting of their sexual identities and
were resilient against homophobic judgment from others. The ability to mindfully describe was
also key determinant of successful identity development and social integration. Participants who
were better able to articulate their feelings, thoughts, and emotions were better able to ascertain
how culture and sexuality plays a part of who they are, and in turn, pursue connections with
people who can best foster their sense of belonging. Interestingly, many participants tended to
demonstrate multiple mindfulness facets of dispositional mindfulness in their quotes, illustrating
interplay between these facets.
Among negative cases, sexual minorities who reported being reactive to feelings of
insecurity, fear, or resentment around being racial-sexual minorities often acted aggressively
without awareness of their motivations. These patterns align with quantitative findings by
Borders and Liang (2011) demonstrating that emotional reactivity mediated some of the effects
of perceived discrimination on aggression and psychosocial problems, as well as findings by
Li | 44

Calvete, Orue, and Sampedro (2017) indicating that difficulties with acting with awareness is
associated with higher frequencies of maladaptive behaviors (Calvete et al., 2017) translates to
protection against minority stress in Latino/a sexual minority young adults. Participants who
expressed difficulties with observing one’s thoughts, feelings, and emotions—especially painful
ones—reported doing things they later regretted, such as avoiding intimacy and coping with
trauma. Moreover, those who judged themselves harshly because of their sexual orientations
tended to express both fear of others and shame, a phenomena in sexual minority health research
that is commonly referred to as internalized homophobia (Newcomb & Mustanski, 2010). Those
who struggled describe those feelings recalled feeling emotionally suffocated and incapable of
seeking understanding from others. Similar to positive cases, these participants tended to
demonstrate clustering of multiple deficiencies in mindfulness facets.
Our deductive findings confirm prior research that cross-sectionally demonstrated that
dispositional mindfulness and attenuates the association between experiences of homophobic
(Lyons, 2016; Toomey & Anhalt, 2016) and racial discrimination (Brown-Iannuzzi et al., 2014),
and is significantly related to adaptive socialization and coping (Womack & Sloan, 2017).
Findings from grounded theory analysis contribute to this knowledge by providing an in-depth
exploration into how different aspects of dispositional mindfulness manifest, as well as the
mechanisms by which they enable Latino/a sexual minority young adults to adapt to minority
stress.
Mindfulness in family members of Latino/a sexual minority young adults
All facets of dispositional mindfulness played a meaningful role in promoting accepting
and supportive behaviors in family members of Latino/a sexual minority young adults. Parents
and siblings who acted with awareness demonstrated thoughtfulness in their behaviors toward
Li | 45

their sexual minority family members. In their interviews, they shared how unconditional love
and support were among their family values, and that they consciously tried to honor those
values by accepting their sexual minority children. Inevitably, some parents experienced
discomfort or concern for their children when they came out. However, non-reacting appeared to
facilitate healthily processing of their initial feelings about their children’s sexual orientation.
Parents who exhibited non-judgment were better able to accept paradoxical realities around
raising sexual minority children, such as supporting their children even if other family members
disapprove, or accepting that the challenges and struggles their children face could be
opportunities for growth.
Limitations
Findings from this qualitative investigation should be interpreted with some limitations in
mind. Our results may have limited transferability (generalizability) to Latino/a sexual minorities
and families outside of the East Los Angeles area. It is also important to note that although the
present study reached theoretical saturation, it is still possible that other modes of dispositional
mindfulness and adaptation to minority stress exist beyond what was captured in this study.
Representation of family members was limited to women in this study, which may introduce
selection bias but also information regarding gender differences, mindfulness, and support of
sexual minorities in Latino/a families. Because sexual minority and family participants were not
recruited in dyads, this present study is unable to make direct inferences about mindfulness in the
family and intrapersonal health outcomes in sexual minority participants. Future research is
needed to qualitatively link sexual minorities and their family members to explore the effects of
dispositional mindfulness in family members on sexual minorities health outcomes.

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Implications
Qualitative investigation the experiences of Latino/a sexual minority young adults and
family shed light on both the individual level and interpersonal benefits of dispositional
mindfulness in the context of minority stress. Furthermore, our research suggests that instilling
mindfulness in family members of Latino/a sexual minorities is also important for improving
family relationships, fostering an environment of acceptance, and helping them process difficult
emotions when family members come out. It is important to note that although dispositional
mindfulness enabled many participants to adapt to minority stress, those who experienced
chronic trauma, neglect, or homophobia at an early age tended to lack dispositional mindfulness.
This further emphasizes the importance of understanding the reciprocal relationship between
dispositional mindfulness and social environment. Some grounded theory research in sexual
minorities suggests that resilience is conscious process of evaluation and compromise when
faced with minority stress (Levitt et al., 2016), whereas our grounded theory analysis elucidates
how successful adaptation (i.e., informed decision-making) depends on one’s ability to be non-
judgmentally aware in the present moment.
We developed this grounded theory of dispositional mindfulness and minority stress to
provide a better scientific understanding of how different aspects of mindfulness in Latino/a
sexual minorities and their family members can facilitate different modes of adaptation and make
health and wellbeing attainable even in the face of prejudice and disadvantage. Future research is
needed to longitudinally test: (a) whether the different facets of mindfulness are protective
against the effects minority stress on health in quantitative samples of racial and sexual
minorities; (b) whether the different facets of mindfulness are associated with resilience and
positive coping styles in racial and sexual minorities; and (c) whether dispositional mindfulness
Li | 47

in family members is associated with positive health outcomes in racial and sexual minorities in
dyadic samples. Some scholars have proposed integrating mindfulness content into clinical care
(Pachankis et al., 2016) and educational curriculum (Berila, 2016) as a remedy for minority
stress among sexual minorities. We hope findings from the present study will help future
development MBIs that incorporate mindfulness facets in ways that address issues of minority
stress in Latino/a sexual minorities and their family members.

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Chapter 2

Dispositional mindfulness in Latino/a parents: Interactions with parent histories of potentially
traumatic events and psychosocial health in their children

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Background
A growing body of research has been investigating how mindfulness, the state or trait of
having non-judgmental, non-reactive moment-to-moment awareness (Kabat-Zinn, 2003, 2015),
can influence parenting and child psychosocial health outcomes (Calam, 2016; Duncan et al.,
2009; Kirby, 2016). Several cross-sectional studies demonstrate that children of parents with
high dispositional mindfulness show lower levels of internalizing and externalizing problems
(Bögels et al., 2008; Parent et al., 2010), and greater wellbeing (Medeiros et al., 2016).
Parents who possess high levels of dispositional mindfulness tend toward authoritative
and positive parenting styles (Coatsworth et al., 2010; Gouveia, Carona, Canavarro, & Moreira,
2016; Miklósi, Szabó, & Simon, 2017; Parent et al., 2010; Parent, McKee, N. Rough, et al.,
2016), less parental stress (Gouveia et al., 2016) and mood problems (May, Reinka, Tipsord,
Felver, & Berkman, 2016; Parent et al., 2010; Turpyn & Chaplin, 2016). In turn, positive
parenting styles (i.e., authoritative) promotes self-esteem (Babore, Trumello, Candelori, Paciello,
& Cerniglia, 2016; Bulanda & Majumdar, 2009; Reese, Bird, & Tripp, 2007; Rudy & Grusec,
2006), and parenting stress, depression, and authoritarian parenting styles exacerbate negative
affect (Casalin, Luyten, Besser, Wouters, & Vliegen, 2014; Tracy, 2006; Williams & Woodruff-
Borden, 2015) and stress in children (Laurent, 2014).
Moreover, improved mindfulness in parents appears to be associated improved parent-
child relationships (Coatsworth et al., 2010; Duncan et al., 2009; Parent, McKee, Anton, et al.,
2016; Parent, McKee, N. Rough, et al., 2016). A handful of quantitative studies have
longitudinally examined the effects of parents’ dispositional mindfulness on relationships with
their children. A pilot study (Coatsworth et al., 2010) and a follow-up randomized-controlled
comparative study (Coatsworth et al., 2015) both demonstrated coinciding improvements in
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parents’ mindfulness, parenting skills, and parent-child relationships in participants, however,
there was no significant differences in effects between the Mindfulness-Enhanced Strengthening
Families Program and the standard Strengthening Families Program: For Parents and Youth 10-
14. One pilot study of an 8-week Mindful Families Stress Reduction course used magnetic
resonance imaging before and after parents’ participation and identified changes in neural
regions related to mindful awareness, which were associated with improvements in children’s
perceived relationships with their parents (May et al., 2016).
History of trauma, mindfulness, and parenting in Latino/as
Latino/a children can be particularly vulnerable to mental health problems if their parents
have histories of traumatic experiences and marginalization (Beckerman & Corbett, 2008;
Gonzalez, Lord, Rex-Kiss, & Francois, 2012; Phipps & Degges-White, 2014). According to
some researchers, Latino/a parents’ negative experiences with acculturation and immigration can
potentially have transgenerational effects on their children (Beckerman & Corbett, 2008;
Gonzalez et al., 2012; Phipps & Degges-White, 2014). Both second and third-generation
Latino/as tend to be at greater risk of mental health diagnoses than first-generation Latino/as
(Alegría et al., 2007) even though the first-generation tends to experience major challenges with
immigration and post-migration discrimination (Perreira & Ornelas, 2013). Whether
transgenerational trauma plays into these differences in mental health diagnoses between
generations is unknown.
Dispositional mindfulness in Latino/a parents may have protective benefits for the mental
health of their children. In addition to the link between dispositional mindfulness and positive
parenting styles, greater dispositional mindfulness has been shown to be associated with lower
levels of psychological symptomatology following trauma exposure (Nitzan-Assayag, Aderka, &
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Bernstein, 2015). Therefore, dispositional mindfulness in Latino/a parents may be protective
against the effects of parent histories of trauma on their children.
Purpose of the study
The present study aims to longitudinally test whether dispositional mindfulness
moderates the effects of potentially traumatic events in Latino/a parents on in stress, depressed
mood, and self-esteem in their children. We hypothesize that traumatic events in Latino/a parents
with greater mindfulness will be not be associated with stress, depressed mood, and self-esteem
in their children. Conversely, we predict that traumatic events in Latino/a parents with greater
mindfulness will be associated with greater stress and depressed mood, and lower self-esteem in
their children.
Methods
Data come from 59 subjects consisting of Latino/a parents (n = 27) matched with their
children aged 10-16 (n = 32) who participated in a community-based participatory research stress
reduction intervention designed for Latino/a families in the Ramona Gardens neighborhood,
which abuts the Health Sciences Campus at the University of Southern California, in the city of
Los Angeles, CA. It is a historically Latino/a neighborhood, named for the public housing
complex that makes up a significant proportion of the housing in this area. The eligibility criteria
were as follows: (a) residing in Ramona Gardens, El Sereno, or Lincoln Heights neighborhoods,
(b) participation in Legacy LA’s academic support program (experimental condition only), (c)
for youth, being aged 11-17 and attendance at a public middle or high school that serves Ramona
Gardens, (e) for parents, fluency in English or Spanish, and being a parent or guardian of a youth
participant. Potential youth participants who are unable to read, speak, and understand English
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were excluded. Both English and Spanish sessions were provided to parents based on language
needs.
Experimental research subjects were recruited from the on-going academic support
program at the community organization, Legacy LA. To recruit controls, outreach workers
recruited youth from middle and high school bus stop locations in Ramona Gardens. The
intervention group consisted of n =23 youth-parent pairs, while the control group consisted of n
= 9 youth-parent pairs. Although the control group did not receive the family intervention, they
still received the general academic community program provided at Legacy LA.
Prior to baseline interviews, parents received both a verbal description and a written copy
of the informed consent form, and provided their signed consent for themselves and their
children. Informed assent was obtain from children as well. Consent documents were provided
in English or Spanish based on their preferred language. All research procedures have been
approved by the human subjects protection committee at the University of Southern California.
Data collection
After receiving informed consent or assent, we interviewed subjects in a one-on-one
session with a trained and experienced interviewer in a private setting at Legacy LA. Similar to
baseline/screening interviews, 3-month follow-up interviews were conducted using by a trained
research interviewer and recorded on paper surveys. Participants received a $20 gift card for
each follow-up interview they complete. Participants in the intervention received $5 for each
session they attended.

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Measures
Sociodemographics: We asked youth their age, gender, school grade, race/ethnicity, country of
birth, and age of immigration (if born outside the U.S.). We asked parents their age, gender,
education level, race/ethnicity, and country of birth.
Parent mindfulness: We assessed mindfulness in parents of Latino/a youth using the
original 15-item Mindful Attention Awareness Scale (MAAS) (Cronbach’s α = .80; test-retest r
= .81) (Brown & Ryan, 2003). The MAAS is a one-factor measure of dispositional mindfulness
that specifically assesses the trait of awareness and attention to present moment experiences.
Responses range from 1-almost always to 6-almost never to statements like, “I could be
experiencing some emotion and not be conscious of it until some time later.”
Parent potentially traumatic events: We measured parents’ past experiences of potentially
traumatic events (PTEs) using the Life Events Checklist (LEC) (Association, 1994). The LEC
was developed by National Center for PTSD and was intended for screening rather than
establishing clinical diagnosis of traumatic exposure. The LEC consists of an inventory of 16
items such as, “Natural disaster (for example, flood, earthquake, hurricane, tornado).” Responses
included 0-does not apply, 1-not sure, 2-learned about it, 3-witnessed it, and 4-happened to me.
Youth perceived stress: Perceived stress in youth was measured using the 10-item
Perceived Stress Scale (PSS) (Cronbach’s α = .84; test-retest r = .85) (Cohen, Kamarck, &
Mermelstein, 1983). The PSS measures the degree to which life challenges are perceived as
distressing or uncontrollable. Responses range from 1-never to 5-very often to statements such as
“In the last month, how often have you felt that you were unable to control the important things
in your life?”
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Youth depressed mood: We measured depressed mood in youth using the Patient Health
Questionnaire (PHQ), which measures depression severity over 9-items (Cronbach’s α = .89;
test-retest r = .84) ( (Kroenke, Spitzer, & Williams, 2001). Participants would rate the frequency
of experiencing symptoms such as “Feeling down, depressed, or hopeless 0” on a rating of 0-not
at all to 3-nearly every day.
Analysis
We used Stata 14 (StataCorp, 2015) to perform all statistical procedures in the present
study. Frequencies and percentages were calculated for gender and country of birth in youth and
parents, as well as education level and income level in parents. Means and standard deviations
were calculated for youth and parent age.
We generated difference scores to represent change in parent mindfulness (Δ MAAS),
change in perceived stress in youth (Δ PSS), and change in depressed mood in youth (Δ PHQ).
We tested two multiple linear regression to test Δ PSS in youth on Δ MAAS in parents, as well
as Δ PHQ in youth on Δ MAAS in parents. In both linear models, we tested whether immigration
status in parents moderated the effects of Δ MAAS in parents on Δ PSS and Δ PSS in youth. We
adjusted for English fluency in parents to rule out language as a confounder. From these models,
we generated linear prediction plots with two separate fitted lines for parent immigration status.

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Results
The sociodemographics for the study sample are presented on Table 2.1. The mean age of
the Latino/a youth participants was 13 years. The youth consisted of 53% (n=17) females, and
the majority were born in the U.S. (n=31, 97%). The mean age of the Latino/a parent participants
was 44 years. The majority of parents were female (n=23, 85%), born in Mexico (n=17, 63%),
and not married. At baseline, 52% of parents had less than a high school diploma, 44% had a
monthly income of $1,327 or less.

Table 2.1. Demographics in youth and their parents

Characteristic
n (%)
Mean (SD, range)
Youth (n = 32)
Gender
Female
Male

17 (53.1)
15 (46.9)
Age 13 (1.4, 10-26)
Country of birth
US
Mexico

31 (96.9)
1 (3.1)
Parents (n = 27)
Gender
Female
Male

23 (85.2)
4 (14.8)
Age 44 (7.1, 28-55)
Country of birth
US
Mexico

10 (37.0)
17 (63.0)
Education level (baseline)
Less than high school diploma
High school diploma or equivalent
Some college or more

14 (51.9)
7 (25.9)
6 (22.2)
Monthly income (baseline)
$1,327 or less
$1,328 to $2,020
$2,021 or more

12 (44.4)
8 (29.6)
7 (25.9)
Marital status
Not married
Married

15 (55.6)
12 (44.4)
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Table 2.2. Descriptive statistics for parent MAAS and youth outcomes

Baseline 3-momth follow-up
Variable M (SD) Cronbach’s α M (SD) Cronbach’s α Possible range
Parent
MAAS 4.12 (1.07) .88 4.36 (1.01) .87 1-6
LEC 2.31 (2.55) .79 - - -
Youth
RSES 27.31 (4.55) .83 27.46 (3.69) .73 10-40
PSS 29.13 (3.81) .78 28.00 (4.57) .79 10-50
PHQ 5.28 (4.86) .80 4.46 (3.50) .73 0-27

Table 2.2 displays the means and internal consistency estimates (Cronbach’s α) for parent
MAAS scores and youth MAAS-A, PSS, and PHQ scores at both baseline and 3-month follow-
up. Parent MAAS performed with good internal consistency (.87 to .88), while youth PSS
performed with acceptable internal consistency (.70 to .80). Youth PSS (.78 to .79) and PHQ
performed with acceptable internal consistency (.73 to .80).

Table 2.3. Moderator effects of parent mindfulness on associations between parent traumatic
events on in youth self-esteem, perceived stress, and depressed mood

RSES PSS PHQ
Parent Variables Β (SE) p Β (SE) p Β (SE) p
Model 1 (Baseline)
MAAS x LEC -0.19 (0.29) .51 0.09 (0.24) .71 0.35 (0.31) .25
LEC 1.03 (1.18) .38 -1.18 (0.96) .22 -2.65 (1.24) .03
MAAS -0.43 (0.83) .60 -0.17 (0.67) .80 0.37 (0.87) .67
Model 2 (3-month follow-up)
MAAS x LEC 0.85 (0.23) < .01 -0.95 (0.34) < .01 -0.49 (0.22) .03
LEC -2.88 (1.07) < .01 2.95 (1.59) .06 1.25 (1.01) .22
MAAS -0.76 (0.89) .39 1.77 (1.14) .16 1.90 (0.79) .02

Note: All models adjust for intervention assignment, youth age and gender, and parent age,
income, and education.
Abbreviations: RSES = Rosenberg Self-Esteem Scale, PSS = Perceived Stress Scale, PHQ =
Patient Health Questionnaire
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Table 2.3 displays the results of adjusted linear regression models at baseline and at 3-
month follow-up of testing children’s outcomes RSES, PSS, and PHQ on parents’ LEC,
moderated by MAAS. At baseline, the estimates for the continuous “parent MAAS x LEC”
interaction term show no significant moderation of the association between parents’ LEC scores
and children’s outcomes. Unexpectedly, parent LEC was negatively associated with youth PHQ
(B = -2.65, p = .03) at baseline.

Figure 2.1. Predicted linear regression lines of youth RSES on parent LEC at 3-month follow-up
for different parent MAAS scores (1, 3, and 5) at 3-month follow-up

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At 3-month follow-up, in parents with low MAAS, greater parents’ LEC was associated
with lower children’s RSES (B = -2.88, p < .01). At this time point, parents’ MAAS significantly
buffered the associations between parent LEC and youth RSES, PSS, and PHQ (B = -0.49, p =
.03), such that increases in parent MAAS scores increased the slope for youth RSES on parent
LEC (B = 0.85, p < .01), and decreased the slopes for youth PSS on parent LEC (B = -0.95, p <
.01) and youth PHQ on parent LEC (B = -0.95, p < .01). Unexpectedly parent MAAS was
positively associated with youth PHQ among parents with lower LEC at follow-up. Figures 2.1-
2.3 display the predicted linear regression lines of youth RSES, PSS, and PHQ on parent LEC
for different parent MAAS scores.
Figure 2.2. Predicted linear regression lines of youth PSS on parent LEC at 3-month follow-up
for different parent MAAS scores (1, 3, and 5) at 3-month follow-up

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Figure 2.3. Predicted linear regression lines of youth PHQ on parent LEC at 3-month follow-up
for different parent MAAS scores (1, 3, and 5) at 3-month follow-up

Discussion
Findings from the present study suggest that greater dispositional mindfulness in Latino/a
parents ameliorates the effects of their histories of potentially traumatic events (PTEs) on their
children’s self-esteem, perceived stress, and depressed mood. Among Latino/a parents with
lower dispositional mindfulness and greater frequencies of potentially traumatic events, their
children appeared to have lower self-esteem and greater perceived stress. In contrast, children
whose parents had greater mindfulness did not show reductions in self-esteem and increases in
perceived stress.
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In prior research, dispositional mindfulness in Latino/a parents is associated with greater
wellbeing and healthier adjustment in their children (Calam, 2016; Duncan et al., 2009; Kirby,
2016). Results from a pilot study (Coatsworth et al., 2010) and a follow-up randomized-
controlled comparative study (Coatsworth et al., 2015) showed that improvements in parents’
mindfulness coincided with improvements in parenting skills, and parent-child relationships. In
prior cross-sectional research, mindfulness in parents has been linked to lower levels of child
internalizing and externalizing problems (Bögels et al., 2008; Parent et al., 2010), and greater
wellbeing reported by children (Medeiros et al., 2016). In general, mindful parents have a
propensity toward authoritative and positive parenting styles (Coatsworth et al., 2010; Gouveia et
al., 2016; Miklósi et al., 2017; Parent et al., 2010; Parent, McKee, N. Rough, et al., 2016), lower
levels of parental stress (Gouveia et al., 2016) and mood problems (May et al., 2016; Parent et
al., 2010; Turpyn & Chaplin, 2016), and in turn, improved parent-child relationships
(Coatsworth et al., 2010; Duncan et al., 2009; Parent, McKee, Anton, et al., 2016; Parent,
McKee, N. Rough, et al., 2016). Parents who employed positive parenting tended to foster
resilience (Armstrong, Birnie-Lefcovitch, & Ungar, 2005; Doty, Davis, & Arditti, 2017;
Hoffman, 2010; Kritzas & Grobler, 2005; Sandler, Ingram, Wolchik, Tein, & Winslow, 2015)
and self-esteem in their children (Babore et al., 2016; Bulanda & Majumdar, 2009; Reese et al.,
2007; Rudy & Grusec, 2006), whereas parenting stress and authoritarian parenting styles are
linked to emotional problems (Cappa, Begle, Conger, Dumas, & Conger, 2011; Chan, 2010;
Tracy, 2006; Williams & Woodruff-Borden, 2015) and stress (Laurent, 2014) in their children.
It is possible that mindful parents’ tendency toward positive parenting explains the
protective benefits of mindfulness against the negative effects of parent histories of PTEs on
their children. For example, parents with low mindfulness and a history of potentially traumatic
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events may have a greater tendency toward negative parenting styles compared to parents with
high mindfulness and histories of trauma or compared to parents with low mindfulness and no
history of trauma. Interestingly, higher numbers PTEs reported by parents was associated with
higher self-esteem and lower stress in children if their parents had high mindfulness (see Figures
2.1 and 2.2). This might be explained by combined effects of parent mindfulness and difficult
life experiences on their resilience, though this was not tested in the present study.
Unexpectedly, among parents who report less PTEs, greater dispositional mindfulness was
associated with greater depressed mood in their children. One explanation is that parents with
less PTEs and enhanced awareness as measured by the MAAS are susceptible to relative
deprivation, the tendency to feel wronged when comparing themselves of better-off others
(Fiske, Smith, & Huo, 2014; Tropp & Wright, 1999). On the other hand, mindful parents with
extensive histories of PTEs may be more likely to compare their present circumstances to the
past rather (Garland, Gaylord, & Park, 2009) than comparing themselves to others.
Limitations
Our findings should be interpreted with consideration of the limitations inherent in design
of this pilot study. The data was derived from a CBPR pilot study, which limits our sample size
and representation to youth and parents of Latino/a heritage from the Ramona Gardens
neighborhood of East Los Angeles. Future research with representative national samples and 3 or
more times points is needed to confirm the protective effects of mindfulness on child outcomes
in Latino/a parents with histories of PTEs throughout the U.S.
Implications
In the present study, our findings suggest that parent histories of PTEs are not necessarily
problematic for their children, and may have interactive effects with parent dispositional
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mindfulness. Transgenerational transmission of trauma only tends to occur if trauma is
unresolved by the parents (Hesse & Main, 1999), but whether or not dispositional mindfulness is
involved in the resolution of trauma in parents is not clear. Our findings allude to the possibility
that instilling mindfulness skills and enhancing dispositional mindfulness in parents through
family-based interventions may benefit children in communities with histories of hardship in the
U.S. Future research is needed to examine the effects of dispositional mindfulness on symptoms
of trauma and parenting styles in parents with histories of PTEs.

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Chapter 3

Using the Applied Mindfulness Process Scale (AMPS) to evaluate daily life application of
mindfulness skills in Mindful USC participants: Effects on within-person changes in
dispositional mindfulness, distress, wellbeing, and concentration

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Background
Mindfulness-based interventions (MBIs) encompass various mind-body practices used to
foster present-centered nonjudgmental attention and self-regulation, and have been studied for
their therapeutic benefits toward psychological and medical ailments and the improvement of
quality of life (Chiesa et al., 2014). Extant research reports the use of MBIs toward reducing
stress, mood and anxiety disorders (Brown & Ryan, 2003; Brown et al., 2007; Chiesa & Serretti,
2009), as well as improving psychological and subjective wellbeing (Hanley et al., 2015),
eudaimonic wellbeing (feeling of a worthwhile life) (Garland et al., 2015), and concentration
(Bostanov, Keune, Kotchoubey, & Hautzinger, 2012)
In addition to reducing psychosocial health problems and enhancing wellbeing, MBIs are
also recognized for augmenting concentration and attentional functioning (Chambers, Lo, &
Allen, 2008; Malinowski, 2013; Mikulas, 2011). For this reason, there has been increased
interest toward implementing MBIs in educational and professional settings as a means to
improve academic (Karunananda, Goldin, & Talagala, 2016) and workplace performance
(McCorquodale, 2015). Experimental research indicates that students who participated in MBIs
were better able to retain information from the classroom independently of mood or relaxation
(Ramsburg & Youmans, 2014). Furthermore, a selective review of literature indicates that MBIs
tailored to workplace settings appear to improve engagement and performance in work tasks
(Dane & Brummel, 2013).
However, understanding the modes by which MBIs provide their therapeutic benefits is
still a major challenge for mindfulness researchers (Chiesa et al., 2014). Understanding these
modes can elucidate which mindfulness content translates into improved health outcomes
(Chiesa et al., 2014). Although the proliferation of MBI research has highlighted the many
Li | 65

potential uses of MBI, it is often unclear whether the reported benefits are driven by sustained
change in trait mindfulness, application of mindfulness techniques in daily life situations, or the
mere state of mindfulness achieved during participation in MBI sessions (Chiesa et al., 2014).
Furthermore, if the goal of an MBI is to instill sustained change in mindfulness as an adaptive
trait, it is important that the MBI teach ways to foster mindfulness in both informal and formal
ways outside of MBI sessions (Kiken, Garland, Bluth, Palsson, & Gaylord, 2015). Mindfulness
practice in the context of daily life experiences and stressors may be necessary to heighten
transitory states of mindfulness to mindfulness as a trait (Kiken et al., 2015).
Therefore, when evaluating an MBI, it is important to determine which aspects of
mindfulness the MBI are instilled in subjects, as well as which measures are appropriate for
evaluating these. There currently exist different approaches to measure mindfulness. One
approach is to measure mindfulness as a state or trait using validated scales of the mindfulness
construct such as the Mindful Attention Awareness Scale (MAAS) (Brown & Ryan, 2003), the
Five Facet Mindfulness Questionnaire (FFMQ) (Baer et al., 2006), and the Freiburg Mindfulness
Inventory (FMI) . Another approach is to evaluate the application of mindfulness as a daily life
process or practice (Li et al., 2016). Some examples of process measures of mindfulness include
the Applied Mindfulness Process Scale (AMPS) (Li et al., 2016) and the Mindfulness Process
Questionnaire (MPQ) (Erisman & Roemer, 2012). Measuring changes in dispositional
mindfulness alone may not fully explain the early benefits of MBI participation, especially if
participants who have limited changes in dispositional mindfulness can still apply their newly
acquired mindfulness skills in challenging situations (Li et al., 2016). Therefore, it is also
important to understand the degree to which MBI participants apply mindfulness in daily living,
and how those practices translate to improvements in psychological health and functioning.
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Evaluating an MBI using both the AMPS and a measure of trait mindfulness may provide
insight into which processes of change that occur during an MBI (Li et al., 2016). Furthermore,
when measuring both mindfulness processes and trait mindfulness, it is possible to test the
degree to which early attempts at applying mindfulness in life situations and actual changes in
trait mindfulness predict the reported effects of the MBI results, as well as the degree to which
applied mindfulness can facilitate achievement of higher levels trait mindfulness (Li et al., 2016).
Research is also needed to test the construct validity of the AMPS and its three subdomains in
the context of an MBI.
Purpose of this study
Our study aims to test the effects of mindfulness practice in the context of daily life
circumstances on changes in trait mindfulness, and distress measures (stress, depression, and
anxiety), estimate the degree to which trait mindfulness mediates the effects of mindfulness
practice on psychological distress measures, and evaluate the construct validity of the AMPS and
its three subdomains within this model.

Methods
Participants and procedures
We recruited 699 subjects to participate in the Mindful USC Program, which provides a
5-week course on mindfulness meditation and contemplative practice to students, staff, and
faculty at the University of Southern California. The program is advertised institution-wide via
the university e-mail and website. Potential participants can register online for the program and
participate for free. The courses take place for 90 minutes per week in spans of five weeks. A
senior mindfulness meditation instructor with ten years of teaching experience leads the course
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and provides the foundational education in mindfulness, mindfulness meditation techniques, and
strategies for daily application and practice.
We contacted participants via e-mail to complete online surveys at two time points: (1)
within 10 days prior to the first session and (2) within 10 days following the end of the course.
We contacted participants up to 4 times to complete each survey. All research procedures were
approved by the Human Subjects Protection Committee of the University of Southern California.
Measures
Applied mindfulness in daily life
At follow-up, we evaluated application of mindfulness skills in daily life in the prior 7
days using the Applied Mindfulness Process Scale (AMPS), which consists of 15 items and three
subscales (5 items each) representing mindfulness applications toward decentering, positive
emotion regulation, and negative emotion regulation (Cronbach’s α = .91) (Li et al., 2016). The
AMPS is displayed in its entirety in Appendix II. Rather than measuring dispositional
mindfulness, the AMPS measures the degree to which MBI participants employ learned
mindfulness skills in the face of daily life challenges (Li et al., 2016). An example of an item is
“I used mindfulness practice to calm my emotions when I am upset.” Responses ranged from 0-
never to 4-almost always.
Dispositional mindfulness
We measured dispositional mindfulness at baseline and follow-up using the abbreviated
6-item Mindful Attention Awareness Scale (MAAS-6) (Cronbach’s α = .89–.93; test–retest r =
.35–.52) (Black, Sussman, Johnson, & Milam, 2012; Brown & Ryan, 2003) ) (Cronbach’s α =
.89; test-retest r = .52) (Brown & Ryan, 2003). The 6-item MAAS is an abbreviated and
validated version of the 15-item MAAS, and assesses dispositional mindfulness by measuring
Li | 68

awareness and attention to present moment experiences. Responses range from 1-almost always
to 6-almost never to statements like, “I find it difficult to stay focused on what’s happening in the
present.”
Psychological distress
At baseline and follow-up, we measured three psychological symptoms commonly
targeted by MBIs, including symptoms of stress, depression, and anxiety. We assessed self-
reported stress using the abbreviated and validated 4-item version of the Perceived Stress Scale
(PSS-4) (Cronbach’s α = .77; test-retest r = .85) (Cohen et al., 1983; Warttig, Forshaw, South, &
White, 2013). The PSS measures feelings of stress and uncontrollability around life situations.
Responses to the PSS ranged from 0-never to 4-very often to statements like “In the last month,
how often have you felt difficulties were piling up so high that you could not overcome them?”.
Generalized anxiety was measured using the Generalized Anxiety Disorder (GAD-7) scale
(Cronbach’s α = .92; test-retest r = .83), which evaluates the frequency and severity of anxiety-
related symptoms across 7 items (Spitzer, Kroenke, Williams, & Löwe, 2006). The scale
includes items such as “Worrying too much about different things.” Responses ranged from 0-
not at all sure to 3-nearly every day. Depressed mood was assessed using the short form version
of the Center for Epidemiologic Studies Depression Scale (CES-D-10) (Cronbach’s α = .86; test-
retest r = .85), which measures severity of behavioral and affective symptoms of depression
(Björgvinsson, Kertz, Bigda-Peyton, McCoy, & Aderka, 2013; Radloff, 1977). The CES-D
consists of 10 items such as “I was bothered by things that usually don't bother me” and
responses ranged from 0-rarely or none of the time to 3-all of the time.

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Psychological wellbeing
At baseline and follow-up, we measured global psychological wellbeing using the
Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) (Cronbach’s α = .91; test-retest r =
.83) (Tennant et al., 2007). The WEMWBS assesses wide aspects of mental wellbeing, including
emotion, cognition and evaluation, and psychological functioning. The scale consists of 14-items
such as “I’ve been feeling confident” with responses ranging from 1-none of the time to 5-all of
the time.
Concentration
At baseline and follow-up, we assessed participants abilities and skills around
maintaining concentration using the 9-item concentration subscale from the Learning and Study
Strategies Inventory (LASSI-CON) (Cronbach’s α = .73-.89, test-retest r = .88) (Weinstein &
Palmer, 1990). This subscale assesses participants’ ability to concentrate or focus when doing
learning, academic, or work-related tasks. Responses ranged from 1-not at all typical to 5-very
much typical to items such as “My mind wanders a lot when I study.”
Analysis
All analyses were conducted using Stata Version 14 (StataCorp, 2015). We computed
frequencies and percentages for gender, university classification (e.g., undergraduate, faculty,
etc.), and race/ethnicity. Means and standard deviations were computed for dispositional
mindfulness (MAAS), perceived stress (PSS), generalized anxiety (GAD), depressed mood
(CES-D), mental wellness (WEMWBS), and concentration (LASSI-CON) at baseline and
follow-up, and AMPS at follow-up. We performed paired samples t-tests from baseline to
follow-up on MAAS, PSS, GAD, CES-D, WEMWBS, and LASSI-CON scores, as well as
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Pearson’s correlations between mindfulness practice (AMPS) and change (Δ) scores for MAAS
and study outcomes (PSS, GAD, CES-D, WEMWBS, and LASSI-CON).
We tested six multiple linear regression models to test six separate posttest outcomes—
dispositional mindfulness (MAAS), perceived (PSS), depressed mood (CES-D), and anxiety
levels (GAD), wellness (WEMWBS), and concentration (LASSI-CON)—on applied mindfulness
in daily life (AMPS) while adjusting for baseline on each outcome (i.e., PSS at pretest). This
approach, as depicted in the equation Y
2
= β
0
+ β
1
AMPS
2
+ β
3
Y
1
+ β
3
ε and in Figure 3.1, shows
that adjusting for baseline on the outcome in allows for interpretation of the estimate for β
1
as
the association between AMPS and change in the outcome at posttest (Paul D. Allison, 1990).

Figure 3.1. Multiple linear regression approach testing each posttest outcome on AMPS while
adjusting for pretest on each outcome

Missing values were modeled using maximum likelihood estimation (P. D. Allison,
2012). In addition to adjusting for pretest on each outcome, we adjusted for gender,
race/ethnicity, and student (versus university professional) status. For models with significant
estimates, we generated prediction plots to illustrate the estimated regression line of posttest
scores for outcomes on AMPS.
We used the “SEM” command to perform structural equation modeling of our conceptual
model shown in Figure 1. In order to test the construct validity of AMPS within our overall
structural equation model (Hays, Revicki, & Coyne, 2005), we performed a confirmatory factor
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analysis by mapping the 15 AMPS items onto three lower order latent variables—corresponding
to decentering, positive emotion regulation, and negative emotion regulation subscales—which
then loaded onto a single higher order AMPS latent variable. Factor loadings for the lower order
latent variables were greater than .90 in the CFA, indicating that the subdomains of the AMPS
(decentering, positive emotion regulation, and negative emotion regulation) were too statistically
similar (see Figure 3.2). Therefore, we proceeded to model AMPS as a summed score in
subsequent path models.

Figure 3.2. Confirmatory factor analysis of high order AMPS latent variable and its three lower
order latent variables (decentering, positive emotion regulation, and negative emotion regulation)
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Path analysis
As shown in Figure 3.3, in each path model, we computed mediated effects of
mindfulness practice (AMPS) on our outcomes—PSS, GAD, CES-D, WEMWBS, and LASSI-
CON measured at posttest—through posttest MAAS scores, while adjusting for baseline on each
outcome. As with the prior regression analyses, adjusting for baseline on each outcome allowed
for interpretation of the estimates for AMPS as associations with change in each outcome at
posttest. The path analysis approach to mediation analysis uses maximum-likelihood estimation
to simultaneously obtain parameter estimates for direct effects and indirect effects (which is the
product of the direct effects along the mediated pathway) (Gunzler, Chen, Wu, & Zhang, 2013).
We adjusted for gender, race/ethnicity, and student (versus university professional status) along
pathways to the mediator (posttest MAAS) and to the outcomes (posttest PSS, GAD, CES-D,
WEMWBS, and LASSI-CON). To rule out the possibility that MAAS at pretest was associated
with AMPS, we initially tested this path in preliminary models (dotted arrow in Figure 3.2). Due
to non-significance, this path was excluded in the final models. We assessed model fit for each
path model by computing the Chi-square (χ
2
) goodness-of-fit test, Tucker-Lewis Index (TLI),
and root mean square error of approximation (RMSEA).

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Figure 3.3. Approach to testing mediation from AMPS to each outcome via MAAS (posttest),
adjusting for pretest on MAAS and each outcome

Note: Pathways from MAAS at pretest to AMPS (dotted arrow) were excluded in final path
models due to non-significance

Path Models 1-3: Mindfulness practice, dispositional mindfulness, and distress measures
Path Models 1-3 tested for direct effects of applied mindfulness (AMPS) on posttest
dispositional mindfulness (MAAS) and on posttest distress measures (PSS, CES-D, and GAD),
as well as indirect effects of mindfulness practice (AMPS) on changes in posttest distress
measures mediated by posttest dispositional mindfulness (MAAS). To do this, we modeled
direct paths from the summed AMPS score to the mediator (posttest MAAS) and the outcome
(i.e., posttest PSS), and a direct path from the mediator (posttest MAAS) to the outcome (i.e.,
posttest GAD) while adjusting for pretest scores on the mediator (MAAS) and on the outcomes
(i.e., CES-D) (as shown in Figure 3.2).
Path Model 4: Mindfulness practice, dispositional mindfulness, and psychological wellbeing
In our fourth path model, we tested for direct effects of AMPS on posttest MAAS and on
posttest wellbeing (WEMWBS), as well as indirect effects of AMPS on posttest WEMWBS
mediated by posttest MAAS. To do this, we modeled two direct paths from AMPS to posttest
MAAS and posttest WEMWBS, and a direct path from posttest MAAS to posttest WEMWBS
while adjusting for pretest scores on the mediator (MAAS) and on the outcome (WEMWBS) (as
shown in Figure 3.2).
Path Model 5: Mindfulness practice, dispositional mindfulness, and concentration
In the third path model, we tested for direct effects of AMPS on posttest MAAS and on
posttest LASSI-CON, as well as indirect effects of AMPS on posttest LASSI-CON mediated by
posttest MAAS. We modeled direct paths from AMPS score to posttest MAAS and posttest
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LASSI-CON, and a direct path from posttest MAAS to posttest LASSI-CON while adjusting for
pretest scores on MAAS and LASSI-CON.
Hypotheses
We hypothesize that applied mindfulness will be associated with posttest increases in
MAAS, WEMWBS, and LASSI-CON, and posttest reductions PSS, CES-D, and GAD, and that
posttest MAAS will mediate the effects of AMPS on each outcome.

Results
Table 1 displays the demographic characteristics of our overall study sample (N=304).
The majority of participants (71%) were female. About half of the participants were students
(49%), while the remaining were university professionals (e.g., faculty, staff). Non-white persons
comprised about 77% of the sample.
As shown in Table 3.2, paired t-tests indicate significant increases in MAAS (p < .001),
WEMWBS (p < .001), LASSI-CON (p < .001) and significant decreases in PSS (p < .001), GAD
(p < .001), and CES-D (p < .001) from baseline to follow-up in participants overall. As shown in
Table 3.2, AMPS and WEMWBS performed with excellent internal consistency (Cronbach’s α =
.92 to .94), MAAS, GAD, and CES-D performed with good internal consistency (Cronbach’s α =
.82 to .88), and PSS and LASSI-CON performed with adequate internal consistency (Cronbach’s
α = .71 to .78).
The top of Table 3.3 displays univariate correlations between pretest measures—MAAS,
PSS, GAD, CES-D, WEMWBS, and LASSI-CON. At pretest, MAAS was positively correlated
with WEMWBS (r = .49 p < .001) and LASSI-CON (r = .37, p < .001) and negative correlated
with PSS (r = -.42, p < .001), GAD (r = -.44, p < .001), and CES-D (r = -.42, p < .001).
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Table 3.1. Demographics of the overall sample (N = 304)

Characteristic n (%)
Sex
Female
Male
Unknown

215 (70.7)
85 (28.0)
4 (1.3)
University classification
Undergraduate student
Graduate student
Staff
Faculty
Unknown

70 (23.0)
79 (26.0)
106 (34.9)
47 (15.5)
2 (0.7)
Ethnicity
White
Asian
Black
Latino
Other
Unknown

69 (22.7)
54 (17.8)
25 (8.2)
21 (6.9)
133 (43.8)
2 (0.7)

Table 3.2. Descriptive statistics for mindfulness practice (AMPS), dispositional mindfulness
(MAAS), and study outcomes (PSS, GAD, CESD, WEMWBS, and LASSI-CON)

Pre-test Post-test
Variable M (SD) Cronbach’s α M (SD) Cronbach’s α t p
AMPS -- -- 40.07 (9.20) .94 -- --
MAAS 3.49 (0.91) .85 4.04 (0.87) .88 9.66 <.001
PSS 8.18 (2.69) .78 6.88 (2.31) .71 -5.52 <.001
GAD 7.27 (4.55) .88 4.89 (3.87) .85 -5.15 <.001
CES-D 11.77 (5.30) .82 8.51 (4.50) .82 -7.21 <.001
WEMWBS 46.78 (8.10) .92 50.58 (7.57) .92 6.54 <.001
LASSI-CON 21.76 (11.11) .76 29.42 (5.40) .77 13.02 <.001

Note: AMPS = Applied Mindfulness Process Scale, MAAS = Mindful Attention Awareness
Scale, PSS = Perceived Stress Scale, GAD = Generalized Anxiety Disoder, CES-D = Center for
Epidemiologic Studies Depression, WEMWBS = Warwick-Edinburgh Mental Wellbeing Scale,
LASSI-CON = concentration domain of Learning and Study Strategies Inventory
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Table 3.3. Pearson’s correlations between applied mindfulness (AMPS) and changes (Δ) in
dispositional mindfulness (MAAS) and study outcomes (PSS, GAD, CES-D, WEMWBS, and
LASSI-CON)

Pretest
AMPS MAAS PSS GAD CES-D WEMWBS LASSI-CON
AMPS -

MAAS - 1.00
(590)

PSS - -.42***
(235)
1.00
(247)

GAD - -.44***
(235)
.64***
(245)
1.00
(245)

CES-D - -.42***
(232)
.68***
(232)
.75***
(232)
1.00
(232)

WEMWBS - .49***
(343)
- - - 1.00
(343)

LASSI-CON - .37***
(561)
-.35***
(233)
-.28***
(232)
-.37***
(225)
.37***
(334)
1.00
(653)
Posttest
AMPS MAAS PSS GAD CES-D WEMWBS LASSI-CON
AMPS 1.00
(290)

MAAS .43***
(289)
1.00
(324)

PSS -.39***
(180)
-.40***
(197)
1.00
(324)

GAD -.37***
(180)
-.43***
(197)
.59***
(199)
1.00
(199)

CES-D -.36***
(179)
-.48***
(192)
.66***
(192)
.70***
(192)
1.00
(192)

WEMWBS .68***
(111)
.63***
(115)
- - - 1.00
(115)

LASSI-CON .23**
(288)
.44***
(298)
-.34***
(188)
-.27**
(188)
-.47***
(187)
.52***
(112)
1.00
(299)

Note: AMPS = Applied Mindfulness Process Scale, MAAS = Mindful Attention Awareness
Scale, PSS = Perceived Stress Scale, GAD = Generalized Anxiety Disorder, CES-D = Center for
Epidemiologic Studies Depression, WEMWBS = Warwick-Edinburgh Mental Wellbeing Scale,
LASSI-CON = concentration domain of Learning and Study Strategies Inventory

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The bottom of Table 3.3 displays univariate correlations between posttest measures—
MAAS, PSS, GAD, CES-D, WEMWBS, and LASSI-CON. At posttest, AMPS was positively
correlated with MAAS (r = -.43, p < .001), WEMWBS (r = .68, p < .001), and LASSI (r = -.44,
p < .001), and negatively correlated with PSS (r = -.39, p < .001), GAD (r = -.37, p < .001), and
CES-D (r = -.36, p < .001). At posttest, MAAS was positively correlated WEMWBS (r = .63, p
< .001) and LASSI-CON (r = .44, p < .001), and negatively correlated with PSS (r = -.40, p <
.001), GAD (r = -.43, p < .001), and CES-D (r = -.48, p < .001).

Table 3.4. Multiple linear regression models of distress measures (PSS, GAD, CES-D),
dispositional mindfulness (MAAS), wellbeing (WEMWBS), and concentration (LASSI-CON) at
posttest on applied mindfulness

Posttest outcome
PSS
(n = 341)
GAD
(n = 337)
CES-D
(n = 324)
MAAS
(n = 688)
WEMWBS
(n = 347)
LASSI-CON
(n = 653)
Predictor β
(SE)
p β
(SE)
p β
(SE)
p β
(SE)
p β
(SE)
p β
(SE)
p
AMPS -.35
(.06)
< .001 -.38
(.06)
< .001 -.29
(.06)
< .001 .32
(.04)
< .001 .41
(.07)
< .001 .19
(.05)
< .001
Pretest measure
PSS .50
(.06)
< .001 - - - - - - - - - -
GAD - - .41
(.08)
< .001 - - - - - - - -
CES-D - - - - .61
(.05)
< .001 - - - - - -
MAAS - - - - - - .55
(.04)
< .001 - - - -
WEMWBS - - - - - - - - .46
(.07)
< .001 - -
LASSI-CON - - - - - - - - - - .29
(.04)
< .001

Note: AMPS = Applied Mindfulness Process Scale, MAAS = Mindful Attention Awareness
Scale, PSS = Perceived Stress Scale, GAD = Generalized Anxiety Disorder, CES-D = Center for
Epidemiologic Studies Depression, WEMWBS = Warwick-Edinburgh Mental Wellbeing Scale,
LASSI-CON = concentration domain of Learning and Study Strategies Inventory. Each model
adjusted for the outcome at pretest, sex, student (versus university professional) status, and
race/ethnicity.
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Multiple linear regressions shown in Table 3.4 indicated that higher AMPS was
significantly associated with decreases in posttest measures of PSS (β = -.35, p < .001), GAD (β
= -.38, p < .001), and CES-D (β = -.29, p < .001) while adjusting for pretest on each outcome and
demographics. Higher AMPS was significantly associated with increases in MAAS (β = .32, p <
.001), WEMWBS (β = .41, p < .001), (β = .19, p < .001).
In Path Model 1 (displayed in Figure 3.4), more frequent application of mindfulness
skills (AMPS) during the last 7 days of the course was directly associated with increases in
posttest dispositional mindfulness (MAAS) (β = .29, p < .001) and decreases in posttest
perceived stress (PSS) (β = -.29, p < .001). In turn, increases in posttest MAAS scores was
directly associated with decreases in posttest PSS (β = -.19, p = .003). The mediated effects of
greater AMPS scores—through increases in posttest MAAS scores—on decreases in posttest
PSS scores were significant (β = -.06, p = .014) and accounted for 16% of the total effect. Path
Model 1 fit indices indicate good fit—χ
2
= 1.17, p = .761, RMSEA = .000, 90% CI [.000, .062],
TLI = 1.058.

Figure 3.4. Path Model 1 (n = 341) illustrating direct and mediated effects (with standardized
coefficients) between AMPS and PSS at posttest, adjusting for MAAS and PSS at pretest.
Standardized coefficients are displayed. Dashed line represents the mediated effects of AMPS on
PSS at posttest via MAAS at posttest.
*p < .05, **p < .01, ***p < .001
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In Path Model 2 (displayed in Figure 3.5), higher AMPS was directly associated with
increases in posttest dispositional mindfulness (MAAS) (β = .30, p < .001) and decreases in
posttest anxiety (GAD) (β = -.29, p < .001). Increases in posttest MAAS scores was directly
associated with decreases in posttest GAD (β = -.24, p = .001). The mediated effects of greater
AMPS scores—through increases in posttest MAAS scores—on decreases in GAD scores were
significant (β = -.07, p = .006) and accounted for 20% of the total effect. Path Model 2 fit indices
indicate good fit—χ
2
= 1.60, p = .864, RMSEA = .000, 90% CI [.000, .072], TLI = 1.048.

Figure 3.5. Path Model 2 (n = 341) illustrating direct and mediated effects (with standardized
coefficients) between AMPS and GAD at posttest, adjusting for MAAS and GAD at pretest.
Standardized coefficients are displayed. Dashed line represents the mediated effects of AMPS on
GAD at posttest via MAAS at posttest.

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Figure 3.6. Path Model 3 (n = 324) illustrating direct and mediated effects (with standardized
coefficients) between AMPS and CES-D at posttest, adjusting for MAAS and CES-D at pretest.
Standardized coefficients are displayed. Dashed line represents the mediated effects of AMPS on
CES-D at posttest via MAAS at posttest.

In Path Model 3 (displayed in Figure 3.6), higher AMPS was directly associated with
increases in posttest dispositional mindfulness (MAAS) (β = .29, p < .001) and decreases in
posttest anxiety (CES-D) (β = -.22, p < .001). Increases in posttest MAAS scores was directly
associated with decreases in posttest CES-D (β = -.24, p = .001). The mediated effects of greater
AMPS scores—through increases in posttest MAAS scores—on decreases in CES-D scores were
significant (β = -.07, p = .004) and accounted for 24% of the total effect. Path Model 3 fit indices
indicate good fit—χ
2
= 1.78, p = .619, RMSEA = .000, 90% CI [.000, .077], TLI = 1.038.

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Path Model 5 indicates (shown in Figure 3.5) that greater AMPS scores directly predicted
increases in MAAS scores (β = .41, p < .001) and WEMWBS (β = 0.34, p < .001). In turn,
increases in MAAS scores directly predicted increases in WEMWBS scores (β = 0.25, p = .001)
and mediated 24% (β = .10, p = .002) of the total effect of AMPS scores on increases in
WEMWBS scores. Path Model 5 fit indices indicate good fit—χ
2
= 0.329, p=.566, RMSEA =
.000, 90% CI [.000, .208], TLI = 1.079.

Figure 3.7. Path Model 3 (n = 347) illustrating direct and mediated effects (with standardized
coefficients) between AMPS and WEMWBS at posttest, adjusting for MAAS and WEMWBS at
pretest. Standardized coefficients are displayed. Dashed line represents the mediated effects of
AMPS on WEMWBS at posttest via MAAS at posttest.

In Path Model 3 (show in Figure 3.4), greater AMPS scores was directly associated with
increases in posttest MAAS (β = .32, p < .001), which in turn directly predicted increases
posttest concentration (LASSI) (β = .32, p < .001). Increases in MAAS scores mediated 63% (β
= .10, p < .001) of the total effect of AMPS scores on increases in posttest LASSI scores. Fit
indices indicate good fit in Model 3—χ
2
= 1.138, p=.768, RMSEA = .000, 90% CI [.000, .044],
TLI = 1.029.

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Figure 3.8. Path Model 3 (n = 653) illustrating direct and mediated effects (with standardized
coefficients) between AMPS and LASSI at posttest, adjusting for MAAS and LASSI at pretest.
Standardized coefficients are displayed. Dashed line represents the mediated effects of AMPS on
LASSI at posttest via MAAS at posttest.

Discussion
Findings from the present study indicate that overall, participants in the 5-week Mindful
USC course reported significant increases in dispositional mindfulness, psychological wellbeing,
and concentration and significant decreases in peceived stress, general anxiety, and depression.
Our study also indicates that application of mindfulness skills in challenging situations is
positively correlated with changes in dispositional mindfulness and negatively correlated with
changes in perceived stress, generalized anxiety, and depressed mood. Multiple linear regression
confirmed that higher applied mindfulness is associated with increases in posttest dispositional
mindfulness, wellbeing, and concentration, and decreases in posttest stress, anxiety, and
depressed mood. Elaborating on these findings, we tested whether dispositional mindfulness
mediated the effects of applying mindfulness in challenging situations on our study outcomes.
Total effects of applied mindfulness (sum of both direct and indirect effects) on posttest stress,
anxiety, depression, and wellbeing were greater than the direct effects of dispositional
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mindfulness in the path models. Dispositional mindfulness partially mediated these associations.
In contrast, with these models Path Model 5 indicates that only mediated effects of applied
mindfulness (through posttest dispositional mindfulness) on posttest concentration was
significant.
Estimates for Path Models 1-3 (see Figures 3.2-3.7) suggest that applying mindfulness
skills in daily life situations may directly reduce stress, anxiety, depression independently of the
degree to which mindfulness practice augments dispositional mindfulness. In other words,
applying newly acquired mindfulness skills in the face of daily life challenges may be another
mode by which MBI’s reduce distress, which has been hypothesized by Chiesa et al. (2014).
Increased in posttest dispositional mindfulness partially mediated the effects of applied
mindfulness on stress, anxiety, depressed mood suggesting that the application of mindfulness
skills also improves distress by enhancing dispositional mindfulness.
Findings from Path Model 2 (see Figure 3.3) aligns with our hypothesis and prior
mindfulness research indicating that the process of applying new mindfulness skills was
associated with global psychological well-being both directly and indirectly—through
dispositional mindfulness (Chiesa et al., 2014). This confirms extant research indicating that
present centered attention as measured by the MAAS is associated with increases in wellbeing
in university-based MBI participants (Brown & Ryan, 2003). The direct effect of mindfulness
practice on wellbeing in Path Model 4 suggests that applying mindfulness skills during life
challenges (i.e., acknowledging positive events) was beneficial to study participants in ways
beyond simply being aware of the present.
In Path Model 3 (see Figure 3.4), mindfulness practice only had significant indirect
effects on change in concentration, suggesting that the benefits of mindfulness practice on
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concentration in our unversity sample was fully explained by the degree to which practice
improved dispositional mindfulness. Again, the MAAS measure of dispositional mindfulness
focuses specifically on present attention and awareness (Grossman, 2011), which may simply
mean that improving present attention is the most relevant aspect of mindfulness practice for
improving concentration. It is also possible that applying mindfulness during a challenge can
benefit concentration indirectly by reducing academic or work-related stress, anxiety, or
depressed mood.
Findings from the present study suggest that mindfulness practice as a process in daily
life situations can explain the improvements in dispositional mindfulness, and in turn
improvements in perceived stress, generalized anxiety, depressed mood, and psychological
wellbeing. A concern in prior evaluations of MBIs was the challenge in identifying the “active
ingredients” or key components of MBIs that influenced change in psychological outcomes
(Chiesa et al., 2014). By measuring mindfulness practice using the AMPS, we were able to
measure the degree to which participants in the Mindful USC Program applied their newly
acquired mindfulness skills to daily life situations and test the degree to which instilled practices
accounted for improvements in posttest outcomes (Chiesa et al., 2014; Li et al., 2016). It is also
important to note that although there was no control group, it is unlikely that applied mindfulness
measured in the study was the result of participants’ dispositional mindfulness levels at pretest,
as pretest MAAS scores were not associated with AMPS. Therefore, it is most likely that the
AMPS truly measured newly acquired mindfulness skills rather than preexisting skills.
Findings from the present study demonstrate that mindfulness practice as measured by
the AMPS can be a useful way of evaluating the degree to which MBI participants applied
mindfulness-specific skills in their daily lives, as well as the extent to which mindfulness
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practice explained improvements in the health outcomes in the study (Li et al., 2016). The AMPS
appeared to be a stronger determinant than MAAS of stress, anxiety, depression, and global
mental wellbeing after participation in the Mindful USC course. This may be explained by the
brevity of the evaluation period. Because follow-up did not extend beyond 10 days following
participants’ completion of the 5-week MBI, it stands to reasons that newly applied mindfulness
practices rather than nascent changes in mindfulness disposition would yield more early benefits.
As previously emphasized, the cultivation of sustained dispositional mindfulness depends on
long-term formal and informal practice (Brown & Ryan, 2003; Chiesa et al., 2014). Future
research is needed to evaluate how well participants in various MBIs sustain mindfulness
practice in daily living over longer evaluation periods, as well as whether maintenance of
everyday practice following MBI participation promotes longer-term health benefits.
Limitations
In the present study, implications about the association between AMPS scores and
improvements in dispositional mindfulness and health outcomes are limited by having only one
time point of AMPS measurement and two time points of outcomes measurement. In future
research, we recommend measuring the AMPS at both midpoint and follow-up, and measuring
study outcomes with three or more waves over a longer evaluation period (Li et al., 2016). This
offers several benefits for analysis and interpretation: (a) the ability to measure change in AMPS;
(b) reduced possiblity of spurious linear change in health outcomes; and (c) the ability to
observe longer-term change in health outcomes as a function of change in AMPS and subsequent
changes in dispositional mindfulness.

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Implications
Still, the direct and indirect associations between AMPS and changes in dispositional
mindfulness, stress, anxiety, depression, wellbeing, and concentration in the present study are
unlikely to be spurious considering that all outcomes showed coinciding, signficant
improvements in relation to AMPS. Findings from the present study may also be limited by
selection bias, as participants self-selected to enroll in the mindfulness course and attritition may
have biased the data. However, estimates did not change more than 15% between complete cases
and modeling of full data, so it is unlikely that there were significant difference between missing
and complete cases.

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Conclusions

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Conclusions
This dissertation examined how dispositional mindfulness and applied mindfulness in daily
living play a role in psychosocial health and well-being at the individual and interpersonal levels
in diverse communities. Findings from this dissertation advance scientific knowledge of the
benefits of dispositional mindfulness in the context of minority stress, the interpersonal benefits
of dispositional mindfulness within families, and the importance of measuring applied
mindfulness—separately from dispositional mindfulness—when evaluating MBIs.
Chapter 1 provides an in-depth, qualitative perspective into how various domains of
dispositional mindfulness—acting with awareness, non-reacting, non-judging, describing, and
observing—impacted how Latino/a sexual minority young adults adapted to their experiences of
minority stress. Latino/a sexual minority young adults who exhibited mindfulness qualities
described instances where they overcame challenges with marginalization, discrimination, and
fear of rejection through self-acceptance, seeking social support, and appreciating one’s
achievements. Chapter 1 also illustrates how dispositional mindfulness has interpersonal benefits
within the families of Latino/a sexual minorities. Family members who possessed mindfulness
traits were better able to process initial feelings of discomfort toward sexual minority family
members, appreciate both strengths and hardships in the LGBTQ community, and act on love
and acceptance of sexual minority family members. Chapter 2 provides quantitative evidence of
the interpersonal benefits of dispositional mindfulness within families. Particularly, Chapter 2
demonstrates how greater dispositional mindfulness in Latino/a parents translates to improved
resilience and self-esteem, and reduced stress and depressed mood in their children over 3
months. Chapter 3 examines the benefits of mindfulness as a process separately from the benefits
of mindfulness as a disposition. Evaluating the application of mindfulness in the face of life
Li | 89

challenges elucidated how much MBI participants used their newly acquired mindfulness skills,
as well as the degree to applied mindfulness predicted improved psychosocial health and
functioning. Although applied mindfulness was moderately correlated with improvements in
dispositional mindfulness, applied mindfulness appeared to be a significant independent
predictor of reduced distress and improved wellbeing.
In order to attain a better understanding of how dispositional mindfulness can provide
resilience in the face of minority stress, future research is needed to synthesize findings from
Chapters 1 and 2 the following ways: (a) by longitudinally testing whether the five facets of
dispositional mindfulness (Baer et al., 2006; Baer et al., 2008) can attenuate the effects of
minority stress on health outcomes in minority participants; (b) by longitudinally testing dyadic
associations between dispositional mindfulness in parents and psychosocial health in their
racial/sexual minority children; and (c) by longitudinally testing whether dispositional
mindfulness in parents can attenuate the effects of external sources of minority stress on their
racial/sexual minority children. Future research on mindfulness domains and minority stress can
inform ways to integrate culturally congruent content into evidence-based MBIs geared toward
minority communities.
To expand upon findings from Chapter 3, evaluating applied mindfulness in daily life
across multiple time points will better elucidate people’s sensitivity to change over the course of
MBI participation. Furthermore, stratified assessment of applied mindfulness in diverse samples
of MBI participants will clarify whether people of different backgrounds utilize mindfulness
skills at varying frequencies, as well as whether applying mindfulness translates into similar
levels of improvement in psychosocial health across different communities. Synthesizing
knowledge from Chapters 1, 2, and 3 in future research may involve: (a) evaluating
Li | 90

improvements in coping behaviors, distress symptoms, and wellbeing in minorities who
participate in culturally-congruent MBIs; (b) evaluating the degree to which participants of
minority status apply mindfulness skills in the face of minority stress; and (c) evaluating the
benefits of MBIs for parents of sexual minority children.
It is important to acknowledge that dispositional mindfulness and mindfulness-based
interventions (MBIs) targeting minority participants may not directly address many distal
sources of minority stress, such as prejudiced opinions of others, societal oppression, and acts of
discrimination. Fuchs, Lee, Roemer, and Orsillo (2013) acknowledge that a challenge in
applying MBIs to minority populations is that the responsibility of change falls upon minorities
themselves along with the realization that the external sources of minority stress are largely
beyond their control. However, because societal level change is often slow, there still remains a
need for strengths and resilience building strategies for minorities to adapt to existing challenges
and stressors. This does not mean that social harms should be unaddressed or that negative
emotions should be unacknowledged. Rather, dispositional mindfulness can enable minority
persons to act with awareness by making changes that are within their control (e.g., educating
others, participating in activism, supporting others in the community, seeking support) and by
having self-compassion in the face of minority stress (Fuchs et al., 2013). Furthermore, findings
from this dissertation indicate that dispositional mindfulness can promote healthier family
environments and interpersonal relationships, suggesting that mindfulness can enables families
to be sources of “safety” from minority stress.

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Appendix I
Chapter 3 interview questions
Minority stress interview domains
 Distal minority stress processes
 “What was it like being a Latino/a in your school/workplace?”
 “What was it like being a Latino/a in your neighborhood?”
 “How did people treat you when they suspected you were [sexual identity]?
 “How were you treated compared to your heterosexual peers in school/work?”
 “How safe was your neighborhood for [sexual identity] people?”
 “How did friends/family/other react when they found out about your sexual orientation?”
 “How do you think the media treats people of your ethnic background/sexual
orientation?”
 “How do you feel people in your community are treated?”
Proximal minority stress processes
 “How did you feel about your cultural identity when you started attending school in the
U.S.?” (immigrant participants only)
 “How did you feel about being Latino/a and U.S. born?” (U.S. born only)
 “How comfortable were you sharing your sexual identity with other people?” (sexual
minority participants only).
 “How did you feel about your sexual orientation?”
 “How did you feel about yourself when people treated you differently?”
 “How safe do you feel being yourself in public?”
 “How safe do you feel being yourself around family, friends, etc?
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Mindfulness interview domains
Acting with awareness:
“What motivated you to make that choice?”
“What was on your mind when you did that?”
“How well have you been able to focus on your tasks/responsibilities?”
Non-react
“What did you do when you felt that way?”
“What went through your mind when that happened?”
“What was your first reaction?”
“How did you handle that in the moment?”
Non-judge
“How did you feel about yourself when you were thinking those things?”
“How accepting were you of yourself during that experience?”
“How difficult was it for you
Describe
“What was it like putting those feelings/thoughts into words?”
“How did you identify those feelings?”
Observe
“What sensations did you notice during that experience?”
“What feelings/thoughts did you notice during that experience?”
“What did you notice yourself doing when you felt that way?”

Li | 93

Appendix II

____________________________________________________________________________

Dear Colleague:

The Applied Mindfulness Process Scale (AMPS) is public domain and does not require special
permission for use in research or clinical work. The AMPS measures the application of
mindfulness practices in daily life among persons participating in mindfulness-based
interventions (MBIs). This process measure has been validated for use among adult mindfulness
practitioners and college students partaking in a MBI (Li, Black, & Garland, 2015). A detailed
description of AMPS, the AMPS instrument itself, and instructions for use and scoring are
available below.

Please e-mail us with any questions about the interpretation or use of the AMPS. We also
appreciate your sharing any new research or clinical findings when using this scale.

Regards,
Eric Garland, Ph.D., LCSW
College Of Social Work
University of Utah
395 South, 1500 East, Room 273
Salt Lake City, UT 84108
E-mail: eric.garland@socwk.utah.edu

David Black, Ph.D., MPH
Keck School of Medicine
University of Southern California
2001 N. Soto St., SSB 302D
Los Angeles, CA 90032
E-mail: davidbla@usc.edu

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The Applied Mindfulness Process Scale (AMPS)

Description of the scale:
The Applied Mindfulness Process Scale (AMPS) is a process measure for researchers to quantify
how participants in mindfulness-based interventions (MBIs) use mindfulness practice when
facing challenges in daily life. Development and validation of the AMPS yielded 15 items
representing three domains of applied mindfulness processes: (a) decentering, (b) positive
emotion regulation, and (c) negative emotion regulation (Li, Black, & Garland, 2015). It has
demonstrated strong internal consistency (Cronbach’s α) ranging between 0.91-0.94, as well as
good nomological validity with related constructs (e.g., stress, depression, trait mindfulness,
anxiety, and general wellbeing). As a process measure, the AMPS can be used as a standalone
measure of practice or alongside a measure of state or trait mindfulness. It should only be used
among current mindfulness practitioners or MBI participants. Completion of the AMPS
questionnaire should take 5 minutes.

AMPS norms to date:
n Mean SD Range
Adult practitioners
AMPS total
Decentering
Positive emotion regulation
Negative emotion regulation
134
54.18
18.12
22.18
14.15

9.83
3.72
3.85
2.64

(0-60)
(0-20)
(0-20)
(0-20)
College students
AMPS total
Decentering
Positive emotion regulation
Negative emotion regulation
180
40.55
13.27
13.85
13.42

9.49
3.34
3.75
3.37

(0-60)
(0-20)
(0-20)
(0-20)

Instructions for administration: We suggest that the AMPS process measure be administered
one or more times during the course of the intervention when the participant has become familiar
with the practice (e.g., at week 4 - the intervention mid-point, at week 8 - the end of the MBI).

Instructions for scoring: (1) Sum each factor individually to obtain a score ranging from 0-20,
and/or (2) sum all 15 items to obtain a score ranging from 0-60.

Decentering items: 1, 3, 12, 13, 15
Positive emotion regulation items: 4, 7, 9, 11, 14
Negative emotion regulation items: 2, 5, 6, 8, 10

Please use the following reference to cite this scale:
Li, M. J., Black, D. S., Garland, E. L. (2015). The Applied Mindfulness Process Scale (AMPS):
A process measure for evaluating mindfulness-based interventions. Personality and
Individual Differences. Advance online publication.
http://dx.doi.org/10.1016/j.paid.2015.10.027.
Li | 95

_____________________________________________________________________________

Instructions: Everyone gets confronted with negative or stressful events in daily life, and people
who practice mindfulness experience these events in different ways. Please indicate how often
you have used mindfulness in each of the following ways for the period of the last week (past 7
days).
_____________________________________________________________________________

I used mindfulness practice to… Never Rarely Sometimes Often
Almost
Always
1. Observe my thoughts in a detached
manner
0

1

2

3

4

2. Relax my body when I am tense
0

1

2

3

4

3. See that my thoughts are not
necessarily true
0

1

2

3

4

4. Enjoy the little things in life more fully
0

1

2

3

4

5. Calm my emotions when I am upset
0

1

2

3

4

6. Stop reacting to my negative impulses
0

1

2

3

4

7. See the positive side of difficult
circumstances
0

1

2

3

4

8. Reduce tension when I am stressed
0

1

2

3

4

9. Realize that I can grow stronger from
difficult circumstances
0

1

2

3

4

10. Stop my unhelpful reactions to
situations
0

1

2

3

4

11. Be aware of and appreciating pleasant
events
0

1

2

3

4

12. Let go of unpleasant thoughts and
feelings
0

1

2

3

4

13. Realize that my thoughts are not facts
0

1

2

3

4

14. Notice pleasant things in the face of
difficult circumstances
0

1

2

3

4

15. See alternate views of a situation
0

1

2

3

4

Li | 96

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Asset Metadata

Creator Li, Michael Jonathan (author)

Core Title Applications of mindfulness toward promoting psychosocial health in diverse communities

School Keck School of Medicine

Degree Doctor of Philosophy

Degree Program Preventive Medicine (Health Behavior Research)

Publication Date 07/18/2017

Defense Date 06/01/2017

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag dispositional mindfulness,Latino/a health,mindfulness-based interventions,minority stress,OAI-PMH Harvest,process measure,sexual minorities

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Bluthenthal, Ricky (committee chair), Black, David (committee member), Chou, Chih-Ping (committee member), Milam, Joel (committee member), Unger, Jennifer (committee member)

Creator Email bunnylambdog@gmail.com,Limichae@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c40-401438

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Legacy Identifier etd-LiMichaelJ-5536.pdf

Dmrecord 401438

Document Type Dissertation

Rights Li, Michael Jonathan

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

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