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1.
J Sch Psychol ; 105: 101323, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38876551

ABSTRACT

Given high levels of adolescent stress and educational institutions' key role in supporting students' mental health, mindfulness instruction is increasingly being implemented in schools. However, there is growing evidence adolescents find traditionally taught formal mindfulness (e.g., structured regular practice like meditation) challenging. Indeed, school-based studies report high levels of student non-compliance and lack of engagement with formal mindfulness strategies. Thus, informal mindfulness practices (e.g., unstructured brief moments integrated within daily routine) may be more accessible and developmentally appropriate for adolescents. Using a randomized experimental school-based design, this study sought to parse out the acceptability and effectiveness of formal and informal mindfulness for adolescents over time. Adolescents (n = 142; 73.9% female) were randomly assigned to a 4-week formal mindfulness, informal mindfulness, or comparison group and assessed on mental health, well-being, and educational outcomes. The informal mindfulness group (a) was more likely to report intending to frequently use the strategies (p = .025, Cramer's V = .262) and (b) reported increased dispositional mindfulness (i.e., general tendency to be mindful) from baseline to follow-up (p = .049, ηp2 = .034) which in turn mediated benefits on depression (indirect effect = -.15, 95% CI [-.31, -.03]), anxiety (indirect effect = -.21, 95% CI [-.36, -.06]), general stress (indirect effect = -.16, 95% CI [-.32, -.04]), school-related stress (indirect effect = -.15, 95% CI [-.28, -.05]), negative affect (indirect effect = -.17, 95% CI [-.35, -.04]), and attentional control (indirect effect = .07, 95% CI [.01, .13]). Thus, brief informal mindfulness strategies may be easier for students to use on a regular basis than formal mindfulness. Overall, these findings highlight the importance of going beyond a one-size-fits-all approach by offering accessible and engaging school-based mindfulness instruction to students. Recommendations for school psychologists seeking to teach mindfulness to adolescents are discussed, including the need to directly teach how to integrate informal mindfulness strategies in students' lives.


Subject(s)
Adolescent Development , Mindfulness , Humans , Mindfulness/methods , Female , Adolescent , Male , Students/psychology , Schools , Mental Health , Stress, Psychological/therapy , Stress, Psychological/psychology
2.
Psychol Rep ; : 332941241254323, 2024 May 10.
Article in English | MEDLINE | ID: mdl-38727173

ABSTRACT

Perceived social support has been posited as an important factor in non-suicidal self-injury (NSSI) cessation. Although, previous research suggests that social connectedness is the mechanism through which perceived social support influences psychological wellbeing. Thus, the present study investigated whether social connectedness is the mechanism through which perceived social support functions to influence NSSI engagement. Fifty-six women with (Mage = 20.18, SD = 2.07) and 84 without (Mage = 20.24, SD = 1.98) a history of NSSI completed online measures of perceived social support and social connectedness. A mediation model was conducted with social connectedness in the relation between perceived social support from family, friends, and significant others and NSSI engagement. Findings revealed that social connectedness fully explained the relation between perceived social support from all sources and NSSI engagement. The results suggest that the relation between perceived social support and NSSI engagement is fully explained by the degree to which individuals report feeling connected to others. Implications for future research and practice will be discussed.

3.
Clin Psychol Rev ; 110: 102433, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38652973

ABSTRACT

Loving-kindness meditations involve sending feelings of kindness and care to a series of people including oneself, loved ones, strangers, and all beings. Loving-kindness interventions (LKIs), which include knowledge and/or practice related to loving-kindness, have been gaining attention as a potential intervention for improving mental health in adults. This meta-analysis synthesized the effects of LKIs on both positive (i.e., mindfulness, compassion, positive affect) and negative (i.e., negative affect, psychological symptoms) indices of mental health across comparison types (i.e., passive control, active control, alternative treatment) and general sample types (i.e., community, university), and explored characteristics of LKIs that may impact their effectiveness (i.e., intervention format, intervention length, presence/absence of a live facilitator). Following a systematic review of six databases in November 2023, 23 randomized controlled studies met eligibility criteria and were included in the review. Relative to passive control groups, LKIs had positive effects on mindfulness, compassion, positive affect, negative affect, and psychological symptoms; these effects were non-significant relative to active control groups and alternative therapeutic treatments. Notably, the effects of LKIs did not differ as a function of sample type, intervention format, intervention length, or the presence/absence of a live facilitator. Findings provide support for the effectiveness of LKIs relative to passive control conditions, as well as their potential comparability to alternative evidence-based therapeutic treatments, and provide insight into resource-effective approaches to the delivery of effective LKIs. However, additional studies are needed to confirm the impacts of LKIs relative to other interventions in the field.


Subject(s)
Mindfulness , Humans , Mindfulness/methods , Empathy , Meditation , Love , Mental Disorders/therapy , Outcome Assessment, Health Care , Mental Health
4.
Psychol Serv ; 2023 Dec 07.
Article in English | MEDLINE | ID: mdl-38059988

ABSTRACT

Nonsuicidal self-injury (NSSI) is defined as the deliberate destruction of one's bodily tissue without suicidal intent. Mindfulness practice is commonly incorporated into universities' stress management programming and may benefit students with a history of NSSI. However, recent findings suggest that these students may respond differentially to specific types of mindfulness practice (i.e., formal vs. informal practice). The present study qualitatively explored the acceptability of different types of mindfulness practice among university students with a history of NSSI. University students with a recent history of NSSI (n = 36) completed a semistructured interview following a brief mindfulness practice (i.e., either a formal body scan, formal sitting meditation, or informal practice). Reflexive thematic analysis of interview transcripts revealed five key themes. First, there appeared to be general misconceptions regarding what constitutes mindfulness practice (Theme 1). Nevertheless, within the present study, all mindfulness practices were carried out with relative ease (Theme 2). Notably, favorable physical and psychological experiences were predominant in response to informal practice (Theme 3). Preferences regarding level of guidance were more mixed in response to formal versus informal practice (Theme 4). Finally, only informal practice inspired feelings of delight and surprise following practice (Theme 5). Informal mindfulness practice is deemed highly acceptable by university students with a history of NSSI and clinicians should strongly consider emphasizing it in mindfulness-based interventions offered to these students, to provide them with the best opportunity to build a regular mindfulness practice and develop their emotion regulation abilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

5.
Psychol Rep ; : 332941231180118, 2023 May 29.
Article in English | MEDLINE | ID: mdl-37247614

ABSTRACT

In trying to better understand why certain individuals self-injure, researchers have proposed high emotional reactivity for negative emotions may influence vulnerabilities and predispose individuals to react to stressful situations in a dysregulated manner, thus engaging in non-suicidal self-injury (NSSI). However, the role of emotional reactivity for positive emotions in those with a history of NSSI is still unclear. Thus, the present study sought to examine group differences in the reactivity of (a) negative and (b) positive emotions in young adults with and without a history of NSSI engagement, and (c) to evaluate whether the reactivity of positive emotions could predict NSSI engagement when controlling for reactivity of negative emotions. The sample consisted of 96 female students who reported engaging in NSSI within the past 2 years (Mage = 20.28 years, SD = 1.65) and an age-matched female comparison group with no NSSI history (Mage = 20.43 years, SD = 1.76). Results from separate MANOVAs indicated individuals with a history of NSSI reported higher negative reactivity across all aspects (emotional intensity, sensitivity, and persistence) than the comparison group, Wilk's λ = .86, F (3,188) = 10.65, p < .001, partial η2 = .145; however, no significant differences emerged for positive reactivity, Wilk's λ = .99, F (3,188) = 0.52, p = .669. Moreover, a logistic regression revealed that persistence of negative emotions was the only significant predictor of NSSI, Wald χ2 (1) = 4.54, p = .03. The present results highlight the importance of the persistence of negative emotions for individuals who engage in NSSI. Furthermore, the current study provides the first suggestion of no significant differences in positive emotional reactivity between individuals with and without NSSI; underlining the importance of focusing on negative emotional reactivity in clinical practice as well as using positive emotions to "undo" the effect of negative emotions.

6.
J Sch Psychol ; 97: 43-62, 2023 04.
Article in English | MEDLINE | ID: mdl-36914366

ABSTRACT

Mindfulness-based programs (MBPs) are increasingly used in educational institutions to enhance students' mental health and resilience. However, reviews of the literature suggest this use may have outpaced the evidence base and further research is needed to better understand the mechanisms underlying these programs' effectiveness and which outcomes are being affected. The purpose of this meta-analysis was to investigate the strength of MBPs' effects on school adjustment and mindfulness outcomes while also considering the potential influence of study and program characteristics, including the role of comparison groups, students' educational level, the type of program being used, and the facilitator's training and previous mindfulness experience. Following a systematic review of five databases, 46 studies using a randomized controlled design with students from preschool to undergraduate levels were selected. At post-program, the effect of MBPs compared to control groups was (a) small for overall school adjustment outcomes, academic performance, and impulsivity; (b) small to moderate for attention; and (c) moderate for mindfulness. No differences emerged for interpersonal skills, school functioning, or student behaviour. The effects of MBPs on overall school adjustment and mindfulness differed based on students' educational level and the type of program being delivered. Moreover, only MBPs delivered by outside facilitators with previous experience of mindfulness had significant effects on either school adjustment or mindfulness. This meta-analysis provides promising evidence of the effectiveness of MBPs in educational contexts to improve students' school adjustment outcomes beyond typically assessed psychological benefits, even when using randomized controlled designs.


Subject(s)
Mindfulness , Child, Preschool , Humans , Adaptation, Psychological , Students/psychology , Mental Health , Schools
7.
Contemp Clin Trials ; 126: 107109, 2023 03.
Article in English | MEDLINE | ID: mdl-36740043

ABSTRACT

BACKGROUND: Mindfulness-based programming comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. However, difficulties with emotion regulation, self-criticism, and a potentially complex relationship with their body may undermine the benefits of FM for students with a history of nonsuicidal self-injury (NSSI), given its requirement of sustained attention on thoughts, emotions, and bodily sensations. IM may be better tolerated by these students. This protocol describes a randomized controlled trial comparing a brief FM practice, a brief IM practice, and an active control task in university students with and without recent NSSI. METHODS: Recruitment began in November 2022. An online, parallel-group, single-blind, randomized controlled trial will compare a 10-min, single-session FM practice, a 10-min, single session IM practice, and a 10-min, single session active control task in university students with and without recent NSSI. Outcomes will be assessed immediately pre-intervention and within five minutes post-intervention. The primary outcome will be state mindfulness. Secondary outcomes will be state stress, state well-being, and acceptability. Students with a history of NSSI are expected to report (i) greater improvements in state mindfulness, stress, and well-being, and (ii) greater acceptability in the IM condition, relative to the FM and control conditions. This distinction is not expected to occur in the no-NSSI comparison group. CONCLUSION: This trial is the first to parse out the impacts of FM versus IM practice among university students with and without a history of self-injury. Findings will be relevant to academic and clinical audiences within university settings.


Subject(s)
Mindfulness , Self-Injurious Behavior , Humans , Universities , Single-Blind Method , Self-Injurious Behavior/prevention & control , Self-Injurious Behavior/psychology , Students/psychology , Randomized Controlled Trials as Topic
8.
Psychol Rep ; 126(5): 2280-2302, 2023 Oct.
Article in English | MEDLINE | ID: mdl-35473432

ABSTRACT

Stressful experiences are abundant in university and students with a history of nonsuicidal self-injury (NSSI) may be hyper-reactive to stress. While brief mindfulness inductions have been proposed as a buffer against acute stress, whether they function differently in students with a history of NSSI remains in question. This study sought to explore the impact of an online mindfulness induction on (a) two facets of state mindfulness (i.e., mind and body) and (b) state stress, following a stress induction task, in university students with versus without a history of NSSI. Participants were Canadian university students with (n = 82; Mage = 21.30 years, SD = 2.92; 87.8% female) and without (n = 82; Mage = 21.71 years, SD = 3.18; 87.8% female) a history of NSSI, matched on gender, age, and faculty, who completed baseline (T1) measures of state stress and state mindfulness. Participants were randomly assigned to complete a mindfulness induction or an active control task. All participants then underwent a stress induction, and again completed measures of state stress and state mindfulness (T2). Results from three-way mixed ANOVAs revealed that state stress increased from T1 to T2 for all participants, regardless of group or condition. Among those assigned to the control condition, state mindfulness of the body was lower at T2 for participants with a history of NSSI compared to those without such a history. However, participants with a history of NSSI who completed the mindfulness induction reported greater state mindfulness of the body at T2 than students with a history of NSSI who completed an active control task. Findings highlight the unique response of university students with a history of NSSI to a brief mindfulness induction. Implications are discussed in the context of future research and clinical applications.


Subject(s)
Mindfulness , Self-Injurious Behavior , Humans , Female , Young Adult , Adult , Male , Universities , Canada , Self-Injurious Behavior/therapy , Students
9.
J Am Coll Health ; : 1-11, 2022 Jun 03.
Article in English | MEDLINE | ID: mdl-35658119

ABSTRACT

OBJECTIVE: The present study explored differences in four domains of university adjustment (i.e. personal-emotional, social, academic, and institutional attachment) among students with and without a history of engaging in non-suicidal self-injury (NSSI) and examined the independent influence of NSSI on university adjustment. PARTICIPANTS AND METHODS: Participants were 231 students from a large Canadian university who completed an online survey during their first and second year of university examining their perceived stress, perceived social support, coping self-efficacy, and university adjustment. RESULTS: Relative to students who never engaged in NSSI, those who did reported lower levels of university adjustment across domains. However, NSSI was not a significant predictor of university adjustment after accounting for perceived stress, perceived social support, and coping self-efficacy. CONCLUSIONS: This study provides preliminary evidence that engaging in NSSI may not confer additional risk for university adjustment, as students' psychological resources appear to be stronger determinants of adjustment.

10.
PLoS One ; 17(6): e0269382, 2022.
Article in English | MEDLINE | ID: mdl-35749457

ABSTRACT

Studies have outlined the negative consequences of the COVID-19 pandemic to psychological health. However, the potential within-individual diversity of experiences during COVID-19, and how such experiences relate to indices of psychological distress and COVID-19-specific stressors, remains to be explored. A large online sample of American MTurk Workers (N = 3,731; Mage = 39.54 years, SD = 13.12; 51.70% female) completed short assessments of psychological distress, COVID-19-specific stressors (e.g., wage loss, death), and seven items assessing negative and positive COVID-19 experiences. Latent profile analyses were used to identify underlying profiles of COVID-19 experiences. A four-profile solution was retained representing profiles that were: (1) predominantly positive (n = 839; 22.49%), (2) predominantly negative (n = 849; 22.76%), (3) moderately mixed (n = 1,748; 46.85%), and (4) high mixed (n = 295; 7.91%). The predominantly positive profile was associated with lower psychological distress, whereas both the predominantly negative and high mixed profiles were associated with higher psychological distress. Interestingly, specific COVID-19 stressful events were associated with the high mixed profile. The present study challenges the narrative that the impacts of COVID-19 have been unilaterally negative. Future directions for research are proposed.


Subject(s)
COVID-19 , Psychological Distress , Adult , COVID-19/epidemiology , Female , Humans , Male , Mental Health , Pandemics , Stress, Psychological/psychology , United States
11.
JMIR Ment Health ; 9(7): e34168, 2022 Jul 22.
Article in English | MEDLINE | ID: mdl-35762935

ABSTRACT

BACKGROUND: University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students' mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations. OBJECTIVE: Thus, the overarching goal of this study was to evaluate a mental health service provider-presented versus peer-presented web-based mental health resilience-building video outreach program against a wait-list comparison group. METHODS: Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider-presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider-presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3). RESULTS: Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider-presented and peer-presented programs were rated very highly and at comparable levels. CONCLUSIONS: Thus, findings suggest that a web-based mental health resilience-building video outreach program may be acceptable for university students regardless of it being mental health service provider-presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592.

12.
J Sch Health ; 92(9): 853-863, 2022 09.
Article in English | MEDLINE | ID: mdl-35578767

ABSTRACT

BACKGROUND: Accumulating evidence has underscored the importance of fostering children's emotion regulation (ER) within primary school settings and the role of teachers in such efforts. This study sought to assess the needs of teachers in supporting students' ER, through a better understanding of teachers' perceptions and use of healthy versus unhealthy ER strategies in the classroom. METHODS: Primary school teachers (n = 212; 91% female) completed an online, researcher-developed needs assessment survey assessing their perceptions regarding the importance of ER instruction and challenges surrounding children's ER, as well as the perceived effectiveness and reported use of healthy and unhealthy ER strategies in the classroom. RESULTS: Cochran's Q and chi-square analyses revealed misperceptions regarding the effectiveness of healthy and unhealthy strategies, as well as discrepancies between teachers' perceptions regarding the effectiveness of specific healthy strategies (eg, meditation) and their reported use of them. CONCLUSIONS: While teachers recognize the growing importance of fostering ER in the classroom, the present findings suggest that there is a need for more professional development regarding the effectiveness and implementation of ER strategies in the primary school context. Efforts should be made to provide teachers with concrete recommendations for the implementation of ER strategies in the classroom.


Subject(s)
Emotional Regulation , Child , Female , Humans , Male , School Teachers/psychology , Schools , Students/psychology , Surveys and Questionnaires
13.
Arch Suicide Res ; 26(2): 871-885, 2022.
Article in English | MEDLINE | ID: mdl-33135590

ABSTRACT

Current theoretical frameworks posit that engagement in non-suicidal self-injury (NSSI) is due to an inability to regulate one's emotions. In turn, mindfulness-based interventions have been shown to enhance emotion regulatory processes in those who engage in NSSI. OBJECTIVE: The purpose of the present study was to determine whether a brief mindfulness activity was differentially effective at increasing state mindfulness and decreasing stress following a stress induction task in university students with versus without a history of NSSI engagement. METHOD: The sample consisted of two groups of participants who identified as women: participants with a history of NSSI engagement (NSSI; n = 57; Mage=20.09, SD = 2.05) and participants without (no-NSSI; n = 87; Mage=20.22, SD = 1.94). All participants were asked to complete pre-intervention measures of state mindfulness and stress and were randomly assigned to either a mindfulness activity (body scan) or control task condition. Following the completion of their respective activities, a Stroop stress induction task was conducted and participants completed post-intervention measures of state mindfulness and stress. RESULTS: Two 3-way mixed ANOVAs (Time X NSSI status X Condition) were conducted and revealed significant time by condition interactions for both state mindfulness, Wilk's Λ = .93, F(1, 140) = 10.70, p = .001, ηp2 = .07, and stress, Wilk's Λ = .97, F(1, 140) = 4.21, p = .04, ηp2 = .03. As such, both groups (NSSI/no-NSSI) demonstrated similar increases in state mindfulness and decreases in stress in response to the brief mindfulness activity following the stress induction. Implications for future research and practice will be discussed.HIGHLIGHTSThe brief mindfulness activity effectively increased state mindfulness.The brief mindfulness activity effectively decreased stress.Benefits were experienced similarly among both groups (NSSI/no-NSSI).


Subject(s)
Mindfulness , Self-Injurious Behavior , Emotions , Female , Humans , Self-Injurious Behavior/prevention & control , Self-Injurious Behavior/psychology , Students , Universities
14.
Front Psychol ; 12: 612792, 2021.
Article in English | MEDLINE | ID: mdl-33732185

ABSTRACT

Non-suicidal self-injury (NSSI) has consistently been associated with self-reported difficulties in emotion reactivity and the regulation of negative emotions; however, less is known about the accuracy of these self-reports or the reactivity and regulation of positive emotions. The present study sought to investigate differences between women with and without a history of NSSI on: (a) self-reported general tendencies of negative and positive emotion reactivity, (b) self-reported general tendencies of negative and positive emotion regulation, and (c) emotion regulation reported in response to a positive and negative mood induction. The sample consisted of 36 women with a recent history of NSSI within the last 2 years (Mage = 20.06; SD = 1.51) and a comparison group with no history of NSSI (n = 34; Mage = 20.15; SD = 1.54). Participants completed self-report measures of negative and positive emotion reactivity and regulation. In a separate session, participants underwent both a negative and positive mood induction using a counterbalanced design and reported their experienced emotions. Results from two-way MANOVAs and ANOVAs revealed those with a history of NSSI reported significantly greater difficulties in negative emotion reactivity and regulation than the no-NSSI comparison group; however, no group differences emerged in self-reported reactivity or regulation of positive emotions. In contrast, repeated measures ANOVAs on data from the mood induction task found no group differences in reactivity or regulation for either negative or positive emotions. These findings highlight the possibility that although individuals with a history of NSSI evaluate their ability to manage negative emotions as significantly worse than individuals with no history of self-injury, this may not reflect their actual emotion regulatory processes.

15.
Br J Soc Psychol ; 57(2): 461-481, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29352471

ABSTRACT

Research applying self-determination theory and the dualistic model of passion (DMP) has shown video games may satisfy basic psychological needs (i.e., competence, autonomy, and relatedness) and be identified as a passion. The DMP distinguishes between healthy or harmonious passion and problematic or obsessive passion (OP), with the latter reflecting an overreliance towards one's passion to obtain needs satisfaction. The experience of daily obstructions to needs satisfaction, or needs frustration (NF), may facilitate such an overreliance. This study explored how NF and both types of passion explain the amount of time that university students spend gaming. The overall association between NF and time spent gaming was not significant. However, for video game users with low levels of OP for gaming, there was a significant negative association between NF and time spent gaming. Additionally, evidence of a mutually reinforcing association between NF and OP for gaming indicates that a vicious cycle exists, whereby a strong OP for gaming predicts and is reinforced by greater NF. The theoretical implications are discussed.


Subject(s)
Frustration , Motivation , Personal Satisfaction , Video Games/psychology , Adolescent , Adult , Female , Humans , Male , Surveys and Questionnaires , Young Adult
16.
Arch Suicide Res ; 20(4): 635-49, 2016.
Article in English | MEDLINE | ID: mdl-26984524

ABSTRACT

Mindfulness is often part of treatment for non-suicidal self-injury (NSSI); however, there has been limited research examining the role of mindfulness in NSSI. Thus, the current study sought to investigate the relationship among mindfulness, depressive symptoms, and NSSI (past year) in adolescents (N = 764; 56.8% female, M age = 14.42, SD = 0.64) with consideration of gender. Adolescents with recent NSSI (n = 74; 83.8% female, M age = 14.36, SD = 0.56) and a matched for age and gender no-NSSI group completed measures of mindfulness and depression. Findings revealed that mindfulness and depressive symptoms were negatively correlated, although significantly less so for the NSSI group. Second, the NSSI group reported greater depressive symptoms and less mindfulness. Finally, mindfulness was found to partially mediate the effect of depressive symptoms on NSSI. The present study is the first to provide empirical support for the protective role of mindfulness in NSSI.


Subject(s)
Depression , Mindfulness/methods , Self-Injurious Behavior , Suicidal Ideation , Suicide, Attempted , Adolescent , Adolescent Behavior/psychology , Depression/diagnosis , Depression/psychology , Depression/therapy , Female , Humans , Male , Patient Outcome Assessment , Risk Factors , Self-Injurious Behavior/diagnosis , Self-Injurious Behavior/physiopathology , Self-Injurious Behavior/prevention & control , Suicide, Attempted/prevention & control , Suicide, Attempted/psychology
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