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Relations between mindfulness and mental health outcomes:

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Article in International Journal of Mental Health Promotion · August 2014

DOI: 10.1080/14623730.2014.931066

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Relations between mindfulness

and mental health outcomes: need
fulfillment as a mediator
a b c
Matthew R. Bice , James Ball & Alex T. Ramsey
a
Kinesiology and Sport Sciences, University of Nebraska Kearney,
905 W. 25th Street, Kearney, NE 68849, USA
b
Exercise, Health Promotion, and Recreation, Colorado State
University-Pueblo, 2200 Bonforte Blvd, Pueblo, CO 81001, USA
c
Brown School of Social Work, Washington University in St. Louis,
One Brookings Drive, St. Louis, MO 63130, USA
Published online: 30 Jun 2014.

To cite this article: Matthew R. Bice, James Ball & Alex T. Ramsey (2014): Relations between
mindfulness and mental health outcomes: need fulfillment as a mediator, International Journal of
Mental Health Promotion, DOI: 10.1080/14623730.2014.931066

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 International Journal of Mental Health Promotion, 2014
http://dx.doi.org/10.1080/14623730.2014.931066

Relations between mindfulness and mental health outcomes:

need fulfillment as a mediator
Matthew R. Bicea*, James Ballb and Alex T. Ramseyc
a
Kinesiology and Sport Sciences, University of Nebraska Kearney, 905 W. 25th Street, Kearney, NE
68849, USA; bExercise, Health Promotion, and Recreation, Colorado State University-Pueblo, 2200
Downloaded by [University of Nebraska Kearney], [Matthew Bice] at 09:22 07 July 2014

Bonforte Blvd, Pueblo, CO 81001, USA; cBrown School of Social Work, Washington University in
St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
(Received 10 April 2014; final version received 2 June 2014)

Links between mindfulness and mental health outcomes have been established, but the
explanatory mechanisms responsible for these associations are far less understood. This
study examined relationships between mindfulness, need fulfillment and mental health
outcomes (negative affect and depressive symptoms). The primary purpose of this paper
was to, first, verify the link between mindfulness and mental health outcomes, and
second, to better understand and explain why mindfulness is important for mental health
outcomes. Specifically, this study sought to examine the potential mediating influence
of need fulfillment in the relationship between mindfulness and mental health outcomes.
A sample of 399 university students and employees responded to an online survey. Data
were collected on personal ratings of trait mindfulness, need fulfillment, negative affect
and depressive symptoms. Results indicated a significant positive relationship between
mindfulness and need fulfillment, and these variables were negatively associated with
poor mental health outcomes (negative affect and depressive symptoms). Further, it was
found that need fulfillment partially mediated the relationship between mindfulness and
both mental health outcomes. Specific facets of need fulfillment (i.e., belongingness,
self-esteem, control, meaningful existence) were also explored individually as potential
mediators to determine which facet accounted for the greatest variance in the
relationship between mindfulness and mental health outcomes. In doing so, this study
helps clarify the relations between mindfulness and mental health outcomes. Results
from this study extend the current literature of mindfulness and further inform the
implementation of clinical mindfulness techniques and strategies.
Keywords: Mindfulness, need fulfillment, depressive symptoms, mental health,
negative affect.

Mental health is a subject of increasing scientific concern due to its substantial social and
public health implications. Serious mental illness has been found to dramatically reduce
life expectancy by up to 32 years, and is estimated to have accounted for over $317 billion
in direct and indirect costs in 2002 (National Institute of Mental Health, 2013a, 2013b).
While the various presentations of mental illness are numerous, two important indicators
of mental health include depression and negative affect.

Mental health outcomes (depression and negative affect)

Depression is considered one of leading causes of disability and burdens individuals
personally and socially (World Health Association, 2012). Depression is a highly

*Corresponding author. Email: bicemr@unk.edu

q 2014 The Clifford Beers Foundation

 2 M.R. Bice et al.

referenced mood disorder influenced by various intrinsic and extrinsic aspects that affect
individual thought patterns, behavior and overall well-being (American Psychiatric
Association, 2013; Langner & Michael, 1963; Salmans, 1997). Psychological symptoms
of depression include feeling chronic sadness, irritability, loss of interest or insomnia
(American Psychiatric Association, 2013). Physical symptoms of depression include
excessive sleeping, inconsistent appetite, back pain, or headaches (American Psychiatric
Association, 2013). Depressive symptoms often transition or extend into activities of daily
living and affect both psychological and physical functionality.
Negative affect is characterized as a mood dimension that reflects pervasive individual
differences in negative emotions (distress) and self-concept (Watson & Clark, 1984).
Downloaded by [University of Nebraska Kearney], [Matthew Bice] at 09:22 07 July 2014

Negative affect is expressed in a variety of different mood states including anger, guilt,
fear and nervousness (Watson & Clark, 1984). Situational and environmental factors, as
well as individual differences can subsequently account for varying mood dimensions. For
examples, factors that affect negative affect include stress, physical health, or unplanned
life events (Beiser, 1974; Jex & Spector, 1996). While not a classified mental illness,
negative affect is a highly studied indicator of mental health and well-being (Coffey,
Hartman, & Fredrickson, 2010; Warr, 1990). Mental health is an important and often
overlooked dimension of health, and better understanding its contributing factors will
further inform efforts to maximize public mental health and well-being.

Mindfulness
Mindfulness has generated extensive scientific and practice-based interest over the past
decade, particularly related to its establishment as a psychological construct and the
identification of effective mindfulness-based interventions (Keng, Smoski, & Robbins,
2011). Mindfulness is defined as ‘paying attention in a particular way: on purpose, in the
present moment, and nonjudgmentally’ (Kabat-Zinn, 2006, p. 145). Being fully present in
the moment can help people better connect with themselves, others and their environment
(Allen, Chambers, & Knight, 2006). In states of mindlessness, or the relative absence of
mindfulness, individuals are more likely to employ rules, heuristics, assumptions and old
habits to make decisions and guide behaviors (Vohs, Baumeister, & Ciarocco, 2005).
Finally, mindlessness can be defensively motivated and expressed by refusing to
acknowledge or attend to a thought, emotion, motive or object of perception (Brown &
Ryan, 2003).
Individuals who reported to be more mindful slept better, engaged in less behavioral
binge eating, and were more physically active (Roberts & Danoff-Burg, 2010). In addition,
mindfulness techniques and meditative practices were found to be positively related to
effective functioning, which includes academic performance, concentration, perceptual
sensitivity, reaction time, memory, empathy and self-esteem (Walsh & Shapiro, 2006).
Practicing mindfulness techniques also have been directly related to better sleep quality,
stress reduction and an overall increase in personal wellness (Caldwell, Harrison, Adams,
Quin, & Greeson, 2010; Carmody & Baer, 2007; Oman, Shapiro, Thoresen, Plante, &
Flinders, 2008).
Mindfulness interventions have shown to benefit those with anxiety and depressive
disorders, chronic pain and binge-eating disorders (Kabat-Zinn, 1990; Kabat-Zinn et al., 1992;
Kristeller & Jones, 2006; Ma & Teasdale, 2004; Segal, Williams, & Teasdale, 2002; Telch,
Agras, & Linehan, 2001). Mindfulness has also been shown to facilitate weight reduction
in obese individuals and drug and alcohol recovery in those struggling with addictions
(Bowen, Parks, Coumar, & Marlatt, 2006; Lillis, Hayes, Bunting, & Masuda, 2009).
 International Journal of Mental Health Promotion 3

Mindfulness and mental health

Carmody and Baer (2007) examined the influence of mindfulness-based cognitive therapy
(MBCT) techniques and strategies concerning medical and psychological symptoms.
This study found that symptoms of depression, anxiety hostility and somatization
significantly decreased with the implementation of mindfulness-based coping strategies
(Carmody & Baer, 2007). Additional studies examined the relationship and influence of
MBCT on psychological health and found similar results, concluding that increased
mindfulness results in a reduction of symptoms including anger-related rumination,
fatigue, negative affect, stress and burnout (Anderson, Lau, Segal, & Bishop, 2007;
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Grossman et al., 2010; Shapiro, Astin, Bishop, & Cordova, 2005). Research has well
established the association between mindfulness and mental health; however, it is noted
that additional research is needed to examine additional mediating factor that contribute to
the association between mindfulness and mental health (Alleva, Roelofs, Voncken,
Meevissen, & Alberts, 2012).

Need fulfillment
Need-based motivation refers to the individual desire to fulfill or obtain core human needs
that are not present or that one desires to maintain (Williams, 2009). Williams (2009)
conceptualized a need fulfillment model that focuses on the importance of four
fundamental human needs that include belongingness, self-esteem, control and meaningful
existence. Williams (2009) model clusters belongingness and self-esteem as inclusionary
needs that serve the purpose of explaining the strong desire of individuals to feel connected
to others. The model proposes that individuals partake in certain activities or events to
make themselves more attractive to others and contribute to an individual feeling a sense of
belongingness and self-esteem. Furthermore, control and meaningful existence were
clustered and explain the combined effect of individual power and provocation (Williams,
2009). The influence of control refers to the extent to which an individual feels conscious
power, including both intrinsic and extrinsic factors. Finally, meaningful existence refers
to the higher level need to lead a purpose-driven and meaningful life.
Depression and negative affect often manifest from unbalanced emotional states that
may be associated with unfulfilled needs (Langner & Michael, 1963; Salmans, 1997;
Watson & Clark, 1984). Thus, it can be suggested that individuals who meet personal
fulfillment needs are less likely to suffer from poor mental health outcomes. Limited
research exists that investigates the role of need fulfillment as a mediating variable, and no
research has specifically examined its potential explanatory role between mindfulness and
mental health.

Purpose of the study

Given the conceivable link between mindfulness and need fulfillment, and the established
association between need fulfillment and mental health, need fulfillment may represent a
mediating link between mindfulness and mental health.
This study examined relationships between mindfulness, need fulfillment and mental
health outcomes (negative affect and depressive symptoms). The primary purpose of this
paper was to, first, verify the link between mindfulness and mental health outcomes, and
second, to better understand and explain why mindfulness is important for mental health
outcomes. Specifically, this study sought to examine the potential mediating influence
of need fulfillment in the relationship between mindfulness and mental health outcomes.
 4 M.R. Bice et al.

It is hypothesized that a negative relationship between mindfulness and mental health

outcomes will be present. Additionally, it is expected that need fulfillment at least partially
mediates the relationship between mindfulness and mental health outcomes (negative
affect and depressive symptoms).

Methods
Subjects and procedure
A total of 399 subjects participated in this study, which constituted a 20.37% response
rate (n ¼ 1959). The research team was granted access to all students and university
Downloaded by [University of Nebraska Kearney], [Matthew Bice] at 09:22 07 July 2014

employees’ email addresses through the Human Resources department at a medium-sized

university in the Midwestern United States. Data were collected using a questionnaire
administered through Survey Monkey. Each participant was emailed the research study
cover letter, description and link to the questionnaire. Subjects were informed that
participation was voluntary, and they could withdraw themselves from the study at any
time. This study was approved by the university’s Human Subjects Committee. Following
data collection, survey responses were uploaded to and analyzed in SPSS version 20.

Instruments
Mindful Attention and Awareness Scale (MAAS). Dispositional mindfulness was measured
with the MAAS, a 15-item questionnaire assessing open awareness and attention to
present moment experiences (Brown & Ryan, 2003). The scale consisted of items such as
‘I find it difficult to stay focused on what’s happening in the present.’ Mindfulness was
measured along a 6-point Likert-type response scale, ranging from 1 (almost never) to 6
(almost always). Prior research has indicated internal consistency estimates ranging from
0.80 to 0.90, and factor analyses have confirmed a single factor structure. The MAAS has
also established convergent, discriminant and criterion-related validity in college student,
general adult and cancer patient samples (Brown & Ryan, 2003; Carlson & Brown, 2005).
This study measured a reliability coefficient of 0.87 for the MAAS.
Need fulfillment measure adapted from Williams (2009), measured the extent to which
respondents felt that the four core human needs (i.e., belongingness, self-esteem, control
and meaningful existence) were generally fulfilled. Twelve items assessed need fulfillment
along a 5-point response scale, anchored at 1 (not at all) and 5 (extremely). Responses to
these items were averaged and indexed into an overall need fulfillment score. This scale
included items such as ‘I feel like an outsider’ (belonging), ‘I feel good about myself’
(self-esteem), ‘I feel I was able to influence the actions of others’ (control) and ‘I feel
invisible’ (meaningful existence). Cronbach’s alpha coefficient ranged between 0.87 and
0.93 for this scale (Williams, 2009). This study found a Cronbach’s a coefficient of 0.87
for this scale.
International Positive and Negative Affect Schedule Short Form (I-PANAS-SF).
Negative affect was assessed using the I-PANAS-SF (Thompson, 2007). This 10-item
scale intended to measure the degree to which participants generally experience adjectives
representing negative affect, which included afraid, upset, nervous, hostile and ashamed.
Participants responded on a scale of 1 (never) to 5 (always). Previous research has noted
acceptable internally consistency (Cronbach’s a ¼ 0.75 –0.78) and established con-
vergent and criterion-related validities for the I-PANAS-SF (Thompson, 2007). The
negative affect scale yielded an adequate internal consistency coefficient of 0.72 in this
study.
 International Journal of Mental Health Promotion 5

Center for Epidemiologic Studies Depression Scale (CES-D). Depression was assessed
using the CES-D, a validated measure of depressive symptoms in clinical and non-clinical
samples (Zhang et al., 2012). The CES-D instrument consisted of 10 items and was
measured on a 4-point Likert-type scale, anchored at 1 (rarely) and 4 (all the time). This
measure included items such as ‘During the last week, I felt depressed’ and ‘During the
last week, I felt like everything I did was an effort.’ Prior research has indicated a
Cronbach’s a coefficient of 0.88 for this scale (Zhang et al., 2012). Internal consistency of
the CES-D in this sample was 0.76.
Demographics. Subjects were asked to report their gender, age, ethnicity, highest
degree (i.e., some high school or less, high school or GED, Bachelors, Masters, Doctorate),
Downloaded by [University of Nebraska Kearney], [Matthew Bice] at 09:22 07 July 2014

current role/position (i.e., graduate student, staff, faculty, administration) and participation
in mindfulness related activities (Yoga, Tai-chi, Meditation, Relaxation, Visualization).

Results
Variables were standardized for the purposes of the mediation analysis. Table 1 presents
general descriptive statistics, ratings of internal consistency (Cronbach’s a) and a Pearson
correlation matrix of key variables and demographics. The sample was primarily female
(75%), white (91%) and non-Hispanic (95%), with an average age of 36. Notably, 34.8%
of respondents scored at or above the 0.8 cutoff for depression, and 23.3% scored at or
above the more conservative 1.0 cutoff for depression.

Relations between mindfulness, need fulfillment and mental health outcomes

To establish the appropriateness of conducting mediational analyses, a series of linear
regression analyses were used to examine the relationships between trait mindfulness
(MAAS), need fulfillment, negative affect (I-PANAS-SF) and depressive symptoms
(CES-D) instruments. As shown in Table 1, this study found significant associations
among each of these constructs. Results indicated that a positive relationship existed
between mindfulness and need fulfillment (b ¼ 0.330, p , 0.001). Significant negative
associations were found between mindfulness and negative affect (b ¼ 2 0.476;
p , 0.001) and between mindfulness and depressive symptoms (b ¼ 2 0.484;
p , 0.001). Furthermore, there also was a negative relationship between need fulfillment
and negative affect (b ¼ 2 0.513, p , 0.001) and between need fulfillment and depressive
symptoms (b ¼ 2 0.455, p , 0.001). Therefore, it was determined that mediational
analyses were warranted.

Need fulfillment as a mediator

Mediation analyses were conducted to examine whether need fulfillment mediated the
relationship between mindfulness and mental health outcomes (negative affect and
depressive symptoms). First, a hierarchical linear regression analysis was conducted to
determine whether the addition of need fulfillment to the model nullified the significant
relationships between mindfulness and negative affect and between mindfulness and
depressive symptoms. This finding would indicate that need fulfillment fully mediated
these relationships. However, while the inclusion of need fulfillment reduced the
association between mindfulness and negative affect from b ¼ 2 0.476 to b ¼ 2 0.344,
and reduced the association between mindfulness and depressive symptoms from
b ¼ 2 0.484 to b ¼ 2 0.375, these relationships remained statistically significant.
 Downloaded by [University of Nebraska Kearney], [Matthew Bice] at 09:22 07 July 2014

Table 1. Intercorrelations and descriptive results for key variables and demographics

Variable 1 2 3 4 5 6 7 8 N Mean SD
1. Trait mindfulness 0.87 0.33** 20.48** 2 0.48** 0.18** 0.11* 0.12* 2 0.02 399 4.19 0.73
2. Need fulfillment 0.87 20.51** 2 0.46** 0.07 0.01 0.01 2 0.04 399 3.99 0.64
3. Negative affect 0.72 0.57** 2 0.15** 2 0.03 20.08 2 0.07 398 2.12 0.40
4. Depressive symptoms 0.76 2 0.10 2 0.02 20.08 0.02 399 0.65 0.42
5. Gender – 0.14** 0.14** 2 0.10 394 0.25 0.43
6. Age – 0.51** 2 0.01 389 35.76 12.00
7. Degree – 2 0.05 393 2.47 0.72
M.R. Bice et al.

8. Mindfulness activities – 399 0.29 0.45

Notes: Gender (0 ¼ Female, 1 ¼ Male). Degree (0 ¼ Some high school or less, 1 ¼ High school or GED, 2 ¼ Bachelors, 3 ¼ Masters, 4 ¼ Doctorate). Mindfulness activities (0 ¼ No
activities, 1 ¼ 1 or more activity). Internal consistency estimates for each measure are reported in italics along the diagonal. *p , 0.05. **p , 0.01.
 International Journal of Mental Health Promotion 7

Need Fulfillment

.330 –.513

Mindfulness Negative
Affect
–.476, reduced to –.344 after
including Need Fulfillment
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Figure 1. Mediation analyses indicating that need fulfillment partially mediates the relationship
between mindfulness and negative affect. Values listed indicate standardized regression coefficients

Therefore, need fulfillment did not fully mediate these relationships. Therefore, a Sobel
(1982) procedure was conducted to test for partial mediation. With adequate sample sizes,
Sobel is an effective test of mediation with sufficient power and appropriate type I error
rates (Baron & Kenny, 1986; Pituch, Whittaker, & Stapleton, 2005). As demonstrated in
Figure 1, a Sobel test indicated that need fulfillment partially mediated the relationship
between mindfulness and negative affect (z ¼ 2 5.6, p , 0.001, 95% CI [2 0.306,
2 0.200]). As indicated in Figure 2, a Sobel test also indicated that need fulfillment
partially mediated the relationship between mindfulness and depressive symptoms
(z ¼ 2 5.2, p , 0.001, 95% CI [2 0.275, 2 0.162]), yielding support for the current
hypotheses that need fulfillment would at least partially mediate the relationships between
mindfulness and mental health outcomes.
In response to these findings, exploratory post hoc mediational analyses were
conducted to determine which factor of the need fulfillment scale (i.e., belongingness, self-
esteem, control, meaningful existence) was most responsible for the partial mediation
reported above. Eight additional mediation analyses were conducted, examining the
mediating influence of the four need fulfillment sub-scales on the two outcomes (negative
affect and depressive symptoms). All eight analyses indicated partial mediation, such that
each need fulfillment factor significantly reduced the associations between mindfulness
and mental health outcomes (all jzjs . 3.6, all ps , 0.001), but did not nullify these
significant relationships completely. Interestingly, for both outcomes, the self-esteem
factor was the strongest mediator in the relationship between mindfulness and mental

Need Fulfillment

.330 –.455

Mindfulness Depressive
Symptoms
–.484, reduced to –.375 after
including Need Fulfillment

Figure 2. Mediation analyses indicating that need fulfillment partially mediates the relationship
between mindfulness and depressive symptoms. Values listed indicate standardized regression
coefficients
 8 M.R. Bice et al.

health outcomes (negative affect: z ¼ 2 5.1, p , 0.001, 95% CI [2 0.254, 2 0.166];

depressive symptoms: z ¼ 2 4.7, p , 0.001, 95% CI [2 0.230, 2 0.136]). For both
outcomes, this mediating influence was followed in successive order by the belongingness
factor (negative affect: z ¼ 2 4.6, p , 0.001, 95% CI [2 0.202, 2 0.122]; depressive
symptoms: z ¼ 2 4.2, p , 0.001, 95% CI [2 0.183, 2 0.098]), meaningful existence
factor (negative affect: z ¼ 2 4.1, p , 0.001, 95% CI [2 0.216, 2 0.114]; depressive
symptoms: z ¼ 2 3.8, p , 0.001, 95% CI [2 0.202, 2 0.095]), and control factor
(negative affect: z ¼ 2 4.1, p , 0.001, 95% CI [2 0.176, 2 0.088]; depressive symptoms:
z ¼ 2 3.6, p , 0.001, 95% CI [2 0.158, 2 0.065]).
Downloaded by [University of Nebraska Kearney], [Matthew Bice] at 09:22 07 July 2014

Discussion
This study yielded several interesting findings regarding the relationships that exist
between mindfulness, need fulfillment, negative affect and depressive symptoms. First, we
found that those reporting higher ratings of mindfulness reported fewer symptoms of
depression and lower scores of negative affect. These results are consistent with previous
studies indicating that people with high ratings of trait mindfulness or who practice
mindfulness techniques report reductions or lower levels of depression (Anderson et al.,
2007). Trait mindfulness, with its implications for present moment attention and
awareness and resistance against ruminating thoughts, may serve a protective influence
against negative mood and symptoms of depression (Alleva et al., 2012).
This study sought to further investigate the relationship between mindfulness and
mental health outcomes (i.e., symptoms of depression and negative affect) through the
potential explanatory variable of need fulfillment. Our results very robustly indicate that
need fulfillment partially mediates the relationship between mindfulness and mental health
outcomes. It appears that need fulfillment plays an important role in explaining the
established influence of trait mindfulness on mental health. These findings suggest that a
fulfillment or satisfaction of core human needs – specifically, the feeling of belonging and
experiencing high levels of self-esteem, control and meaningful existence – may serve a
key role in explaining the importance of mindfulness for mental health.
To enable a more comprehensive understanding of the mediating influence of need
fulfillment, each of the four sub-scales were independently tested as a potential mediator.
Self-esteem emerged as the strongest mediator in that, relative to the other facets of need
fulfillment, it explained the largest amount of variance in the association between
mindfulness and mental health. More than any other facet of need fulfillment, self-esteem
appears to be most responsible for this relationship. The link between mindfulness and
self-esteem is well established (Thompson & Waltz, 2008); however, little to no research
has examined whether self-esteem may account for the influence of mindfulness on
negative affect and depressive symptoms. Focusing on things that one can do in the present
moment, rather than worrying about things that one was unable to accomplish in the past
or is unlikely to control in the future, may be critically important for establishing one’s
self-esteem. In turn, these feelings of self-worth may lead to the lower degrees of negative
affect and depressive symptoms, in relation to mindfulness, that are reported here and in
previous studies (Alleva et al., 2012; Anderson et al., 2007).
However, each of these factors was found to partially mediate the relationship between
trait mindfulness and mental health outcomes; none were found to be full mediators.
Further, the collective influence of all four factors explained more variance in the
relationship between mindfulness and mental health than did any single factor. Therefore,
when possible, it may be wise to focus on efforts to bolster all facets of need fulfillment
 International Journal of Mental Health Promotion 9

together, rather than specifically attending to only one facet. This remains an empirical
question, however, and should be tested in future research. Future studies should also
examine the degree to which these findings regarding trait mindfulness translate to
mindfulness-based interventions. For instance, it is possible that the benefits of
mindfulness-based interventions on mental health could be maximized by ensuring that
these interventions influence facets of need fulfillment.

Limitations
Despite its strengths, this study had limitations. First, this study was conducted at a small
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Midwestern university on a sample of university employees and graduate students that

may not be generalizable for large populations. Furthermore, this study used email survey
distribution. Email solicitation letters could have been delivered to SPAM folders or not
read due to the sender being unknown. In addition, the opportunity for participation may
have been reduced in individuals who did not regularly check their university email.
Question interpretation and clarification might have been limited due to a lack of
understanding of mindfulness concepts. Finally, participants might have given socially
desirable answers based on their knowledge of negative mental health outcomes.

Conclusions
This research serves to verify the link between mindfulness and mental health outcomes
and further elucidates this relationship by investigating the fulfillment of core human
needs as an explanatory mechanism. The mediating influence of need fulfillment suggests
that feelings of belongingness, self-esteem, control and meaningful existence do play
significant roles in understanding the association between trait mindfulness and individual
mental health and well-being. This research helps to shed light on the construct of trait
mindfulness by examining its mechanisms of action. Further, it may emphasize the
importance of establishing that mindfulness-based interventions directly influence facets
of need fulfillment in order to maximize the benefits of enhanced mindfulness for those
experiencing poor mental health outcomes.

Acknowledgements
The current authors have no conflicts of interest to report.

Funding
This research and manuscript preparation was supported in part by the NIMH T32 Training Grant no.
[T32MH019960].

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