Short CommunicationValidation of the Mindful Attention Awareness Scale in a cancer population
Introduction
Mindfulness refers to a receptive attention to and awareness of present events and experience [1]. Clinical interest in mindfulness and its enhancement stems, in large part, from research conducted over the past 25 years showing that mindfulness-based stress reduction (MBSR) programs have salutary effects on mental and physical health in a variety of medical, psychiatric, and general populations (see Ref. [2] for review). Among cancer patients, for example, MBSR has been shown to reduce mood disturbance and stress symptoms and effect positive immunological and endocrinological changes [3], [4], [5], [6].
Despite this growing body of clinical research, there has, until recently, been no measure of the mindfulness construct and thus no way to assess whether MBSR interventions actually facilitate change in this quality of consciousness, which is the central focus of these interventions. Brown and Ryan [1] developed a dispositional measure of mindfulness, termed the Mindful Attention Awareness Scale (MAAS), demonstrated its utility to predict motivational and well-being outcomes and showed that changes in MAAS-measured mindfulness pre- to postintervention were related to declines in mood disturbance and stress in a small sample of cancer patients in an MBSR program. However, the MAAS was formally validated in nonclinical (student and general adult) populations only [1]. This leaves open the question as to whether MAAS-assessed mindfulness has construct and criterion validity in clinical populations, comparable with that found in the populations in which the instrument was validated. This issue is important, given the recognized need for a valid measure of mindfulness for use in clinical MBSR and related research [2], [7], [8], [9].
The present study was designed, first, to assess the construct validity of the MAAS in a clinical population. We compared the factor structure and internal consistency of the MAAS in two matched samples: (i) cancer outpatients with heterogeneous diagnoses and (ii) adult controls drawn from the same local community. Second, we assessed the criterion validity of the MAAS among cancer patients and compared the utility of the MAAS to predict mood disturbance and stress across the matched samples. We expected to find an invariant factor structure and similarly high internal consistency across the two samples. We also predicted that the MAAS would be associated, invariantly across samples, with higher well-being.
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Participants
Cancer outpatients (N=245) who self-referred to the MBSR program at the Tom Baker Cancer Centre in Calgary, Canada, completed all measures (see below) as part of a preintervention evaluation. Of those approached to participate, approximately 95% did so. A local community sample was then obtained from a list brokerage firm that matched the cancer sample on gender, age (±10 years), and education level. Community members were asked to complete a mailed survey of “moods, symptoms of stress, and
Construct validity and factorial invariance of the MAAS
In each sample, EFA on the MAAS using the principal-factors method revealed a clear single-factor structure with comparable item loadings across samples. Specifically, in the cancer/community samples, the first factor eigenvalues were 5.10/5.08 and the next largest eigenvalues were 0.87/0.84; Factor 1 accounted for 75%/78% of the total variation across factors. The factor loadings ranged from 0.31/0.32 to 0.85/0.79 (M=0.52/0.57). EFA using maximum likelihood estimation showed very similar
Discussion
This study indicates that the MAAS is appropriate for assessing mindfulness in cancer populations, given evidence for the scale's psychometric soundness in a cancer sample and equivalent factor structure to that of a general adult sample. As in past research [1], higher scores on this single-factor measure of mindfulness were associated with lower mood disturbance and stress. The structurally group-invariant relation found here between these variables suggests that lower levels of psychological
Acknowledgments
Dr. Linda Carlson is currently a Canadian Institutes of Health Research New Investigator. We thank Lori Tillotson for collecting the cancer patient data, Jodi Cullum for coordinating the community survey, and Chantal Levesque for statistical assistance.
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