Abstract
BACKGROUND: The ongoing mental health crisis warrants investigations to understand why trait mindfulness is associated with beneficial mental health outcomes. This study examined attention monitoring and acceptance as psychological mechanisms underlying the relationship between trait mindfulness and emotion regulation and connectivity between the dorsolateral prefrontal cortex (dlPFC) and posterior cingulate cortex (PCC) as a potential neural mechanism. METHODS: A cross-sectional study was conducted with 501 adult participants (age range: 17-79, M = 31, SD = 11.3) representing the general population. To assess emotion regulation and trait mindfulness, participants completed the Difficulties in Emotion Regulation Scale (DERS) and Five Facets Mindfulness Questionnaire (FFMQ). Resting-state functional MRI was acquired in a subsample of 20 participants to explore the role of dlPFC-PCC functional connectivity. RESULTS: Higher levels of acceptance, as measured using the Non-judging and Non-reactivity subscales of the FFMQ, were significantly associated with fewer overall emotion regulation difficulties and predicted all emotion regulation subscales. In contrast, higher levels of attention monitoring, measured using the Observe subscale, predicted only three DERS subscales and with mixed effects: higher emotional awareness and clarity, but greater difficulties in goal-directed behaviour. The interaction between monitoring and acceptance was not significant, and no correlation was found between these variables and dlPFC-PCC functional connectivity. CONCLUSIONS: These findings challenge previous theories that argue that attention monitoring is crucial for effective emotion regulation. Instead, we conclude that acceptance is the key psychological mechanism, indicating that the traditional focus on attention monitoring in mindfulness training may be less effective than a primary emphasis on acceptance. This study provides a critical review of past research, highlighting issues with operationalising acceptance, and offers recommendations for future studies and practical implications for developing mindfulness interventions.