Mindful Acceptance Research Articles

The effectiveness and acceptability of formal versus informal mindfulness among university students with and without recent self-injury: A randomized controlled trial.

Mindfulness instruction comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. FM involves sustaining attention on thoughts, emotions and bodily sensations through structured practices, while IM involves incorporating mindfulness into daily activities. However, recent evidence suggests that FM may pose challenges for students with recent non-suicidal self-injury (NSSI), whereas the flexibility and brevity inherent in IM may be better tolerated. This randomized controlled trial compared a FM induction, IM induction and control task among university students with (n = 103) and without (n = 123) past-year NSSI in terms of acceptability and pre-post state mindfulness, stress and well-being. Notably, results did not differ as a function of NSSI history. Two-way ANOVAs revealed that only IM was consistently preferred over the control task. Furthermore, three-way mixed ANOVAs revealed that-when assessed using brief Visual Analogue Scales-state well-being increased in all conditions, state mindfulness increased after both IM and FM, and state stress only decreased after IM. Notably, these differences by condition appeared to be of short duration as they were not found with lengthier measures. Results highlight the potential promise of IM and the importance of measurement selection when assessing the transient effects of mindfulness inductions in research.

Supporting caregivers of children living with disability in a humanitarian context: realist-informed evaluation of the ‘Mighty Children’ programme in Afghanistan

IntroductionTo ensure that humanitarian action is disability-inclusive, evidence is needed to understand how different strategies to support children living with disabilities and their families can work in these settings. Evidence...

Impact of mindfulness dimensions on work engagement among white-collar employees during the new normal in Malaysia

This study examines the impact of mindfulness dimensions on work engagement among white-collar employees during the new normal in Malaysia. Employees today feel disengaged from their company in an environment where productivity and performance are critical. Research has indicated that elevated mindfulness levels have positive effects on the workplace and are a strong indicator of employee engagement. Previous studies have not thoroughly examined the impact of various facets of mindfulness on employee work engagement following the pandemic. This study investigated the impact of the four dimensions of mindfulness on employee engagement. This study was based on positivist philosophy and a deductive approach. Data for this quantitative study came from 227 employees in Malaysia's private sector who were employed in white-collar jobs. We gathered the primary data using a survey strategy and a self-administered questionnaire. The study's findings demonstrate a positive and significant relationship between work engagement and the four dimensions of mindfulness. More specifically, work engagement was most impacted by the mindfulness acceptance dimension, followed by the mindfulness awareness dimension. The study provided implications for both employers and employees regarding organizational programs aimed at enhancing mindfulness and work engagement, particularly in light of emerging work trends like remote work culture. This study expanded on the understanding of mindfulness at work for future researchers by looking at how mindfulness affects work engagement for white-collar workers and provided fresh insights, such as the greatest influence of the mindfulness-acceptance dimension.

"BrainHeart": Pilot Study on a Novel Application for Elderly Well-Being Based on Mindfulness Acceptance and Commitment Therapy.

The rising prevalence of mental illness is straining global mental health systems, particularly affecting older adults who often face deteriorating physical health and decreased autonomy and quality of life. Early detection and targeted rehabilitation are crucial in mitigating these challenges. Mindfulness acceptance and commitment therapy (ACT) holds promise for enhancing motivation and well-being among the elderly, although delivering such psychological interventions is hindered by limited access to services, prompting exploration of remote delivery options like mobile applications. In this paper, we introduce the BrainHeart App (v.1.1.8), a mobile application tailored to improve physical and mental well-being in seniors. The app features a 10-day ACT program and other sections promoting healthy lifestyle. In a pilot study involving twenty participants, individuals engaged in daily mental exercises for 10 days using the app. Clinical evaluations, including assessments of psychological flexibility, overall cognitive profile, mindfulness disposition, cognitive fusion, and heart rate collected with Polar H10, were conducted at baseline (T0) and one month post-intervention (T1). Analysis revealed significant improvements in almost all neuropsychological scores, with high usability reported (system usability scale average score: 82.3 ± 9.31). Additionally, a negative correlation was found between usability and experiential avoidance (r = -0.51; p = 0.026), and a notable difference in heart rate was observed between baseline and post-intervention (F-value = 3.06; p-value = 0.09). These findings suggest that mindfulness-ACT exercises delivered via the BrainHeart App can enhance the well-being of elderly individuals, highlighting the potential of remote interventions in addressing mental health needs in this population.

Associations Between Chronic Stress, Attention, Working Memory, and Mindful Acceptance in the Context of Monitor and Acceptance Theory: A Direct Replication and Exploratory Cross-Sectional Study

Associations Between Chronic Stress, Attention, Working Memory, and Mindful Acceptance in the Context of Monitor and Acceptance Theory: A Direct Replication and Exploratory Cross-Sectional Study

Thinking critically in the moment? The relationship between mindfulness and critical thinking dispositions among pre-service teachers

ABSTRACT The present study examined the association between pre-service teachers’ mindfulness and critical thinking dispositions, as indexed by engagement, cognitive maturity, and innovativeness in critical thinking. A total of 72 Chinese pre-service teachers were recruited from Hong Kong to complete an online questionnaire cross-sectionally. Hierarchical regression analysis indicated that mindfulness was differentially associated with critical thinking dispositions. As important dimensions of mindfulness, mindful presence was positively associated with engagement in critical thinking, whereas mindful acceptance was positively associated with cognitive maturity in the regression models. However, neither mindful presence nor mindful acceptance was related to innovativeness in critical thinking. As a covariate, gender was not related to dimensions of mindfulness and critical thinking dispositions. The present findings inform the literature on the relation between pre-service teachers’ mindfulness and critical thinking dispositions, particularly in the Chinese context. As a major implication, policymakers should be made aware of the importance of strengthening pre-service teachers’ mindfulness, such that they could have a greater disposition to teach critically as they enter the workforce.

Design of a Remote Time-Restricted Eating and Mindfulness Intervention to Reduce Risk Factors Associated with Early-Onset Colorectal Cancer Development among Young Adults.

Early-onset colorectal cancer (EOCRC) is defined as a diagnosis of colorectal cancer (CRC) in individuals younger than 50 years of age. While overall CRC rates in the United States (US) decreased between 2001 and 2018, EOCRC rates have increased. This research project aims to evaluate the feasibility and acceptability of Time-Restricted Eating (TRE), Mindfulness, or TRE combined with Mindfulness among young to middle-aged adults at risk of EOCRC. Forty-eight participants will be randomly assigned to one of four groups: TRE, Mindfulness, TRE and Mindfulness, or Control. Data on feasibility, adherence, and acceptability will be collected. Measures assessed at baseline and post-intervention will include body weight, body composition, dietary intake, physical activity, sleep behavior, circulating biomarkers, hair cortisol, and the gut microbiome. The effects of the intervention on the following will be examined: (1) acceptability and feasibility; (2) body weight, body composition, and adherence to TRE; (3) circulating metabolic, inflammation, and oxidative stress biomarkers; (4) intestinal inflammation; and (5) the gut microbiome. TRE, combined with Mindfulness, holds promise for stress reduction and weight management among individuals at risk of EOCRC. The results of this pilot study will inform the design and development of larger trials aimed at preventing risk factors associated with EOCRC.

Retraction: Effects of "mindfulness acceptance insight commitment" training on flow state and mental health of college swimmers: a randomized controlled experimental study.

[This retracts the article DOI: 10.3389/fpsyg.2022.799103.].

Relationships between Self-Talk, Inner Speech, Mind Wandering, Mindfulness, Self-Concept Clarity, and Self-Regulation in University Students.

In this study, the researchers explored novel relationships between the self-related processes of self-talk, inner speech, self-concept clarity, mindfulness, mind wandering, and self-regulation. Using self-report questionnaires (n = 227), we found a small positive association between inner speech use and mind wandering, as well as a medium positive association of mindfulness with self-regulation, in accordance with claims made in the literature. We found a medium positive relationship between mindfulness awareness and inner speech responses, potentially because mindfulness awareness represents an active state of self-focus, requiring verbal self-directed probes. Conversely, the correlations between reports of inner speech use and mindfulness acceptance were medium and negatively associated, perhaps because self-acceptance is a less active process that does not require as much self-directed speech as acquiring self-awareness, or perhaps self-acceptance consists of silencing the mind. Furthermore, the mindfulness-acceptance responses were negatively associated with mind wandering but positively correlated with self-concept clarity and self-regulation (all significant and of medium strength). Another noteworthy result was that mind wandering was negatively correlated with self-concept clarity and self-regulation, in accordance with the view that mind wandering represents a self-escape mechanism and thus impedes the transparency of one's self-view and efforts at controlling oneself. This study pieces together what has been presented in the literature, examining variables that are typically studied in isolation. Further, these results have implications for the future study of self-regulation in that self-focused attention, self-acceptance, and self-concept clarity may be mediators on the paths between self-talk or inner speech use and self-regulation.

Integrating Mindfulness to Reduce Injury Rates in Athletes: A Critically Appraised Topic

Clinical Question: Is there evidence to support the use of mindfulness to reduce injury risk in athletic populations? Clinical Bottom Line: There is currently inconsistent, good-quality evidence to support that mindfulness interventions are effective in decreasing injury rates in athletes compared to the standard of care. Future research should investigate the effectiveness of mindfulness in other populations and types of sports activity (e.g., basketball, gymnastics, etc.). Additionally, future research should investigate different mindfulness delivery techniques in addition to the Mindfulness–Acceptance–Commitment (MAC) approach. Due to the inconsistent, good-quality evidence to support the use of mindfulness to reduce injury rates, the grade of B is recommended by the Strength of Recommendation Taxonomy. Mindfulness interventions should be incorporated into clinical practice but stakeholders (e.g., coaches, athletes, administration) should be included in the decision to implement these programs.

Acceptability of the combined online interactive mindfulness and exercise programme (MOVE-Online) for adults with chronic pain – A qualitative study

Purpose The aim of this qualitative study was to utilise the recent Theoretical Framework of Acceptability (TFA) to explore participants’ acceptability of the mindfulness and exercise interventions in the MOVE-Online pain management programme (PMP) and the programmes’ online delivery method. Methods Online focus groups were carried out following the completion of the PMP. The data were analysed using template analysis in terms of the seven TFA constructs of acceptability [(i) Perceived Effectiveness, (ii) Affective Attitude, (iii) Self-Efficacy, (iv) Ethicality, (v) Burden, (vi) Opportunity Costs and (vii) Intervention Coherence]. Results Twenty-one participants took part in the focus groups. Five of the seven TFA constructs of acceptability were identified in the analysis. The participants perceived the intervention to have been effective at achieving the goals of the PMP (TFA construct: (i) Perceived Effectiveness), to have supported their emotional management ((ii) Affective Attitude), promoted long term self-directed engagement ((iii) Self-Efficacy), fostered a valued group environment ((iv) Ethicality) and the online delivery of the programme reduced the physical burden associated with participation at an in-person PMP ((v) Burden). Conclusion The results of the study supports the utility of the TFA as a tool to explore the multi-dimensional construct of acceptability for the participants in the MOVE-Online programme.

Life after Imprisonment: Exploring the Repercussions of Jail Time on Ex-Convicts

Representation is imperative to help society comprehend what life is like after imprisonment. This qualitative study delves into the nuanced experiences of formerly incarcerated individuals, commonly referred to as ex-convicts, within the province of Davao del Sur. Through snowball sampling and in-depth interviews, we explored the challenges they faced, the consequences of these challenges, the coping mechanisms they employed, and the insights gained during their reintegration into society. Utilizing a phenomenological approach, the research uncovers three primary challenges faced by ex-convicts: (1) anticipated stigma and stigma management, the struggle to secure (2) emotional and material support, and (3) social readjustment and reintegration due to their preconceived detachment from society outside prison. Moreover, the findings indicate that former inmates experienced negative effects caused by their time in jail, leading to (1) emotional distress. However, the experience also served as a means for them to (2) restore their faith and become more (3) introspective in their thoughts and actions. Their coping mechanisms provided them hope and a positive mindset in overcoming the challenges they encountered, such as (1) social and spiritual, and (2) mindful acceptance of their current situation, which showed their resilience, faith, and as a repercussion of their violations. Furthermore, imprisonment became insightful learning to them to have a (1) stronghold between family ties and emotional support, as well as (2) renewed their faith in God. Consequently, government social reentry programs must be reinforced to help these individuals in many facets of their lives to promote resilient adjustments and prevent recidivism.

Feasibility and Acceptability of Virtual Reality Mindfulness in Residents, Fellows, and Students at a University Medical Campus

ObjectiveTo explore the feasibility, acceptability, engagement, and impact of a virtual reality (VR) mindfulness program for students, residents, and fellows at a university medical campus. Patients and MethodsA total of 30 participants consented to participate in the study from September 13, 2021 to November 12, 2022. They completed a baseline assessment and were trained to use a VR headset to access mindfulness content. Participants were instructed to use the VR mindfulness program 3-5 times per week, or as often as they found helpful, and they completed midline and endline assessments and a semistructured interview about their experience with VR mindfulness. ResultsParticipant engagement in VR mindfulness ranged from 0 to 29 times over 8 weeks. Restricted free time, low portability, and privacy were identified as barriers to use. Participants reported positive experiences with VR mindfulness, especially with the gamified nature of the content. They also reported a desire for increased customization options. Participants’ stress scores decreased, and their mindful awareness and self-compassion scores increased. ConclusionOverall findings support evidence of the feasibility and acceptability of VR mindfulness for college students on a medical campus. Short sessions and variable content may maximize sustained engagement. Implementation efforts should support participant engagement by including training and technological support. Future research should replicate study methods with the addition of a comparison group and should focus on evaluating the efficacy of VR mindfulness in the college student population.

Orthorexia nervosa versus healthy orthorexia: Anxiety, perfectionism, and mindfulness as risk and preventative factors of distress.

Orthorexia nervosa is a recently conceptualised pathological entity presenting as an obsessive focus on healthy eating with associated psychosocial impairment. The present study investigated the differential associations between orthorexia nervosa and healthy orthorexia with distress and impairment. With a community sample (N = 268) multiple measures of orthorexia nervosa and health orthorexia were compared as explanatory variables in mediation structural equation modelling (SEM). Outcome variables assessed and investigated were psychological distress while demographic variables were controlled. The mediating roles of perfectionism and health anxiety on orthorexia nervosa were examined with further preventative mediation role of mindfulness on distress. Distinctive to other eating disorders, gender showed no significant effects on orthorexia nervosa and healthy orthorexia. Signalling measurement issues for this disorder, the different measures of orthorexia nervosa resulted in mixed findings regarding body mass index and age. Findings supported perfectionism and health anxiety as risk factors, as well as mindfulness acceptance as a preventative factor in both orthorexia nervosa and healthy orthorexia. Orthorexia nervosa and healthy orthorexia assessed by most measures, contrary to the expectations, had significant positive associations with psychological distress indicated by stress, anxiety, and depression. The complexity in differentiating orthorexia nervosa from healthy orthorexia calls for further investigation. This research effort should serve to substantiate the status of orthorexia nervosa as a distinct clinical disorder.

Mindfulness-enhanced internet-based cognitive behavioural therapy for anxiety and depression: Outcomes in routine care

BackgroundClinical trials support the efficacy of mindfulness-enhanced, internet-based cognitive behavioural therapies (CBT) in reducing anxiety and depression symptom severity. However, it is unclear how effective these interventions are when delivered in routine clinical care settings. This study investigated the utilisation and treatment outcomes of an online mindfulness-enhanced CBT program in the general Australian community. MethodsOver a one-year study period, 2187 adults commenced the online mindfulness-enhanced CBT program. The program consisted of six sequential lessons to be completed within 90 days. Participants (mean age= 39 ± 14 years, 68 % female) completed measures of symptom severity for anxiety, depression, and psychological distress at pre-, mid- and post-treatment. Treatment effects were assessed via intention-to-treat linear mixed models with Hedges' g effect size calculations. ResultsFrom pre- to post-treatment, the mindfulness-enhanced CBT program was associated with medium and large effect sized reductions in generalised anxiety symptom severity (g = 0.80, 95%CI: 0.74–0.86), depression symptom severity (g = 0.74, 95%CI: 0.68–0.80), and psychological distress (g = 0.97, 95%CI: 0.90–1.03). Program adherence was modest with approximately 30 % of participants completing all six lessons of the program. LimitationsThis study is limited by its lack of a comparator condition, longer-term follow-up, and assessment of the reasons for participant non-adherence. The relative acceptability and effectiveness of mindfulness versus CBT components was not examined. ConclusionThis study supports the effectiveness of mindfulness-enhanced iCBT for symptoms of anxiety and depression when delivered in a routine care setting under the supervision of community health care practitioners.

Effectiveness of Mindfulness-acceptance-commitment based approach for Rumination, Cognitive Flexibility and Sports Performance of Elite Players of Beach Soccer: A Randomized Controlled Trial with 2-months Follow-up.

There is little research on the effectiveness of new approaches to psychology, including mindfulness-acceptance-commitment, especially in team disciplines. Therefore, this study compared mindfulness-acceptance and commitment-based approaches to rumination, cognitive flexibility, and sports performance of elite beach soccer players during a two-month follow-up. The research design consisted of a randomized controlled trial (RCT), with follow-up. Thus, 34 players of the premier league of beach soccer were randomly divided into intervention and control groups based on mindfulness acceptance and commitment. The experimental group exercises consisted of one session per week for 7 weeks and daily homework. Participants filled out the questionnaires of the Ruminative Response Scale, Cognitive Flexibility Inventory, and Sports Performance Questionnaire before, after, and at two months of follow-up of the intervention. Multivariate Analysis of Variance (MANOVA) and Analysis of Variance (ANOVA) with repeated measures were used to evaluate the changes over time and compare the scores of the subjects of the two groups. The results showed a significant difference in mindfulness-acceptance and commitment intervention in the experimental group on pre- vs. post-test and pre-test vs. follow-up scores of research variables. Also, a comparison of groups using independent T-test analysis showed a significant effect of mindfulness-acceptance and commitment exercises on research variables in the experimental group in the post-test and follow-up stages. Findings suggest that mindfulness, commitment, and acceptance exercises can be used as a new method to reduce rumination and increase cognitive flexibility and sports performance of elite beach soccer players.

Mindfulness for voices: An experimental analogue study of the effect of manipulating response style to simulated voices in a non-clinical population.

We aimed to investigate the effects of directly manipulating response style to simulated voice hearing on emotional and cognitive outcomes in a non-clinical population. A between-subjects design with one independent variable, response style (with two levels: mindful acceptance vs attentional avoidance). The dependent variables were subjective distress and anxiety (primary outcomes) and performance on a sustained attention task (secondary outcomes). Participants were randomly assigned to one of two response styles (mindful acceptance vs. attentional avoidance). They completed a computerised attention task (continuous performance task) whilst listening to a simulation of voice hearing. Participants rated their experience of anxiety and distress before and after completing the sustained attention task which was used to measure their accuracy and response times. One hundred and one participants took part (mindful acceptance (n = 54); attentional avoidance (n = 47)). There were no statistically significant group differences on post-test distress and anxiety scores, correct response rate or response times on the computerised attention task. Participants reported a range of different response styles along the spectrum of avoidance to acceptance, but this had no association with their assigned experimental condition. Adherence to task instructions was therefore low. We are unable to conclude from this study whether experimentally inducing people to respond to voices under cognitively demanding conditions in an avoidant or accepting way has an impact on their emotional or cognitive outcomes. Further research should focus on the development of more robust and reliable procedures for inducing differences in response style under experimental conditions.

Longitudinal Relationship Between Mindful Awareness, Acceptance and Mental Health Problems: A Mediation Model.

Mental health problems among college students are increasingly prominent. The negative effects of emotional distress on college students' mental health have been supported empirically. It is important to understand the psychological processes underlying this relationship. Using a longitudinal design, the present study aimed to reveal the explanatory mechanism of the association between dimensions of dispositional mindfulness and mental health problems among Chinese college students by testing the mediating effects of experiential avoidance and intolerance of uncertainty. A total of 907 Chinese college students (57% male; Mage = 20.33years) were invited to complete self-report questionnaires at two time points. Mindful awareness, acceptance and mental health problems (depression, anxiety and stress) were assessed at baseline (T0). Experiential avoidance, intolerance of uncertainty and mental health problems were assessed at the 6month follow-up (T1). Following structural equation modeling (SEM) analyses, the results show that high levels of mindful awareness and acceptance may diminish mental health problems by decreasing the levels of experiential avoidance among college students. However, only mindful acceptance diminished mental health problems through decreased intolerance of uncertainty. In addition, our study found that mindful awareness and acceptance may have different functions when working alone. Specifically, these two constructs may have different relationships with mental health. Identifying these mechanisms by which dispositional mindfulness is associated with college students' mental health over time has potential value for the prevention of potential mental health issues and timely interventions.

Clinical study of lurasidone combined with nutritional intervention strategy in the treatment of chronic schizophrenia

BackgroundSchizophrenia is a complex mental disorder with a chronic course. The atypical antipsychotics represented by lurasidone are commonly used in chronic schizophrenia, and its mechanism of action determines the superiority of efficacy and safety. However so far, there are still some adverse reactions, of which the more significant are lethargy, nausea, and sedentary inability. In view of these situations, we will combine nutrition intervention with the use of lurasidone to eliminate adverse reactions and provide help for the formulation of treatment plans.Subjects and MethodsThe study will be based on whether to add nutrition intervention as a difference set up control experiment, the experimental group using lurasidone combined nutrition intervention, the control group using lurasidone single factor intervention. The patients who received treatment in the psychiatric department of our hospital from March 2021 to March 2022 were selected as the research objects, and the efficacy and adverse reactions of the patients were monitored during the treatment. The efficacy will be judged by the medical scale of symptom severity of patients with schizophrenia (Positive and Negative Syndrome Scale, PANSS) and the monitoring data will be statistically analyzed by SPSS.ResultsWith the treatment, the results of the Experimental group and the control group are shown in Table 1. The PANSS scores of the two groups finally reached a range of 30-40, with a difference of 4. The incidence of nausea, lethargy and sedentary disorder in adverse symptoms was higher in the control group, and the difference was statistically significant (P < 0.05). It shows that nutritional intervention cannot affect the efficacy of psychosis itself, yet can alleviate the adverse symptoms after medication.Table 1.Efficacy and adverse reactions of the two groupsGroupPANSSNauseaSomnolenceSedentary disorderExperimental group (n=46)32.3±4.13(6.5%)4(8.7%)2(4.3%)Control group (n=41)36.3±5.28(19.5%)6(14.6%)5(12.2%)P>0.05<0.05<0.05<0.05ConclusionsThe group of schizophrenics is not limited to a certain age. Therefore, adverse symptoms caused by psychotropic drugs need to be considered in the practice. Symptoms in the course of the patient’s disease can be used as a treatment optimization path. Although the nutrition intervention strategy has no direct impact on the indicators of mental illness, the prevention of adverse symptoms during treatment can improve the actual experience of patients. In the future, the nutrition strategy will be adaptively optimized to improve the rehabilitation effect of chronic schizophrenia.AcknowledgementsThe research is supported by: Key Discipline of Nutrition and Food Hygiene of Changsha Medical university Quality Engineering Construction Project+2016; Study on Intervention Effect of Mindfulness Acceptance Stress Project on Nurses Aid to COVID-19+Outstanding Youth Project of Scientific Research of Hunan Education Department +2020(264)20B070.

Effectiveness of the mindfulness–acceptance–commitment approach: a meta-analysis

ABSTRACT The presented study evaluates the evidence base underpinning the use of the Mindfulness–Acceptance–Commitment approach (MAC) in applied sport psychology. To assess the effectiveness of the MAC protocol on improving mindfulness and psychological flexibility, and on enhancing sport performance and well-being among athletes, we used Robust Bayesian Meta-Analysis with Publication Selection Model-Averaging (RoBMAPSMA). In total, there were eleven controlled trials included in the meta-analysis. Results of the RoBMAPSMA show: a moderate model-averaged effect size estimate for developing mindfulness with strong evidence (g = 0.64, 95% CI 0.00–0.91, BFes = 25.35); a small model-averaged effect size estimate for experiential acceptance with anecdotal evidence (g = 0.36, 95% CI 0.00–0.92, BFes = 2.32); and a small model-averaged effect size estimate for improving sport performance with moderate evidence (g = 0.37, 95% CI 0.00–0.79, BFes = 3.27). Only one study assessed the effectiveness of the MAC protocol on well-being and averaged effect sizes ranged from 0.01 to 0.82. Based on the results of the meta-analysis, the Mindfulness–Acceptance–Commitment protocol can be effective in improving mindfulness. In addition, results suggest that the MAC protocol might be effective in improving sport performance. Currently available trials, however, do not provide sufficient evidence supporting the MAC protocol's effectiveness in developing psychological flexibility, experiential acceptance, and promoting well-being among athletes.