Primenjena psihologija
Vol. 15, No4., pp.527-548, 2022
Research Article
The Mediation Role of Trait Mindfulness in the
Relationship between Alexithymia and
Alcohol Consumption
Ivana Marcinko
1 Faculty of Humanities and Social Sciences, University of J. J. Strossmayer in Osijek, Croatia
Even though the relationship between alexithymia and alcohol consumption has
been long established, little is known about the factors which may explain this
association. The purpose of this study was to investigate trait mindfulness as the
mediator of the association between alexithymia and alcohol use. The study was
conducted online. A convenient sample was used in the study which consisted of
629 adult participants (243 males). Alexithymia, mindfulness, and, alcohol
consumption were assessed with questionnaires. The results were analyzed with
Proces macro. The results revealed a full mediation between alexithymia, trait
mindfulness and, alcohol consumption. It was shown that high alexithymia via high
trait mindfulness contributes to greater levels of alcohol use. The present findings
are discussed in the light of mindfulness as a mechanism which guide adaptable and
unadaptable tendencies which therefore, can control the consequences alexithymia
has on alcohol use.
: alexithymia, mindfulness, alcohol consumption
UDC: 159.942:178
DOI: 10.19090/pp.v15i4.2418
Received: 30.06.2022.
Revised: 23.11.2022.
Accepted: 28.11.2022..
Copyright © 2022 The Author(s).
This is an open access article distributed
under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author
and source are credited.
Corresponding author email:
Ivana Marcinko
PP (2022) 15(4), 527-548
Alcohol consumption represents one of the leading health problems. It is
accountable for 7.10% of the diseases among males and 2.20% among females
(World Health Organisation, 2022). The etiology of alcohol dependence is
complex, emphasizing the interaction between biological, psychological, and
sociological factors. Among biological factors genes, reward system, and
changes in dopamine levels are commonly mentioned (Carvalho et al., 2019;
Edenberg & Foroud, 2013; Koob &Volkow, 2016). Socioeconomic status,
childhood trauma, or parents abusing alcohol are some of the environmental
influences contributing to drinking (Haugland et al., 2021; Sudhinaraset et al.,
2016; Zdankiewicz-Scigala & Scigala, 2018) while psychological factors include
various personality traits such as high novelty seeking, impulsivity or trait
mindfulness (Foulds et al., 2017; Nicola et al., 2014; Sala et al., 2019). Another
personality trait most commonly mentioned in the context of alcohol
consumption is alexithymia.
Alexithymia is described as the inability to identify, describe and
communicate feelings as well as a difficulty in the differentiation of emotions
(Messina et al., 2014; Sifneos, 1973). In the past, alexithymia has been commonly
seen as a stable trait with a continuous distribution (Keefeer et al. 2019) while
recent studies suggest it's levels can change during psychosocial interventions
(Cameron et al., 2014). This difficulty in the differentiation of emotions, so-called
granularity, is particularly pronounced in the range of negative emotions (Aaron
et al., 2018). A person with low emotion granularity will define their own state as
„not good“ or "bad" while a person with high emotion granularity the same
emotional state will label as „anxious“ or „irritated“. Moreover, alexithymic also
presents difficulties in interpreting somatic sensations that accompany
emotions. Some argue alexithymia is a deficit of interoceptive accuracy (Bird et
al., 2010; Herbert et al., 2011) and is thought to be crucial for the correct
identification of emotional states (Barrett, 2006; Herbert & Pollatos, 2012).
The relationship between alcohol consumption and alexithymia is widely
confirmed. The prevalence of alexithymia among alcohol addicts ranges from
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Alexithymia, Mindfulness and Alcohol Use
4567% (Thorberg et al., 2011) while in the general population the prevalence is
estimated to be around 10% (Hiirola et al., 2017). It has been shown that
emotional deficits contribute not only to the development but also maintenance
of alcohol abuse (Kopera et al., 2015). Recently abstinent and recovering
alcoholics tend to have problems with facial expression recognition, especially
with regards to negative emotions, and a tendency to overestimate the intensity
of emotions (Philippot et al., 2006; Townshed & Duka, 2003). It has also been
shown that alexithymic alcoholics experience more negative affect in
comparison to non-alexithymic alcoholics, while no difference between these
two groups was found regarding positive affect (Cox et al., 1998). Since
alexithymic alcoholics have greater problems with negative emotions, it's been
argued that this tendency is caused by the discomfort they tend to experience
in social situations (Uzun et al., 2003). It is supposed that alexithymic
susceptibility toward alcohol in social situations is aimed to reduce stress and
improve their interpersonal interactions (Kauhanen et al 1992).
Literature attempts to explain the linked relationship between
alexithymia and alcohol. According to some, the association between
alexithymia and problematic drinking can be explained by negative affect but
studies which controlled the effects of negative affect in the analyses still
confirmed the relationship between these variables (de Timary et al., 2008).
Others explain the link between alexithymia and alcohol with parental bonding
and attachment style (Lyvers et al., 2019) or even with impulsivity (Herman et al.,
2020). Conversely, no attempts have been made to explain this relationship with
trait mindfulness considering there is a plethora of evidence on the association
between alcohol consumption and mindfulness (e.g., Karyadi & Cyders, 2015; Sala
et al., 2019) as well as alexithymia and mindfulness (e.g., Aaron et al., 2020;
Norman et al., 2019). With regard to the alexithymia and mindfulness link, it was
shown that this association is inverted. Different components of mindfulness
negatively relate to alexithymia (Teixeira & Pereira, 2015). Also, mindfulness
training contributes to increased emotional granularity (Van der Gucht et al.,
2018) and improved interoceptive accuracy which results in decreased
alexithymia over time (Edwards et al, 2018).
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PP (2022) 15(4), 527-548
Trait mindfulness is defined as the ability to be aware and focused on
present experiences in a nonjudgemental manner (Brown & Ryan, 2003).
Distance from the experience, which a person creates by implementing
mindfulness, allows one to observe the ever-changing nature of emotions and
sensations accepting them as they are, not acting upon them. As an outcome,
this nonjudgemental and non-reactive stance allows a person to break a cycle of
unhealthy behaviors and initiate positive change (Ryan & Deci, 2000). According
to studies, trait mindfulness is negatively associated with stress, neuroticism,
anxiety trait, and state and depression while positively with positive affect,
vitality, life satisfaction, and satisfaction of basic psychological needs (Brown &
Ryan, 2003; de Sousa et al., 2021). Also, even though mindfulness was for a long
time considered to have dispositional quality, recent studies demonstrate it can
be developed over time with regular mindfulness meditation practice (Kiken et
al., 2015).
Mindfulness has also been negatively related to addictive behaviors
(Karyadi et al., 2014) by redirecting attention from maladaptive cognitions, such
as cravings or ruminations, to a broader context making room for the positive
assessment of the situation (Garland et al., 2015) which then initiates change for
the better. With respect to alcohol consumption, mindfulness is invertedly
related to alcohol abuse in student and clinical populations (Bowen & Enkema,
2014; Karyadi & Cyders, 2015). Specific facets of mindfulness, awareness and
nonjudgmental acceptance, seem to have a particularly important role in shaping
positive outcomes when alcohol use is concerned (Short et al., 2016; Stanley et
al., 2019). Practicing awareness and acceptance makes a person embrace
negative emotions which weakens mood-regulatory drinking motives (Roos et
al., 2015) and prevents alcohol abuse. In general, the relationship between trait
mindfulness and alcohol use is stronger for psychiatric than non-psychiatric
populations due to the inability of the psychiatric population to distance
themselves from negative thoughts, treating them non-judgementally (Sala et
al., 2019).
On the other hand, there are also studies which have demonstrated that
the effects of mindfulness on health-related behaviors may not always be
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positive. Farias et al. (2020) found that adverse effect rates for mindfulness range
between 4 and 33%. It is suggested that the increased awareness, which reflects
the presence of high mindfulness, prompts the presence of heightened anxiety
or full-blown panic attacks while practicing increased psychological distance
from the experience may initiate affective blunting and dissociation (Britton,
2019). With respect to alcohol consumption, research suggests acting with
awareness decreases alcohol consumption while nonjudgement increases it.
(Carter, 2015). Also, mindful curiosity is linked to alcohol misuse which is due to
fewer inhibitions associated with high levels of curiosity (Carter, 2015). According
to some authors, Mindfulness forms an inverted U-shape relationship with other
psychological constructs (Britton, 2019) explaining why too much of a good
thing, in this case, mindfulness, can turn bad. It is commonly found that the
negative effects of mindfulness are the most pronounced among those actively
participating in intense mindfulness sessions. For example, Reangsing et al (2022)
demonstrated that a greater number of mindfulness sessions in a week, rather
than a few, resulted in greater depression among emerging adults. In the same
fashion, Saltsman et al (2021) found that high mindfulness activates
cardiovascular response typical of stress-relates states due to greater attention
and cognitive processing given to this particular stressor in an attempt to
overcome it.
Presently, not many attempts have been made to uncover the pathway
through which alexithymia affects alcohol consumption. Since no one has tried
to look into trait mindfulness within that role, especially if the mixed findings
about its effects on alcohol consumption are taken into account, the aim of this
study is to investigate whether trait mindfulness mediates the association
between alexithymia and alcohol use. Based on the majority of earlier studies
which associate mindfulness with health-related behaviors, it is expected that
trait mindfulness is a mediator of the relationship between alexithymia and
alcohol use. It is predicted that high alexithymia through low mindfulness
contributes to high alcohol consumption.
Ivana Marcinko
PP (2022) 15(4), 527-548
The convenience sample was used. In total 639 participants took part in
the study of which 10 were not yet 18 years of age so their data were omitted
from the further analyses. Therefore, the results of 629 adult participants (243
males, 383 females, and 3 choosing „other“) entered the final analyses. The age
range was 18 to 80 with the average age being 31.43 (
= 13.31). The age
distribution of the current sample according to developmental stages suggested
by Lally and Valentine-French (2019) was as follows: 51% of participants were in
the emerging adulthood stage (18-25-year-olds), 22% were in the early
adulthood stage (26-40-year-olds), 25% was in the middle adulthood stage (41-
65-year-olds) and 2% belong to late adulthood stage (65 onwards). The sample
consisted of 22 participants who had finished elementary school, 370 with
finished secondary school, 93 with high school qualifications, and 144 who had a
university degree and above. Socioeconomically, 7 participants were considered
as having low status, 27 reported below-average status, 470 considered to be in
the average range, 104 to be above average while 21 participants reported high
socioeconomic status. Of all participants, 57 (9.10%) reported having some kind
of mental health condition.
The sociodemographic questionnaire was used to collect data on age,
gender, socioeconomic status, education, and mental health status of
participants. The socioeconomic status was assessed by asking the respondents
to choose the answer from the 5-point scale (1-low socioeconomic level to 5
high socioeconomic level) which best indicated their socioeconomic level.
Participants' education is assessed by asking them to indicate their level of
education by choosing one of the answers from a 4-point scale (1 -
to 4 -
high education
). Mental health status was measured by asking
participants if they suffer from any mental health illness which they indicated by
choosing between Yes/No option. The information on parents' educational
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background and problematic consumption of alcohol was collected too.
Education level was assessed for each parent choosing answers from a 4-point
scale (1-elementary school to 4-high school diplomas). Parents' problematic
alcohol consumption was measured by asking participants to indicate if any
parent has/or had problematic alcohol use which they answered by choosing
between Yes/No options. If the Yes option was chosen, then they had to indicate
which parent has/had such difficulties.
Toronto Alexithymia Scale (TAS-26; Bagby et al., 1986)
Alexithymia was measured with Toronto Alexithymia Scale (TAS-26;
Bagby et al., 1986). This scale consisted of 26 items grouped into four subscales:
a) difficulty to identify and distinguish between feelings and bodily sensations;
b) difficulty to describe feelings; c) reduced daydreaming; and d) externally
oriented thinking. The answers are given on a 5-point Likert scale (1 -
, 5 -
strongly agree
). Results are calculated by adding together all the
answers which a participant chose. The higher the results, the more profound
alexithymic tendencies. The scale was already used in research on Croatian
samples. This instrument was translated and validated by Kocijan Lovko, Gelo,
and Karlovic (2015). The internal reliability of the scale in that study was .71. The
reliability of the scale on the sample of this study is α= .73.
Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003)
Trait mindfulness was assessed with the Mindful Attention Awareness
Scale (MAAS; Brown & Ryan, 2003). The scale assesses the capability to bring
attention and awareness to what is happening at a particular moment. It has a
total of 15 items on which participants are answering on a six-point scale (1 -
, 6 -
). The total score is calculated by summing all the answers and
dividing them by the number of questions. Higher scores indicate the presence
of higher dispositional mindfulness. This scale was translated and validated on a
Croatian sample by Kalebic Jakupcevic (2014). The Cronbach alpha reported from
that study was .89. The measured internal consistency of scale on the sample of
this study is .88.
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PP (2022) 15(4), 527-548
The level of alcohol consumption was measured with the Alcohol
consumption scale from Alcohol Use Disorders Identification Test (Saunders et
al., 1993). This scale consists of three items on which respondents answer
choosing from a five-point scale (0 to 4). The composite score is obtained by
summing across the items whereas higher scores indicate greater consumption
of alcohol. This scale was already adapted and used on a Croatian language by
Spehar (2009). In that study the internal consistency of the scale was .78.
Cronbach alpha for this scale in the current study is .75.
All procedures performed in the study were in accordance with the
ethical standards of the Institutional Research Board of the Department of
Psychology, Faculty of Humanities and Social Sciences, University of J. J.
Strossmayer in Osijek, Croatia. The study was conducted online by advertising
the study on social networks. As part of general instructions, participants were
familiarized with aim of the study, that only those who are 18 years of age and
above can take part in the study as well as being familiarized with their rights.
The contacts of psychological services were available before and after the
instruments in case questions on alcohol consumption were too disturbing for
them. After general instruction, participants were asked to give their consent for
taking part in the study by choosing the option „I agree“.
The descriptive statistics can be seen in Table 1.
Table 1
Descriptive data of the examined variables (
= 629)
Alcohol consumption
Note. Tmin
- theoretical minimum;
- theoretical maximum.
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The descriptive statistics reveal that participants reported the presence
of moderate levels of alexithymia and mindfulness. The consumption of alcohol
was reported to be pretty low among participants in the study which is not
surprising considering that a non-clinical sample was used. The results also reveal
that all three variables are positively skewed but visual inspection of the results
(histogram) shows that the mindfulness result distribution was normal while the
other two were positively skewed. The greatest skewness was observed with
alcohol consumption, a result distribution which is common for measures of
clinical phenomena obtained from non-clinical populations. The only negative
kurtosis of data was obtained with mindfulness results while the other two
distributions were positive. The correlations between research variables can be
seen in Table 2.
Table 2
The correlations between examined variables (
= 629)
1. Age
2. Gender
3. Socioeconomic
4. Education
5. Education of
6. Education of
7. Mental health
8. Alcohol
consumption of
9. Alexythimia
10. Mindfulness
11. Alcohol
. *p < .05, **p < .01; gender: 1 - male/ 2 female.
Ivana Marcinko
PP (2022) 15(4), 527-548
Age correlated with alexithymia, mindfulness, and alcohol consumption.
Older participants had lower levels of alexithymia, mindfulness, and alcohol
consumption. Gender was negatively associated with the consumption of
alcohol indicating male-to-female drinking prevalence. Both socioeconomic
status and education negatively correlated with alexithymia and mindfulness in
a way that participants with lower socioeconomic status and less education
experienced greater alexithymia and mindfulness. Mental health status
negatively correlated with alexithymia and mindfulness indicating that having
pre-existing mental health condition is associated with more profound
alexithymia and mindfulness.
Alexithymia is highly positively associated with mindfulness and weakly
positively with alcohol consumption. This indicates that the greater the
alexithymia, the higher mindfulness and consumption of alcohol. Finally,
mindfulness was weakly positively related to alcohol consumption indicating
that people with greater mindfulness had higher levels of alcohol intake.
In order to test the mediation role of mindfulness on the relationship
between alexithymia and alcohol consumption, SPSS Process Macro (Hayes,
2013) was used. The number of bootstrap samples for calculating confidence
intervals was 5000. The obtained results can be seen in Figure 1.
Figure 1. The mediation effects of mindfulness on the relationship between alexithymia
and alcohol consumption
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Alexithymia, Mindfulness and Alcohol Use
As Figure 1 shows full mediation occurred. That is, the indirect
contribution of alexithymia to alcohol intake entirely takes place through
mindfulness (
= .02,
5 = .006 .031). High alexithymia through high
mindfulness contributes to high alcohol use.
Bearing in mind that pre-existing mental health conditions could affect
tested relationships (Sala et al., 2019) the mediator role of trait mindfulness on
the association between alexithymia and alcohol consumption was also tested
whilst controlling the effects of mental health condition status. The results of
this analysis also confirm mindfulness as the full mediator of the relationship
between alexithymia and alcohol use (
= .02,
= .006 .030).
Using available literature on the relationship between alexithymia and
alcohol consumption on one hand, and the positive effects of trait mindfulness
on human functioning on the other, the current work investigated if trait
mindfulness mediates the association between alexithymia and level of alcohol
consumption. The hypothesis that trait mindfulness mediates the relationship
between alexithymia and alcohol consumption was confirmed. Considering
numerous studies demonstrated the positive effects of mindfulness on health-
related behaviors, it was expected that low alexithymia would, through high
mindfulness, initiate low levels of alcohol consumption. Surprisingly, this
assumption was not confirmed. It was shown that high alexithymia via high
mindfulness contributes to higher alcohol consumption.
The findings highlight several important points. Firstly, heightened
attention and awareness of emotional experiences rising from high mindfulness,
create a context where those experiences are not observed from the distance
but rather submerge a person completely into them. Secondly, for these reasons
such experiences are most likely falsely negatively interpreted which most likely
perpetuates high anxiety that makes alexithymic's, who poorly deal with social
stressors (Uzun et al., 2003), resort to excessive drinking as means of coping with
the given circumstances. Therefore, high trait mindfulness amplifies the already
existing negative effects of alexithymia on alcohol consumption. Finally, these
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PP (2022) 15(4), 527-548
effects of high mindfulness may not be a problem for „healthy“ individuals but it
is an issue for the vulnerable, those who struggle with emotional experiences, or
those who are prone to negative interpretations of feelings as a result of already
existing mental conditions. The following information confirms these claims.
Mindfulness Attention Awareness Scale (Brown &Ryan, 2003), which was
used in this research, is comprised of items that are mainly oriented at measuring
awareness. This means that in the current study mindfulness was mainly
evaluated through this dimension. Now, even though high awareness has many
benefits (Brown & Ryan, 2003) for meditators who are working to develop this
quality, it is reported that heightened awareness also produces harmful
consequences. The negative consequences of practicing high awareness
reported by meditation practitioners are profound symptoms of anxiety,
sadness, and trauma-related memories (Cebolla et al., 2017; Lomas et al., 2015).
In addition, some authors argue that mindfulness, like some other
positive traits, is non-monotonic meaning it has its optimal level which initiates
positive change but above and below negative effects exist. Since it was shown
that greater levels of mindfulness contribute to the low intensity of emotions,
emotional numbing, and dissociation (Cebolla et al., 2017; Lindahl et al., 2017;
Taylor et al., 2011) it would not be surprising that for these reasons higher
mindfulness contributed to greater alcohol consumption. After all, higher
mindfulness has been shown to activate physiological responses typical of high-
stress states (Saltzman et al., 2021) and initiate the presence of depression
among those who practice mindfulness intensively (Reangsing et al., 2022).
Support for given claims is also drawn from research findings regarding
characteristics of alexithymia. It was shown that people with alexithymia have
susceptibility toward low granularity of negative emotions (Aaron et al., 2018)
that is, failing to make fine differentiation between different negative emotions.
For example, alexithymic confronted with a stressor will interpret their own
feelings as „negative“ rather than „irritated“ or „angry“. This feature of alexithymia,
on its own, may not represent a problem if it were not for the magnifying
properties of high mindfulness which accentuates the feeling of a generally
present negative mood. Thus, for an individual with such a constellation of
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personality traits, confrontation with stressors initiates a cycle of catastrophizing
thoughts and the usage of coping strategies, such as problematic alcohol use,
which should alleviate the generally present negative mood.
Further, the tested relationships are examined on a sample whose
majority consists of emerging adults. With this in mind, it is likely that the given
associations were established due to a large subsample of emerging adults
participating in this study. Because of limited personal resources whilst facing
transitioning from adolescence to adulthood these individuals face a greater
number of life stressors which makes them more prone to mental health
problems in comparison to individuals from other age groups (Arnett, 2000;
Marchica et al, 2019). So, all point to the conclusion that the negative effects of
high mindfulness may be more observable among those who are psychologically
vulnerable in comparison to those who are well-adapted.
Similarly, mindfulness shares some characteristics with other
psychological phenomena, such as introspection (Chambers et al, 2009) or
neuroticism-related analyses of bodily sensations, feelings, and experiences
which are then interpreted negatively. We can't be sure if this study's answers
on mindfulness measure truly reflect mindful tendencies or features of some
other phenomena which contributed to the presence of negative relationships
between variables.
The fact that the adverse effects of mindfulness on the tested
relationship are established on a random sample rather than a population with
pre-existing psychiatric conditions confirms naturally occurring individual
differences in mindfulness. In the past, the adverse effects of mindfulness were
mainly reported by those who already had a tendency toward negative
emotional experiences or who are in rigorous mindfulness training. Pauly et al.
(2022) reported that meditators who had a pre-existing inclination toward
negative thinking (i.e. poorer mental health) were the ones who reported those
negative experiences. However, the authors also demonstrated when the effects
of mental health status were controlled in the analysis, no association between
negative thinking and adverse mindfulness effects was found. Considering that
in this study the negative effects of mindfulness were evident even after
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PP (2022) 15(4), 527-548
controlling for the mental status of participants suggests that the unpleasant
effects of trait mindfulness are naturally occurring and are widespread in the
general population.
Overall, this study suggests that mindfulness sometimes may not be
bound by positive outcomes. According to the findings, it seems that the
unwanted effects of mindfulness may be expected among groups that are
susceptible to excessive alcohol consumption, as well as those who are having
difficulty to adequately deal with emotions (e.g. those with high trauma
exposure) or interpretations of internal experiences, for example, those who are
mental disadvantaged (e.g. those with body dysmorphic disorder) or those prone
to high-stress reactivity due to age-related limitations (e.g. emerging adults). For
this reason, trait mindfulness could be assessed as part of the standard
psychodiagnostic procedure in order to gain insight into the extent to which trait
mindfulness complicates the clinical picture of those with pre-existing clinical
diagnoses. Also, the findings remind us that mindfulness-fueled interventions
should be individually tailored where the intensity or frequency of mindfulness
practice should accommodate the patient characteristics in order to achieve
optimal results. For this reason, studies like this are needed to gain insight into
the all-around effects of trait mindfulness as well as to recognize individuals
which may be particularly vulnerable to the adverse effects of this trait rather
than just promising quick positive change for those who are trying to initiate
their own development.
Some limitations need to be taken into consideration when interpreting
the results of this study. Taking into consideration an indirect mediation effect
confidence interval suggests a significant but weak indirect mediation effect
which suggests that such findings should attempt to be replicated once more.
Because of the cross-sectional nature of the study, no conclusions about
causality can be drawn. In order to control the effects of pre-existing mental
status on the results, mental health status was controlled in the analysis.
However, we can’t know if the results of participants with sub-clinical symptoms
of depression or anxiety affected the data. Future studies should control these
variables more rigorously. This study used the Mindfulness Attention Awareness
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Alexithymia, Mindfulness and Alcohol Use
Scale (Brown &Ryan, 2003) which may not have the best capture of the full
effects of mindfulness since it is primarily oriented toward measuring the
awareness facet. Maybe the use of an instrument which, besides awareness,
assesses other facts of mindfulness (e.g. Five Facet Mindfulness Questionnaire)
may yield different results. Some studies indicate that different facets of
mindfulness are related to different aspects of alcohol use behaviors (e.g.
Fernandez et al., 2010) so it would be useful to assess the indirect effects of
mindfulness facets on the tested relationship to gain a fuller understanding of
established effects. Furthermore, even though the negative effects of high
mindfulness were detected among those prone to greater alcohol consumption,
the findings can not be generalized to other substance use behaviors. Literature
suggests that trait mindfulness is more related to alcohol and tobacco use in
comparison to marijuana consumption (Robinson et al, 2008) so it would be
interesting to test the effects of trait mindfulness on the relationship between
alexithymia and other substance use behaviors to see if findings would be
replicated. Finally, the choice of an instrument with which alcohol use was
assessed may not be the best as it did not cover other alcohol-related behaviors
(e.g. duration of alcohol use, or alcohol-related symptoms) which may more
objectively reflect the problematic consumption of alcohol among participants.
The author received no specific funding for this work.
Conflict of interest
We have no conflicts of interest to disclose.
Data availability statement
The data that support the findings of this study are available on request from the
Ivana Marcinko
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