The associations among Mindfulness, Psychological Flexibility, Adverse Childhood Experiences, and Psychological Symptoms in young adulthood

The associations among Mindfulness, Psychological Flexibility, Adverse Childhood Experiences, and Psychological Symptoms in young adulthood | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The associations among Mindfulness, Psychological Flexibility, Adverse Childhood Experiences, and Psychological Symptoms in young adulthood Andria Christodoulou, Elena Constantinou, Aggelina Agathokleous, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8142530/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives Adverse Childhood experiences (ACE) history is a well-established risk factor for the development of psychopathology in adulthood. Although mindfulness and psychological flexibility have been proposed as protective factors, their distinct dimensions through which they buffer the impact of early trauma remain unclear. The present study aimed to examine the associations among early trauma, mindfulness facets, psychological flexibility dimensions and psychological symptoms by using network analysis, and to examine whether specific mindfulness and psychological flexibility dimensions moderate the impact of ACE on psychological symptoms. Methods A sample of 516 young adults aged 18–35 years old (M = 26.96, SD = 4.67) mostly women (73.8%) completed an online survey including measures of early trauma (ETI-SR-SF), mindfulness facets (KIMS), psychological flexibility dimensions (MPFI) and psychological symptoms (DASS). Results Network analysis identified Acceptance without Judgement. Awareness, Describing (mindfulness facets), and Committed Action (psychological flexibility dimension) as central processes associated with psychological symptom intensity. Early trauma was associated only with psychological symptoms, whereas Acceptance without Judgement and Committed Action were the only significant moderators of the relationship between early trauma and psychological symptoms. Conclusions Findings underscore the protective role of Acceptance without Judgement and Committed Action, in mitigating the long-term psychological consequences of early trauma. These processes may be important targets for early intervention and prevention programs. Adverse Childhood Experiences Mindfulness Psychological Flexibility Psychological Symptoms Network Analysis Moderation Analysis Figures Figure 1 Figure 2 Introduction Adverse childhood experiences (ACE) refer to distressing or traumatic events experienced in childhood or adolescence, including various forms of abuse, neglect or broader traumatic events such as natural disasters or loss of a loved one (Felitti et al., 1998 ; Martins et al., 2011 ). A recent meta-analysis has shown that about 60% of participants reported having experienced at least one ACE (Madigan et al., 2023 ). Such early trauma can significantly affect emotional and psychological development, increasing vulnerability to later psychological difficulties (Aafjes-van Doorn et al., 2020 ). Beyond trauma-specific symptoms, ACE have been linked to higher levels of anxiety and depression in adulthood (Berber Celik & Odaci, 2020; Edwards et al., 2003 ; Kessler et al., 1997 , 2010 ). However, not everyone with ACE history will go on to develop mental health problems in adulthood (Crouch et al., 2019 ). Research suggests that various biological, developmental, social and psychological factors can buffer individuals with ACE against the development of mental health problems (Wu et al, 2013 ). Personality traits that influence the way people adapt to and cope with difficulties and environmental stressors, like dispositional Mindfulness and Psychological Flexibility (PF) are among those factors examined by previous literature. Both mindfulness and PF have been identified as protective factors, since they have both been negatively associated with early trauma and subsequent psychological symptoms (Gloster et al., 2017 ; McKeen et al., 2023 ; Richardson & Jost, 2019 ). Dispositional mindfulness refers to the process of directing attention to present moment experiences in a non-judgemental way (Kabat-Zinn, 2003 ). Mindfulness can be seen understood both as a state and as a trait (dispositional mindfulness), reflecting a tendency to maintain present-moment awareness across situations (Kabat-Zinn, 2003 ). This trait tendency can vary along a continuum in the general population, while it can also be increased by mindfulness-based interventions and training, which impact state mindfulness, but also in the long-term increase levels of dispositional mindfulness (Quaglia et al., 2016 ). Mindfulness is a multi-faceted construct comprising of five distinct facets: Observing (i.e., noticing internal and external experiences), Describing (i.e., labelling internal and external experiences), Acting with Awareness (i.e., focusing attention to the moment), Non-reactivity (i.e., allowing thoughts and feelings without reacting to them) and Acceptance without Judgement (i.e., openly experiencing thoughts and feelings without evaluation; Baer et al., 2006 ). Nevertheless, various conceptualizations and ways to assess mindfulness exist in the literature, incorporating some or all these facets (Baer et al., 2006 ). What emerges, though, from prior research is that mindfulness facets may have different relationships with psychological symptoms, stressing the need for exploring the various facets separately (Baer et al., 2006 ; Medvedev et al., 2018 ). Mindfulness is an important trait in understanding mental health outcomes following trauma, with higher mindfulness consistently linked to better psychological well-being and fewer symptoms in both general populations (Brown & Ryan, 2003 ; Tomlinson et al., 2018 ), and individuals with ACEs history (Moyes et al., 2022 ). Research indicates that mindfulness may help individuals to adjust to traumatic experiences (Harper et al., 2022 ; Thompson et al., 2011 ), yet its precise role in the ACE-psychopathology relationship remains unclear. Some studies identify mindfulness as a mediator, showing that ACE lowers trait mindfulness, which then increases psychological symptoms, particularly through the facets of Describing, Acting with Awareness and Acceptance without Judgement (Bolduc et al, 2018 ; Boughner et al., 2016 ). Others suggest a moderating role, with higher mindfulness, especially Acceptance without Judgement facet, weakening association between trauma and anxiety (Dolbier et al, 2021 ; Tubbs et al., 2019 ). More recent evidence shows that specific facets, such as Acting with Awareness, may serve as both mediating and moderating functions in the case of depression (McKeen et al., 2023 ). Overall, findings suggest differential involvement of mindfulness facets in trauma adjustment, but inconsistencies, particularly in moderation effects, highlight the need for further research. A related, yet distinct from mindfulness, concept is that of Psychological Flexibility (PF). PF refers to the ability to remain fully aware and open to the present moment, without trying to avoid or control unpleasant experiences, while intentionally choosing to act in alignment with one’s core values (Hayes et al., 2012 , 2013 ). It is a mechanism comprising a set of dynamic processes that influence how individuals respond to their experiences. Specifically, it consists of 6 interconnected components: a) Acceptance (i.e., being open to experience), b) Cognitive Defusion (i.e., observation of thoughts and emotions from a distance), c) Present Moment Awareness (i.e., contact with presence and current internal experiences), d) Self as Context (i.e., awareness of internal experiences as external viewers), e) Values (i.e., freely chosen, personally meaningful life directions) and f) Committed Action (i.e., effective action according to important goals; Hayes et al., 2012 , 2013 ). These six healthy components interact and operate together to enhance PF through Acceptance and Commitment Therapy (ACT; Hayes et al., 2004 ). Research shows that elevated levels of PF are associated with a reduction in mental health problems emerging from trauma experiences (Tol et al., 2020 ). While PF has generally been identified as a protective factor against trauma and subsequent psychological outcomes (Kashdan & Rottenberg, 2010 ; Malo et al., 2024 ), few studies have examined its mediating and moderating role to trauma and associated negative mental health outcomes (Boykin et al., 2020 ; Hostutler et al., 2023 ; Makriyianis et al., 2019 ; Richardson & Jost, 2019 ). While some studies have explored the PF component as distinct mediators (Makriyianis et al., 2019 ), to date no research has examined the moderating role of the six PF components in changing the relationship between ACE and mental health outcomes. Research highlights the role of mindfulness and PF in linking early traumatic experiences and subsequent mental health issues (Dolbier et al, 2021 ; Makriyianis et al., 2019 ; McKeen et al., 2023 ; Richardson & Jost, 2019 ). While some aspects conceptually overlap (i.e., Acceptance and Acceptance without Judgement both emphasize openness to experience), others (i.e., Committed Action, Values) appear unique to ACT theory (Baer et al., 2004 ; Hayes et al., 2012 ). Despite their relevance, limited studies have examined their contributions to trauma and psychological symptoms. Given the direct link of these two traits with therapeutic processes, disentangling the unique contributions of these components on trauma and psychological symptoms can have important implications for directing prevention and treatment targets for people with ACEs. Accordingly, the present study aims to examine how the different aspects of mindfulness and PF interrelate with ACEs and psychological symptoms using a novel statistical approach of network analysis. This analysis enables us to visualize the complex and dynamic connections among these constructs, allowing for the identification of central and strong components that maybe linked to ACEs and subsequent psychopathology (Borsboom, 2017 ; Borsboom et al., 2021 ; Contreras et al., 2019 ). Another aim of this study is to explore the moderating role that these components may have in the relationship between ACEs and psychological symptoms in young adulthood; essentially, whether these strengths can buffer the long-term impact of ACE. Thus, upon identifying core processes involved in trauma and psychological symptoms using network analysis, moderation models were conducted to confirm their role as protective factors. Method Sample and procedure The sample consisted of Greek-speaking young adults (18-35 years) living in Cyprus, recruited using convenience sampling via social media advertisements and age-relevant online groups. Data were collected online, using a Google Forms survey. Of 535 respondents, 19 were excluded for not meeting eligibility criteria, resulting in a final sample of 516 participants (M age = 26.96, SD age = 4.67): 133 men (25.8%) and 381 women (73.8%) and 2 identifying as other. Overall, 47.5% reported at least one ACE and 25.2% reported a current mental health diagnosis (see Table A, Supplementary Materials). Participation was anonymous and voluntary, with informed consent obtained electronically. Ethical approval was granted by the Cyprus National Bioethics Committee (EEΒΚ/ΕΠ/2023/77) and data were collected between February and April 2024. Measures Early Trauma Inventory Self Report - Short Form (ETI-SR-SF; Bremner et al., 2007; Greek version: Antonopoulou et al., 2017) consists of 27 items assessing four trauma categories: general, trauma due to physical abuse, trauma due to emotional abuse and trauma due to sexual abuse. Each item, is rated on (a) yes/no scale indicating whether the event occurred and (b) a frequency scale (No; Yes-once or twice; Yes-sometimes; Yes-often). For the present analyses, only the dichotomous rating were used, summing the number of endorsed events (range 0-27), which exhibited good reliability in this sample (α = .83). Kentucky Inventory of Mindfulness Skills (KIMS; Baer et al., 2004; Greek version: Psarraki et al., 2022) is a 38-item self-report measuring trait mindfulness. Participants rated items on a 5-point Likert scale (from 1-never or very rarely true to 5-very often or always true). The scale includes four facets of mindfulness (Observing, Describing, Acting with Awareness and Acceptance without judgement), each scored by summing relevant items (with reversals as instructed), with higher scores indicated greater mindfulness skill. The four subscales have shown good internal consistency in the present sample (α= .80 -.88). Multidimensional Psychological Flexibility Inventory (MPFI; Rolffs et al., 2018; Greek version: Christodoulou et al., 2023) is a 60-item self-report scale evaluating psychological flexibility/inflexibility (PF/PI) through the six PF and PI components, rated on 6-point Likert scale (from 1-Does not apply at all to 6-Always applies). For this study, only the first 30 items assessing PF through its six components (Acceptance, Defusion, Present Moment Awareness, Self-as-Context, Values, Committed Action) were used. Subscale scores were averaged, with higher scores indicating greater PF components. Internal consistency was good for all PF componetns in the present study (α=.77-.94). Depression Anxiety Stress Scale-21 (DASS-21; Lovibond & Lovibond, 1995; Greek version: Lyrakos & Arvaniti, 2009) includes 21 items assessing the psychological symptoms of depression, anxiety and stress. Participants rated each item on a 4-point Likert scale (from 0 = did not apply to me at all to 3 = applied to me very much) and subscale scores were computed by summing relevant items. Because the three subscales were highly correlated in this sample (ρ = .78 - .84), a total score (range 0-63) was used, which demonstrated excellent internal consistency (α = .96). Demographics. Participants reported age, gender, family status, nationality and education level. They also indicated (Yes/No) whether they had experienced trauma before age, received lifetime mental health diagnosis, or were currently receiving treatment for a mental health condition. Statistical Analyses All analyses were conducted in RStudio (v. 2025.05.1; Posit team, 2024). Descriptive statistics and normality tests were carried out with the psych package (Revelle, 2024). A regularized partial correlation network was estimated using graphical LASSO (EBICglasso) via bootnet (Epskamp et al., 2018), with Spearman correlations due to non-normality, and visualized with qgraph (Epskamp et al., 2012). Node centrality and stability were examined through nonparametric bootstrapping (1,000 iteration) in bootnet . Group differences in network structure, global strength, and edge weights based on early trauma, gender, and psychological symptoms were tested using the Network Comparison Text (NCT; van Borkulo, 2016). For exploratory and visualization purposes, participants were divided into low/high groups via median split for early trauma ( Mdn = 8) and psychological symptoms ( Mdn = 19), following prior research while acknowledging methodological limitations(Iacobucci et al., 2015; McClelland et al., 2015). Moderation effects were assessed with multiple linear regressions using the R’s lm function. Results Data screening Descriptive statistics and normality testing for all variables revealed significant normality violations based on the Kolmogorov-Smirnov test (D range = 0.06 – 0.89, p < .001). Skewness values varied between −0.33 and 0.95, and kurtosis values ranged from −0.67 to 0.64, indicating only mild departures from normality. No extreme outlier cases were detected in the final sample. Network Estimation and Stability A regularized partial correlation network was computed, including 12 variables: Early Traumatic Experiences, Psychological Symptoms, the six components of Psychological Flexibility (PF; Acceptance, Present Moment Awareness, Self-as-Context, Defusion, Values, Committed Action), and the four facets of Mindfulness (Observing, Describing, Acting with Awareness, Acceptance without Judgement) . Stability analysis indicates adequate network robustness, with non-parametric bootstrapping revealing small to moderate confidence intervals around most edge weights (see Figure A, Supplementary Materials), supporting the reliability of the network structure for further interpretation. The estimated network consisted of 24 non-zero edges (36.4%) out of 66 possible connections, with a mean edge weight of 0.05 (Figure 1), indicating a sparse structure that facilitates clearer interpretation and reduces likelihood of overfitting (Epskamp et al., 2018). Psychological symptoms connected positively strongly with early traumatic experiences ( r = .38) and acceptance (PF dimension; r = .27). Also, they were strongly negatively linked to Acceptance without Judgement (mindfulness facet; r = -.32) and exhibited moderate negative connections with the other mindfulness facets ( r = -.11; except Observing) and Committed Action (PF dimension; r =- .08). Additionally, only three of the mindfulness faces (except Acceptance without judgment) showed moderate association with four PF dimensions (except self-as-context and defusion), with correlation ranging from r = .09 to .17. Notably, early traumatic experiences had no connections to any PF dimensions and mindfulness facets in the estimated network. Network Centrality and Stability Case-drop bootstrapping was performed to assess the stability of centrality indices. The results confirm the robustness of the strength ( CS-coefficient = 0.672) and the expected influence ( CS-coefficient = 0.75), as both exceeded the recommended threshold of 0.50 (Epskamp et al., 2018). However, the CS-coefficients for closeness and betweenness did not reach acceptable levels and were therefore excluded from further reporting (Figure B, Supplementary Materials). Psychological symptoms demonstrated the highest strength ( z = 1.52) and high negative expected influence ( EI = -1.02), highlighting its centrality and inhibitory influence in the network. Among the psychological flexibility dimensions, committed action ( strength = 1.14, EI = 1.03 ) and values ( strength = 0.96, EI = 1.25 ) were identified as the next most central nodes, indicating their important activating roles. Present moment awareness ( strength = 0.39, EI = 0.91) and self-as-context ( strength = 0.11, EI = 0.75) showed relatively low strength centrality but moderate expected influence, suggesting a potential activating role despite their lower centrality. In contrast, acceptance ( strength = -0.24, EI = 0.54) and defusion ( strength = -0.06, EI = 0.65) were the least central psychological flexibility components, indicating a more peripheral, yet still activating role in the network. Among the mindfulness facets, acceptance without judgement was the third most central node in terms of strength (z = 0.51) but exhibited a highly negative influence (EI = -1.86), indicating a strong inhibitory function. The remaining mindfulness facets played a more peripheral role ( strength range = -0.39 - -1.63) and showed moderate inhibitory effects ( EI range = -0.15 - -1.05). Finally, early traumatic experiences demonstrated low centrality ( strength = -1.66, EI = -0.30) revealing a weaker role within the overall network. Moderation models To investigate the buffering role of PF and mindfulness facets on the link between ACE and psychological symptoms, moderation models were formulated informed by the network analysis results presented above. . Specifically, the network analysis showed that the facets that had unique correlations with psychological symptoms were Acceptance and Committed Action from the PF measure and Acceptance without Judgement, Describing and Acting with Awareness from the mindfulness measure. Thus, each of these five facets and its interaction with ACE (ETI-SR-SF total score) were entered as predictors (all mean-centered prior to analysis) in separate multiple linear regressions. As illustrated in Table 1, all five models were statistically significant, predicting between 35-46% of the variance in psychological symptoms. In all models, the number of ACE experiences (i.e. ETI-SR-SF total score) had a significant effect, with more ACE predicting more psychological symptoms in adulthood. As for the moderators, all five moderators had significant main effects on psychological symptoms, with Acceptance without Judgement, Acting with Awareness, Describing and Committed Action having a protective role, i.e. higher scores predicted less psychological symptoms, while Acceptance as PF facet had the opposite effect, i.e. higher scores predicted more psychological symptoms. As for moderation effects, the only facets that showed a significant interaction with the number of ACE were Acceptance without Judgement and Committed Action. Specifically, as illustrated in Figure 2A, the effect of Acceptance without Judgement on psychological symptoms is more pronounced at higher levels of ACE, with high levels of Acceptance predicting fewer psychological symptoms than low levels of Acceptance. For Committed Action (Figure 2B), a similar pattern was observed only at high levels of ACE, whereas at low levels of ACE, Committed Action has no effect on Psychological Symptoms. These findings suggest that Acceptance without Judgment and Committed Action are two skills that buffer individuals that have experienced traumatic events from developing psychological symptoms. Table 1. Multiple regression models with ACE, different facets of PF and Mindfulness as moderators and their interaction in the prediction of psychological symptoms (total DASS score). Moderator in each model Constant ACE (ETI-SR-SF score) Moderator main effect ACE x Moderator Adj. R 2 F(df) Model 1 - Acceptance w/o Judgement 18.62 (0.52) *** 1.09 (0.11) *** -0.86 (0.07) *** -0.03 (0.01) * 0.464 149.7 (3,512) *** Model 2 - Acting with Awareness 18.82 (0.55) *** 1.37 (0.12) *** -0.75 (0.08) *** -0.02 (0.02) 0.400 115.5 (3,512) *** Model 3 - Describing 18.87 (0.55) *** 1.62 (0.12) *** -0.50 (0.09) *** -0.02 (0.02) 0.348 92.41 (3,512) *** Model 4 - Acceptance (PF) 18.90 (0.55) *** 1.49 (0.12) *** 4.14 (0.52) *** 0.06 (0.10) 0.373 103.1 (3,512) *** Model 5 - Committed Action (PF) 18.82 (0.54) *** 1.63 (0.12) *** -2.75 (0.42) *** -0.22 (0.08) ** 0.357 96.22 (3,512) *** Note: PF= Psychological Flexibility. For each predictor, estimates and standard errors (in brackets) are provided. *p< .05, **p<.01, ***p<.001 Discussion Prior literature has shown the negative impact of ACE on psychological symptoms in adulthood, as well as the protective role of psychological flexibility and dispositional mindfulness (Dolbier et al., 2021 ). Given the conceptual overlap of these traits, the present study aimed to investigate the complex interconnection among them, as well as psychological symptoms and traumatic experiences using cross-sectional data from a healthy young sample. The study first utilized a network analysis approach to delineate the relationship and role of different facets of PF and mindfulness and then tested the most central and influential facets as moderators of the link between ACE and psychological symptoms. Network analysis findings highlighted that ACEs had the strongest positive connection with psychological symptoms, consistent with extensive research supporting the long-term effect of childhood adversity on adult psychopathology and the dose-dependent nature of this effect (e.g. Berber Celik & Odaci, 2020; Edwards et al., 2003 ; Kessler et al., 1997 , 2010 ). Surprisingly, none of the psychological flexibility or mindfulness components were directly connected to ACE. This suggests that early trauma may operate as a distal risk factor for psychological symptoms, without being immediately influenced by other psychological mechanisms. Instead, mindfulness and PF processes might emerge later as protective factors that shape the impact of trauma on psychopathology development (Gloster et al., 2017 ; McKeen et al., 2023 ; Richardson & Jost, 2019 ). A notable finding was the connection of Acceptance without Judgement (Mindfulness facet) with psychological symptoms, as well as its high centrality and inhibitory influence in the network. This suggests that cultivating a non-judgmental stance towards stressful or distressing experiences may play an important role in reducing psychological symptoms. This aligns with previous research showing that non-judgmental acceptance is linked to reduced psychopathology (Boughner et al., 2016 ; Dolbier et al., 2021 ; McKeen et al., 2023 ). The moderation analyses further confirm that acceptance without judgment may buffer the negative consequences of trauma, by reducing rumination and maladaptive responses to emotional experiences (Li et al., 2022 ). Clinically, early interventions that focus on cultivating acceptance of internal experiences without judgement may be particularly beneficial for individuals with ACEs history, as this approach has shown to reduce the risk of psychopathology development (Dolbier et al., 2021 ; McKeen et al., 2023 ; Ortiz & Sibinga, 2017 ; Wahbeh et al, 2011 ). An unexpected finding emerged regarding the effect of Acceptance (PF dimension) on psychological symptoms. Acceptance, a construct similar to Acceptance without Judgment (both of which assess openness to experience) was expected to correlate negatively with psychological symptoms. However, higher levels of Acceptance were unexpectedly associated with greater psychopathology. This difference may reflect conceptual differences between the two concepts and what they assess. On one hand, Acceptance reflects an individual’s willingness to actively engage with and fully experience distressing internal experiences (Hayes et al., 2012 ), which might have short-term negative effects, like heightened distress and psychological symptoms (Dunn et al., 2009 ). However, in the long-term, this mechanism may become adaptive as the individual develops greater psychological flexibility in managing their experiences (Gloster et al., 2017 ; Kashdan & Rottenberg, 2010 ). On the other hand, Acceptance without Judgement represents a more detached stance toward internal experiences, in which the individual observes them without actively engaging (Baer et al., 2004 ), which in short-term this may reduce distress and symptoms (Boughner et al., 2016 ; Garland et al., 2015 ). Further research could clarify these conceptual differences and examine their associations with symptom reduction, thereby enabling clinicians to tailor interventions to clients’ needs. For example, clients experiencing elevated emotional distress may initially benefit from mindfulness techniques that emphasize non-judgmental observation of thoughts and feelings, which can help reduce immediate distress (Creswell & Lindsay, 2014 ; Khoury et al., 2015 ). As therapy progresses, it may be therapeutically appropriate to introduce holistic practices that cultivate an open, aware and engaged stance towards internal experiences, thereby enhancing psychological flexibility and long-term adaptive coping skills (Beygi et al., 2023 ; Gloster et al., 2020 ). Besides Acceptance without judgement, Awareness and Describing (Mindfulness facets) also emerged as central processes in the network exhibiting negative connections with psychological symptoms. However, they did not moderate the relationship between ACEs and psychological symptoms. This suggests that, although these facets are linked with lower psychopathology (Boden & Thompson, 2015 ; Keng et al., 2011 ; Weissman et al., 2020 ), they do not buffer the impact of early trauma. They are, though important processes clinically, since being aware of the present moment enables individuals to notice thoughts and emotions as they arise, while the ability to identify and name these experiences fosters familiarity with stressful stimuli. These processes, in turn, reduce emotional reactivity and enhance adaptive emotion regulation, which collectively contribute to lower psychopathology levels (Holzel et al., 2011 ; Maddock & Blair, 2021; van der Velden et al., 2015 ). On the other hand, the Observing facet of Mindfulness did not have a similar impact as the other facets confirming previous findings in the literature that illustrate a complicated link between Observing and psychological symptoms (Medvedev et al., 2018 ; Siegling & Petrides, 2016 ). Specifically, a high ability to observe internal and external sensations can have beneficial or detrimental effects depending on the presence of other facets of mindfulness (Baer et al., 2006 ) or other traits like anxiety sensitivity (Moscow Diamond et al., 2025). If observing is combined with non-reactivity, then it enables adaptive emotion regulatory processes. However, when observing is combined with reactivity, it can lead to maladaptive responses like worry and rumination (Desrosiers et al., 2014 ). This complexity may, thus, explain why Observing on its own did not emerge as a facet with a strong connection to psychological symptoms in our study. As for the PF components, besides Acceptance, Committed Action was another important PF dimension showing a buffering effect and close links to reduced psychological symptoms. This is a novel finding, since prior studies have shown PF to moderate the impact of ACE on mental health outcomes (Boykin et al., 2020 ; Hostutler et al., 2023 ) but did not look at its components separately. Our findings add to this literature by showing that Committed Action can have such a moderating role. This supports previous research emphasizing the importance of actions being guided by personal values rather than by short-term relief-oriented goals. It shows that even in the face of adversity, people can continue to align their behaviors with their values and engage in meaningful actions (McCracken, 2013 ; Stockton et al., 2019 ). It should be noted that committed action is a therapeutic process of change common to various treatment protocols, not just ACT (Forman et al., 2012), making it a critical intervention target. Incorporating exercises such as values clarification, goal-setting, and behavioral activation can directly enhance committed action skills, thereby personalizing interventions and maximizing their protective effects against the development of psychopathology (Levin et al., 2020 ). As for the remaining PF components (i.e. Present Moment Awareness, Self-as-Context, Values and Cognitive Defusion), these did not have a direct connection with psychological symptoms. This finding contrasts with earlier evidence by Makriyianis et al. ( 2019 ), who reported that certain PF components, particularly Self-as-Context and Cognitive Defusion, were related to lower psychological symptoms. In contrast, the present network analysis illustrates that, when considered within their broader interrelations with other PF components, these specific components do not exhibit distinct or direct associations with psychological symptoms. Instead, these findings point out the complex and interconnected nature of PF, suggesting that its influence on symptomatology may emerge from the interaction among its components rather than their distinct contributions. Specifically, these four PF dimensions seem to primarily operate at a cognitive and metacognitive level, influencing how individuals relate to internal experiences, rather than directly producing behavioral change (Assaz et al., 2023 ; Fortier et al., 2024 ; Godbee & Kangas, 2020 ; Goldberg et al., 2018 ). This may account for their strong interconnectivity with the other PF dimensions, despite their low centrality in the overall network. While ACT theory posits that all six PF dimensions are interconnected (Hayes et al., 2012 ), the current findings suggest that not all of them play an equal role in reducing symptomatology. Clinically, this implies that cognitive or observational strategies might serve as a foundation upon which more action-oriented practices can build, thus maximizing therapeutic change. To sum up, the present study used a novel analytical approach, network analysis, to disentangle the processes involved in PF and mindfulness in relation to psychological symptoms and ACE, as well as to examine their role as moderators. Nevertheless, several limitations need to be noted. First, the cross-sectional design does not allow causal inferences among study variables. Longitudinal research is required to examine the causal effect of ACEs, PF components and mindfulness facets on the development of psychopathology. Such designs would also allow for the examination of whether PF components and mindfulness facets precede trauma exposure or develop because of it (Makriyannis et al., 2019; Richardson & Jost, 2019 ). Second, the retrospective assessment of ACEs before adulthood may be subject to recall biases and does not capture the current impact of trauma, since it assesses only the occurrence of trauma events rather than the individuals’ reactions to them (Hardt & Rutter, 2004 ). Third, the use of convenience sampling may not be representative of the population. Given the small number of men and the large number of people in our sample that reported familiarity with mindfulness (about 45%), it is possible that there was a self-selection bias, with participants interested in mindfulness being more likely to choose to complete our survey. Furthermore, in the current analyses, we examined ACE as a total score rather than looking at different types of traumatic events separately (e.g., physical or sexual abuse), given that the literature suggests that various forms of trauma tend to coexist (Edwards et al., 2003 ; Felitti et al., 1995). However, different types of trauma have been shown to exhibit distinct associations to psychological symptoms in adulthood (Whitaker et al., 2014 ). Thus, future studies with larger samples could explore the differential impact of specific traumatic experiences. Similarly, psychological symptoms were analyzed as a total score without separating anxiety, depression and stress subscales, which was justified by the high correlations among the subscales in our sample. However, anxiety and depression may be differentially related to PF and mindfulness facets (Desrosiers et al., 2013). Future research using different assessment tools that capture anxiety and depression more distinctly could clarify these differential effects. Finally, this study focused primarily on components of Psychological Flexibility in relation to Mindfulness facets, rather than examining the Psychological Inflexibility dimensions as well, which have been shown to differentially relate to ACEs and psychological symptoms (Makriyianis et al., 2019 ). Nevertheless, the current study adds to the existing literature by examining the combined effects of multiple psychological processes central to PF and mindfulness on psychological symptoms. The findings suggest that ACEs history is not directly linked to PF and mindfulness components. However, some of them, particularly acceptance without judgement and committed action, appear to function as moderators, buffering the negative impact of ACEs on psychological symptoms in adulthood. These results carry important theoretical implications, providing preliminary empirical support for the mechanism through which PF and mindfulness may mitigate psychological symptoms among individuals with ACEs history. Clinically, the findings reinforce the utility of acceptance-based interventions such as Acceptance and Commitment Therapy (Hayes et al., 2004 ) and Mindfulness-Based Stress Reduction (Kabat-Zinn, 1990) and contribute to a clearer understanding of their underlying mechanisms. These findings highlight the importance of interventions or prevention programs aimed at individuals with ACEs history that enhance acceptance and non-judgmental interaction with internal experiences (Tomlinson et al., 2018 ) and promote values-guided behaviors (Engle & Follette, 2015 ). Declarations Author Contribution CRediT author statement: AC: Conceptualization, Methodology, Formal Analysis, Writing-Original draft preparation, Writing- Reviewing and Editing, Supervision EC: Conceptualization, Methodology, Formal Analysis, Writing-Original draft preparation, Writing- Reviewing and Editing, Supervision AA: Conceptualization, Methodology, Investigation, Data Curation EK: Conceptualization, Methodology, Investigation, Data Curation Data Availability The data is not publicly available due to ethical committee restrictions, but is available upon reasonable request. Authors note. The study was approved by the Cyprus National Bioethics Committee (EEΒΚ/ΕΠ/2023/77). All participants provided informed consent. The authors have no competing interests. The data are available upon request. References Aafjes-van Doorn, K., Kamsteeg, C., & Silberschatz, G. (2020). Cognitive mediators of the relationship between adverse childhood experiences and adult psychopathology: A systematic review . Development and Psychopathology, 32 (3), 1017-1029. https://doi.org/10.1017/S0954579419001317 Antonopoulou, Z., Konstantakopoulos, G., Tzinieri-Coccosis. M., & Sinodimou, C. (2017) Rates of childhood trauma in a sample of university students in Greece: The Greek version of the Early Trauma Inventory-Self Report. Psychiatriki, 28 (1), pp. 19–27. https://doi.org/10.22365/jpsych.2017.281.19 Assaz, D. A., Tyndall, I., Oshiro, C. K., & Roche, B. (2023). A process-based analysis of cognitive defusion in acceptance and commitment therapy. Behavior Therapy , 54 (6), 1020-1035. https://doi.org/10.1016/j.beth.2022.06.003 Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills. Assessment , 11 (3), 191-206. https://doi.org/10.1177/1073191104268029 Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13 (1), 27-45. https://psycnet.apa.org/doi/10.1037/t05514-000 Berber Çelik, Ç., & Odacı, H. (2020). Does child abuse have an impact on self-esteem, depression, anxiety and stress conditions of individuals?. International Journal of Social Psychiatry, 66 (2), 171-178. https://doi.org/10.1177/0020764019894618 Beygi, Z., Jangali, R. T., Derakhshan, N., Alidadi, M., Javanbakhsh, F., & Mahboobizadeh, M. (2023). An overview of reviews on the effects of acceptance and commitment therapy (ACT) on depression and anxiety. Iranian Journal of Psychiatry , 18 (2), 248-257. https://doi.org/10.18502/ijps.v18i2.12373 Boden, M. T., & Thompson, R. J. (2015). Facets of emotional awareness and associations with emotion regulation and depression. Emotion, 15 (3), 399-410. https://doi.org/10.1037/emo0000057 Bolduc, R., Bigras, N., Daspe, M.-È., Hébert, M., & Godbout, N. (2018). Childhood cumulative trauma and depressive symptoms in adulthood: The role of mindfulness and dissociation. Mindfulness, 9 (5), 1594–1603. https://doi.org/10.1007/s12671-018-0906-3 Borsboom, D. (2017). A network theory of mental disorders. World psychiatry , 16 (1), 5-13. https://doi.org/10.1002/wps.20375 Borsboom, D., Deserno, M. K., Rhemtulla, M., Epskamp, S., Fried, E. I., McNally, R. J., ... & Waldorp, L. J. (2021). Network analysis of multivariate data in psychological science. Nature Reviews Methods Primers , 1 (1), 58. https://doi.org/10.1038/s43586-021-00055-w Boughner, E., Thornley, E., Kharlas, D., & Frewen, P. (2016). Mindfulness-related traits partially mediate the association between lifetime and childhood trauma exposure and PTSD and dissociative symptoms in a community sample assessed online. Mindfulness , 7 (3), 672-679. https://doi.org/10.1007/s12671-016-0502-3 Boykin, D. M., Anyanwu, J., Calvin, K., & Orcutt, H. K. (2020). The moderating effect of psychological flexibility on event centrality in determining trauma outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 12 (2), 193-199. https://psycnet.apa.org/doi/10.1037/tra0000490 Bremner, J. D., Bolus, R., & Mayer, E. A. (2007). Psychometric properties of the early trauma inventory–self report. The Journal of Nervous and Mental Disease , 195 (3), 211-218. https://doi.org/10.1097/01.nmd.0000243824.84651.6c Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of personality and social psychology , 84(4), 822-848. https://doi.org/10.1037/0022-3514.84.4.822 Christodoulou, A., Karekla, M., Costantini, G., & Michaelides, M. P. (2023). A network analysis approach on the psychological flexibility/inflexibility model. Behavior Therapy , 54 (5), 719-733. https://doi.org/10.1016/j.beth.2023.01.002 Contreras, A., Nieto, I., Valiente, C., Espinosa, R., & Vazquez, C. (2019). The study of psychopathology from the network analysis perspective: A systematic review. Psychotherapy and Psychosomatics, 88 (2), 71–83. https://doi.org/10.1159/000497425 Creswell, J. D., & Lindsay, E. K. (2014). How does mindfulness training affect health? A mindfulness stress buffering account. Current Directions in Psychological Science , 23 (6), 401-407. https://doi.org/10.1177/0963721414547415 Crouch, E., Radcliff, E., Strompolis, M., & Srivastav, A. (2019). Safe, stable, and nurtured: Protective factors against poor physical and mental health outcomes following exposure to adverse childhood experiences (ACEs). Journal of child & adolescent trauma, 12(2), 165-173. https://doi.org/10.1007/s40653-018-0217-9 Desrosiers, A., Vine, V., Curtiss, J., & Klemanski, D. H. (2014). Observing nonreactively: A conditional process model linking mindfulness facets, cognitive emotion regulation strategies, and depression and anxiety symptoms. Journal of Affective Disorders , 165 , 31-37. https://doi.org/10.1016/j.jad.2014.04.024 Dolbier, C. L., Haley, E. N., Conder, L., & Guiler, W. (2021). Adverse childhood experiences and adult psychopathological symptoms: The moderating role of dispositional mindfulness. Journal of Contextual Behavioral Science , 21 , 73-79. https://doi.org/10.1016/j.jcbs.2021.06.001 Dunn, B. D., Billotti, D., Murphy, V., & Dalgleish, T. (2009). The consequences of effortful emotion regulation when processing distressing material: A comparison of suppression and acceptance. Behaviour Research and Therapy , 47 (9), 761-773. https://doi.org/10.1016/j.brat.2009.05.007 Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. American Journal of Psychiatry, 160 (8), 1453-1460. https://doi.org/10.1176/appi.ajp.160.8.1453 Engle, J., & Follette, V. M. (2015). Mindfulness and valued action: An acceptance and commitment therapy approach to working with trauma survivors. In V. M. Follette, J. Briere, D. Rozelle, J. W. Hopper, & D. I. Rome (Eds.), Mindfulness-oriented interventions for trauma: Integrating contemplative practices (pp. 103–120). The Guilford Press. Epskamp, S., Borsboom, D., & Fried, E. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50 (1), 195–212. https://doi.org/10.3758/s13428-017-0862-1 Epskamp, S., Cramer, A. O. J., Waldorp, L. J., Schmittmann, V. D., & Borsboom, D. (2012). qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48 (4), 1–18. https://doi.org/10.18637/jss.v048.i04 Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults . American Journal of Preventive Medicine, 14 (4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8 Fortier, S. M., Strand, E., Zottarelli, L. K., Stevens, M., & Springer, C. M. (2024). Values work with adolescents: A qualitative component analysis using an integrative model of values and behavior. Cognitive and Behavioral Practice . https://doi.org/10.1016/j.cbpra.2024.08.001 Garland, E. L., Geschwind, N., Peeters, F., & Wichers, M. (2015). Mindfulness training promotes upward spirals of positive affect and cognition: multilevel and autoregressive latent trajectory modeling analyses. Frontiers in Psychology , 6 , 15. https://doi.org/10.3389/fpsyg.2015.00015 Gloster, A. T., Meyer, A. H., & Lieb, R. (2017). Psychological flexibility as a malleable public health target: Evidence from a representative sample. Journal of Contextual Behavioral Science, 6 (2), 166-171. https://doi.org/10.1016/j.jcbs.2017.02.003 Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science , 18 , 181-192. https://doi.org/10.1016/j.jcbs.2020.09.009 Godbee, M., & Kangas, M. (2020). The relationship between flexible perspective taking and emotional well-being: A systematic review of the “self-as-context” component of acceptance and commitment therapy. Behavior Therapy , 51 (6), 917-932. https://doi.org/10.1016/j.beth.2019.12.010 Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review , 59 , 52-60. https://doi.org/10.1016/j.cpr.2017.10.011 Hardt, J., & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. Journal of Child Psychology and Psychiatry , 45 (2), 260-273. https://doi.org/10.1111/j.1469-7610.2004.00218.x Harper, L., Jones, A., Goodwin, L., & Gillespie, S. (2022). Association between trait mindfulness and symptoms of post-traumatic stress: A meta-analysis. Journal of Psychiatric Research , 152 , 233-241. https://doi.org/10.1016/j.jpsychires.2022.05.027 Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44 (2), 180-198. https://doi.org/10.1016/j.beth.2009.08.002 Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist , 40 (7), 976-1002. https://doi.org/10.1177/0011000012460836 Hayes, S.C., Strosahl, K.D., Bunting, K., Twohig, M., Wilson, K.G. (2004). What Is Acceptance and Commitment Therapy?. In: Hayes, S.C., Strosahl, K.D. (eds) A Practical Guide to Acceptance and Commitment Therapy (pp. 3-29). Springer, Boston, MA. https://doi.org/10.1007/978-0-387-23369-7_1 Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science , 6 (6), 537-559. https://doi.org/10.1177/1745691611419671 Hostutler, C. A., Snider, T., Wolf, N., & Grant, R. (2023). ACEs screening in adolescent primary care: Psychological flexibility as a moderator. Families, Systems, & Health, 41 (2), 182–191. https://doi.org/10.1037/fsh0000717 Iacobucci, D., Posavac, S. S., Kardes, F. R., Schneider, M. J., & Popovich, D. L. (2015). The median split: Robust, refined, and revived. Journal of Consumer Psychology , 25 (4), 690-704. https://doi.org/10.1016/j.jcps.2015.06.014 Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10 (2), 144–156. https://doi.org/10.1093/clipsy.bpg016 Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30 (7), 865-878. https://doi.org/10.1016/j.cpr.2010.03.001 Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review , 31 (6), 1041-1056. https://doi.org/10.1016/j.cpr.2011.04.006 Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine, 27 (5), 1101-1119. https://doi.org/10.1017/s0033291797005588 Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., ... & Williams, D. R. (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. The British Journal of Psychiatry, 197 (5), 378-385. https://doi.org/10.1192/bjp.bp.110.080499 Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research , 78 (6), 519-528. https://doi.org/10.1016/j.jpsychores.2015.03.009 Levin, M. E., Krafft, J., Hicks, E. T., Pierce, B., & Twohig, M. P. (2020). A randomized dismantling trial of the open and engaged components of acceptance and commitment therapy in an online intervention for distressed college students. Behaviour Research and Therapy , 126 , 103557. https://doi.org/10.1016/j.brat.2020.103557 Li, P., Mao, L., Hu, M., Lu, Z., Yuan, X., Zhang, Y., & Hu, Z. (2022). Mindfulness on rumination in patients with depressive disorder: A systematic review and meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health , 19 (23), 16101. https://doi.org/10.3390/ijerph192316101 Lovibond, P. F., & Lovibond, S. H. (1995). Depression Anxiety and Stress Scales (DASS-42) [Database record]. APA PsycTests. https://doi.org/10.1037/t39835-000 Lyrakos, G. N., Arvaniti, C., Smyrnioti, M., & Kostopanagiotou, G. (2011). Translation and validation study of the depression anxiety stress scale in the Greek general population and in a psychiatric patient's sample. European Psychiatry , 26 (S2), 1731. https://doi.org/10.1016/S0924-9338(11)73435-6 Maddock, A., & Blair, C. (2023). How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review. Current Psychology , 42 (12), 10200-10222. https://doi.org/10.1007/s12144-021-02082-y Madigan, S., Deneault, A. A., Racine, N., Park, J., Thiemann, R., Zhu, J., ... & Neville, R. D. (2023). Adverse childhood experiences: a meta‐analysis of prevalence and moderators among half a million adults in 206 studies. World Psychiatry , 22 (3), 463-471. https://doi.org/10.1002/wps.21122 Makriyianis, H. M., Adams, E. A., Lozano, L. L., Mooney, T. A., Morton, C., & Liss, M. (2019). Psychological inflexibility mediates the relationship between adverse childhood experiences and mental health outcomes. Journal of Contextual Behavioral Science, 14 , 82-89. https://doi.org/10.1016/j.jcbs.2019.09.007 Malo, R., Acier, D., & Bulteau, S. (2024). Psychological flexibility: toward a better Understanding of a key concept. Trends in Psychology, 32 (3), 734-759. https://doi.org/10.1007/s43076-022-00188-1 Martins, C. M. S., Baes, C. V. W., & Juruena, M. (2011). Analysis of the occurrence of early life stress in adult psychiatric patients: a systematic review. Psychology & Neuroscience , 4 , 219-227. https://doi.org/10.3922/j.psns.2011.2.007 McClelland, G. H., Lynch Jr, J. G., Irwin, J. R., Spiller, S. A., & Fitzsimons, G. J. (2015). Median splits, Type II errors, and false–positive consumer psychology: Don't fight the power. Journal of Consumer Psychology , 25 (4), 679-689. https://doi.org/10.1016/j.jcps.2015.05.006 McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain , 14 (8), 828-835. https://doi.org/10.1016/j.jpain.2013.02.009 McKeen, H., Hook, M., Podduturi, P., Beitzell, E., Jones, A., & Liss, M. (2023). Mindfulness as a mediator and moderator in the relationship between adverse childhood experiences and depression. Current Psychology , 42 (8), 6576-6586. https://doi.org/10.1007/s12144-021-02003-z Medvedev, O. N., Norden, P. A., Krägeloh, C. U., & Siegert, R. J. (2018). Investigating unique contributions of dispositional mindfulness facets to depression, anxiety, and stress in general and student populations. Mindfulness, 9 (6), 1757-1767. https://doi.org/10.1007/s12671-018-0917-0 Moskow Diamond, D., Curtiss, J., Carpenter, J. K., Ito, M., & Hofmann, S. G. (2025). Influence of anxiety sensitivity on the observe facet of the five facet mindfulness questionnaire: differential item functioning in a clinical population. BMC Psychiatry , 25 (1), 312. https://doi.org/10.1186/s12888-025-06488-x Moyes, E., Nutman, G., & Mirman, J. H. (2022). The efficacy of targeted mindfulness-based interventions for improving mental health and cognition among youth and adults with ACE histories: a systematic mixed studies review. Journal of Child & Adolescent Trauma , 15 (4), 1165-1177. https://doi.org/10.1007/s40653-022-00454-5 Posit team (2025). RStudio: Integrated Development Environment for R . Posit Software, PBC, Boston, MA. URL http://www.posit.co Psarraki, E. E., Bacopoulou, F., Vlachakis, D., Chrousos, G. P., Michou, M., Pelekasis, P., ... & Darviri, C. (2022). The Kentucky Inventory of Mindfulness Skills in Greek Undergraduate and Postgraduate Students. In Vlamos, P. (Ed.), GeNeDis 2020: Advances in Experimental Medicine and Biology (vol 1339). Springer, Cham. https://doi.org/10.1007/978-3-030-78787-5_28 Ortiz, R., & Sibinga, E. M. (2017). The role of mindfulness in reducing the adverse effects of childhood stress and trauma. Children , 4 (3), 16. https://doi.org/10.3390/children4030016 Quaglia, J. T., Braun, S. E., Freeman, S. P., McDaniel, M. A., & Brown, K. W. (2016). Meta-analytic evidence for effects of mindfulness training on dimensions of self-reported dispositional mindfulness. Psychological assessment, 28 (7), 803-818. https://doi.org/10.1037/pas0000268 Revelle, W. (2024). psych: Procedures for Psychological, Psychometric, and Personality Research (Version 2.4.1) [R package]. Northwestern University. URL: https://CRAN.R-project.org/package=psych Richardson, C. M., & Jost, S. A. (2019). Psychological flexibility as a mediator of the association between early life trauma and psychological symptoms. Personality and individual differences, 141 , 101-106. https://doi.org/10.1016/j.paid.2018.12.029 Rolffs, J. L., Rogge, R. D., & Wilson, K. G. (2018). Disentangling components of flexibility via the hexaflex model: Development and validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment , 25 (4), 458-482. https://doi.org/10.1177/1073191116645905 Siegling, A. B., & Petrides, K. V. (2016). Zeroing in on mindfulness facets: Similarities, validity, and dimensionality across three independent measures. PloS one , 11 (4), e0153073. https://doi.org/10.1371/journal.pone.0153073 Stockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., & Miles, G. (2019). Identifying the underlying mechanisms of change during acceptance and commitment therapy (ACT): A systematic review of contemporary mediation studies. Behavioural and Cognitive Psychotherapy , 47 (3), 332-362. https://doi.org/10.1017/S1352465818000553 Tol, W. A., Leku, M. R., Lakin, D. P., Carswell, K., Augustinavicius, J., Adaku, A., ... & van Ommeren, M. (2020). Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial. The Lancet Global Health, 8 (2), e254-e263. https://doi.org/10.1016/S2214-109X(19)30504-2 Tubbs, J. D., Savage, J. E., Adkins, A. E., Amstadter, A. B., & Dick, D. M. (2019). Mindfulness moderates the relation between trauma and anxiety symptoms in college students. Journal of American College Health , 67 (3), 235-245. https://doi.org/10.1080/07448481.2018.1477782 Tomlinson, E. R., Yousaf, O., Vittersø, A. D., & Jones, L. (2018). Dispositional mindfulness and psychological health: A systematic review. Mindfulness , 9 (1), 23-43. https://doi.org/10.1007/s12671-017-0762-6 Thompson, R. W., Arnkoff, D. B., & Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Trauma, Violence, & Abuse , 12 (4), 220-235. https://doi.org/10.1177/1524838011416375 van Borkulo, C. D. (2016). NetworkComparisonTest: Statistical comparison of two networks based on three invariance measures (Version 2.0.1). Available from https://CRAN.Rproject.org/package=NetworkComparisonTest van der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., ... & Piet, J. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review , 37 , 26-39. https://doi.org/10.1016/j.cpr.2015.02.001 Wahbeh, H., Lu, M., & Oken, B. (2011). Mindful awareness and non-judging in relation to posttraumatic stress disorder symptoms. Mindfulness , 2 (4), 219-227. https://doi.org/10.1007/s12671-011-0064-3 Weissman, D. G., Nook, E. C., Dews, A. A., Miller, A. B., Lambert, H. K., Sasse, S. F., ... & McLaughlin, K. A. (2020). Low emotional awareness as a transdiagnostic mechanism underlying psychopathology in adolescence. Clinical Psychological Science , 8 (6), 971-988. https://doi.org/10.1177/2167702620923649 Whitaker, R. C., Dearth-Wesley, T., Gooze, R. A., Becker, B. D., Gallagher, K. C., & McEwen, B. S. (2014). Adverse childhood experiences, dispositional mindfulness, and adult health. Preventive Medicine , 67 , 147-153. https://doi.org/10.1016/j.ypmed.2014.07.029 Wu, G., Feder, A., Cohen, H., Kim, J. J., Calderon, S., Charney, D. S., & Mathé, A. A. (2013). Understanding resilience. Frontiers in behavioral neuroscience , 7 , 10. https://doi.org/10.3389/fnbeh.2013.00010 Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8142530","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":555896196,"identity":"cfce4f0d-ebb5-499b-a3eb-631a25d5baa5","order_by":0,"name":"Andria Christodoulou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYHACAwbGBgYeEEuCgcGCgYG9gVgtbGAtQMRzgDgtDAgtEgn41fPPbt7A8HPHPRn5+c0Hb3xsk5AzuPn4mMQPBjt5BvYzBti0SNw5VsDYe6aYx+AYW7LlzDYJY4PbaWmSPQzJhg08OVi1MNzIMWBmbEvgMWDjMZPmbZNI3HA7x0yagYE5gUGCB6sWeZgW+TaYlpvnvwG11OPUYgDTwnAMpuUGDxtQy2GcWgxvpBUc7AU57FhasuWMcxLGkmfSjC17DI4btvGkFWDTIncjeeODn20J9vLNhw/e+FBmI8d3/PDDGz8qquX52Q9vwOp9IDiAzcGgiOLAHmL4APsDkrWMglEwCkbBcAQAg+VVq+O1HX8AAAAASUVORK5CYII=","orcid":"","institution":"European University Cyprus","correspondingAuthor":true,"prefix":"","firstName":"Andria","middleName":"","lastName":"Christodoulou","suffix":""},{"id":555896197,"identity":"e7d66f3a-12b7-4e39-b2d6-ccf0bc790a6e","order_by":1,"name":"Elena Constantinou","email":"","orcid":"","institution":"European University Cyprus","correspondingAuthor":false,"prefix":"","firstName":"Elena","middleName":"","lastName":"Constantinou","suffix":""},{"id":555896198,"identity":"38214afe-8e54-4203-ab1d-efabd01b79ad","order_by":2,"name":"Aggelina Agathokleous","email":"","orcid":"","institution":"European University Cyprus","correspondingAuthor":false,"prefix":"","firstName":"Aggelina","middleName":"","lastName":"Agathokleous","suffix":""},{"id":555896199,"identity":"e8858108-5901-44a1-885f-aeb7bc2c9960","order_by":3,"name":"Erasmia Kyprianou","email":"","orcid":"","institution":"European University Cyprus","correspondingAuthor":false,"prefix":"","firstName":"Erasmia","middleName":"","lastName":"Kyprianou","suffix":""}],"badges":[],"createdAt":"2025-11-18 07:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8142530/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8142530/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97895284,"identity":"e9bef51b-5c11-482a-8419-7309afa691ca","added_by":"auto","created_at":"2025-12-10 15:33:56","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1118739,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscriptblinded.docx","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/a52c8baba5bddb0b6217fefc.docx"},{"id":97713591,"identity":"1223536a-08c0-4a7b-b492-b0f2f3688e4b","added_by":"auto","created_at":"2025-12-08 14:09:05","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6226,"visible":true,"origin":"","legend":"","description":"","filename":"cd0f8fed359247789e9876e4ab4482bf.json","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/6988195e03e79b50856ab60f.json"},{"id":97713583,"identity":"d19b76f5-a861-41ee-8dd6-bc981607460d","added_by":"auto","created_at":"2025-12-08 14:09:04","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2758963,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/b733f732f0d836c7d04f0e4e.docx"},{"id":97713588,"identity":"e15f3a97-fa6c-4b00-978c-33a05b231923","added_by":"auto","created_at":"2025-12-08 14:09:05","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":191219,"visible":true,"origin":"","legend":"","description":"","filename":"cd0f8fed359247789e9876e4ab4482bf1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/5e6095e043f4068284ac1a29.xml"},{"id":97713581,"identity":"d5596eca-475b-4da7-b3f8-4d2ee1d67e18","added_by":"auto","created_at":"2025-12-08 14:09:04","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10599,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/a6734fa48d4ddefd7fe0b234.png"},{"id":97713590,"identity":"9fd4220b-af38-4ad1-b012-79186703e1c9","added_by":"auto","created_at":"2025-12-08 14:09:05","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1074,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/bd2b25b40693f96fdcfdeefe.jpeg"},{"id":97713589,"identity":"b4f5106d-1985-4daf-81e1-4bf59fcc0b53","added_by":"auto","created_at":"2025-12-08 14:09:05","extension":"jpeg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":820844,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/b9fe1b4d4a496e3c725a3936.jpeg"},{"id":97713593,"identity":"7d19e063-9783-43b7-b138-2ee98dfa1318","added_by":"auto","created_at":"2025-12-08 14:09:06","extension":"jpeg","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":315690,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/267e92549e446b0392bb2367.jpeg"},{"id":97713585,"identity":"74493604-598c-4157-8aee-d48a81563f8f","added_by":"auto","created_at":"2025-12-08 14:09:05","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11180,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/6a8c0086405fd0362c82d425.png"},{"id":97713586,"identity":"e5a93dc8-3bb3-4d59-a51e-2b8d977933dc","added_by":"auto","created_at":"2025-12-08 14:09:05","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":935,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/b367cb55cf05a8472ab62b16.png"},{"id":97713597,"identity":"fa369e86-afc3-4378-b640-1dcf1ad8eab3","added_by":"auto","created_at":"2025-12-08 14:09:06","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":164467,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/73586223ec19a1b1e744860d.png"},{"id":97713584,"identity":"766b0511-1573-4bc0-9282-a4d3d169917f","added_by":"auto","created_at":"2025-12-08 14:09:04","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58676,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/165b6326e40135603e7dc3e3.png"},{"id":97713582,"identity":"4a68da0f-a545-4c24-9bec-f96a9178dcd3","added_by":"auto","created_at":"2025-12-08 14:09:04","extension":"xml","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":188161,"visible":true,"origin":"","legend":"","description":"","filename":"cd0f8fed359247789e9876e4ab4482bf1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/9301ee11554bb6e6a5f54f36.xml"},{"id":97713595,"identity":"220326d4-5676-4dc4-9495-3e777e993e4d","added_by":"auto","created_at":"2025-12-08 14:09:06","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":200958,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/80b09360071a2a15c8783320.html"},{"id":97895378,"identity":"b8e39488-7cde-4ac3-bda9-afdf72269963","added_by":"auto","created_at":"2025-12-10 15:34:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":214286,"visible":true,"origin":"","legend":"\u003cp\u003eRegularized Partial Correlation Network of Early Traumatic Experiences, Psychological Symptoms, Psychological Flexibility dimensions and Mindfulness Dimensions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eNotes.\u003c/strong\u003e\u003c/em\u003e Nodes represent variables: Early Traumatic Experiences (Trauma), Psychological Symptoms (Psych.Sympt), Psychological Flexibility dimensions: Acceptance (ACC), Present Moment Awareness (PMA), Self-as-Context (SACxt), Defusion (DEF), Values, (VAL), Committed Action (CA), and mindfulness facets: Acceptance without Judgment (ACC.MIND), Observing (OBS), Describing (DESC), Acting with Awareness (AWARE).Blue edges represent positive associations, red edges indicate negative associations.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/13abd4d8565e7443336999d1.png"},{"id":97895728,"identity":"2a74c144-8bd3-47a8-8dbb-70d0c8aeb624","added_by":"auto","created_at":"2025-12-10 15:34:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":201015,"visible":true,"origin":"","legend":"\u003cp\u003eA) Acceptance without Judgment (ACCcen) x number of ACE interaction on the prediction of psychological symptoms (both predictors mean centered). B) Committed Action (CAcen) x number of ACE interaction on the prediction of psychological symptoms. In both cases, the ACE-psychological symptoms relationship is depicted at mean (blue line), +1SD (green line) and –1SD (red line) of the moderator.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/22623c156bf4f73f721a9310.png"},{"id":98421432,"identity":"104fec22-5e54-4dd6-a297-282273b8a432","added_by":"auto","created_at":"2025-12-17 16:27:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1101730,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/8b986fdd-0a27-4000-a9ed-bbce13f3c9aa.pdf"},{"id":97713587,"identity":"bf4a21fc-ef7d-41a7-bf57-f02b36cb88b5","added_by":"auto","created_at":"2025-12-08 14:09:05","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":2758963,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-8142530/v1/e83fa7627a4e5baa579fa69f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The associations among Mindfulness, Psychological Flexibility, Adverse Childhood Experiences, and Psychological Symptoms in young adulthood","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdverse childhood experiences (ACE) refer to distressing or traumatic events experienced in childhood or adolescence, including various forms of abuse, neglect or broader traumatic events such as natural disasters or loss of a loved one (Felitti et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1998\u003c/span\u003e; Martins et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). A recent meta-analysis has shown that about 60% of participants reported having experienced at least one ACE (Madigan et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Such early trauma can significantly affect emotional and psychological development, increasing vulnerability to later psychological difficulties (Aafjes-van Doorn et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Beyond trauma-specific symptoms, ACE have been linked to higher levels of anxiety and depression in adulthood (Berber Celik \u0026amp; Odaci, 2020; Edwards et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Kessler et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e1997\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, not everyone with ACE history will go on to develop mental health problems in adulthood (Crouch et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Research suggests that various biological, developmental, social and psychological factors can buffer individuals with ACE against the development of mental health problems (Wu et al, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Personality traits that influence the way people adapt to and cope with difficulties and environmental stressors, like dispositional Mindfulness and Psychological Flexibility (PF) are among those factors examined by previous literature. Both mindfulness and PF have been identified as protective factors, since they have both been negatively associated with early trauma and subsequent psychological symptoms (Gloster et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; McKeen et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Richardson \u0026amp; Jost, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDispositional mindfulness refers to the process of directing attention to present moment experiences in a non-judgemental way (Kabat-Zinn, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Mindfulness can be seen understood both as a state and as a trait (dispositional mindfulness), reflecting a tendency to maintain present-moment awareness across situations (Kabat-Zinn, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). This trait tendency can vary along a continuum in the general population, while it can also be increased by mindfulness-based interventions and training, which impact state mindfulness, but also in the long-term increase levels of dispositional mindfulness (Quaglia et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMindfulness is a multi-faceted construct comprising of five distinct facets: Observing (i.e., noticing internal and external experiences), Describing (i.e., labelling internal and external experiences), Acting with Awareness (i.e., focusing attention to the moment), Non-reactivity (i.e., allowing thoughts and feelings without reacting to them) and Acceptance without Judgement (i.e., openly experiencing thoughts and feelings without evaluation; Baer et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Nevertheless, various conceptualizations and ways to assess mindfulness exist in the literature, incorporating some or all these facets (Baer et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). What emerges, though, from prior research is that mindfulness facets may have different relationships with psychological symptoms, stressing the need for exploring the various facets separately (Baer et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Medvedev et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMindfulness is an important trait in understanding mental health outcomes following trauma, with higher mindfulness consistently linked to better psychological well-being and fewer symptoms in both general populations (Brown \u0026amp; Ryan, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Tomlinson et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and individuals with ACEs history (Moyes et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Research indicates that mindfulness may help individuals to adjust to traumatic experiences (Harper et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Thompson et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), yet its precise role in the ACE-psychopathology relationship remains unclear. Some studies identify mindfulness as a mediator, showing that ACE lowers trait mindfulness, which then increases psychological symptoms, particularly through the facets of Describing, Acting with Awareness and Acceptance without Judgement (Bolduc et al, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Boughner et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Others suggest a moderating role, with higher mindfulness, especially Acceptance without Judgement facet, weakening association between trauma and anxiety (Dolbier et al, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tubbs et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). More recent evidence shows that specific facets, such as Acting with Awareness, may serve as both mediating and moderating functions in the case of depression (McKeen et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Overall, findings suggest differential involvement of mindfulness facets in trauma adjustment, but inconsistencies, particularly in moderation effects, highlight the need for further research.\u003c/p\u003e\u003cp\u003eA related, yet distinct from mindfulness, concept is that of Psychological Flexibility (PF). PF refers to the ability to remain fully aware and open to the present moment, without trying to avoid or control unpleasant experiences, while intentionally choosing to act in alignment with one\u0026rsquo;s core values (Hayes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). It is a mechanism comprising a set of dynamic processes that influence how individuals respond to their experiences. Specifically, it consists of 6 interconnected components: a) Acceptance (i.e., being open to experience), b) Cognitive Defusion (i.e., observation of thoughts and emotions from a distance), c) Present Moment Awareness (i.e., contact with presence and current internal experiences), d) Self as Context (i.e., awareness of internal experiences as external viewers), e) Values (i.e., freely chosen, personally meaningful life directions) and f) Committed Action (i.e., effective action according to important goals; Hayes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese six healthy components interact and operate together to enhance PF through Acceptance and Commitment Therapy (ACT; Hayes et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Research shows that elevated levels of PF are associated with a reduction in mental health problems emerging from trauma experiences (Tol et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). While PF has generally been identified as a protective factor against trauma and subsequent psychological outcomes (Kashdan \u0026amp; Rottenberg, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Malo et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), few studies have examined its mediating and moderating role to trauma and associated negative mental health outcomes (Boykin et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Hostutler et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Makriyianis et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Richardson \u0026amp; Jost, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). While some studies have explored the PF component as distinct mediators (Makriyianis et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), to date no research has examined the moderating role of the six PF components in changing the relationship between ACE and mental health outcomes.\u003c/p\u003e\u003cp\u003eResearch highlights the role of mindfulness and PF in linking early traumatic experiences and subsequent mental health issues (Dolbier et al, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Makriyianis et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; McKeen et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Richardson \u0026amp; Jost, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). While some aspects conceptually overlap (i.e., Acceptance and Acceptance without Judgement both emphasize openness to experience), others (i.e., Committed Action, Values) appear unique to ACT theory (Baer et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Hayes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Despite their relevance, limited studies have examined their contributions to trauma and psychological symptoms. Given the direct link of these two traits with therapeutic processes, disentangling the unique contributions of these components on trauma and psychological symptoms can have important implications for directing prevention and treatment targets for people with ACEs.\u003c/p\u003e\u003cp\u003eAccordingly, the present study aims to examine how the different aspects of mindfulness and PF interrelate with ACEs and psychological symptoms using a novel statistical approach of network analysis. This analysis enables us to visualize the complex and dynamic connections among these constructs, allowing for the identification of central and strong components that maybe linked to ACEs and subsequent psychopathology (Borsboom, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Borsboom et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Contreras et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Another aim of this study is to explore the moderating role that these components may have in the relationship between ACEs and psychological symptoms in young adulthood; essentially, whether these strengths can buffer the long-term impact of ACE. Thus, upon identifying core processes involved in trauma and psychological symptoms using network analysis, moderation models were conducted to confirm their role as protective factors.\u003c/p\u003e"},{"header":"Method","content":"\u003ch2\u003eSample and procedure\u003c/h2\u003e\n\u003cp\u003eThe sample consisted of Greek-speaking young adults (18-35 years) living in Cyprus, recruited using convenience sampling via social media advertisements and age-relevant online groups.\u0026nbsp;Data were collected online, using a Google Forms survey. Of\u0026nbsp;535 respondents, 19 were excluded for not meeting eligibility criteria, resulting in a final sample of 516 participants (M\u003csub\u003eage\u003c/sub\u003e= 26.96, SD\u003csub\u003eage\u003c/sub\u003e= 4.67): 133 men (25.8%) and 381 women (73.8%) and 2 identifying as other. Overall, 47.5% reported at least one ACE and 25.2% reported a current mental health diagnosis (see Table A, Supplementary Materials). Participation was anonymous and voluntary, with informed consent obtained electronically. Ethical approval was granted by the Cyprus National Bioethics Committee (EE\u0026Beta;\u0026Kappa;/\u0026Epsilon;\u0026Pi;/2023/77) and data were collected between February and April 2024. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEarly Trauma Inventory Self Report - Short Form\u003c/strong\u003e (ETI-SR-SF; Bremner et al., 2007; Greek version: Antonopoulou et al., 2017) consists of 27 items assessing four trauma categories: general, trauma due to physical abuse, trauma due to emotional abuse and trauma due to sexual abuse. Each item, is rated on (a) yes/no scale indicating whether the event occurred and (b) a frequency scale (No; Yes-once or twice; Yes-sometimes; Yes-often). For the present analyses, only the dichotomous rating were used, summing the number of endorsed events (range 0-27), which exhibited good reliability in this sample (\u0026alpha; = .83).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKentucky Inventory of Mindfulness Skills\u003c/strong\u003e (KIMS; Baer et al., 2004; Greek version: Psarraki et al., 2022) is a 38-item self-report measuring trait mindfulness. Participants rated items on a 5-point Likert scale (from 1-never or very rarely true to 5-very often or always true). The scale includes four facets of mindfulness (Observing, Describing, Acting with Awareness and Acceptance without judgement), each scored by summing relevant items (with reversals as instructed), with higher scores indicated greater mindfulness skill. The four subscales have shown good internal consistency in the present sample (\u0026alpha;= .80 -.88).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultidimensional Psychological Flexibility Inventory\u003c/strong\u003e (MPFI; Rolffs et al., 2018; Greek version: Christodoulou et al., 2023) is a 60-item self-report scale evaluating psychological flexibility/inflexibility (PF/PI) through the six PF and PI components, rated on 6-point Likert scale (from 1-Does not apply at all to 6-Always applies). For this study, only the first 30 items assessing PF through its six components (Acceptance, Defusion, Present Moment Awareness, Self-as-Context, Values, Committed Action) were used. Subscale scores were averaged, with higher scores indicating greater PF components. Internal consistency was good for all PF componetns in the present study (\u0026alpha;=.77-.94).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression Anxiety Stress Scale-21\u003c/strong\u003e (DASS-21; Lovibond \u0026amp; Lovibond, 1995; Greek version: Lyrakos \u0026amp; Arvaniti, 2009) includes 21 items assessing the psychological symptoms of depression, anxiety and stress. Participants rated each item on a 4-point Likert scale (from 0 = did not apply to me at all to 3 = applied to me very much) and subscale scores were computed by summing relevant items. Because the three subscales were highly correlated in this sample (\u0026rho; = .78 - .84), a total score (range 0-63) was used, which demonstrated excellent internal consistency (\u0026alpha; = .96).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographics.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eParticipants reported age, gender, family status, nationality and education level. They also indicated (Yes/No) whether they had experienced trauma before age, received lifetime mental health diagnosis, or were currently receiving treatment for a mental health condition.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStatistical Analyses\u003c/h2\u003e\n\u003cp\u003eAll analyses were conducted in RStudio (v. 2025.05.1; Posit team, 2024). Descriptive statistics and normality tests were carried out with the \u003cem\u003epsych\u003c/em\u003e package (Revelle, 2024). A regularized partial correlation network was estimated using graphical LASSO (EBICglasso) via \u003cem\u003ebootnet\u003c/em\u003e (Epskamp et al., 2018), with Spearman correlations due to non-normality, and visualized with qgraph (Epskamp et al., 2012). Node centrality and stability were examined through nonparametric bootstrapping (1,000 iteration) in \u003cem\u003ebootnet\u003c/em\u003e. Group differences in network structure, global strength, and edge weights based on early trauma, gender, and psychological symptoms were tested using the Network Comparison Text (NCT; van Borkulo, 2016). For exploratory and visualization purposes, participants were divided into low/high groups via median split for early trauma (\u003cem\u003eMdn\u003c/em\u003e = 8) and psychological symptoms (\u003cem\u003eMdn\u003c/em\u003e = 19), following prior research while acknowledging methodological limitations(Iacobucci et al., 2015; McClelland et al., 2015). Moderation effects were assessed with multiple linear regressions using the R\u0026rsquo;s \u003cem\u003elm\u003c/em\u003e function. \u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eData screening\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;Descriptive statistics and normality testing for all variables revealed significant normality violations based on the Kolmogorov-Smirnov test (D\u003cem\u003e\u003csub\u003erange\u003c/sub\u003e\u003c/em\u003e = 0.06 \u0026ndash; 0.89, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). Skewness values varied between \u0026minus;0.33 and 0.95, and kurtosis values ranged from \u0026minus;0.67 to 0.64, indicating only mild departures from normality. No extreme outlier cases were detected in the final sample.\u003c/p\u003e\n\u003ch2\u003eNetwork Estimation and Stability\u003c/h2\u003e\n\u003cp\u003eA regularized partial correlation network was computed, including 12 variables: \u003cem\u003eEarly Traumatic Experiences, Psychological Symptoms, the six components of Psychological Flexibility (PF; Acceptance, Present Moment Awareness, Self-as-Context, Defusion, Values, Committed Action), and the four facets of Mindfulness (Observing, Describing, Acting with Awareness, Acceptance without Judgement)\u003c/em\u003e. Stability analysis indicates adequate network robustness, with non-parametric bootstrapping revealing small to moderate confidence intervals around most edge weights (see Figure A, Supplementary Materials), supporting the reliability of the network structure for further interpretation.\u003c/p\u003e\n\u003cp\u003eThe estimated network consisted of 24 non-zero edges (36.4%) out of 66 possible connections, with a mean edge weight of 0.05 (Figure 1), indicating a sparse structure that facilitates clearer interpretation and reduces likelihood of overfitting (Epskamp et al., 2018).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePsychological symptoms connected positively strongly with early traumatic experiences (\u003cem\u003er\u003c/em\u003e= .38) and acceptance (PF dimension;\u003cem\u003e\u0026nbsp;r\u003c/em\u003e= .27). Also, they were strongly negatively linked to Acceptance without Judgement (mindfulness facet; \u003cem\u003er\u003c/em\u003e= -.32) and exhibited moderate negative connections with the other mindfulness facets (\u003cem\u003er\u003c/em\u003e= -.11; except Observing) and Committed Action (PF dimension; \u003cem\u003er\u003c/em\u003e=- .08). Additionally, only three of the mindfulness faces (except Acceptance without judgment) showed moderate association with four PF dimensions (except self-as-context and defusion), with correlation ranging from \u003cem\u003er\u003c/em\u003e = .09 to .17. Notably, early traumatic experiences had no connections to any PF dimensions and mindfulness facets in the estimated network.\u003c/p\u003e\n\u003ch2\u003eNetwork Centrality and Stability\u003c/h2\u003e\n\u003cp\u003eCase-drop bootstrapping was performed to assess the stability of centrality indices. The results confirm the robustness of the strength (\u003cem\u003eCS-coefficient\u003c/em\u003e = 0.672) and the expected influence (\u003cem\u003eCS-coefficient\u003c/em\u003e = 0.75), as both exceeded the recommended threshold of 0.50 (Epskamp et al., 2018). However, the CS-coefficients for closeness and betweenness did not reach acceptable levels and were therefore excluded from further reporting (Figure B, Supplementary Materials). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePsychological symptoms\u003c/em\u003e demonstrated the highest strength (\u003cem\u003ez\u003c/em\u003e = 1.52) and high negative expected influence (\u003cem\u003eEI\u003c/em\u003e = -1.02), highlighting its centrality and inhibitory influence in the network. Among the psychological flexibility dimensions, \u003cem\u003ecommitted action\u0026nbsp;\u003c/em\u003e(\u003cem\u003estrength\u003c/em\u003e = 1.14, \u003cem\u003eEI\u0026nbsp;\u003c/em\u003e= 1.03\u003cem\u003e)\u0026nbsp;\u003c/em\u003eand \u003cem\u003evalues\u003c/em\u003e (\u003cem\u003estrength\u003c/em\u003e = 0.96, \u003cem\u003eEI\u003c/em\u003e =\u003cem\u003e\u0026nbsp;\u003c/em\u003e1.25\u003cem\u003e)\u0026nbsp;\u003c/em\u003ewere identified as the next most central nodes, indicating their important activating roles. \u003cem\u003ePresent moment awareness\u003c/em\u003e (\u003cem\u003estrength\u003c/em\u003e = 0.39, \u003cem\u003eEI\u003c/em\u003e = 0.91) and \u003cem\u003eself-as-context\u003c/em\u003e (\u003cem\u003estrength\u003c/em\u003e = 0.11, \u003cem\u003eEI\u003c/em\u003e = 0.75) showed relatively low strength centrality but moderate expected influence, suggesting a potential activating role despite their lower centrality. In contrast, \u003cem\u003eacceptance\u003c/em\u003e (\u003cem\u003estrength\u003c/em\u003e = -0.24, \u003cem\u003eEI\u003c/em\u003e = 0.54) and \u003cem\u003edefusion\u003c/em\u003e (\u003cem\u003estrength\u003c/em\u003e = -0.06, \u003cem\u003eEI\u003c/em\u003e = 0.65) were the least central psychological flexibility components, indicating a more peripheral, yet still activating role in the network. Among the mindfulness facets, \u003cem\u003eacceptance without judgement\u003c/em\u003e was the third most central node in terms of strength (z = 0.51) but exhibited a highly negative influence (EI = -1.86), indicating a strong inhibitory function. The remaining mindfulness facets played a more peripheral role (\u003cem\u003estrength range\u003c/em\u003e = -0.39 - -1.63) and showed moderate inhibitory effects (\u003cem\u003eEI range\u003c/em\u003e = -0.15 - -1.05). Finally, \u003cem\u003eearly traumatic experiences\u003c/em\u003e demonstrated low centrality (\u003cem\u003estrength\u003c/em\u003e = -1.66, \u003cem\u003eEI\u003c/em\u003e = -0.30) revealing a weaker role within the overall network.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModeration models\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate the buffering role of PF and mindfulness facets on the link between ACE and psychological symptoms, moderation models were formulated informed by the \u0026nbsp;network analysis results presented above. \u0026nbsp;. Specifically, the network analysis showed that the facets that had unique correlations with psychological symptoms were Acceptance and Committed Action from the PF measure and Acceptance without Judgement, Describing and Acting with Awareness from the mindfulness measure. Thus, each of these five facets and its interaction with ACE (ETI-SR-SF total score) were entered as predictors (all mean-centered prior to analysis) in separate multiple linear regressions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs illustrated in Table 1, all five models were statistically significant, predicting between 35-46% of the variance in psychological symptoms. In all models, the number of ACE experiences (i.e. ETI-SR-SF total score) had a significant effect, with more ACE predicting more psychological symptoms in adulthood. As for the moderators, all five moderators had significant main effects on psychological symptoms, with Acceptance without Judgement, Acting with Awareness, Describing and Committed Action having a protective role, i.e. higher scores predicted less psychological symptoms, while Acceptance as PF facet had the opposite effect, i.e. higher scores predicted more psychological symptoms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs for moderation effects, the only facets that showed a significant interaction with the number of ACE were Acceptance without Judgement and Committed Action. Specifically, as illustrated in Figure 2A, \u0026nbsp;the effect of Acceptance without Judgement on psychological symptoms is more pronounced at higher levels of ACE, with high levels of Acceptance predicting fewer psychological symptoms than low levels of Acceptance. For Committed Action (Figure 2B), a similar pattern was observed only at high levels of ACE, whereas at low levels of ACE, Committed Action has no effect on Psychological Symptoms. \u0026nbsp;These findings suggest that Acceptance without Judgment and Committed Action are two skills that buffer individuals that have experienced traumatic events from developing psychological symptoms.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 612px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003e\u003cem\u003eMultiple regression models with ACE, different facets of PF and Mindfulness as moderators and their interaction in the prediction of psychological symptoms (total DASS score).\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eModerator in \u0026nbsp;each model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eACE\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(ETI-SR-SF score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eModerator main effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eACE x Moderator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eAdj. R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eF(df)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eModel 1 -\u003c/p\u003e\n \u003cp\u003eAcceptance w/o Judgement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18.62\u003c/p\u003e\n \u003cp\u003e(0.52)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.09\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.11)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.86\u003c/p\u003e\n \u003cp\u003e(0.07)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003cp\u003e(0.01)\u003csup\u003e\u0026nbsp;*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e149.7\u003c/p\u003e\n \u003cp\u003e(3,512)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eModel 2 -\u003c/p\u003e\n \u003cp\u003eActing with Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18.82 (0.55)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.37\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.12)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.75\u003c/p\u003e\n \u003cp\u003e(0.08)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003cp\u003e(0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e115.5\u003c/p\u003e\n \u003cp\u003e(3,512)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eModel 3 -\u003c/p\u003e\n \u003cp\u003eDescribing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18.87\u003c/p\u003e\n \u003cp\u003e(0.55)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.62\u003c/p\u003e\n \u003cp\u003e(0.12)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.50\u003c/p\u003e\n \u003cp\u003e(0.09)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003cp\u003e(0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e92.41\u003c/p\u003e\n \u003cp\u003e(3,512)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eModel 4 -\u003c/p\u003e\n \u003cp\u003eAcceptance (PF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18.90 (0.55)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.49\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.12)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003cp\u003e(0.52)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003cp\u003e(0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e103.1 (3,512)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eModel 5 -\u003c/p\u003e\n \u003cp\u003eCommitted Action (PF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18.82\u003c/p\u003e\n \u003cp\u003e(0.54)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003cp\u003e(0.12)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-2.75\u003c/p\u003e\n \u003cp\u003e(0.42)\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003cp\u003e(0.08)\u003csup\u003e\u0026nbsp;**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e96.22\u003c/p\u003e\n \u003cp\u003e(3,512)\u003csup\u003e\u0026nbsp;***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote:\u0026nbsp;\u003c/em\u003ePF= Psychological Flexibility. For each predictor, estimates and standard errors (in brackets) are provided. *p\u0026lt; .05, **p\u0026lt;.01, ***p\u0026lt;.001\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrior literature has shown the negative impact of ACE on psychological symptoms in adulthood, as well as the protective role of psychological flexibility and dispositional mindfulness (Dolbier et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Given the conceptual overlap of these traits, the present study aimed to investigate the complex interconnection among them, as well as psychological symptoms and traumatic experiences using cross-sectional data from a healthy young sample. The study first utilized a network analysis approach to delineate the relationship and role of different facets of PF and mindfulness and then tested the most central and influential facets as moderators of the link between ACE and psychological symptoms.\u003c/p\u003e\u003cp\u003eNetwork analysis findings highlighted that ACEs had the strongest positive connection with psychological symptoms, consistent with extensive research supporting the long-term effect of childhood adversity on adult psychopathology and the dose-dependent nature of this effect (e.g. Berber Celik \u0026amp; Odaci, 2020; Edwards et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Kessler et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e1997\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Surprisingly, none of the psychological flexibility or mindfulness components were directly connected to ACE. This suggests that early trauma may operate as a distal risk factor for psychological symptoms, without being immediately influenced by other psychological mechanisms. Instead, mindfulness and PF processes might emerge later as protective factors that shape the impact of trauma on psychopathology development (Gloster et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; McKeen et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Richardson \u0026amp; Jost, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA notable finding was the connection of Acceptance without Judgement (Mindfulness facet) with psychological symptoms, as well as its high centrality and inhibitory influence in the network. This suggests that cultivating a non-judgmental stance towards stressful or distressing experiences may play an important role in reducing psychological symptoms. This aligns with previous research showing that non-judgmental acceptance is linked to reduced psychopathology (Boughner et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Dolbier et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; McKeen et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The moderation analyses further confirm that acceptance without judgment may buffer the negative consequences of trauma, by reducing rumination and maladaptive responses to emotional experiences (Li et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Clinically, early interventions that focus on cultivating acceptance of internal experiences without judgement may be particularly beneficial for individuals with ACEs history, as this approach has shown to reduce the risk of psychopathology development (Dolbier et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; McKeen et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ortiz \u0026amp; Sibinga, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Wahbeh et al, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAn unexpected finding emerged regarding the effect of Acceptance (PF dimension) on psychological symptoms. Acceptance, a construct similar to Acceptance without Judgment (both of which assess openness to experience) was expected to correlate negatively with psychological symptoms. However, higher levels of Acceptance were unexpectedly associated with greater psychopathology. This difference may reflect conceptual differences between the two concepts and what they assess. On one hand, Acceptance reflects an individual\u0026rsquo;s willingness to actively engage with and fully experience distressing internal experiences (Hayes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), which might have short-term negative effects, like heightened distress and psychological symptoms (Dunn et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). However, in the long-term, this mechanism may become adaptive as the individual develops greater psychological flexibility in managing their experiences (Gloster et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Kashdan \u0026amp; Rottenberg, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). On the other hand, Acceptance without Judgement represents a more detached stance toward internal experiences, in which the individual observes them without actively engaging (Baer et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), which in short-term this may reduce distress and symptoms (Boughner et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Garland et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Further research could clarify these conceptual differences and examine their associations with symptom reduction, thereby enabling clinicians to tailor interventions to clients\u0026rsquo; needs. For example, clients experiencing elevated emotional distress may initially benefit from mindfulness techniques that emphasize non-judgmental observation of thoughts and feelings, which can help reduce immediate distress (Creswell \u0026amp; Lindsay, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Khoury et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). As therapy progresses, it may be therapeutically appropriate to introduce holistic practices that cultivate an open, aware and engaged stance towards internal experiences, thereby enhancing psychological flexibility and long-term adaptive coping skills (Beygi et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Gloster et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBesides Acceptance without judgement, Awareness and Describing (Mindfulness facets) also emerged as central processes in the network exhibiting negative connections with psychological symptoms. However, they did not moderate the relationship between ACEs and psychological symptoms. This suggests that, although these facets are linked with lower psychopathology (Boden \u0026amp; Thompson, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Keng et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Weissman et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), they do not buffer the impact of early trauma. They are, though important processes clinically, since being aware of the present moment enables individuals to notice thoughts and emotions as they arise, while the ability to identify and name these experiences fosters familiarity with stressful stimuli. These processes, in turn, reduce emotional reactivity and enhance adaptive emotion regulation, which collectively contribute to lower psychopathology levels (Holzel et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Maddock \u0026amp; Blair, 2021; van der Velden et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn the other hand, the Observing facet of Mindfulness did not have a similar impact as the other facets confirming previous findings in the literature that illustrate a complicated link between Observing and psychological symptoms (Medvedev et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Siegling \u0026amp; Petrides, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Specifically, a high ability to observe internal and external sensations can have beneficial or detrimental effects depending on the presence of other facets of mindfulness (Baer et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) or other traits like anxiety sensitivity (Moscow Diamond et al., 2025). If observing is combined with non-reactivity, then it enables adaptive emotion regulatory processes. However, when observing is combined with reactivity, it can lead to maladaptive responses like worry and rumination (Desrosiers et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This complexity may, thus, explain why Observing on its own did not emerge as a facet with a strong connection to psychological symptoms in our study.\u003c/p\u003e\u003cp\u003eAs for the PF components, besides Acceptance, Committed Action was another important PF dimension showing a buffering effect and close links to reduced psychological symptoms. This is a novel finding, since prior studies have shown PF to moderate the impact of ACE on mental health outcomes (Boykin et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Hostutler et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) but did not look at its components separately. Our findings add to this literature by showing that Committed Action can have such a moderating role. This supports previous research emphasizing the importance of actions being guided by personal values rather than by short-term relief-oriented goals. It shows that even in the face of adversity, people can continue to align their behaviors with their values and engage in meaningful actions (McCracken, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Stockton et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It should be noted that committed action is a therapeutic process of change common to various treatment protocols, not just ACT (Forman et al., 2012), making it a critical intervention target. Incorporating exercises such as values clarification, goal-setting, and behavioral activation can directly enhance committed action skills, thereby personalizing interventions and maximizing their protective effects against the development of psychopathology (Levin et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs for the remaining PF components (i.e. Present Moment Awareness, Self-as-Context, Values and Cognitive Defusion), these did not have a direct connection with psychological symptoms. This finding contrasts with earlier evidence by Makriyianis et al. (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), who reported that certain PF components, particularly Self-as-Context and Cognitive Defusion, were related to lower psychological symptoms. In contrast, the present network analysis illustrates that, when considered within their broader interrelations with other PF components, these specific components do not exhibit distinct or direct associations with psychological symptoms. Instead, these findings point out the complex and interconnected nature of PF, suggesting that its influence on symptomatology may emerge from the interaction among its components rather than their distinct contributions.\u003c/p\u003e\u003cp\u003eSpecifically, these four PF dimensions seem to primarily operate at a cognitive and metacognitive level, influencing how individuals relate to internal experiences, rather than directly producing behavioral change (Assaz et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Fortier et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Godbee \u0026amp; Kangas, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Goldberg et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This may account for their strong interconnectivity with the other PF dimensions, despite their low centrality in the overall network. While ACT theory posits that all six PF dimensions are interconnected (Hayes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), the current findings suggest that not all of them play an equal role in reducing symptomatology. Clinically, this implies that cognitive or observational strategies might serve as a foundation upon which more action-oriented practices can build, thus maximizing therapeutic change.\u003c/p\u003e\u003cp\u003eTo sum up, the present study used a novel analytical approach, network analysis, to disentangle the processes involved in PF and mindfulness in relation to psychological symptoms and ACE, as well as to examine their role as moderators. Nevertheless, several limitations need to be noted. First, the cross-sectional design does not allow causal inferences among study variables. Longitudinal research is required to examine the causal effect of ACEs, PF components and mindfulness facets on the development of psychopathology. Such designs would also allow for the examination of whether PF components and mindfulness facets precede trauma exposure or develop because of it (Makriyannis et al., 2019; Richardson \u0026amp; Jost, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Second, the retrospective assessment of ACEs before adulthood may be subject to recall biases and does not capture the current impact of trauma, since it assesses only the occurrence of trauma events rather than the individuals\u0026rsquo; reactions to them (Hardt \u0026amp; Rutter, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Third, the use of convenience sampling may not be representative of the population. Given the small number of men and the large number of people in our sample that reported familiarity with mindfulness (about 45%), it is possible that there was a self-selection bias, with participants interested in mindfulness being more likely to choose to complete our survey.\u003c/p\u003e\u003cp\u003eFurthermore, in the current analyses, we examined ACE as a total score rather than looking at different types of traumatic events separately (e.g., physical or sexual abuse), given that the literature suggests that various forms of trauma tend to coexist (Edwards et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Felitti et al., 1995). However, different types of trauma have been shown to exhibit distinct associations to psychological symptoms in adulthood (Whitaker et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Thus, future studies with larger samples could explore the differential impact of specific traumatic experiences. Similarly, psychological symptoms were analyzed as a total score without separating anxiety, depression and stress subscales, which was justified by the high correlations among the subscales in our sample. However, anxiety and depression may be differentially related to PF and mindfulness facets (Desrosiers et al., 2013). Future research using different assessment tools that capture anxiety and depression more distinctly could clarify these differential effects. Finally, this study focused primarily on components of Psychological Flexibility in relation to Mindfulness facets, rather than examining the Psychological Inflexibility dimensions as well, which have been shown to differentially relate to ACEs and psychological symptoms (Makriyianis et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNevertheless, the current study adds to the existing literature by examining the combined effects of multiple psychological processes central to PF and mindfulness on psychological symptoms. The findings suggest that ACEs history is not directly linked to PF and mindfulness components. However, some of them, particularly acceptance without judgement and committed action, appear to function as moderators, buffering the negative impact of ACEs on psychological symptoms in adulthood. These results carry important theoretical implications, providing preliminary empirical support for the mechanism through which PF and mindfulness may mitigate psychological symptoms among individuals with ACEs history. Clinically, the findings reinforce the utility of acceptance-based interventions such as Acceptance and Commitment Therapy (Hayes et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) and Mindfulness-Based Stress Reduction (Kabat-Zinn, 1990) and contribute to a clearer understanding of their underlying mechanisms. These findings highlight the importance of interventions or prevention programs aimed at individuals with ACEs history that enhance acceptance and non-judgmental interaction with internal experiences (Tomlinson et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and promote values-guided behaviors (Engle \u0026amp; Follette, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCRediT author statement: AC: Conceptualization, Methodology, Formal Analysis, Writing-Original draft preparation, Writing- Reviewing and Editing, Supervision EC: Conceptualization, Methodology, Formal Analysis, Writing-Original draft preparation, Writing- Reviewing and Editing, Supervision AA: Conceptualization, Methodology, Investigation, Data Curation EK: Conceptualization, Methodology, Investigation, Data Curation\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data is not publicly available due to ethical committee restrictions, but is available upon reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthors note.\u003c/strong\u003e The study was approved by the Cyprus National Bioethics Committee (EE\u0026Beta;\u0026Kappa;/\u0026Epsilon;\u0026Pi;/2023/77). All participants provided informed consent. The authors have no competing interests. The data are available upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAafjes-van Doorn, K., Kamsteeg, C., \u0026amp; Silberschatz, G. (2020). Cognitive mediators of the relationship between adverse childhood experiences and adult psychopathology: A systematic review\u003cem\u003e. Development and Psychopathology, 32\u003c/em\u003e(3), 1017-1029. https://doi.org/10.1017/S0954579419001317\u003c/li\u003e\n\u003cli\u003eAntonopoulou, Z., Konstantakopoulos, G., Tzinieri-Coccosis. M., \u0026amp; Sinodimou, C. (2017) Rates of childhood trauma in a sample of university students in Greece: The Greek version of the Early Trauma Inventory-Self Report. \u003cem\u003ePsychiatriki, 28\u003c/em\u003e(1), pp. 19\u0026ndash;27. https://doi.org/10.22365/jpsych.2017.281.19\u003c/li\u003e\n\u003cli\u003eAssaz, D. A., Tyndall, I., Oshiro, C. K., \u0026amp; Roche, B. (2023). A process-based analysis of cognitive defusion in acceptance and commitment therapy. \u003cem\u003eBehavior Therapy\u003c/em\u003e, \u003cem\u003e54\u003c/em\u003e(6), 1020-1035. https://doi.org/10.1016/j.beth.2022.06.003\u003c/li\u003e\n\u003cli\u003eBaer, R. A., Smith, G. T., \u0026amp; Allen, K. B. (2004). Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills. \u003cem\u003eAssessment\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(3), 191-206. https://doi.org/10.1177/1073191104268029\u003c/li\u003e\n\u003cli\u003eBaer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., \u0026amp; Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. \u003cem\u003eAssessment, 13\u003c/em\u003e(1), 27-45. https://psycnet.apa.org/doi/10.1037/t05514-000\u003c/li\u003e\n\u003cli\u003eBerber \u0026Ccedil;elik, \u0026Ccedil;., \u0026amp; Odacı, H. (2020). Does child abuse have an impact on self-esteem, depression, anxiety and stress conditions of individuals?. \u003cem\u003eInternational Journal of Social Psychiatry, 66\u003c/em\u003e(2), 171-178. https://doi.org/10.1177/0020764019894618\u003c/li\u003e\n\u003cli\u003eBeygi, Z., Jangali, R. T., Derakhshan, N., Alidadi, M., Javanbakhsh, F., \u0026amp; Mahboobizadeh, M. (2023). An overview of reviews on the effects of acceptance and commitment therapy (ACT) on depression and anxiety. \u003cem\u003eIranian Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(2), 248-257. https://doi.org/10.18502/ijps.v18i2.12373\u003c/li\u003e\n\u003cli\u003eBoden, M. T., \u0026amp; Thompson, R. J. (2015). Facets of emotional awareness and associations with emotion regulation and depression. \u003cem\u003eEmotion, 15\u003c/em\u003e(3), 399-410. https://doi.org/10.1037/emo0000057\u003c/li\u003e\n\u003cli\u003eBolduc, R., Bigras, N., Daspe, M.-\u0026Egrave;., H\u0026eacute;bert, M., \u0026amp; Godbout, N. (2018). Childhood cumulative trauma and depressive symptoms in adulthood: The role of mindfulness and dissociation. \u003cem\u003eMindfulness, 9\u003c/em\u003e(5), 1594\u0026ndash;1603. https://doi.org/10.1007/s12671-018-0906-3\u003c/li\u003e\n\u003cli\u003eBorsboom, D. (2017). A network theory of mental disorders. \u003cem\u003eWorld psychiatry\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), 5-13. https://doi.org/10.1002/wps.20375\u003c/li\u003e\n\u003cli\u003eBorsboom, D., Deserno, M. K., Rhemtulla, M., Epskamp, S., Fried, E. I., McNally, R. J., ... \u0026amp; Waldorp, L. J. (2021). Network analysis of multivariate data in psychological science. \u003cem\u003eNature Reviews Methods Primers\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(1), 58. https://doi.org/10.1038/s43586-021-00055-w\u003c/li\u003e\n\u003cli\u003eBoughner, E., Thornley, E., Kharlas, D., \u0026amp; Frewen, P. (2016). Mindfulness-related traits partially mediate the association between lifetime and childhood trauma exposure and PTSD and dissociative symptoms in a community sample assessed online. \u003cem\u003eMindfulness\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(3), 672-679. https://doi.org/10.1007/s12671-016-0502-3\u003c/li\u003e\n\u003cli\u003eBoykin, D. M., Anyanwu, J., Calvin, K., \u0026amp; Orcutt, H. K. (2020). The moderating effect of psychological flexibility on event centrality in determining trauma outcomes. \u003cem\u003ePsychological Trauma: Theory, Research, Practice, and Policy, 12\u003c/em\u003e(2), 193-199. https://psycnet.apa.org/doi/10.1037/tra0000490\u003c/li\u003e\n\u003cli\u003eBremner, J. D., Bolus, R., \u0026amp; Mayer, E. A. (2007). Psychometric properties of the early trauma inventory\u0026ndash;self report. \u003cem\u003eThe Journal of Nervous and Mental Disease\u003c/em\u003e, \u003cem\u003e195\u003c/em\u003e(3), 211-218. https://doi.org/10.1097/01.nmd.0000243824.84651.6c\u003c/li\u003e\n\u003cli\u003eBrown, K. W., \u0026amp; Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. \u003cem\u003eJournal of personality and social psychology\u003c/em\u003e, 84(4), 822-848. https://doi.org/10.1037/0022-3514.84.4.822\u003c/li\u003e\n\u003cli\u003eChristodoulou, A., Karekla, M., Costantini, G., \u0026amp; Michaelides, M. P. (2023). A network analysis approach on the psychological flexibility/inflexibility model. \u003cem\u003eBehavior Therapy\u003c/em\u003e, \u003cem\u003e54\u003c/em\u003e(5), 719-733. https://doi.org/10.1016/j.beth.2023.01.002\u003c/li\u003e\n\u003cli\u003eContreras, A., Nieto, I., Valiente, C., Espinosa, R., \u0026amp; Vazquez, C. (2019). The study of psychopathology from the network analysis perspective: A systematic review. \u003cem\u003ePsychotherapy and Psychosomatics, 88\u003c/em\u003e(2), 71\u0026ndash;83. https://doi.org/10.1159/000497425\u003c/li\u003e\n\u003cli\u003eCreswell, J. D., \u0026amp; Lindsay, E. K. (2014). How does mindfulness training affect health? A mindfulness stress buffering account. \u003cem\u003eCurrent Directions in Psychological Science\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(6), 401-407. https://doi.org/10.1177/0963721414547415\u003c/li\u003e\n\u003cli\u003eCrouch, E., Radcliff, E., Strompolis, M., \u0026amp; Srivastav, A. (2019). Safe, stable, and nurtured: Protective factors against poor physical and mental health outcomes following exposure to adverse childhood experiences (ACEs). Journal of child \u0026amp; adolescent trauma, 12(2), 165-173. \u003cu\u003ehttps://doi.org/10.1007/s40653-018-0217-9\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eDesrosiers, A., Vine, V., Curtiss, J., \u0026amp; Klemanski, D. H. (2014). Observing nonreactively: A conditional process model linking mindfulness facets, cognitive emotion regulation strategies, and depression and anxiety symptoms. \u003cem\u003eJournal of Affective Disorders\u003c/em\u003e, \u003cem\u003e165\u003c/em\u003e, 31-37. https://doi.org/10.1016/j.jad.2014.04.024\u003c/li\u003e\n\u003cli\u003eDolbier, C. L., Haley, E. N., Conder, L., \u0026amp; Guiler, W. (2021). Adverse childhood experiences and adult psychopathological symptoms: The moderating role of dispositional mindfulness. \u003cem\u003eJournal of Contextual Behavioral Science\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e, 73-79. https://doi.org/10.1016/j.jcbs.2021.06.001\u003c/li\u003e\n\u003cli\u003eDunn, B. D., Billotti, D., Murphy, V., \u0026amp; Dalgleish, T. (2009). The consequences of effortful emotion regulation when processing distressing material: A comparison of suppression and acceptance. \u003cem\u003eBehaviour Research and Therapy\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(9), 761-773. https://doi.org/10.1016/j.brat.2009.05.007\u003c/li\u003e\n\u003cli\u003eEdwards, V. J., Holden, G. W., Felitti, V. J., \u0026amp; Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. \u003cem\u003eAmerican Journal of Psychiatry, 160\u003c/em\u003e(8), 1453-1460. https://doi.org/10.1176/appi.ajp.160.8.1453\u003c/li\u003e\n\u003cli\u003eEngle, J., \u0026amp; Follette, V. M. (2015). Mindfulness and valued action: An acceptance and commitment therapy approach to working with trauma survivors. In V. M. Follette, J. Briere, D. Rozelle, J. W. Hopper, \u0026amp; D. I. Rome (Eds.), \u003cem\u003eMindfulness-oriented interventions for trauma: Integrating contemplative practices\u003c/em\u003e (pp. 103\u0026ndash;120). The Guilford Press.\u003c/li\u003e\n\u003cli\u003eEpskamp, S., Borsboom, D., \u0026amp; Fried, E. I. (2018). Estimating\u003cu\u003e \u003c/u\u003epsychological networks and their accuracy: A tutorial\u003cu\u003e \u003c/u\u003epaper. \u003cem\u003eBehavior Research Methods, 50\u003c/em\u003e(1), 195\u0026ndash;212. https://doi.org/10.3758/s13428-017-0862-1\u003c/li\u003e\n\u003cli\u003eEpskamp, S., Cramer, A. O. J., Waldorp, L. J., Schmittmann, V. D., \u0026amp; Borsboom, D. (2012). qgraph: Network visualizations\u003cu\u003e \u003c/u\u003eof relationships in psychometric data. \u003cem\u003eJournal of Statistical Software, 48\u003c/em\u003e(4), 1\u0026ndash;18. https://doi.org/10.18637/jss.v048.i04\u003c/li\u003e\n\u003cli\u003eFelitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., \u0026amp; Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults\u003cem\u003e. American Journal of Preventive Medicine, 14\u003c/em\u003e(4), 245\u0026ndash;258. https://doi.org/10.1016/s0749-3797(98)00017-8\u003c/li\u003e\n\u003cli\u003eFortier, S. M., Strand, E., Zottarelli, L. K., Stevens, M., \u0026amp; Springer, C. M. (2024). Values work with adolescents: A qualitative component analysis using an integrative model of values and behavior. \u003cem\u003eCognitive and Behavioral Practice\u003c/em\u003e. https://doi.org/10.1016/j.cbpra.2024.08.001\u003c/li\u003e\n\u003cli\u003eGarland, E. L., Geschwind, N., Peeters, F., \u0026amp; Wichers, M. (2015). Mindfulness training promotes upward spirals of positive affect and cognition: multilevel and autoregressive latent trajectory modeling analyses. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e, 15. https://doi.org/10.3389/fpsyg.2015.00015\u003c/li\u003e\n\u003cli\u003eGloster, A. T., Meyer, A. H., \u0026amp; Lieb, R. (2017). Psychological flexibility as a malleable public health target: Evidence from a representative sample. \u003cem\u003eJournal of Contextual Behavioral Science, 6\u003c/em\u003e(2), 166-171. https://doi.org/10.1016/j.jcbs.2017.02.003\u003c/li\u003e\n\u003cli\u003eGloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., \u0026amp; Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. \u003cem\u003eJournal of Contextual Behavioral Science\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e, 181-192. https://doi.org/10.1016/j.jcbs.2020.09.009\u003c/li\u003e\n\u003cli\u003eGodbee, M., \u0026amp; Kangas, M. (2020). The relationship between flexible perspective taking and emotional well-being: A systematic review of the \u0026ldquo;self-as-context\u0026rdquo; component of acceptance and commitment therapy. \u003cem\u003eBehavior Therapy\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(6), 917-932. https://doi.org/10.1016/j.beth.2019.12.010\u003c/li\u003e\n\u003cli\u003eGoldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., \u0026amp; Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. \u003cem\u003eClinical Psychology Review\u003c/em\u003e, \u003cem\u003e59\u003c/em\u003e, 52-60. https://doi.org/10.1016/j.cpr.2017.10.011\u003c/li\u003e\n\u003cli\u003eHardt, J., \u0026amp; Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. \u003cem\u003eJournal of Child Psychology and Psychiatry\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(2), 260-273. https://doi.org/10.1111/j.1469-7610.2004.00218.x\u003c/li\u003e\n\u003cli\u003eHarper, L., Jones, A., Goodwin, L., \u0026amp; Gillespie, S. (2022). Association between trait mindfulness and symptoms of post-traumatic stress: A meta-analysis. \u003cem\u003eJournal of Psychiatric Research\u003c/em\u003e, \u003cem\u003e152\u003c/em\u003e, 233-241. https://doi.org/10.1016/j.jpsychires.2022.05.027\u003c/li\u003e\n\u003cli\u003eHayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., \u0026amp; Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. \u003cem\u003eBehavior Therapy, 44\u003c/em\u003e(2), 180-198. https://doi.org/10.1016/j.beth.2009.08.002\u003c/li\u003e\n\u003cli\u003eHayes, S. C., Pistorello, J., \u0026amp; Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. \u003cem\u003eThe Counseling Psychologist\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(7), 976-1002. https://doi.org/10.1177/0011000012460836\u003c/li\u003e\n\u003cli\u003eHayes, S.C., Strosahl, K.D., Bunting, K., Twohig, M., Wilson, K.G. (2004). What Is Acceptance and Commitment Therapy?. In: Hayes, S.C., Strosahl, K.D. (eds) \u003cem\u003eA Practical Guide to Acceptance and Commitment Therapy\u003c/em\u003e (pp. 3-29). Springer, Boston, MA. https://doi.org/10.1007/978-0-387-23369-7_1\u003c/li\u003e\n\u003cli\u003eHolzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., \u0026amp; Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. \u003cem\u003ePerspectives on Psychological Science\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(6), 537-559. https://doi.org/10.1177/1745691611419671\u003c/li\u003e\n\u003cli\u003eHostutler, C. A., Snider, T., Wolf, N., \u0026amp; Grant, R. (2023). ACEs screening in adolescent primary care: Psychological flexibility as a moderator. \u003cem\u003eFamilies, Systems, \u0026amp; Health, 41\u003c/em\u003e(2), 182\u0026ndash;191. https://doi.org/10.1037/fsh0000717\u003c/li\u003e\n\u003cli\u003eIacobucci, D., Posavac, S. S., Kardes, F. R., Schneider, M. J., \u0026amp; Popovich, D. L. (2015). The median split: Robust, refined, and revived. \u003cem\u003eJournal of Consumer Psychology\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(4), 690-704. https://doi.org/10.1016/j.jcps.2015.06.014\u003c/li\u003e\n\u003cli\u003eKabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. \u003cem\u003eClinical Psychology: Science and Practice, 10\u003c/em\u003e(2), 144\u0026ndash;156. https://doi.org/10.1093/clipsy.bpg016 \u003c/li\u003e\n\u003cli\u003eKashdan, T. B., \u0026amp; Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. \u003cem\u003eClinical Psychology Review, 30\u003c/em\u003e(7), 865-878. https://doi.org/10.1016/j.cpr.2010.03.001\u003c/li\u003e\n\u003cli\u003eKeng, S. L., Smoski, M. J., \u0026amp; Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. \u003cem\u003eClinical Psychology Review\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(6), 1041-1056. https://doi.org/10.1016/j.cpr.2011.04.006\u003c/li\u003e\n\u003cli\u003eKessler, R. C., Davis, C. G., \u0026amp; Kendler, K. S. (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. \u003cem\u003ePsychological Medicine, 27\u003c/em\u003e(5), 1101-1119. https://doi.org/10.1017/s0033291797005588\u003c/li\u003e\n\u003cli\u003eKessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., ... \u0026amp; Williams, D. R. (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. \u003cem\u003eThe British Journal of Psychiatry, 197\u003c/em\u003e(5), 378-385. https://doi.org/10.1192/bjp.bp.110.080499\u003c/li\u003e\n\u003cli\u003eKhoury, B., Sharma, M., Rush, S. E., \u0026amp; Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. \u003cem\u003eJournal of Psychosomatic Research\u003c/em\u003e, \u003cem\u003e78\u003c/em\u003e(6), 519-528. https://doi.org/10.1016/j.jpsychores.2015.03.009\u003c/li\u003e\n\u003cli\u003eLevin, M. E., Krafft, J., Hicks, E. T., Pierce, B., \u0026amp; Twohig, M. P. (2020). A randomized dismantling trial of the open and engaged components of acceptance and commitment therapy in an online intervention for distressed college students. \u003cem\u003eBehaviour Research and Therapy\u003c/em\u003e, \u003cem\u003e126\u003c/em\u003e, 103557. https://doi.org/10.1016/j.brat.2020.103557\u003c/li\u003e\n\u003cli\u003eLi, P., Mao, L., Hu, M., Lu, Z., Yuan, X., Zhang, Y., \u0026amp; Hu, Z. (2022). Mindfulness on rumination in patients with depressive disorder: A systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(23), 16101. https://doi.org/10.3390/ijerph192316101\u003c/li\u003e\n\u003cli\u003eLovibond, P. F., \u0026amp; Lovibond, S. H. (1995). \u003cem\u003eDepression Anxiety and Stress Scales (DASS-42)\u003c/em\u003e [Database record]. APA PsycTests. https://doi.org/10.1037/t39835-000\u003c/li\u003e\n\u003cli\u003eLyrakos, G. N., Arvaniti, C., Smyrnioti, M., \u0026amp; Kostopanagiotou, G. (2011). Translation and validation study of the depression anxiety stress scale in the Greek general population and in a psychiatric patient\u0026apos;s sample. \u003cem\u003eEuropean Psychiatry\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(S2), 1731.\u003cu\u003e \u003c/u\u003ehttps://doi.org/10.1016/S0924-9338(11)73435-6\u003c/li\u003e\n\u003cli\u003eMaddock, A., \u0026amp; Blair, C. (2023). How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review. \u003cem\u003eCurrent Psychology\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(12), 10200-10222. https://doi.org/10.1007/s12144-021-02082-y\u003c/li\u003e\n\u003cli\u003eMadigan, S., Deneault, A. A., Racine, N., Park, J., Thiemann, R., Zhu, J., ... \u0026amp; Neville, R. D. (2023). Adverse childhood experiences: a meta‐analysis of prevalence and moderators among half a million adults in 206 studies. \u003cem\u003eWorld Psychiatry\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(3), 463-471. https://doi.org/10.1002/wps.21122\u003c/li\u003e\n\u003cli\u003eMakriyianis, H. M., Adams, E. A., Lozano, L. L., Mooney, T. A., Morton, C., \u0026amp; Liss, M. (2019). Psychological inflexibility mediates the relationship between adverse childhood experiences and mental health outcomes. \u003cem\u003eJournal of Contextual Behavioral Science, 14\u003c/em\u003e, 82-89. https://doi.org/10.1016/j.jcbs.2019.09.007\u003c/li\u003e\n\u003cli\u003eMalo, R., Acier, D., \u0026amp; Bulteau, S. (2024). Psychological flexibility: toward a better Understanding of a key concept. \u003cem\u003eTrends in Psychology, 32\u003c/em\u003e(3), 734-759. https://doi.org/10.1007/s43076-022-00188-1\u003c/li\u003e\n\u003cli\u003eMartins, C. M. S., Baes, C. V. W., \u0026amp; Juruena, M. (2011). Analysis of the occurrence of early life stress in adult psychiatric patients: a systematic review. \u003cem\u003ePsychology \u0026amp; Neuroscience\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e, 219-227. https://doi.org/10.3922/j.psns.2011.2.007\u003c/li\u003e\n\u003cli\u003eMcClelland, G. H., Lynch Jr, J. G., Irwin, J. R., Spiller, S. A., \u0026amp; Fitzsimons, G. J. (2015). Median splits, Type II errors, and false\u0026ndash;positive consumer psychology: Don\u0026apos;t fight the power. \u003cem\u003eJournal of Consumer Psychology\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(4), 679-689. https://doi.org/10.1016/j.jcps.2015.05.006\u003c/li\u003e\n\u003cli\u003eMcCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. \u003cem\u003eThe Journal of Pain\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(8), 828-835. https://doi.org/10.1016/j.jpain.2013.02.009\u003c/li\u003e\n\u003cli\u003eMcKeen, H., Hook, M., Podduturi, P., Beitzell, E., Jones, A., \u0026amp; Liss, M. (2023). Mindfulness as a mediator and moderator in the relationship between adverse childhood experiences and depression. \u003cem\u003eCurrent Psychology\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(8), 6576-6586. https://doi.org/10.1007/s12144-021-02003-z\u003c/li\u003e\n\u003cli\u003eMedvedev, O. N., Norden, P. A., Kr\u0026auml;geloh, C. U., \u0026amp; Siegert, R. J. (2018). Investigating unique contributions of dispositional mindfulness facets to depression, anxiety, and stress in general and student populations. \u003cem\u003eMindfulness, 9\u003c/em\u003e(6), 1757-1767. https://doi.org/10.1007/s12671-018-0917-0\u003c/li\u003e\n\u003cli\u003eMoskow Diamond, D., Curtiss, J., Carpenter, J. K., Ito, M., \u0026amp; Hofmann, S. G. (2025). Influence of anxiety sensitivity on the observe facet of the five facet mindfulness questionnaire: differential item functioning in a clinical population. \u003cem\u003eBMC Psychiatry\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(1), 312. https://doi.org/10.1186/s12888-025-06488-x \u003c/li\u003e\n\u003cli\u003eMoyes, E., Nutman, G., \u0026amp; Mirman, J. H. (2022). The efficacy of targeted mindfulness-based interventions for improving mental health and cognition among youth and adults with ACE histories: a systematic mixed studies review. \u003cem\u003eJournal of Child \u0026amp; Adolescent Trauma\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(4), 1165-1177. https://doi.org/10.1007/s40653-022-00454-5\u003c/li\u003e\n\u003cli\u003ePosit team (2025). \u003cem\u003eRStudio: Integrated Development Environment for R\u003c/em\u003e. Posit Software, PBC, Boston, MA. URL http://www.posit.co\u003c/li\u003e\n\u003cli\u003ePsarraki, E. E., Bacopoulou, F., Vlachakis, D., Chrousos, G. P., Michou, M., Pelekasis, P., ... \u0026amp; Darviri, C. (2022). The Kentucky Inventory of Mindfulness Skills in Greek Undergraduate and Postgraduate Students. In Vlamos, P. (Ed.), \u003cem\u003eGeNeDis 2020: Advances in Experimental Medicine and Biology\u003c/em\u003e (vol 1339). Springer, Cham. https://doi.org/10.1007/978-3-030-78787-5_28\u003c/li\u003e\n\u003cli\u003eOrtiz, R., \u0026amp; Sibinga, E. M. (2017). The role of mindfulness in reducing the adverse effects of childhood stress and trauma. \u003cem\u003eChildren\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(3), 16. https://doi.org/10.3390/children4030016\u003c/li\u003e\n\u003cli\u003eQuaglia, J. T., Braun, S. E., Freeman, S. P., McDaniel, M. A., \u0026amp; Brown, K. W. (2016). Meta-analytic evidence for effects of mindfulness training on dimensions of self-reported dispositional mindfulness. \u003cem\u003ePsychological assessment, 28\u003c/em\u003e(7), 803-818. https://doi.org/10.1037/pas0000268\u003c/li\u003e\n\u003cli\u003eRevelle, W. (2024). psych: \u003cem\u003eProcedures for Psychological, Psychometric, and Personality Research\u003c/em\u003e (Version 2.4.1) [R package]. Northwestern University. URL: https://CRAN.R-project.org/package=psych\u003c/li\u003e\n\u003cli\u003eRichardson, C. M., \u0026amp; Jost, S. A. (2019). Psychological flexibility as a mediator of the association between early life trauma and psychological symptoms. \u003cem\u003ePersonality and individual differences, 141\u003c/em\u003e, 101-106. https://doi.org/10.1016/j.paid.2018.12.029\u003c/li\u003e\n\u003cli\u003eRolffs, J. L., Rogge, R. D., \u0026amp; Wilson, K. G. (2018). Disentangling components of flexibility via the hexaflex model: Development and validation of the Multidimensional Psychological Flexibility Inventory (MPFI). \u003cem\u003eAssessment\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(4), 458-482. https://doi.org/10.1177/1073191116645905\u003c/li\u003e\n\u003cli\u003eSiegling, A. B., \u0026amp; Petrides, K. V. (2016). Zeroing in on mindfulness facets: Similarities, validity, and dimensionality across three independent measures. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(4), e0153073. https://doi.org/10.1371/journal.pone.0153073\u003c/li\u003e\n\u003cli\u003eStockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., \u0026amp; Miles, G. (2019). Identifying the underlying mechanisms of change during acceptance and commitment therapy (ACT): A systematic review of contemporary mediation studies. \u003cem\u003eBehavioural and Cognitive Psychotherapy\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(3), 332-362. https://doi.org/10.1017/S1352465818000553\u003c/li\u003e\n\u003cli\u003eTol, W. A., Leku, M. R., Lakin, D. P., Carswell, K., Augustinavicius, J., Adaku, A., ... \u0026amp; van Ommeren, M. (2020). Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial. \u003cem\u003eThe Lancet Global Health, 8\u003c/em\u003e(2), e254-e263. https://doi.org/10.1016/S2214-109X(19)30504-2\u003c/li\u003e\n\u003cli\u003eTubbs, J. D., Savage, J. E., Adkins, A. E., Amstadter, A. B., \u0026amp; Dick, D. M. (2019). Mindfulness moderates the relation between trauma and anxiety symptoms in college students. \u003cem\u003eJournal of American College Health\u003c/em\u003e, \u003cem\u003e67\u003c/em\u003e(3), 235-245. https://doi.org/10.1080/07448481.2018.1477782\u003c/li\u003e\n\u003cli\u003eTomlinson, E. R., Yousaf, O., Vitters\u0026oslash;, A. D., \u0026amp; Jones, L. (2018). Dispositional mindfulness and psychological health: A systematic review. \u003cem\u003eMindfulness\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(1), 23-43. https://doi.org/10.1007/s12671-017-0762-6\u003c/li\u003e\n\u003cli\u003eThompson, R. W., Arnkoff, D. B., \u0026amp; Glass, C. R. (2011). Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. \u003cem\u003eTrauma, Violence, \u0026amp; Abuse\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(4), 220-235. https://doi.org/10.1177/1524838011416375\u003c/li\u003e\n\u003cli\u003evan Borkulo, C. D. (2016). \u003cem\u003eNetworkComparisonTest: Statistical\u003c/em\u003e\u003cem\u003e\u003cu\u003e \u003c/u\u003e\u003c/em\u003e\u003cem\u003ecomparison of two networks based on three invariance\u003c/em\u003e\u003cem\u003e \u003c/em\u003e\u003cem\u003emeasures\u003c/em\u003e (Version 2.0.1). Available from https://CRAN.Rproject.org/package=NetworkComparisonTest\u003c/li\u003e\n\u003cli\u003evan der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., ... \u0026amp; Piet, J. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. \u003cem\u003eClinical Psychology Review\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e, 26-39. https://doi.org/10.1016/j.cpr.2015.02.001\u003c/li\u003e\n\u003cli\u003eWahbeh, H., Lu, M., \u0026amp; Oken, B. (2011). Mindful awareness and non-judging in relation to posttraumatic stress disorder symptoms. \u003cem\u003eMindfulness\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(4), 219-227. https://doi.org/10.1007/s12671-011-0064-3\u003c/li\u003e\n\u003cli\u003eWeissman, D. G., Nook, E. C., Dews, A. A., Miller, A. B., Lambert, H. K., Sasse, S. F., ... \u0026amp; McLaughlin, K. A. (2020). Low emotional awareness as a transdiagnostic mechanism underlying psychopathology in adolescence. \u003cem\u003eClinical Psychological Science\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e(6), 971-988. https://doi.org/10.1177/2167702620923649\u003c/li\u003e\n\u003cli\u003eWhitaker, R. C., Dearth-Wesley, T., Gooze, R. A., Becker, B. D., Gallagher, K. C., \u0026amp; McEwen, B. S. (2014). Adverse childhood experiences, dispositional mindfulness, and adult health. \u003cem\u003ePreventive Medicine\u003c/em\u003e, \u003cem\u003e67\u003c/em\u003e, 147-153. https://doi.org/10.1016/j.ypmed.2014.07.029\u003c/li\u003e\n\u003cli\u003eWu, G., Feder, A., Cohen, H., Kim, J. J., Calderon, S., Charney, D. S., \u0026amp; Math\u0026eacute;, A. A. (2013). Understanding resilience. \u003cem\u003eFrontiers in behavioral neuroscience\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e, 10. https://doi.org/10.3389/fnbeh.2013.00010\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adverse Childhood Experiences, Mindfulness, Psychological Flexibility, Psychological Symptoms, Network Analysis, Moderation Analysis","lastPublishedDoi":"10.21203/rs.3.rs-8142530/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8142530/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eAdverse Childhood experiences (ACE) history is a well-established risk factor for the development of psychopathology in adulthood. Although mindfulness and psychological flexibility have been proposed as protective factors, their distinct dimensions through which they buffer the impact of early trauma remain unclear. The present study aimed to examine the associations among early trauma, mindfulness facets, psychological flexibility dimensions and psychological symptoms by using network analysis, and to examine whether specific mindfulness and psychological flexibility dimensions moderate the impact of ACE on psychological symptoms.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA sample of 516 young adults aged 18\u0026ndash;35 years old (M\u0026thinsp;=\u0026thinsp;26.96, SD\u0026thinsp;=\u0026thinsp;4.67) mostly women (73.8%) completed an online survey including measures of early trauma (ETI-SR-SF), mindfulness facets (KIMS), psychological flexibility dimensions (MPFI) and psychological symptoms (DASS).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNetwork analysis identified Acceptance without Judgement. Awareness, Describing (mindfulness facets), and Committed Action (psychological flexibility dimension) as central processes associated with psychological symptom intensity. Early trauma was associated only with psychological symptoms, whereas Acceptance without Judgement and Committed Action were the only significant moderators of the relationship between early trauma and psychological symptoms.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eFindings underscore the protective role of Acceptance without Judgement and Committed Action, in mitigating the long-term psychological consequences of early trauma. These processes may be important targets for early intervention and prevention programs.\u003c/p\u003e","manuscriptTitle":"The associations among Mindfulness, Psychological Flexibility, Adverse Childhood Experiences, and Psychological Symptoms in young adulthood","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 14:08:46","doi":"10.21203/rs.3.rs-8142530/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dc454af0-399c-4932-9314-9150c7f62a36","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T14:08:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 14:08:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8142530","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8142530","identity":"rs-8142530","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}