Association of mindfulness to resilience, anxiety, and depressive symptoms after spinal cord injury—a correlational study


Study design

Online survey of individuals with spinal cord injuries (SCI).


This pilot study examined associations between mindfulness factors, resilience, and levels of depression and anxiety after SCI.


Community-based; United States.


A survey was posted online and shared with individuals with recent SCI (≤5 years).


Thirty-four individuals responded to the survey. The Five Facet Mindfulness Questionnaire (FFMQ) measures mindfulness with the following subscales: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity of inner experience. Nonjudgment of inner experience was significantly associated with depression (β = −0.74, p = 0.007) and anxiety (β = −0.60, p = 0.01). Nonreactivity to inner experience was significantly associated with anxiety (β = −0.57, p = 0.007) and resilience (β = 0.55, p = 0.004); and there was a trend with depression (β = −0.45, p = 0.07). Higher resilience was significantly associated with less anxiety (r = −0.62, p = 0.04) and less depression (r = −0.75, p < 0.001). Depression and anxiety were significantly correlated (r = 0.84, p < 0.001). When comparing those who are employed to those who are not, they differed significantly in terms of anxiety (t(32) = 2.53, p = 0.02).


These findings suggest that factors of mindfulness, specifically the practice of acting nonjudgmentally and nonreactively to one’s inner experience, may act as protective factors against depression and anxiety following SCI. These preliminary data support the literature that individuals with lower resilience are more susceptible to depression following SCI. Interventions aimed at maximizing mental well-being following SCI may benefit from incorporating these factors of mindfulness practice.

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  1. 1.

    National Spinal Cord Injury Statistics Center. Spinal cord injury (SCI) facts and figures at a glance. Birmingham: University of Alabama; 2018 (English).

  2. 2.

    Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychologist. 2004;59:20–8.

  3. 3.

    Terrill AL, Molton IR, Ehde DM, Amtmann D, Bombaridier CH, Smith AE et al. Resilience, age, and perceived symptoms in persons with long-term physical disabilities. J Health Psychol. 2016;21:640–9.

  4. 4.

    Terrill AL, MacKenzie JJ, Einerson J, Reblin M. Resilience and disability: intra-personal, interpersonal, and social environment factors. In: Dunn DS, editor. Disability: social psychological perspectives. New York. NY: Oxford University Press; 2019. p. 313–5.

  5. 5.

    Tugade MM, Fredrickson BL. Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol. 2004;86:320–33.

  6. 6.

    Ehde DM. Application of positive psychology to rehabilitation psychology. In: Frank RG, Rosenthal M, Caplan B, editors. Handbook of rehabilitation psychology. Washington, DC: American Psychological Association; 2010. p. 417–24.

  7. 7.

    Pietrzak RH, Tracy M, Galea S, et al. Resilience in the face of disaster: prevalence and longitudinal course of mental disorders following hurricane Ike. PLoS ONE. 2012;7:e38964.

  8. 8.

    Costanzo ES, Ryff CD, Singer BH. Psychosocial adjustment among cancer survivors: Findings from a national survey of health and well-being. Health Psychol. 2009;28:147–56.

  9. 9.

    Bonanno GA, Kennedy P, Galatzer-Levy IR, Lude P, Elfström ML. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilitation Psychol. 2012;57:236–47.

  10. 10.

    Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, et al. Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment. 2007;15:329–42.

  11. 11.

    Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31:23–33.

  12. 12.

    Coffey KA, Hartman M. Mechanisms of action in the inverse relationship between mindfulness and psychological distress. Complement Health Pract Rev. 2008;13:79–91.

  13. 13.

    Ostafin BD, Chawla N, Bowen S, Dillworth TM, Witkiewitz K, Marlatt GA. Intensive mindfulness training and the reduction of psychological distress: a preliminary study. Cogn Behav Pract. 2006;13:191–7.

  14. 14.

    Shapiro SL, Brown KW, Biegel GM. Teaching self-care to caregivers: effects of mindfulness-based stress reduction on the mental health of therapists in training. Train Educ Prof Psychol. 2007;1:105–15.

  15. 15.

    Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15:88–92.

  16. 16.

    Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998;21:581–99.

  17. 17.

    Tang Y, Ma Y, Wang J, Fan Y, Feng S, Lu Q et al. Short-term meditation training improves attention and self-regulation. Proc Natl Acad Sci USA. 2007;104:17152–6.

  18. 18.

    Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. J Trauma Stress. 2007;20:1019–28.

  19. 19.

    White B, Driver S, Warren AM. Resilience and indicators of adjustment during rehabilitation from a spinal cord injury. Rehabil Psychol. 2010;55:23–32.

  20. 20.

    Guest R, Perry KN, Ephraums C, Hales A, Crino R, Craig A et al. Resilience following spinal cord injury: a prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation. Rehabil Psychol. 2015.

  21. 21.

    Terrill AL, Molton IR, Ehde D, Amtmann D, Bombardier C, Jensen MP. Resilience, age, and perceived symptoms in persons with long-term physical disabilities. J Health Psychol. 2016;21:640–9.

  22. 22.

    Bohlmeijer E, ten Klooster PM, Fledderus M, Veehof M, Baer R. Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment. 2011;18:308–20.

  23. 23.

    Wheeler AC, Miller S, Wylie AC, Edwards A. Mindfulness and acceptance as potential protective factors for mothers of children with fragile X syndrome. Front Public Health. 2018.

  24. 24.

    Curtis K, Hitzig SL, Bechsgaard G, Stoliker C, Alton C, Saunders N et al. Evaluation of a specialized yoga program for persons with a spinal cord injury: a pilot randomized controlled trial. J Pain Res. 2017;10:999–1017.

  25. 25.

    Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–8. J Clin Epidemiol. 2010;63:1179–94.

  26. 26.

    Schalet BD, Pilkonis PA, Yu L, Dodds N, Johnston KL, Yount S et al. Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical samples. J Clin Epidemiol. 2016;73:119–27.

  27. 27.

    Amtmann D, Cook KF, Johnson KL, Cella D. The PROMIS initiative: involvement of rehabilitation stakeholders in development and examples of applications in rehabilitation research. Arch Phys Med Rehabil. 2011;92:S12–9.

  28. 28.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42:377–81.

  29. 29.

    Pharr JR, Moonie S, Bungum TJ. The impact of unemployment on mental and physical health, access to health care and health risk behaviors. ISRN Public Health. 2012;2012:1–7.

  30. 30.

    Whiteneck G, Gassaway J, Dijkers M, Jha A. New approach to study the contents and outcomes of spinal cord injury rehabilitation: the SCIRehab project. J Spinal Cord Med. 2009;32:251–9.

  31. 31.

    Leach LS, et al. Gender differences in depression and anxiety across the adult lifespan: the role of psychosocial mediators. Soc Psychiatry Psychiatr Epidemiol. 2008;43:983–98.

  32. 32.

    Teunissen FR, Verbeek BM, Cha TD, Schwab JH. Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders. J Neurosurg: Spine. 2017;27:709–16.

  33. 33.

    Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. J Am Med Assoc. 1999;281:1304–9.

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Correspondence to Alexandra L. Terrill.

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Pincock, J.S., Terrill, A.L. Association of mindfulness to resilience, anxiety, and depressive symptoms after spinal cord injury—a correlational study. Spinal Cord Ser Cases 6, 7 (2020).

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