Abstract
A growing body of international research suggests emerging adulthood (i.e., 18 to 29 years of age) presents a period of vulnerability to stress, psychological distress, poor university adjustment, academic failure, substance abuse and even significant psychopathology. Consequently, optimising the resilience, mental health, and well-being of emerging adults (EAs) during transition to university has been identified as a global priority. There is also evidence to suggest EAs in high demand programs such as medicine are at elevated risk for stress-related impacts, including higher psychological distress and psychopathology, chronic stress and burnout compared to the general EA university population. Within Australia, an urgent call has been made for researchers to better understand the issues of EA and enhance the capacity of university and mental health sectors to effectively respond to the needs of this group. Researchers and institutions argue that effective, preventative and developmentally appropriate supports and interventions aimed at building resilience are needed; however, there is mixed evidence on factors underpinning resilience and well-being in this population. Additionally, a lack of evidence-based interventions currently exists. Consequently, further investigation of evidence-based well-being frameworks and effective preventative support interventions for this population is required.Mindfulness meditation training has been identified as an effective practice for reducing stress and psychological distress in young people. However, limited mindfulness-based models have been evaluated with EA university students. There are also limited application of such models to specific developmental stages, considering the unique neurological and systemic processes crucial to this life stage. This appears critical in providing interventions designed to target resilience and well-being for young people during change and adversity. The overarching aim of this thesis was to enhance the understanding of psychological well-being during EA, re-conceptualise the definition of resilience in this population, and evaluate an evidence-based framework and intervention for enhancing resilience and psychological well-being via mindfulness meditation training in this population.
A mixed methodological approach was used with three sequential studies conducted. To address the limitations of current definitions of resilience for the EA population, the current thesis proposes the new definition Eudaimonic Integration (EI). EI contends the process of fostering adaptive self-regulation, meaning making and wisdom during and following adversity involves integrated neurobiology and balanced, adaptive components of mind and body considered within the context of relational systems. To investigate the similarities and differences in resilience among EA university students from different regions, Study 1 investigated stress perceptions, psychological distress and satisfaction with the university experience among EA university students from Australia, Hong Kong and USA (N = 221). These regions were chosen to explore similarities and difference among EAs studying in these locations. Study 1 highlighted the importance of resilience in reducing perceptions of stress and psychological distress across these regions, as well as the differences in mental health and resilience among students studying in these regions. Therefore, Study 2 aimed to provide a more comprehensive understanding of components comprising EA resilience and EI relevant to cultural context. Study 2 aimed to develop and evaluate a new theoretical model of resilience and psychological well-being for an EA university population from Australia, the Model of Eudaimonic Integration (MEI). The MEI proposed an integrated systems view of how mindfulness promotes resilience, fostering response flexibility, positive emotion and self-compassion as foundations for personal beneficial meaning making of life events and challenges (i.e., positive reappraisal). The model was not intended to be linear in process, but rather describes a comprehensive and interwoven relationship between facets which over time operate in conjunction to foster expanding levels of embodied resilience and psychosomatic processing of present moment experience within the individual, impacting the inter-connected systems which surround them.
The MEI was initially evaluated with EA students across all disciplines, to provide a guiding framework for the development of a pilot mindfulness-based intervention (MBI) in culturally specific settings (i.e., Australian EA students; N = 420). Results showed support for MEI as a model predicting higher resilience and lower perceived stress and psychological distress in this population. To further understand the application and efficacy of the MEI, Study 3 used the MEI as a guiding framework for the development and evaluation of a pilot six-session MBI the Mindful Awareness Resilience Skills Training Program (MARST-P) via a Randomised Control Trial (RCT). The MARST-P was developed specifically for an EA medical student population from Australia (N = 52). EA medical students were chosen to evaluate the efficacy of the MEI and MARST-P with an at-risk population of EAs to the development of chronic stress and psychological distress.
Study 1 showed EA university students with higher resilience experienced lower levels of psychological distress and perceived stress, and higher satisfaction with academic experience. Significant relationships between perceived stress and psychological distress were partially mediated by resilience. Differences in mental health were reported among students from different regions, with participants from Australia generally reporting significantly lower psychological distress and lower perceived stress. This highlighted the importance of understanding the unique developmental and cultural contexts relevant to EA populations. Study 2 provided evidence for the MEI as an effective resiliency model for reducing stress and psychological distress, and promoting positive re-appraisal, psychological well-being and resilience in Australian EA university students from all disciplines. Higher mindfulness was a significant predictor of all aspects of the model; higher psychological flexibility, self-compassion, positive emotions and positive re-appraisal. These results provided evidence for higher levels of mindfulness as a predictor of all mechanisms proposed within the MEI, suggesting the MEI provides an effective framework to guide and inform MBIs with this population. Study 3 showed
support for the effectiveness of pilot MARST-P with an at-risk population of EA medical students in targeting all factors identified within the MEI. Compared to the Waitlist-Control Group, the Intervention Group reported significantly higher mindfulness, psychological flexibility, self-compassion, positive re-appraisal, and resilience scores post-intervention. Results were maintained at one-month follow-up, with positive emotions also significantly higher in the Intervention Group.
Overall, this thesis highlights the importance of enhancing resilience in EA university students via mindfulness meditation training and provides support for the MEI as a framework for both understanding and promoting resilience and psychological well-being. This thesis provides preliminary evidence for the MARST-P as an effective intervention with EA medical students. Whilst further research is recommended to evaluate the efficacy of the MEI and the MARST-P in additional EA samples and cultural contexts, this thesis provides preliminary evidence for the efficacy of these aspects and highlights the need for researchers, policy makers and institutions to better consider the unique vulnerability and growth potential of this developmental stage. This thesis offers a novel systemic perspective on resilience. Ongoing research is vital, to ensure EA’s receive greater awareness, understanding and access to evidence based MBI programs which promote successful transition through this developmental life stage, moving them towards self-differentiation and into well-adjusted adulthood.
| Date of Award | 30 Nov 2022 |
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| Original language | English |
| Supervisor | Peta Stapleton (Supervisor) & Douglas Angus (Supervisor) |