Keywords

1 Introduction

Mindfulness is defined as non-judgmental observation of continuous waves of internal and external stimuli, just as they occur [1]. A more functional definition of mindfulness is as follows: the awareness emerging from intentional and non-judgmental focusing of attention on the present moment and on the experience unfolding every minute. These aspects of attention and awareness can be developed through mindfulness meditation [2]. Historically, mindfulness has its origins in the principals of Buddhist meditation [3]. Nevertheless, during the last 60 years, these Buddhist traditions have been adopted by the western world [4] as techniques being practiced in everyday life as well as intense courses of meditation conducted by specialized teachers. Mindfulness has attracted western countries’ interest, as focusing on here and now is a universal, innate human need and ability [2]. Furthermore, mindfulness practice concerns a variety of skills possible to be taught irrespective of religious beliefs [5] and traditional meditation [6]. These skills have been applied in various types of medical and psychological interventions, such as the mindfulness-based stress reduction, (MBSR) [5], the mindfulness-based cognitive therapy (MBCT) [7], and the dialectical behavior therapy (DBT) [8].

Numerous instruments have been constructed for measuring mindfulness. The Kentucky Inventory of Mindfulness Skills (KIMS) is one of the most widely used. This tool was constructed by Baer et al. for the assessment of the general tendency of individuals to be mindful in everyday life. The authors intended to create a measure whose items would be understandable both by general and clinical populations, even if the respondents had never practiced any kind of meditation. The assessment concerns four basic mindfulness skills corresponding to four subscales of the inventory: “Observing,” “Describing,” “Acting with awareness,” and “Accepting without judgment” [9].

KIMS has demonstrated good content validity, moderate to high internal consistency reliability, and good test-retest reliability [9]. It has been translated and standardized in various languages, such as Swedish [10], German [11], French [12], Dutch [13], and Chinese [14]. It has been used in studies conducted both on healthy samples [9, 10, 12, 13], such as students, parents, civil servants, community samples, and relatives of individuals with mental disorders, and on clinical samples, such as people with borderline personality disorder [9, 10, 12], major depressive disorder, posttraumatic stress disorder [11], and alcohol dependence [15].

A large number of studies have assessed mindfulness using KIMS, and its subscales have shown a positive correlation with mental health, emotional intelligence [9], quality of life [10], self-expression in social circumstances, ability to empathize, satisfaction with body image [11], and sustained and executive attention [16]. In addition, KIMS’ subscales have been negatively correlated with levels of psychopathology [10], alexithymia, neuroticism [9, 13, 15], depression [17], feeling of hopelessness [12], anxiety and sensitivity to it [18], negative affectivity [19], and perceived stress [20, 21]. Lastly, KIMS has been used in interventional studies to assess the effectiveness of mindfulness-based stress reduction programs [19, 22,23,24]. Therefore, KIMS appears to be helpful for assessing mindfulness both in observational and interventional studies conducted in the general population and clinical samples.

The absence of such a tool from the Greek research field was the motive for the present study. The purpose of this study was to translate KIMS into Greek and to standardize this inventory in Greek population. Given that mindfulness is negatively correlated with alexithymia and perceived stress, cross-validation of the Greek version of KIMS was conducted using the Mindful Attention and Awareness Scale (concurrent validity), Toronto Alexithymia Scale, and Perceived Stress Scale (predictive validity).

2 Methods

2.1 Measures

2.1.1 Demographic Data

Requested information concerned gender, age, marital status, educational level, and educational institution.

2.1.2 Kentucky Inventory of Mindfulness Skills (KIMS)

This self-report instrument consists of 39 items. Participants rate each item according to the degree the statement describes what is generally true for them. Rating is built on a five-point Likert scale (1 = never or very rarely true, 5 = almost always or always true). Some of the sentences directly describe the mindfulness skill which is rated, while others describe a skill’s absence and reverse scoring needs to be applied. High scores represent more mindfulness. KIMS includes four subscales: “Observing,” “Describing,” “Acting with awareness,” and “Accepting without judgment.” “Observing” concerns the participant’s tendency to observe a variety of stimuli, both internal, such as body sensations, thoughts, and emotions, and external, such as sounds and colors. “Describing” refers to the tendency to describe and put into words a wide range of phenomena. “Acting with awareness” means full participation in current activity with undivided attention. “Accepting without judgment” means to accept reality as it is, without trying to change it and without putting evaluative labels on facts [9].

2.1.3 Mindful Attention and Awareness Scale (MAAS)

This scale, constructed by Brown and Ryan, includes 15 items, which refer to a single factor and assess the individual’s tendency to act in “automatic pilot” without paying attention on current experience. Answers are given on a six-point Likert scale ranging from 1 (almost always) to 6 (almost never). High scores correspond to more mindfulness. Other factors of mindfulness, such as accepting situations without criticism, are not measured, as, according to the authors, focusing on here and now and awareness are the fundamental principles of mindfulness [25]. This tool has been standardized in the Greek population and has good psychometric properties [26]. In the present study, the internal consistency of MAAS was also adequate (Cronbach’s α = 0.86).

2.1.4 Toronto Alexithymia Scale (TAS-20)

This is a self-reported scale created by Bagby, Parker, and Taylor [27]. TAS-20 includes 20 items, which comprise three subscales: “Difficulty identifying feelings,” “Difficulty describing feelings,” and “Externally oriented thinking.” “Difficulty identifying feelings” refers to the individual’s difficulty to identify his/her own emotions and make a distinction between them and bodily sensations associated with emotional arousal. “Difficulty describing feelings” refers to the difficulty to describe feelings to others. “Externally oriented thinking” assesses the tendency of individuals to direct their attention externally. The respondent indicates the degree to which he/she agrees with each statement using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). High scores mean high levels of alexithymia. This scale has been adapted to the Greek population and good validity and reliability have been reported [28]. Moreover, in this study, TAS-20 and its subscales appeared to have adequate internal consistency (Cronbach’s α: “Difficulty describing feelings” = 0.81, “Difficulty identifying feelings” = 0.79, “Externally oriented thinking” = 0.65, Total = 0.84).

2.1.5 Perceived Stress Scale (PSS-14)

Perceived Stress Scale is a 14-item self-reported scale measuring the degree to which an individual perceives situations of his/her life as stressful [29]. The respondent is asked to indicate the frequency to which he/she experienced the reported thoughts and feelings during the previous month based on a five-point Likert scale (from 0 (never) to 4 (very often)). This scale includes seven positive and seven negative statements, and the total score is calculated summing the ratings for each item, after firstly all the positive items have been reversed (minimum total score = 0, maximum total score = 56). High scores reflect high levels of perceived stress. Good psychometric properties of this scale have been reported in the general population of Greece [30]. In this study, PSS-14 was found to have satisfactory internal consistency (Cronbach’s alpha = 0.85).

2.2 Procedure and Sample Translation

Independent forward translations of the original KIMS were conducted by two translators and backward translation was performed by one translator, native speaker [31]. The Greek KIMS was pretested on a sample of five individuals, so as to indicate ambiguous questions and determine the final form.

2.2.1 License

After contacting the developer of the inventory, it was ascertained that permission was not required to use KIMS.

2.2.2 Data Collection

The study took place in Attica, Greece. Questionnaires were distributed between January and May 2020. Participants were fully informed about the study purpose and completed the questionnaires voluntarily and anonymously. Completion required 15 minutes approximately.

2.2.3 Sample

The sample constituted 217 Greek undergraduate and postgraduate students of various educational institutions. Two hundred and thirteen of them completed the questionnaires (98.16% return rate).

2.3 Data Analysis

Data are presented as N (%) for qualitative variables, namely, gender, marital status, and education level, and as mean (SD) for quantitative variables, such as age and scales’ and subscales’ scores. Principal component analysis (PCA) was conducted to extract the factors of KIMS. Kaiser-Meyer-Olkin measure and Bartlett’s test of sphericity were applied to assess the sample’s adequacy and the correlation among the items, respectively. The varimax rotation method was used to maximize the loadings of items. Items were assigned to factors to whom loadings were greater than 0.3. Cronbach’s alpha for internal consistency, the percentage of variance explained, and eigenvalues were calculated for each one of the extracted factors. Range, mean, SD, minimum, and maximum were also used to describe factors. Correlations between KIMS’ subscales, as well as between KIMS’ subscales and other measurements of the study, were calculated. Normality of data distribution was tested, and, as it was violated, nonparametric Spearman’s rho coefficient was used to assess correlations. Nonparametric Mann-Whitney U and Kruskal-Wallis tests were conducted to evaluate between group differences. The SPSS program v.25 for Windows was used to perform statistical analyses and p = 0.05 was considered to be the level of significance for all analyses.

3 Results

In Table 1, sociodemographic characteristics of the study’s sample are reported. Subjects were mostly females (75.60%), young adults with mean age 23.92 (SD = 5.69), unmarried (94.40%), and BSc students (78.90%). Mean scores and standard deviations (SD) for KIMS, MAAS, TAS, PSS, and their subscales are also reported.

Table 1 Sociodemographic characteristics of the study’s sample, scales, and subscales of measurements
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Table 2 presents the rotated factor loadings of principal component analysis (PCA) for the 38 mindfulness skills items, which were finally included in the inventory. The sample’s adequacy was confirmed by the Kaiser-Meyer-Olkin measure (KMO = 0.819), and, according to the Bartlett’s test of sphericity χ2(741) = 3493.57, p < 0.0001, the correlation among the items was satisfactory, so as to proceed to PCA. The scree plot (not presented) indicated the selection of four components, corresponding to four subscales, similar to the structure of the inventory’s English version: “Observing,” “Describing,” “Acting with awareness,” and “Accepting without judgment.” All components had eigenvalues >1 and in combination explained 45.79% of variance. The item “When I’m doing chores, such as cleaning or laundry, I tend to daydream or think of other things” did not load adequately to any of the factors. Thus, it was excluded from the final list of items. In the English version, the item “I pay attention to how my emotions affect my thoughts and behavior” loaded on the subscale “Observing.” However, in the Greek version this item presented an adequate loading on the subscale “Describing.”

Table 2 Rotated factor loadings of the principal components analysis (PCA) for 38 mindfulness skills items (N = 213)
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Table 3 presents main descriptive measures of the four subscales of KIMS. Given the possible ranges, the dispersion of subscales in this study was found to be satisfying.

Table 3 Descriptive characteristics of the four subscales of KIMS
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Table 4 presents the correlations between KIMS subscales. According to this table, “Observing” scores are positively correlated with “Describing” scores (p < 0.05) and negatively with “Accepting without judgment scores” (p < 0.01). Moreover, “Describing” is positively correlated with “Acting with awareness” (p < 0.01) and “Accepting without judgment” (p < 0.05). “Acting with awareness” is positively correlated with “Accepting without judgment” (p < 0.01).

Table 4 Correlations (Spearman’s rho) between KIMS subscales
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Table 5 presents associations between KIMS’ subscales and other variables, namely, demographic characteristics, MAAS, TAS, and PSS. Females were more skilled in “Observing” compared to males (p = 0.003). Regarding the educational level, significant difference was observed in the “Observing” subscale (p = 0.024). Married subjects had higher scores in the “Observing” subscale compared to the other categories (p = 0.016). “Describing,” “Acting with awareness,” and “Accepting without judgment” skills were significantly positively correlated with MAAS scores. The “Describing,” “Acting with awareness,” and “Accepting without judgment” subscales were significantly negatively correlated with the TAS “Difficulty describing feelings” and the TAS “Difficulty identifying feelings” subscales. “Observing” and “Describing” were significantly negatively correlated with TAS “Externally oriented thinking,” and “Accepting without judgment” was significantly but positively associated with TAS “Externally oriented thinking.” All the KIMS subscales were significantly negatively associated with the total TAS score. “Describing,” “Acting with awareness,” and “Accepting without judgment” scores were significantly negatively associated with PSS scores.

Table 5 Association between KIMS subscales and other study measurements
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4 Discussion

During the last decades, mindfulness practice has proved helpful for reducing the symptoms of a wide variety of mental and physical health disorders [32]. Thus, it is of prominent importance to clarify whether patients learn and develop the skills that mindfulness-based treatments intend to teach and whether improvement in their clinical conditions can be attributed to these learned skills. Tools for assessing mindfulness are necessary for this purpose [33].

This study provides evidence that a Greek version of KIMS is reliable and valid. Adaptation was conducted in a sample of 213 Greek undergraduate and postgraduate students of various academic institutions. The four-factor structure resulting from the principal component analysis comes in accordance with previous studies [9, 11,12,13], and it was found to explain 45.79% of the inventory’s variance. The items presented adequate loadings onto the factors, except for the item “When I’m doing chores, such as cleaning or laundry, I tend to daydream or think of other things,” which did not have a sufficient loading to any of the factors. As a result, this item was not included in the Greek version of KIMS. In the English version of the inventory, this item was assigned to the “Acting with awareness” subscale. One explanation could be that Greek students’ tendency to disperse their thoughts while they are doing simple house tasks does not have to do with their skills to focus their attention on more demanding activities, such as working and driving, and to let themselves be absorbed by these activities. Furthermore, in the Greek version of KIMS, the item “I pay attention to how my emotions affect my thoughts and behavior” had an acceptable loading on the “Describing” subscale. Nevertheless, in the original KIMS version, this item loaded on the “Observing” subscale. This finding could be attributed to social and cultural factors; it seems that Greek students perceive this item differently from American students and outpatients with borderline personality disorder, which were the samples utilized for the construction of the English KIMS [9]. All the four factors of the inventory presented satisfactory internal consistency, as has been confirmed in previous reports [9,10,11,12,13].

Associations between KIMS’ subscales appeared to be moderate and significant. However, the association between the “Observing” and “Acting with awareness” subscales was found to be insignificant. “Observing” was negatively associated with “Accepting without judgment.” It seems that individuals tending to observe external stimuli and their own thoughts and feelings also have the tendency to judge and try to change them. These results agree with those of other studies [9,10,11,12,13].

Regarding demographic characteristics, females, subjects with a higher educational level, and married participants were found to be more skilled in “Observing.” The finding that females presented higher scores in the “Observing” subscale than males agrees with reports from a Swedish study [10], while Baer et al. [9] found no difference between the two genders in “Observing.” Additionally, three of the KIMS’ subscales were positively associated with MAAS, indicating satisfactory concurrent validity for KIMS. All the subscales of KIMS were observed to be negatively associated with the total TAS score, and three of the KIMS’ subscales were negatively associated with PSS, as expected [9, 13, 15, 20, 21], suggesting good predictive validity for KIMS. It appears that individuals having more developed mindfulness skills tend to experience less difficulties identifying and describing their emotions. Moreover, participants with more mindfulness seem to have less perceived stress, namely, they seem to feel more capable of coping with stressors, to consider their lives as less uncontrollable and to present less negative reactions to stress [29]. These findings provide support for the protective role of mindfulness skills against mental health issues and for the benefits that mindfulness-based interventions can have on individuals suffering from stress-related disorders.

The present study has some limitations. Firstly, the generalization of the results is limited, as the sample was not representative of the whole Greek population. The sample included undergraduate and postgraduate students exclusively. Thus, it is possible that the study sample consisted of highly educated participants. Moreover, most of the subjects were young adults, hampering the generalization of the findings to middle-aged and older adults. Secondly, no clinical sample was utilized for this study. Despite these, adequacy of the sample size and good criterion validity permit to recommend this inventory for future studies in Greek populations. Thirdly, considering that some of the questionnaires were completed during the pandemic of coronavirus disease 2019 (COVID-19), it is possible that this stressful condition altered the PSS scores, since previous studies indicate that the pandemic might lead to increased levels of stress in university students [34]. Lastly, no test-retest reliability evaluation was conducted. Future research should be performed in community and clinical samples, such as individuals with mental health disorders, and include test-retest assessment.

In conclusion, this Greek version of KIMS meets requirements for criterion validity and internal consistency and can be safely recommended for future research in the Greek population. This measure could be proven useful for the assessment of mindfulness skills of various healthy and clinical populations as well as for evaluating the efficacy of mindfulness-based treatment and stress-management programs.