Awareness and perceptions of nicotine replacement therapy among adults in Saudi Arabia: A cross-sectional study.

Many evidence-based treatments deliver skills-based psychoeducation around mindfulness (awareness resulting from purposeful and nonjudgmental attention to one’s moment-by-moment experience; ), self-compassion (supporting oneself in moments of pain or suffering; ), and values engagement (taking action that is purposive and aligned with one’s chosen values; ) to reduce emotion dysregulation. Although these three skills have distinct conceptual underpinnings and ‘mechanisms of action,’ they are typically included together in third-wave cognitive behavioral treatments (e.g., ; ). By accounting for concurrent variability in assessment of these skills, a clearer picture of how these skills relate to emotion regulation is attainable. Given that these skills have demonstrated positive impacts on symptom and functional outcomes in veterans (; ; ), further examination of how these skills may improve emotion dysregulation over time can inform future clinical interventions for this population. Emotion dysregulation is a transdiagnostic process implicated in the onset, maintenance, and progression of various mental health disorders (). Specifically, for the purposes of the current study, we define emotion dysregulation as: the non-acceptance of negative emotions, inability to engage in goal-directed behavior when distressed, difficulties controlling impulsive behavior when distressed, limited access to emotion regulation strategies that could be effective given situational demands, and lack of emotional clarity (). Emotion dysregulation—more broadly defined—is likely to play a crucial role in disorders common in veterans, including depression () and posttraumatic stress disorder (PTSD) (; ), and poorer quality of life (). Importantly, emotion dysregulation predicts suicidal behavior in veterans (; ). As such, emotion dysregulation is a crucial target of therapeutic interventions for this population. Greater mindfulness, self-compassion, and values engagement are thought to be associated with less emotion dysregulation. Theoretically, mindfulness increases awareness and nonreactivity () that may in turn facilitate emotional clarity, self-regulatory capacities, and or inhibition of impulsive behaviors. Cross-sectional work in adolescent clinical and adult non-clinical samples has found that those with higher levels of mindfulness report lower emotion dysregulation (; ; ). Further, data collected over three months in healthy but stressed adolescents found that within-person changes in mindfulness were associated with reductions in rumination following an intensive mindfulness retreat (). An app-based mindfulness intervention tested over four weeks also promoted emotion regulation in adults (). Lastly, within-person increases in mindfulness have been found to negatively relate to emotion dysregulation over two months in a transdiagnostic adult sample with emotion regulation difficulties who participated in skills-based or supportive therapy, but there was no evidence for lagged associations (). Regarding the impact of mindfulness on emotion regulation in veterans, research has found that mindfulness predicted reductions in expressive suppression and improvement in cognitive reappraisal over time (). As such, there is evidence supporting mindfulness as both a correlate and a predictor of lower emotion dysregulation with less evidence for prospective associations when separating within- and between-person effects of mindfulness. The impact of mindfulness on emotion dysregulation more broadly in veterans also deserves more attention given the negative impact of emotion dysregulation on mental health outcomes in this population (; ).