The research, conducted by Ben C. L. Yu of The Hong Kong Polytechnic University and colleagues at The Chinese University of Hong Kong and The University of Hong Kong, set out to compare two competing qualities of mindfulness that appear, on the surface, to be nearly contradictory. The first is nonjudgment, the familiar operationalization embedded in the widely used Five Facet Mindfulness Questionnaire, which asks whether people approach their thoughts and feelings in a non-evaluative way. The second is discernment, a construct rooted in classical Buddhist teachings that emphasizes actively assessing whether one’s mental states are wholesome or unwholesome, that is, whether they lead toward well-being or toward suffering. From a Buddhist psychological perspective, this evaluative function is not a corruption of mindfulness but one of its defining features. In the ancient text The Questions of King Milinda, the monk Nāgasena describes mindfulness precisely as the examination of the wholesomeness and unwholesomeness of mental states, and early discourses such as the Kālāma Sutta frame unwholesome states as those marked by greed, aversion, and delusion that lead to harm, while wholesome states are those conducive to welfare and happiness.

To translate these concepts into testable psychological terms, the research team drew on the Mindfulness-Discernment Scale, a recently validated instrument grounded in Buddhist teachings that reconceptualizes mindfulness as having two functions. The first function is maintaining steady, non-forgetting awareness of internal and external objects, including sensations, thoughts, feelings, and mental states. The second is discernment, a clear knowing of those objects, such as recognizing whether one’s breath is long or short, or whether one’s current mental state is characterized by greed. The scale’s developers found that discernment correlated moderately with well-being, lower stress, and lower psychological distress, and showed moderate-to-strong associations with secularized Buddhist constructs including nonattachment, acceptance of impermanence, wisdom, tranquility, and concentration. Nonjudgment, meanwhile, has accumulated its own impressive empirical record. Studies have linked the nonjudging facet of the Five Facet Mindfulness Questionnaire to higher well-being, lower psychological disturbance, and, in a meta-analysis, strongly reduced post-traumatic stress symptoms.

The Hong Kong study followed 275 adults with no meditation experience over eight months, with assessments at baseline, four months, and eight months. Participants had a mean age of 24.5 years, just over half were women, and nearly all held at least an undergraduate degree, with the majority reporting no religious affiliation. The researchers used path analysis with full maximum likelihood estimation in Mplus, structuring their models with baseline discernment and nonjudgment as independent variables, nonattachment at the four-month follow-up as the mediator, and either life satisfaction or psychological distress at eight months as the outcome. Crucially, the longitudinal portion of the model controlled for baseline levels of the mediator and outcomes, allowing the team to test whether the mindfulness qualities genuinely predicted change over time rather than merely correlating with it. Indirect effects were estimated using bias-corrected bootstrapping with 5,000 resamples, and the models showed excellent fit to the data.

The answer to which quality matters more depended entirely on the timescale. When all variables were measured at the same time point, both discernment and nonjudgment performed respectably. Both were significantly associated with higher nonattachment, which in turn was associated with lower psychological distress and greater life satisfaction. But the concurrent results already hinted at an asymmetry: after controlling for each other, discernment showed a much stronger association with nonattachment than nonjudgment did, with standardized coefficients of 0.51 versus 0.18. The indirect effect of discernment on distress through nonattachment was roughly two and a half times larger than that of nonjudgment. In other words, even in the cross-sectional picture, the evaluative quality of mindfulness appeared to be doing considerably more work.

The longitudinal results were more decisive. When the researchers inserted a four-month time lag between the predictor and the mediator, nonjudgment simply stopped predicting anything. Baseline nonjudgment showed no significant association with nonattachment at four months, and no indirect pathway to either distress or life satisfaction at eight months. Discernment, by contrast, held its ground. Baseline discernment significantly predicted higher nonattachment at four months, and nonattachment at four months in turn significantly predicted greater life satisfaction at eight months, producing a significant indirect effect of discernment on life satisfaction through nonattachment. The parallel indirect pathway to reduced psychological distress, while directionally consistent, did not reach significance, likely because of the modest effect sizes involved and the attrition of participants reporting higher distress. Still, the pattern was unambiguous: only discernment carried psychological benefits forward across time.

Why might this be? The researchers draw on Buddhist psychological models in which suffering arises from habitual clinging to pleasant feeling tones and aversion to unpleasant ones, followed by mental proliferation of the initial events. Mindfulness, in this framework, is not an end in itself but a vehicle for recognizing these patterns of clinging and repulsion and fostering nonattachment, defined psychologically as a flexible, balanced way of relating to one’s experiences without clinging to or suppressing them. Discernment, the authors argue, is what makes this possible. According to the theory of embodied mindfulness, bodily states and cognitive-emotional processes interact bidirectionally: unwholesome states characterized by greed, aversion, or delusion may manifest as visceral tightness, constriction, or physiological agitation, while wholesome states present as bodily ease, spaciousness, and relaxation. A person with discerning awareness can use these somatic signals as a compass, deliberately letting go of unwholesome states and cultivating wholesome ones. Nonjudgment, by contrast, may offer only a temporary buffer, shielding people from the sting of negative experiences in the short term without fostering the deeper understanding needed to release them.

There is also a darker possibility that has concerned scholars for a decade. Some researchers have warned that an emphasis on nonjudging may foster passive acceptance, in which individuals tolerate adverse or even abusive situations rather than changing or leaving them, potentially exacerbating their difficulties and allowing harmful sensations to accumulate unexamined. Intriguingly, the new study found a hint of this: after controlling for nonattachment and discernment, nonjudgment showed a significant negative direct effect on life satisfaction at the eight-month follow-up. The authors are appropriately cautious, noting the small effect size and the absence of a zero-order correlation between nonjudgment and life satisfaction, and they stop short of declaring nonjudgment harmful. But they urge researchers to remain alert to its potential long-term costs.

The findings also connect to a growing body of temporal evidence suggesting that the benefits of mindfulness may be less durable than cross-sectional studies imply. Previous work by the same research group using ecological momentary assessment found that mindfulness predicted nonattachment and positive affect only when variables were measured concurrently, with the association vanishing when a lag of a few hours was introduced. A subsequent two-month study produced the same pattern. The authors of the new study suspected that part of the problem lay in measurement: those earlier studies used instruments capturing bare awareness or the mere absence of inattention, which may not capture the multidimensional richness of mindfulness. By pitting two distinct, well-measured qualities against each other, the present study suggests that the choice of which quality to cultivate, not merely whether to be mindful, may determine whether benefits persist.

The practical implications could be significant for the design of mindfulness-based interventions. If discernment is the active ingredient for enduring well-being, programs might benefit from teaching participants not just to observe thoughts, bodily states, and emotions without immediate reactivity, but to evaluate whether those states are wholesome, unwholesome, skillful, or unskillful, and to respond without clinging or avoidance. Such training would represent a meaningful departure from the strictly non-evaluative stance that has dominated secular mindfulness pedagogy. The study’s authors also caution that future research should not treat mindfulness qualities as interchangeable, recommending finer-grained measurement rather than reliance on broad global scales.

Limitations remain. The sample consisted of young, highly educated, predominantly non-religious university affiliates in Hong Kong with no meditation experience, and the authors note that meditators interpret mindfulness qualities differently. The longitudinal design, while stronger than cross-sectional work, cannot establish causation, all measures were self-reported within the same surveys, raising the possibility of common method bias, and attrition reached roughly 21 percent by the final follow-up, though full information maximum likelihood estimation was used to mitigate missing data. Even so, the study represents one of the most rigorous comparisons to date between two rival conceptions of what mindfulness actually is. Taken together with earlier null findings for bare awareness and inattentiveness, the evidence points toward a provocative conclusion: simply watching the mind without judgment may calm it for a moment, but learning to discern the nature of what arises, and to release what harms, may be what sustains well-being over the long run.

Psychotic-like experiences, which are subclinical and not necessarily indicative of full-blown psychotic disorders, serve as crucial markers of mental health vulnerability. The high prevalence of PLEs reported in this study underscores a silent crisis faced by Afghan migrant children and adolescents living in Mashhad, Iran. With 94% of the 770 participants admitting to experiencing at least one psychotic-like symptom, the data signals an alarming mental health burden that has largely gone unaddressed in this demographic.

The study’s authors employed the Prodromal Questionnaire-Brief Child Version (PQ-BC), a validated tool designed to screen psychotic-like experiences among young populations. This approach allowed for a nuanced identification not just of the presence of PLEs but also the distress associated with these symptoms. Notably, around 34% of the sample surpassed the clinical cutoff point — indicating they experienced significant distress related to their psychotic-like symptoms — which highlights the urgent need for targeted mental health interventions.

A notable facet of this research is its differentiation between children and adolescents within the migrant cohort. Adolescents were found to be nearly twice as likely as younger children to report PLEs, a finding that aligns with developmental psychology frameworks suggesting heightened vulnerability during adolescence due to emotional, neurological, and social transitions. This age-related trend offers critical implications for designing age-appropriate and developmentally sensitive mental health services.

Central to the study’s inquiry was the examination of childhood trauma, particularly emotional abuse, as a predictor of PLEs. Emotional abuse, often elusive and underreported compared to physical or sexual abuse, emerged as a significant contributing factor. The study quantified this relationship, revealing that higher degrees of reported emotional abuse were associated with increased odds of experiencing psychotic-like symptoms. This finding resonates with a broader body of psychiatric literature that links early traumatic experiences with long-term alterations in cognitive and emotional processing.

Beyond trauma, the researchers explored two psychological constructs known to influence resilience and mental health outcomes: mindfulness and cognitive flexibility. Mindfulness, defined as the ability to maintain non-judgmental awareness of the present moment, was inversely correlated with the occurrence of PLEs, suggesting that higher mindfulness may serve as a protective factor amidst the mental health challenges posed by displacement and trauma. Conversely, higher cognitive flexibility — the capacity to adapt one’s thinking and behavior in response to changing environments and demands — was unexpectedly associated with increased PLEs, posing intriguing questions about how adaptability interacts with vulnerability in stress-exposed populations.

A comprehensive multivariate analysis integrating these variables confirmed their collective explanatory power for PLEs, accounting for 22% of variance in children and 29% in adolescents. While these figures indicate substantial unexplained variance remains, they firmly establish the interrelation between traumatic experiences and cognitive-emotional processes in shaping psychotic-like experiences. This multifaceted insight emphasizes the necessity of holistic mental health strategies that address not only trauma but also enhance adaptive cognitive skills and mindfulness.

The implications of these findings stretch beyond academic interest. Afghan migrant children and adolescents embody a distinctly vulnerable group, navigating the complexities of displacement, socio-economic marginalization, and cultural dislocation. This study elevates their mental health needs to the forefront, challenging policymakers, clinicians, and educators to rethink and strengthen support systems in host countries, particularly those bordering conflict zones like Iran.

Importantly, this research does not merely diagnose problems but gestures toward pathways of resilience and hope. The protective role of mindfulness interventions, widely accessible through schools and community programs, opens avenues for scalable mental health promotive practices. Simultaneously, the nuanced findings on cognitive flexibility invite renewed investigation into how adaptive cognitive traits can be harnessed or potentially moderated to mitigate psychological distress.

These results add a crucial new layer to the global psychiatric understanding of how migration-related adversity manifests in the mental health profiles of youth. They spotlight the subtleties of psychotic-like experiences — often hidden and misunderstood — as significant indicators of distress, underscoring the urgency for early detection and culturally congruent therapeutic approaches.

Moreover, the authors advocate for future longitudinal and intervention studies, encouraging a dynamic exploration of how these psychological factors evolve over time and how targeted therapies might recalibrate the mental health trajectories of young migrants. Such efforts align with contemporary agendas in psychiatry aimed at precision medicine and individualized care.

In conclusion, this pioneering study amplifies the voices of Afghan migrant children and adolescents, weaving a complex narrative that intertwines trauma, mindfulness, cognition, and psychotic-like experiences. It challenges prevailing stigmas around mental health in migrant populations and calls for science-informed, compassionate responses. As global displacement and migration trends persist, the insights gleaned here will be vital for informing mental health policies and services that are equitable, effective, and sensitive to the lived realities of migrant youth worldwide.

Subject of Research: Psychotic-like experiences among Afghan migrant children and adolescents, with predictive roles of childhood trauma, mindfulness, and cognitive flexibility.

Article Title: Prevalence of psychotic-like experiences among Afghan migrant children and adolescents: examining the predictive role of childhood trauma, mindfulness, and cognitive flexibility

Article References:
Rezaee, A.R., Hosseini, S.R. & Firoozabadi, A. Prevalence of psychotic-like experiences among Afghan migrant children and adolescents: examining the predictive role of childhood trauma, mindfulness, and cognitive flexibility. BMC Psychiatry 25, 678 (2025). https://doi.org/10.1186/s12888-025-06979-x

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12888-025-06979-x