Abstract
Although research suggests that trait mindfulness has been negatively associated with perceived stress, an integrative examination of the underlying mechanisms is lacking. Consequently, the purpose of this study was to establish an integrative model within Monitor and Acceptance Theory (MAT). This model examined the relationship between trait mindfulness and perceived stress by assessing two important psychological resources: basic psychological needs satisfaction (BPNS) and psychological flexibility. A total of 679 young adults (Mage = 19.27 years, SD = 1.06) participated in this research. They completed a set of standardized instruments that assessed trait mindfulness, BPNS, psychological flexibility, and perceived stress. Serial multiple mediation analyses showed that trait mindfulness was associated with higher levels of BPNS and psychological flexibility, which in turn were associated with less perceived stress. Furthermore, the path coefficient of the serial multiple mediation was higher than other pathways. These findings demonstrate that BPNS and psychological flexibility are important mechanisms that underlie the relationship between trait mindfulness and perceived stress, particularly when they are synergistic.
Keywords
Introduction
Mindfulness has been demonstrated to be associated with less perceived stress. In addition to mindfulness-based interventions for stress reduction (Creswell, 2017; Lindsay & Creswell, 2019; Pascoe et al., 2017; Tang et al., 2015), trait mindfulness is an important aspect (Tomlinson et al., 2018). Trait mindfulness, as a psychological construct, refers to an individual’s awareness tendency and ability of self-regulated attention to be attentive, open, receptive, curious, and non-judgmental towards present experiences and events (Brown & Ryan, 2003; Kabat-Zinn, 2009; Tran et al., 2022). As a stable internal resource, trait mindfulness could potentially serve as a protective factor during times of stress (Brown et al., 2012). While existing meta-analysis and experimental studies have suggested a negative association between trait mindfulness and perceived stress (Tomlinson et al., 2018; Weinstein et al., 2009), an integrative examination of the underlying mechanisms is lacking. This study built an integrative model within Monitor and Acceptance Theory (MAT) to explore the potential psychological mechanisms linking trait mindfulness and perceived stress.
Trait Mindfulness and Perceived Stress
Perceived stress refers to an individual’s subjective experience or cognition of the stress they are under during a specific period, including their perception of feelings of uncertainty in life and their confidence in their ability to deal with hardship (Phillips, 2013). It is influenced by factors such as personality, coping resources, and support (Phillips, 2013). Therefore, the cognition of life events is important factors affecting individual perceived stress.
MAT explains how mindfulness affects cognition and stress. It emphasizes that attention monitoring can improve cognitive function results generated by mindfulness in a neutral environment, and enhance emotional experiences and reactivity (both negative and positive indications). However, monitoring alone is not sufficient to reduce stress perception. When monitoring and acceptance are combined, negative reactivity and unhealthy pursuits of positive experiences (e.g., cravings) are reduced, thus resulting in improved health outcomes associated with stress (Lindsay & Creswell, 2017). The theory applies to the explanation of trait mindfulness functions as well.
Trait mindfulness is an experiential mode of processing that affects perceived stress (Weinstein et al., 2009). First, according to MAT theory, a mindful individual is able to engage in the present moment despite stressful situations, and is less influenced by his or her past experiences or future expectations. This trait allows them to effectively regulate reactions to situations, thereby reducing perceived stress. Second, empirical studies and meta-analysis have demonstrated that trait mindfulness is negatively related to perceived stress across various contexts (Lu et al., 2019; MacAulay et al., 2022; Mesmer-Magnus et al., 2017; Weinstein et al., 2009). Furthermore, randomized controlled trials (RCTs) have provided causal evidence that increases in mindfulness ability lead to subsequent decreases in perceived stress (Baer et al., 2012; Ju et al., 2022). This indicates that as trait mindfulness is enhanced, perceived stress decreases. The current study aims to replicate this well-established link to confirm its robustness. Based on the above arguments, the first hypothesis in this study is as follows:
Trait mindfulness is negatively related to perceived stress by replicating previous findings.
The Mediating Role of Basic Psychological Needs Satisfaction
Basic psychological needs satisfaction (BPNS) is considered to be one of the mediators of the positive effects of trait mindfulness on psychological health, including reduced perceived stress (Chang et al., 2015, 2018; Renault et al., 2023; Shannon et al., 2020). BPNS is an essential resource for individuals to cultivate self-organization, adaptability, and flourishing lives (Ryan, 1995; Ryan & Deci, 2017). This resource is an important pathway between high trait mindfulness and better psychological health (Charbonneau, 2019).
First, trait mindfulness facilitates BPNS by opening and accepting one’s present-moment experience rather than trying to control it (Ryan & Deci, 2017). According to MAT, mindful individuals improve cognitive functioning by enhancing awareness through attention monitoring, enabling them to better understand their basic psychological needs. Acceptance reduces emotional reactivity, which helps individuals accepting address and fulfill their needs without becoming overly obsessed with them. Therefore, trait mindfulness contributes to individuals’ greater psychological satisfaction. Previous research has found that trait mindfulness aids in BPNS as an internal psychological resource (Beloborodova & Brown, 2023; Schultz et al., 2015; van den Broeck et al., 2016).
Second, BPNS facilitates improved management and a proactive approach to stress handling (Weinstein & Ryan, 2011). Meta-analysis reviews have shown that BPNS is associated with well-being and health (Ng et al., 2012; Yu et al., 2018). When these needs are frustrated, it is a potent predictor of multiple unhealthy factors, including stress (Campbell et al., 2017; Neufeld et al., 2020; Weinstein & Ryan, 2011). The mediating role of BPNS in the relationship between trait mindfulness and perceived stress has been previously demonstrated in clinical trainees (Renault et al., 2023). This study aims to replicate this link to confirm its robustness in a non-clinical population. Based on the above arguments, the second hypothesis in this study is as follows:
BPNS mediates the relationship between trait mindfulness and perceived stress by replicating previous findings.
The Mediating Role of Psychological Flexibility
Psychological flexibility refers to the capacity to be present in the current moment and modify or continue actions to attain desired objectives (Hayes et al., 2006). As a dynamic self-regulation process, psychological flexibility involves adaptation, resource allocation, perspective shifting, and balance maintenance, especially in the context of distress, and is “a fundamental aspect of health” (Kashdan & Rottenberg, 2010). According to MAT, experiential acceptance is a key psychological flexibility process (Hayes et al., 2006) and is the crucial mechanism that acts between trait mindfulness and perceived stress (Lindsay & Creswell, 2017). Previous research has indicated that psychological flexibility functions as a mediator between trait mindfulness and better mental health outcomes (Mak et al., 2021). Consequently, this study hypothesized that psychological flexibility may mediate the relationship between trait mindfulness and perceived stress.
First, trait mindfulness may relate to psychological flexibility. The characteristics of trait mindfulness include the processes of acceptance and awareness, as well as the ability to be curious and receptive to negative experiences (Bishop et al., 2004). These characteristics are probably precursors to psychological flexibility (Kashdan & Rottenberg, 2010). RCTs have provided indirect evidence that improved mindfulness ability preceded two-week improvement in psychological flexibility during a seven-week mindfulness intervention (Li et al., 2023). This suggests that as trait mindfulness is enhanced, psychological flexibility increases.
Second, psychological flexibility may relate to perceived stress. Psychological flexibility may alter the way individuals relate to distressing internal experiences (Levin et al., 2012). For example, one’s subjective appraisal and affective reactions to stress can influence their perception of stress (Lee, 2012). RCTs using mindfulness-based interventions have demonstrated that psychological flexibility has a protective effect on mental health, including protecting against stress (Fledderus et al., 2010; Levin et al., 2012; Puolakanaho et al., 2020). However, few studies have explored the mediating role of psychological flexibility between trait mindfulness and perceived stress. Based on the above arguments, the third hypothesis in this study is as follows:
Psychological flexibility mediates the relationship between trait mindfulness and perceived stress.
The Serial Multiple Mediation Model
BPNS and psychological flexibility have been proven to be mechanisms through which high levels of trait mindfulness are associated with lower perceived stress. However, few studies have simultaneously considered these two mechanisms and their sequence. According to MAT, the effectiveness of mindfulness primarily stems from attention monitoring and acceptance. Individuals need to develop their attention monitoring abilities, which then combine with an attitude of acceptance to protect against perceived stress. In other words, acceptance is founded on the basis of attention monitoring. BPNS reflects the combination of monitoring and acceptance of one’s state (Beloborodova & Brown, 2023; Ryan & Deci, 2017), while psychological flexibility is an important manifestation of acceptance (Hayes et al., 2006). There is a potential sequential relationship: individuals need to be aware of their state (awareness of the fulfillment of psychological needs) before they can accept their state and respond adaptively ( i.e., exhibit psychological flexibility; Fledderus et al., 2012). Specifically, basic psychological needs represent crucial resources that underlie an individual’s innate tendency towards self-organization (Ryan, 1995). Individuals who meet these needs can achieve their full potential and modulate their actions in a way that aligns with their emotions, thoughts, goals, and values (Ryan & Deci, 2017). According to previous research, need-satisfaction enables individuals to adapt to their environment actively and flexibly, and to achieve their goals effectively (van den Broeck et al., 2016; Weinstein & Ryan, 2011).
Therefore, trait mindfulness is mediated through BPNS (influenced by the combined effects of monitoring and acceptance) and then through psychological flexibility (the main characteristic of acceptance). Ultimately, it correlates with perceived stress. In this pathway, BPNS and psychological flexibility work both jointly and independently. Based on the above arguments, the fourth hypothesis in this study is as follows:
BPNS and psychological flexibility sequentially mediate the relationship between trait mindfulness and perceived stress. Specifically, trait mindfulness is positively related to BPNS, which in turn is positively related to psychological flexibility. Then, psychological flexibility is negatively related to perceived stress.
The Present Study
This study tested an integrated model that expands on the underlying mechanisms between trait mindfulness and perceived stress. Specifically, the study had three aims: (1) to replicate and extend prior research on the relationship between trait mindfulness and perceived stress; (2) to investigate the parallel mediating roles of BPNS and psychological flexibility in this relationship for a deeper comprehension of these mechanisms; and (3) to assess the sequential mediating effects of the two mediators to clarify their combined effect. By devising a novel integrated mediation framework, this research provides a fresh perspective on the intricate interplay between trait mindfulness and the avenues of perceived stress.
Method
Participants
The data came from an ongoing psychological project named Personality, Social Behaviors and Mental Health. A total of 724 young adults participated in this research. Forty-five participants failed to correctly answer two or more attention check questions (e.g., “Please select Did not apply to me at all for this item”). The final sample thus comprised 679 participants, with 276 (40.65%) males and 403 (59.35%) females. Their ages ranged from 18 to 29 years (Mage = 19.27 years, SD = 1.06). Of the total sample, 20.18% had an annual family income of less than 50,000 RMB (≈ US$7,265), 30.19% had an annual family income of 50,000 RMB to 100,000 RMB (≈ US$14,530), 31.37% of 100,000 RMB to 200,000 RMB (≈ US$29,060), 15.46% of 200,000 RMB to 500,000 RMB (≈ US$72,650), and 2.80% of more than 500,000 RMB.
Procedure
First, participants provided their informed consent by signing a consent form that outlined the study procedures and their rights as participants prior to their participation in the study. Second, they completed a set of standardized instruments that collected demographic information, and assessed trait mindfulness, perceived stress, BPNS, and psychological flexibility as well as other questionnaires that were not relevant to this study (e.g., mate value). Third, participants received 10 RMB (US$1.46) for their participation. They were also given the option of attending a free mindfulness lecture voluntarily. Data collection was conducted using the online platform Credamo (www.credamo.com), which has demonstrated good performance in academic research (e.g., Gong et al., 2020; Jiang & Sedikides, 2022; Li et al., 2021). The online questionnaire was structured to ensure no missing data, allowing submission only after all items were answered. This survey was conducted anonymously, and participants participated voluntarily. They were free to withdraw at any time or refuse participation without consequences. This research was approved by the ethics committee of the authors’ affiliated institute.
Measures
Trait Mindfulness
Trait mindfulness was measured using the Cognitive and Affective Mindfulness Scale – Revised (CAMS-R; Feldman et al., 2007). The 12-item scale has four dimensions: attention, present-focus, awareness, and acceptance. Each item is rated on a four-point Likert scale ranging from 1 (Rarely/Not at all) to 4 (Almost always). A sample item is “It is easy for me to concentrate on what I am doing.” The scores of all items were summed, with higher total scores indicating higher levels of trait mindfulness. The Cronbach’s α coefficient was .77 in this study.
Perceived Stress
Perceived stress was measured using the stress subscale of the 21-item Depression Anxiety Stress Scales (DASS-21; Lovibond & Lovibond, 1995). The stress subscale consists of seven items, and each item is rated on a four-point Likert scale ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much). A sample item is “I couldn’t seem to experience any positive feeling at all.” The scores of all items were summed, with higher total scores indicating greater perceived stress. The Cronbach’s α coefficient was .80 in this study.
Basic Psychological Needs Satisfaction
BPNS was measured using the Basic Psychological Needs Scales (Deci & Ryan, 2000; Gagné, 2003). The 21-item scale has three dimensions: autonomy, competence, and relatedness. Each item is rated on a seven-point Likert scale ranging from 1 (Not true at all) to 7 (Definitely true). A sample item is “I feel like I am free to decide for myself how to live my life.” The scores of all items were summed, with higher scores indicating higher degrees of satisfaction of basic psychological needs. The Cronbach’s α coefficient was .91 in this study.
Psychological Flexibility
Psychological flexibility was measured using the Acceptance and Action Questionnaire-II (AAQ-II; Fledderus et al., 2012). AAQ-II is a seven-item unidimensional scale, and each item is rated using a seven-point Likert scale ranging from 1 (Never true) to 7 (Always true). A sample item is “My painful experiences and memories make it difficult for me to live a life that I would value.” The scores for each item were reverse-coded and summed (Brassell et al., 2016). Higher scores indicated higher psychological flexibility. The Cronbach’s α coefficient was .86 in this study.
Control Variables
This study used the following variables as covariate controls: age, annual family income, and subjective socioeconomic status (SES). SES was measured using the ladder technique (Adler et al., 2000). A ladder with 10 steps was shown to respondents, with 1 representing the lowest socioeconomic status, and 10 representing the highest socioeconomic status. Respondents rated their perceived family’s status as compared to that of other families. The selection of these covariates was based on previous literature that has indicated their potential importance in mental health (De Neve & Oswald, 2012; Ursache et al., 2015).
Data Analysis
First, SPSS 26.0 facilitated the descriptive and correlational analyses, assessing bivariate links between research and control variables. Second, mediation analysis took trait mindfulness as the independent variable, perceived stress as the dependent variable, and BPNS and psychological flexibility as the mediating variables. Age, annual family income, and SES were included as control variables. Serial mediation analyses were conducted using the PROCESS macro 4.0 in SPSS 26.0 (Model 6; Hayes, 2017) with the 95% bias-corrected bootstrapping method (n = 5,000) and the non-zero confidence interval indicated that mediation effects were significant. Considering the increased likelihood of committing a Type I error in the significance testing of PROCESS mediation paths, a Bonferroni correction was applied to control for this risk. In this study, with three mediation paths being tested, the alpha level was divided by 3 to adjust the significance threshold. Consequently, the significance assessment cut-off became .0167 (i.e., p = .05/3 comparisons), rather than the standard .05.
Results
Descriptive Statistics and Correlational Analysis
Descriptive Statistics and Correlations Analysis of the Study Variables.
Note. TM = Trait mindfulness, BPNS = Basic psychological needs satisfaction, PF = Psychological flexibility, PS = Perceived stress, SES = Subjective socioeconomic status. Gender: Female = 1, Male = 0.
*p < .05, **p < .01, ***p < .001.
Mediating Effect Analysis
Figure 1 and Table 2 show that the mediation model had a significant overall effect size (β = −.43, SE = .04, p < .001), and the direct path coefficient of trait mindfulness on stress was significant (β = −.12, SE = .04, p < .01). Three mediation paths are significant in this study. Specifically, in the first pathway, BPNS was the mediating variable. Trait mindfulness was positively associated with BPNS, which in turn was negatively associated with stress (indirect effect = −.11, SE = .03, 95% CI [−.16, −.05], p < .001). The percentage of the indirect effect in the total effect was 24.20%. In the second pathway, psychological flexibility was the mediator variable. Trait mindfulness was positively associated with psychological flexibility, which in turn was negatively associated with stress (indirect effect = −.06, SE = .02, 95% CI [−.11, −.02], p < .001). The percentage of the indirect effect in the total effect was 14.42%. The third pathway involved serial mediation, where the relationship between trait mindfulness and stress was sequentially mediated by BPNS and psychological flexibility (indirect effect = −.15, SE = .02, 95% CI [−.19, −.12], p < .001). The indirect effects contributed to 34.99% of the total effect. Overall, the percentage of the total indirect effects in the total effect was 73.59%. Serial mediation model with standardized path coefficients. *p < .05, **p < .01, ***p < .001. Descriptive Statistics and Correlations Analysis of the Study Variables. Note. TM = Trait mindfulness, BPNS = Basic psychological needs satisfaction, PF = Psychological flexibility, PS = Perceived stress.
Discussion
Within the MAT framework, the current study examined the link between trait mindfulness and perceived stress, as well as investigating the mediating roles of BPNS and psychological flexibility. Specifically, our findings revealed that BPNS and psychological flexibility could sequentially mediate the relationship between trait mindfulness and perceived stress. Furthermore, the path coefficient of the serial multiple mediation was higher than that of other pathways. Even when control variables were included, the results remained stable. Four hypotheses were supported and contributed to a deeper understanding of the underlying mechanisms between these psychological constructs.
Trait Mindfulness Has Positive Implications for Perceived Stress
In line with the findings of prior studies, trait mindfulness was negatively related to perceived stress, supporting our first hypothesis. MAT emphasizes the combined benefits of attention regulation and acceptance in mindfulness practices. Those with pronounced trait mindfulness tend to respond more attentively and with greater acceptance during stress, leading to decreased stress reactions (Lindsay et al., 2019). As a result, negative cognitions and negative experiences of stressful events are reduced, and confidence in one’s ability to cope with stress is increased, which in turn leads to a reduction in perceived stress. These results are consistent with the theoretical model, in that people who are more mindful feel less stressed. Taken together, these observations indicate that trait mindfulness is an important personal resource for coping with perceived stress.
Psychological Mechanisms of the Trait Mindfulness-Stress Relationship
In the current study, BPNS and psychological flexibility were used to explain the relationship between trait mindfulness and perceived stress. First, consistent with our second hypothesis, mindful individuals tended to experience a greater sense of satisfaction with their basic psychological needs, while reporting reduced perceived stress. It should be highlighted that this result aligns with MAT’s theoretical framework, underscoring the significance of monitoring and an intentional acceptance attitude. This attitude has been proven to be beneficial in decoupling desire from hedonic experience (Hadash et al., 2016). In other words, mindful individuals satisfy their psychological needs through insight into their internal needs and by pursuing intrinsic over extrinsic goals, which is associated with less stress incursion (Weinstein & Ryan, 2011). Other research has shown similar results. For example, a higher level of trait mindfulness has been associated with higher BPNS in medical students and a lower feeling of stress among them (Neufeld et al., 2020).
Second, consistent with our third hypothesis, mindful individuals demonstrate greater psychological flexibility, which enables them to cope with stress using various of abilities. These can include the ability to “recognize and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values” (page 1; Kashdan & Rottenberg, 2010). It is consistent with previous research and with the perspective of MAT that mindful individuals are more flexible in stressful situations, use fewer avoidant coping strategies, more approach coping strategies, and perceive less stress (Weinstein et al., 2009). In contrast, individuals with a low level of mindfulness exhibit psychological inflexibility (Mak et al., 2021) and have difficulty accepting negative thoughts and feelings (Lindsay & Creswell, 2017). Therefore, they tend to avoid or attempt to change these thoughts and feelings, both of which can exacerbate perceived stress (Bardeen et al., 2013; Karekla & Panayiotou, 2011).
Third, consistent with our fourth hypothesis, the sequential multiple mediation of BPNS and psychological flexibility confirms a previous inference that first, one’s basic psychological needs are met, and then flexibility is displayed (Ryan & Deci, 2017). It was notable that this was the strongest pathway in this model, indicating that the synergistic effects of BPNS and psychological flexibility provide more protection against the intrusion of stress compared to either mechanism alone. Specifically, when individuals’ basic psychological needs are satisfied, they are likely to develop and utilize psychological flexibility, which in turn allows them to adapt effectively to stressful situations. This result aligns with the MAT, which posits that mindfulness can effectively protect against stress intrusions when monitoring and acceptance are combined. In this study, BPNS is the outcome of the combined effects of monitoring and acceptance, thus serving as a mediator in the model. Psychological flexibility, being a crucial aspect of acceptance (Fledderus et al., 2012), functions as a mediator. When these two factors are combined, the awareness of and satisfaction with basic psychological needs enhance flexible responses to environmental demands, enabling individuals to better adapt to stress than either mechanism alone. This sequential mediation model highlights the importance of addressing both BPNS and psychological flexibility in interventions aimed at stress reduction. It also provides a comprehensive understanding of the mechanisms through which trait mindfulness exerts its beneficial effects on perceived stress. This integrated perspective offers contributions to the domain by suggesting that fostering both BPNS and psychological flexibility can enhance the overall efficacy of mindfulness-based stress reduction programs, thereby offering a novel approach to improving mental health outcomes.
Implications
The findings of this study have implications for both theory and practice. Theoretically, this study proposes an integrative model within MAT to explain the psychological mechanisms linking trait mindfulness and perceived stress. In addition to expanding the connotations of MAT, this study deeply explores the protective mechanism against stress incursion. Practically, this study provides reference points for developing of targeted interventions for stress reduction and mental health promotion. Specifically, it focuses on individual differences, as groups with low levels of mindfulness may be at increased risk of stress. It would be beneficial for researchers and clinicians to develop targeted prevention and intervention programs to prevent or mitigate risks. More importantly, the satisfaction of basic psychological needs and psychological flexibility is important inner resources for mental health, especially when interwoven. Regular mindfulness practice may provide an opportunity for further development of these resources.
Limitations and Future Directions
This study has several limitations. First, the cross-sectional design limits the ability to establish causal relationships in this study. Future studies should utilize multiple approaches, such as RCTs based on an eight-week mindfulness intervention (Creswell, 2017), to establish causal relationships among research variables. Second, this study did not assess stressors and stress coping, which are important components of perceived stress (Lazarus & Folkman, 1984). Future research should use ambulatory assessment approaches to investigate whether trait mindfulness and mediation mechanisms have synergistic effects on these two components of stress assessment (i.e., stress sources and stress coping). Third, it is important to note that BPNS and psychological flexibility are dynamic by nature (Kashdan & Rottenberg, 2010; Ryan & Deci, 2017). Future research could examine how psychological mechanisms interact dynamically through ecological momentary assessments, such as daily diary designs. By capturing of subjective experiences and behaviors, these designs may provide insight into how these mechanisms resist stress invasion in daily life.
Conclusions
While research suggests that trait mindfulness is negatively associated with perceived stress, there is a lack of an integrative examination of the underlying mechanisms. This study establishes an integrative model, in which the satisfaction of basic psychological needs and psychological flexibility emerge as crucial mechanisms in the relationship between high trait mindfulness and reduced perceived stress, particularly when they work synergistically. These findings enrich the content of the Monitor and Acceptance Theory and offer new insights into the protective role of trait mindfulness in psychological well-being.
Footnotes
Acknowledgements
We would like to express our sincere gratitude to all the participants who generously volunteered their time and contributed to this study.
Author Contributions
PL contributed to the Conceptualization, Investigation, Methodology, Formal analysis and Writing-original draft preparation. YZ contributed to the Conceptualization, Funding acquisition, Investigation and Writing-review and editing. YF contributed to the Conceptualization, Investigation, Methodology, Writing-review and editing, Funding acquisition, and Supervision. ZC contributed to the Conceptualization, and Funding acquisition, Writing-review and editing. All authors approved the final version of the manuscript for submission.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
This work was supported by the fellowship of the China Postdoctoral Science Foundation (Grant No. 2021M703467), the Special Research Assistant Program of the Chinese Academy of Sciences (Grant No. E2CX0114), the Science Foundation of Nanjing University of Posts and Telecommunications (Grant No. NYY221022), and the General Program of Philosophy and Social Sciences Research in College and University in Jiangsu Province (Grant No. 2023SJYB0143).
Ethical Statement
Data Availability Statement
The datasets generated for this study are available on request to the authors.
