Personality and Individual Differences 64 (2014) 78–83
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Relating mindfulness and self-control to harm to the self and to others Cleoputri Yusainy a,⇑, Claire Lawrence b a b
Psychology Programme, Faculty of Social and Political Science, University of Brawijaya, Malang, Indonesia Personality, Social Psychology, and Health (PSPH) Group, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK
a r t i c l e
i n f o
Article history: Received 26 September 2013 Received in revised form 31 January 2014 Accepted 8 February 2014 Available online 13 March 2014 Keywords: Mindfulness Self-control Aggression Self-harm
a b s t r a c t Aggression to others and harm to the self (self-harm) have both been associated with similar possible antecedents; however, literatures on aggression and self-harm are commonly separated. This web-based study (N = 241) aimed to explore the dynamics of self-reported mindfulness and self-control towards aggression and self-harm. As predicted, those who were more mindful and more self-controlled reported being less aggressive and self-harmless typically. Bootstrap analyses suggested that self-control mediated the link between mindfulness and general trait aggression, physical aggression, anger, hostility, and self-harm, but not verbal aggression. With the inclusion of self-control, the direct effect of mindfulness on trait aggression, anger, and hostility, but not on physical aggression and self-harm, remained significant. Self-control, therefore, may be a pertinent individual difference on the link between mindfulness and behaviours that are physically harmful to the self and to others. Ó 2014 Elsevier Ltd. All rights reserved.
1. Introduction A previous review (Hillbrand, 2001) has pointed out that although aggression and self-harm often coexist, the risk assessment of these behaviours are typically separated. It could be argued that those who self-harmed are less likely to harm others, as some research suggest that self-harm is psychological distress, particularly anger, directed inwards (Hill & Dallos, 2012). Repetition of self-harm is also related to intropunitive but not to extrapunitive hostility (Brittlebank et al., 1990). Even so, the presence of similar possible mechanisms for harm to the self and to others, such as lower levels of serotonin (Barbui, Esposito, & Cipriani, 2009) and cerebrospinal fluid monoamine metabolite (Placidi et al., 2001), would mean that aggressive individuals may, in fact, also lack inhibition to harm themselves. As proposed by Selby, Anestis, and Joiner (2008), when dealing with intense negative emotions, individuals may ruminate on these emotions, or use thought suppression as an attempt to stop rumination. Because both strategies may paradoxically increase the intensity and frequency of negative emotions, some individuals might then engage in a dysregulated behaviour to distract themselves. Indeed, emotional relief has been reported as the most common reason for self-harm in studies using self-report methodologies (Brown, Comtois, & Linehan, 2002). Similarly, ruminating ⇑ Corresponding author. Tel.: +62 81333128950. E-mail address:
[email protected] (C. Yusainy). http://dx.doi.org/10.1016/j.paid.2014.02.015 0191-8869/Ó 2014 Elsevier Ltd. All rights reserved.
about a provocation increases the likelihood of displaced aggression (Bushman, 2002). By contrast, mindfulness may decrease both over-engagement (i.e., rumination) and avoidance of experiences, by bringing attention back to the ‘‘here-and-now’’ with a nonjudgemental attitude (Hayes & Feldman, 2004). The current literature has increasingly documented the application of mindfulness as an intervention technique for aggressive behaviours (Singh et al., 2012) and repeated episodes of self-harm (Williams, Dugan, Crane, & Fennell, 2006). Nevertheless, mindfulness has also been conceptualised as a natural predisposition to pay attention to and be aware of on-going events in daily life (Brown & Ryan, 2003). Mindfully keeping attention on experiences, with minimal effort to act on them, should lead to a situation of exposure and, in turn, extinction (Baer, 2003). Thus, although all individuals may encounter situations that potentially could trigger aggressive and self-harmful behaviours, those who are mindful may experience the resulting habitually associated responses to a reduced extent. As shown elsewhere, trait mindfulness is associated with lower levels of self-reported aggressiveness (e.g., Borders, Earleywine, & Jajodia, 2010; Brown & Ryan, 2003). The mechanisms of mindfulness towards aggression and self-harm, however, are yet unclear. Borders et al. (2010) found that while rumination may be a crucial mechanism between self-reported mindfulness and verbal aggression, anger, hostility, other mechanisms could come into play for reductions of physical aggression. This highlighted the importance of testing not only general trait aggression but also
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its specific components. Borders et al. suggested that the effect that mindfulness has on behavioural aggression may be mediated through relaxation, emotion regulation, better cognitive functioning and flexibility, and decrease impulsivity. Some of these suggested mechanisms appear to be related to the capacity of the self to control itself by altering its dominant response tendencies (Tangney, Baumeister, & Boone, 2004). Self-control was explicitly mentioned (but not tested) by Heppner et al. (2008) as a potential mediator between mindfulness and aggression. In self-harm studies, self-controlled emotion regulation is typically measured separately from mindfulness (e.g., Gratz & Roemer, 2004; Slee, Spinhoven, Garnefski, & Arensman, 2008). It is a key aim of the current study, therefore, to examine the dynamics of self-reported mindfulness, self-control, aggression, and self-harm. The link between self-control and aggression per se has been well documented (see Moffitt et al., 2011), and self-reported measures of mindfulness and self-control are strongly related with each other (Bowlin & Baer, 2012; Brown & Ryan, 2003). As the influential theory of feedback loops (Carver & Scheier, 1982) implies, self-control demands a continuous monitoring of one’s current states against some desirable goals or standards. Since this process is not affectively neutral, individuals who mindfully monitor their emotions may be better attuned to when self-control is required before impulsive reactions occur (Brown, Ryan, & Creswell, 2007; Teper, Segal, & Inzlicht, 2013). It is recently shown that in experienced mindfulness meditators, emotional acceptance and brain-based performance monitoring are related to greater self-control (Teper & Inzlicht, 2013). Arguably, mindfulness may also decrease aggression and self-harm through successful selfcontrolled efforts to refrain from acting on impulses to harm the self and others. Accordingly, the current study examines three hypotheses. First, self-reported mindfulness and self-control will be positively correlated to each other, negatively associated with aggression and self-harm. Second, individual differences in aggression will be positively associated with self-harm. Third, self-control will mediate any relationships between mindfulness and aggression and self-harm. If mindfulness and self-control could predict individuals’ tendency to harm themselves in the same way as they predicts harm to others, then the risk factors of aggression that potentially curable through mindfulness may also include self-harm and poor behavioural self-control (e.g., impulsivity), in addition to problems of anger. We focus on self-harm in the absence of suicidal intent as suicide attempts are frequently intended to decrease the burden for others (Brown et al., 2002).
2. Methods 2.1. Participants and procedures The study was approved by the School of Psychology University of Nottingham Ethics Committee. In order to provide a broader range of data, we targeted adult participants with no exclusion criteria. An internet survey link of the study was advertised in leaflets on campus and on the social networking site (Facebook) of the authors’ colleagues from non-student groups. Of 309 participants who agreed to participate, 25 subjects did not fill out any items and 43 did not continue to the last survey. After the removal of these 68 subjects, final sample consisted of 241 subjects (152 females, 4 did not report sex). Ages ranged from 18 to 41 (M = 23.87, SD = 5.93). All measures were completed online. Interested participants were told that the survey was not concerned with their actual levels of mindfulness, self-control, aggression, and self-harm—but with how these behaviours and propensities were associated with
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each other. Those who consented were then presented with a series of questionnaires, and an option to enter an email address to win a £25 prize draw incentivising the study. To examine whether participants provided more than one set of data, they were also asked to enter some ‘‘security details’’ (e.g., the last letter of most favourite colour). Finally, an electronic debriefing about the study hypotheses and useful points of contact was presented. 2.2. Materials 2.2.1. Mindful Attention Awareness Scale (MAAS: Brown & Ryan, 2003) The MAAS consists of 15 items assessing the absence of a single factor encompassing attention to and awareness of the present reality in daily life (e.g., ‘‘I find myself preoccupied with the future or the past’’) on a 6-point Likert-scale (1 = almost always and 6 = almost never). Higher MAAS scores were related to less reactivity during emotional threat as indicated by bilateral amygdale response and prefrontal cortical activation (Creswell, Way, Eisenberger, & Lieberman, 2007). Evidence for the predicted validity of the MAAS has been reported in a number of studies (Sauer et al., 2013). Internal reliability in the current sample was good (a = .88). 2.2.2. Brief Self-Control Scale (Brief SCS: Tangney et al., 2004) The brief version of the SCS covered the same range of content with the full 36-item version (i.e., control over thoughts, emotional control, impulse control, performance regulation, and habit breaking). Participants responded to 13 statements reflecting how they typically are (e.g., ‘‘People can count on me to keep on schedule’’) on a 5-point Likert-scale (1 = not at all and 5 = very much). Compared to other widely used self-reported measures of self-control, the SCS showed stronger relationships to overall behaviour (De Ridder, Lensvelt-Mulders, Finkenauer, Stok, & Baumeister, 2012). Internal reliability in the current sample was good (a = .82). 2.2.3. Aggression Questionnaire (AQ: Buss & Perry, 1992) The AQ is one of the most broadly used self-reported measures of aggression. It consists of four subscales, i.e., physical aggression (9 items, e.g., ‘‘If somebody hits me, I hit back’’), verbal aggression (5 items, e.g., ‘‘I tell my friends openly when I disagree with them’’), anger (7 items, e.g., ‘‘When frustrated, I let my irritation show’’), and hostility (8 items, e.g., ‘‘I am sometimes eaten up with jealousy’’), along with a composite of the 29-score of trait aggression. Participants indicated how accurately each item described the way in which they act when they feel angry or aggressive on a 5-point Likert-scale (1 = very inaccurate and 5 = accurate). Good internal reliability was shown in the current sample (a = .90, .84, .74, .78, .80 for total score, physical aggression, verbal aggression, anger, and hostility, respectively). 2.2.4. Deliberate Self-Harm Inventory (DSHI: Gratz, 2001) Participants indicated ‘‘yes’’ or ‘‘no’’ to a list of 17 items (e.g., ‘‘Have you ever intentionally (i.e., on purpose), cut your wrist, arms, or other area(s) of your body? (without intending to kill yourself?’’), and rated the number of times they have administered each act. Responses to item number 17 (i.e., ‘‘Have you ever intentionally done anything else to hurt yourself that was not asked about in this questionnaire? If yes, what did you do to hurt yourself?’’) would be included only if they were consistent with Gratz’s (2001) definition of deliberate self-harm. As a final score, a dichotomous self-harm variable was derived by assigning a score of ‘‘1’’ to participants who provided the rating of ‘‘five times or more’’ on any items, and a score of ‘‘0’’ to the rest of the participants (Gratz & Chapman, 2007).
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2.3. Plan of analyses The proposed mediation of self-control on the link between mindfulness and aggression/self-harm was tested with a bootstrap method (Hayes, 2012). Separate multiple regression analyses were conducted for the total aggression score, aggression subscales, and self-harm scale (see Fig. 1). Compared to four-step causal approach (Baron & Kenny, 1986) or Sobel test, bootstrapping is superior in terms of power and Type I error rates (see Shrout & Bolger, 2002). As a bootstrap sampling distribution of ab is estimated empirically, no assumptions are made about normality (Preacher & Hayes, 2008). To bootstrap an indirect effect, the available sample size n is re-sampled with replacement intensively for a total of k times to estimate the a (the effect of mindfulness on self-control) and b (the effect of self-control on the aggression/self-harm when controlling for the effect of mindfulness) as usual. These estimates of a and b are used to calculate ab⁄ (the indirect effect in a single resample), and the distribution of the k values of ab⁄ provides a nonparametric approximation of the sampling distribution of ab. The mean of the k estimates of ab⁄ represents the indirect effect, and a significant mediation of self-control on the mindfulness and aggression/self-harm link could be suggested if the bias-corrected confidence intervals of ab does not include zero. Information on whether the c0 (the direct effect of mindfulness on aggression/ self-harm) would still be significant after the inclusion of selfcontrol could also be obtained. It should be noted, however, that non-experimental data can only suggest that a proposed mediation pattern is plausible (Shrout & Bolger, 2002). 3. Results Unless specified, all analyses were performed using 5000 bootstrap resamples (N = 241) with 95% bias-corrected confidence intervals. Preliminary analyses showed that although participant’s age was not correlated to any aggression measures, it was positively associated with mindfulness (p < .001, CI = .06 to .33) and self-control (p < .001, CI = .11 to .39), and negatively associated with self-harm status (p < .001, CI = 1.21 to 4.06; M self-harmers = 21.76, SD = 4.00 vs. M non self-harmers = 24.42, SD = 6.23). Age was controlled in subsequent mediation analyses. As in the developmental study of the AQ, sex differences occurred in physical aggression (p < .001, CI = .22 to .67; M males = 2.61, SD = .62 vs. M females = 2.47, SD = .67), followed by verbal aggression (p < .05, CI = .02 to .48; M males = 3.03, SD = .87 vs. M females = 2.78, SD = .80). Sex was also controlled for these two subscales.
Our first hypothesis was that mindfulness and self-control would be positively correlated to each other, negatively associated with aggression and self-harm. As predicted, a positive correlation was found between mindfulness and self-control, and both scales were negatively correlated to total aggression and all aggression subscales (Table 1 below diagonal). Findings shown in Table 2 provide a further support for Hypothesis 1 in suggesting that selfharmers (n = 49 out of 241 participants) scored lower than non self-harmers in both mindfulness and self-control. Hypothesis 2 was partially supported in that those who selfharmed also reported higher levels of total aggression, physical aggression, and anger. No significant differences were found between self-harmers and non-harmers in verbal aggression or hostility (see again Table 2). Hypotheses 3 (that self-control would mediate any relationships between mindfulness and aggression and self-harm) was analysed for aggression and self-harm variables separately. The first mediation analysis revealed that mindfulness predicted selfcontrol (B = .40, SE = .04, p < .001), while total aggression was predicted by mindfulness (B = .30, SE = .05, p < .001) and self-control (B = .24, SE = .07, p < .001). As expected, self-control mediated the relationship between mindfulness and total aggression (B = .09, SE = .03, 95% CI [.15, .04]). The direct effect of mindfulness on total aggression was still highly significant (B = .21, SE = .06, p < .001) when accounting for self-control. The mediation of selfcontrol was consistent when participant’s age was included as covariate, and age had no effect on total aggression (p = .21). To scrutinise the proposed mediational model, the analysis was repeated for each aggression subscales (Table 3). Self-control continued to mediate the link between mindfulness and physical aggression, anger, and hostility, but not verbal aggression. With the inclusion of self-control, the direct effect of mindfulness on physical aggression was no longer significant (B dropped from .22 to .12). Mindfulness still significantly predicted anger and hostility. The mediation pattern was consistent when age and sex were included as covariates. Additionally, males scored higher in physical aggression (B = .49, SE = .009, p < .001), while younger participants scored higher in anger (B = .02, SE = .008, p < .05). A similar analysis for the dichotomous self-harm measure showed that self-harm was predicted by mindfulness (B = .47, SE = .21, p < .05) and self-control (B = .74, SE = .31, p < .01). Self-control mediated the relationship between mindfulness and self-harm (B = .30, SE = .13, 95% CI [.57, .05]), and the model explained between 4.40% (Cox & Snell R2) and 6.96% (Nagelkerke R2) of the variance in self-harm status. When accounting for selfcontrol, the direct effect of mindfulness was no longer significant (B = .20, SE = .24, p = .42). The mediation pattern was consistent when age was included as covariate, and older participants reported less self-harming behaviours (B = .08, SE = .04, p < .05). Overall, the mediation analyses revealed that Hypothesis 3 was largely supported in that self-control mediated the relationship between mindfulness and trait aggression, physical aggression, anger, hostility, and self-harm. No mediational model could be proposed for verbal aggression. After accounting for the potential influence of self-control, the direct effect of mindfulness on total aggression, anger, and hostility remained significant, but not on physical aggression and self-harm.
4. Discussion
Fig. 1. Simple mediation model. The causal effect of X on Y (c) is apportioned through its indirect effect on Y through M (ab) and its direct effect on Y (c0 ). X = predictor (mindfulness), Y = outcome (aggression variables or self-harm), M = proposed mediator (self-control). a, b, c, c’ = unstandardised regression coefficient.
The primary purpose of this study was to investigate the dynamics of self-reported mindfulness and self-control towards aggression and self-harm. A positive association was found between mindfulness and self-control, and both variables were related to lower propensities to aggress and self-harmed. Bootstrap
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C. Yusainy, C. Lawrence / Personality and Individual Differences 64 (2014) 78–83 Table 1 Zero order correlations and psychometric properties of measures. Measures
MAAS (1) SCS (2) Total AQ (3) AQ Physical (4) AQ Verbal (5) AQ Anger (6) AQ Hostility (7) M (SD)
Bias-corrected bootstrap 95% CI 1
2
3
1.00 [.39, .61]*** [.48, .23]*** [.35, .05]** [.26, .01]* [.44, .21]*** [.55, .37]** 3.84 (.78)
4
1.00 [.45, .24]*** [.35, .12]*** [.27, .02]* [.39, .16]*** [.53, .33]*** 3.02 (.62)
1.00 [.73, [.70, [.79, [.72, 2.53
.83]*** .81]*** .87]*** .82]** (.65)
1.00 [.34, [.46, [.33, 2.20
.54]*** .66]*** .56]*** (.85)
5
6
7
1.00 [.42, .61]*** [.33, .53]*** 2.88 (.83)
1.00 [.45, .65]*** 2.46 (.80)
1.00 2.60 (.84)
Note: MAAS = Mindful Attention Awareness Scale; SCS = Self-Control Scale; AQ = Aggression Questionnaire. p < .05. ** p < .01. *** p < .001. *
Table 2 Differences in measures as a function of self-harm status. Measures
Self-harmers M (SD)
Non self-harmers M (SD)
Bias-corrected bootstrap 95% CI
MAAS SCS Total AQ AQ Physical AQ Verbal AQ Anger AQ Hostility
3.62 2.77 2.76 2.58 3.05 2.70 2.72
3.91 3.09 2.46 2.09 2.83 2.38 2.55
[.01, .56*] [.14, .50***] [.51, .10**] [.79, .20**] [.47, .03] [.58, .05*] [.46, .11]
(.89) (.54) (.67) (.95) (.78) (.84) (.93)
(.73) (.62) (.64) (.80) (.84) (.78) (.80)
Note: MAAS = Mindful Attention Awareness Scale; SCS = Self-Control Scale; AQ = Aggression Questionnaire. p < .05. p < .01. *** p < .001. *
**
analyses supported the mediating role of self-control on the association between mindfulness and aggression and self-harm. These findings suggest that people who are naturally predisposed to monitor the ‘‘in-the-moment’’ experience could be less harmful towards themselves and others due partly to their high capacity in self-control. Examination on the four aggression subscales revealed that the pattern of mediation was consistent with self-control mediating the link between mindfulness and physical aggression, anger, and hostility, but not verbal aggression. It could be that verbal aggression is more related to other mechanisms, such as rumination (Borders et al., 2010). Possibly because verbal aggression may be considered as mild acts of aggression than physical aggression, refraining from these acts might not particularly tap self-control. Even so, in the development sample it was shown that once angered, self-controlled individuals reported both physically and
verbally lower outwardly directed aggression (Tangney et al., 2004). The detrimental effect of experimentally lowering self-control ability on verbal aggression also occurred when participants had been insulted (DeWall, Baumeister, Stillman, & Gailliot, 2007). Thus, a stronger association between self-control and verbal aggression may plausibly be obtained following aggression-provoking events. Behavioural verbal aggression tasks (e.g., essay feedback) could help clarify this issue. The differences between self-harmers and non-harmers were also lacking in verbal aggression, and in hostility, although selfharmers were higher in trait aggression, physical aggression, and anger. The lack of correlation between self-harm and verbal aggression could have simply mirrored the conceptualisation of self-harm that involves behaviours that are physically but not verbally harmful to the self. On the other hand, as Buss and Perry (1992) noted, a cognitive residual of hostility may be caused by
Table 3 Mediation models with bootstrap method, using mindfulness as predictor, self-control as mediator, aggression subscales as outcomes. Model tested
MAAS to AQ MAAS to SCS SCS to AQ MAAS to AQ, via SCS Indirect path Bias-corrected bootstrap 95% CI
AQ Physical
AQ Verbal
AQ Anger
AQ Hostility
B
SE
B
SE
B
SE
B
SE
.22*** .40*** .26** .12 .10 a [.18, .03]
.07 .04 .10 .08 .04
.14* .40*** .15 .08 .05 [.15, .03]
.07 .04 .10 .08 .06
.34*** .40*** .20* .26*** .08 a [.16, .01]
.06 .04 .09 .07 .04
.51*** .40*** .36*** .36*** .14 a [.22, .09]
.06 .04 .09 .07 .03
Note: B = unstandardised regression coefficient; SE = standard error. MAAS = Mindful Attention Awareness Scale; SCS = Self-Control Scale; AQ = Aggression Questionnaire. a Zero is not included in the 95% confidence interval, indicating that the indirect path is significantly different from zero. * p < .05. ** p < .01. *** p < .001.
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dissipation of anger over time. Although speculative, the expression of anger into self-harmful behaviours might have limited the accumulation of hostile thoughts towards others. With the inclusion of self-control, the direct effect of mindfulness on trait aggression, anger, and hostility, but not on physical aggression and self-harm, remained significant. Thus, self-control appears to be a salient variable through which mindfulness may predict physical aggression and self-harm. Perhaps due to their physical nature, these behaviours can be seen overtly as threating one’s desirable goals or standards. The remaining significant association between mindfulness and the covert components of aggression (i.e., anger and hostility) in particular should be explored through other conceivable mechanisms such as the mindfulness acceptance of internal experiences, nonattachment, and insight into psychological states (Bowlin & Baer, 2012; Brown et al., 2007; Hayes & Feldman, 2004). Our results must be interpreted cautiously due to some limitations. Crucially, while the study hypotheses were derived from the proposal that self-control is more likely to be acquired from the ability to be mindful (Baer, 2003; Brown et al., 2007), correlational data cannot completely rule out the opposite mechanism (see Masicampo & Baumeister, 2007). Fully experimental studies of causal process are of particularly important. Second, because the study advertising materials already contained an internet link of the survey, information on what percentage of people responded to our request based on method of recruitment (i.e., from Facebook vs. from a university) could not be obtained. We did, however, perform covariate analyses to control for the influence of demographics on the measures. Third, for comparability with previous findings in the literature of mindfulness and aggression (e.g., Borders et al., 2010; Heppner et al., 2008), a strict Bonferronicorrected a on the aggression subscales was not employed. At this threshold, the mediation of self-control on the mindfulness and anger link, and the differences between self-harmers and non selfharmers in anger did not reach significance. Fourth, information on participants’ self-harm was limited to the direct destruction of body tissue in the absence of suicidal intent. For practical purposes, the distinction between suicidal and nonsuicidal self-harm may not be necessary because the presence/absence of suicidal intent could be unclear even to the individuals who harm themselves (National Collaborating Centre for Mental Health, 2012). Despite the limitations, this is the first study to show that selfreported mindfulness and self-control may predict individuals’ tendency to harm themselves in the same way as they may predict harm to others. Therapeutic tools focusing on the mechanism for controlling the expression of aggression could benefit from an inclusion of mindfulness-based strategies and an early identification of individual’s risks for self-harm. Conflicts of interest The authors have no conflicts of interest to declare. References Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. http://dx.doi.org/10.1093/clipsy.bpg015. Barbui, C., Esposito, E., & Cipriani, A. (2009). Selective serotonin reuptake inhibitors and risk of suicide: A systematic review of observational studies. Canadian Medical Association Journal, 180(3), 291–297. http://dx.doi.org/10.1503/ cmaj.081514. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. http://dx.doi.org/10.1037/0022-3514.51.6.1173.
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