A pilot study examining the effect of mindfulness on depression and anxiety for minority children

Mental health intervention development for indigenous youth: Essential elements and guiding principles

There is a need for intervention studies to address mental health issues with Indigenous youth. The purpose of this work is to: 1) consider calming approaches introduced by Native-American adolescents who described in writing how they manage day-to-day stress; and 2) identify culturally relevant constructs (elements and principles) for development of mental health promotion interventions for use with Indigenous youth. Central ideas shared by Native-American adolescents were merged with existing literature to identify essential elements and guiding principles for intervention development. Three essential elements (talking circles; mindfulness practice; tailored educational content) with associated guiding principles are recommended for intervention development.

Effect of Short-term Deep Breathing Exercises on Perioperative Anxiety and Pain in Pediatric Orthopedic Patients: A Randomized Controlled Trial

PURPOSE

There are currently no pediatric studies examining the effects of deep breathing on perioperative pain and anxiety. This study sought to determine the effect of short-term deep breathing exercises on perioperative anxiety and pain in pediatric patients and their parents.

DESIGN

A randomized controlled trial was conducted in the Department of Orthopaedic Surgery where pediatric patients about to undergo surgery were allocated to a control group or a deep breathing group. In the intervention group, patients and their main guardian were guided to practice 10 minutes of deep breathing exercises twice a day for 3 to 4 days prior to surgery. Perioperative anxiety and pain were measured for both the children and parents as outcome indicators.

METHODS

Perioperative anxiety was measured using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) and state anxiety was measured using the State-Trait Anxiety Inventory (STAI). Patients reported their pain levels daily using the Wong-Baker FACES Pain Rating Scale. The following cutoffs were determined as high levels of anxiety: STAI (adult) > 44, STAI (child) > 36, and mYPAS-SF ≥ 30.

FINDINGS

No significant differences were found in the STAI, mYPAS-SF, and Wong-Baker FACES Pain Rating Scale scores of the patients between the intervention and control group. Overall statistics showed that parents had significantly higher postoperative state anxiety levels toward female children (44.93 ± 9.01) compared to male children (40.18 ± 9.89). Preoperative and postoperative parental state anxiety levels were correlated with the child's postoperative anxiety. Furthermore, children's postoperative state anxiety was slightly correlated with postoperative pain.

CONCLUSIONS

Short-term use of our deep breathing exercises was ineffective in reducing incidences of perioperative pain and anxiety in pediatric orthopedic patients. A longer period of deep breathing administration may be required for the intervention to be effective. Parental anxiety may have an effect on anxiety levels in children, and postoperative parental anxiety may be affected by the gender of the child.

Trait Mindfulness and Problematic Smartphone Use in Chinese Early Adolescent: The Multiple Mediating Roles of Negative Affectivity and Fear of Missing Out

This study used a cross-sectional study design to investigate whether the mindfulness trait was a protective factor against problematic smartphone use (PSPU) of early adolescents, and whether negative affectivity and fear of missing out (FoMO) mediated this relationship. The study selected a sample of middle school students (N = 517, 46.03% males, Mage = 13.81, SD = 1.40) in China. The results of the structural equation modelling indicated that (a) mindfulness significantly and negatively predicted PSPU, (b) FoMO played a mediating role between mindfulness and PSPU, (c) negative affectivity (including depression and anxiety) played a mediating role between mindfulness and PSPU, but loneliness did not, and (d) negative affectivity and FoMO played a chain-mediated role, and depression, anxiety, and loneliness played a chain-mediated role with FoMO between mindfulness and PSPU. We discuss the possibility that high levels of mindfulness in early adolescents may reduce the short-term effects of problematic smartphone use by reducing negative emotions and FoMO and relate our results to an emphasis on the role of enhanced mindfulness in long-term internal self-regulation and well-being. Findings have implications for individuals and schools for PSPU prevention and intervention.

The influences of mindfulness on high-stakes mathematics test achievement of middle school students

Research has shown that mindfulness can reduce students' negative emotions associated with high-stakes tests and thereby improve test performance. This study explored the association between mindfulness-based intervention (MBI) and high-risk math test scores of middle school students, which is noticeably slim in the domain of mathematics education, through a mediating process involving math-specific test anxiety and math self-efficacy. Using data from a sample of 45 students, age 12-13, we found empirical support for a significant positive correlation between mindfulness and middle school students' math achievement. Participants listened to a mindfulness audio every other week before a mathematics test. Weekly mathematics test scores, student group discussion data, and in-depth interview data were analyzed to explore how mindfulness affected students' mathematics test performance, which showed a statistically significant improvement after mindfulness compared to mathematics achievement without the intervention. Our results indicate that mindfulness can relieve mathematics anxiety symptoms, including physiological manifestations, test-unrelated thinking and worries, and problem-solving obstacles caused by mathematics anxiety. Also, mindfulness, especially its non-judgmental attitude, positively affects students' mathematical self-efficacy. The current research provides evidence of the mindfulness intervention's efficacy for improving middle school mathematics test performance but also identifies the complexities of implementing it with large numbers of students.

Systematic Review of Mindfulness-Based Interventions in Child-Adolescent Population: A Developmental Perspective

Human development implies deep changes in cognitive, attentional, emotional, and behavioral skills. Therefore, Mindfulness-Based Interventions (MBIs) should be adapted in terms of dose, frequency, kind of exercises, assessment methods, and expected effects regarding the abilities and limitations of each developmental period. The present review seeks to describe and compare MBIs characteristics, assessment methods, and effects in youth between 3 and 18 years old considering four developmental periods. A systematic review was carried out including experimental primary studies published during the last five years. Results show that the frequency of the sessions and program duration varies widely. Differences were observed in instructors’ training and in assessment strategies. Discrepancies were observed regarding the effects of MBIs both within and between periods in cognitive, socio-emotional, symptoms, and mindfulness variables. Consistency was observed in prosocial behaviors for preschoolers, and in emotional and behavioral problems and hyperactivity in ages between preschool and early adolescence. Nevertheless, it was impossible to compare most results and determine consistency or discrepancy due to the lack of studies. Regarding mindfulness, it is defined and assessed in different ways in each period. Orientations are suggested to move from a compartmentalized view of isolated MBIs, towards an integrative perspective that allows tracing developmental trajectories for mindfulness and other key cognitive and socioemotional skills for children and adolescents.

A Large-Scale Naturalistic Evaluation of the AIM Curriculum in a Public-School Setting

This study evaluated the effectiveness of the AIM curriculum when implemented in a public-school setting by schoolteachers and direct care staff. Three hundred eighteen students took part in this quasiexperimental design where all received the AIM curriculum every day for an entire school year. The participants completed a series of self-assessments (the Avoidance and Fusion Questionnaire for Youth, the Child and Adolescent Mindfulness Measure, and the Strength and Difficulties Questionnaire) at the onset of the study and at the end of the school year to assess psychological flexibility, mindfulness, and emotional behavioral skills. Results suggest that at the end of the school year, participants increased psychological flexibility and mindfulness. State standardized testing scores also showed increases school-wide as compared to the previous 2 years. These results suggest that the AIM curriculum may be effective in large school settings, appeared easy to implement by school staff to address the needs of both the individual student and the entire student body, and likely participated in improving school-wide academic success.

Initial Efficacy of a Community-Derived Mindfulness-Based Intervention for Latinx Parents and their Children

Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress, enhance emotion regulation, and foster social support. We assessed pilot data from Latinx parents in Eastside Los Angeles (n = 27) matched with their children aged 10-16 (n = 32) to determine whether participation in a community-derived MBI was associated with greater improvements in dispositional mindfulness, perceived stress, emotion regulation, and family social support compared to a control condition. Compared to the control group, parents in the MBI group showed greater reductions in perceived stress scale (PSS) scores (B =  - 2.94, 95% CI [- 5.58, - 0.39], p = 0.029), while their children reported greater increases in perceived social support from family (B = 2.32, 95% CI [0.26, 4.38], p = 0.027). Findings show a community-derived MBI may improve stress in Latinx parents and social support for their children.

The Limited Effect of Mindfulness-Based Interventions on Anxiety in Children and Adolescents: A Meta-Analysis

Anxiety disorders are common mental health problems amongst youth with harmful impacts often extending into adulthood. Mindfulness-based interventions (MBIs) have become increasingly popular for addressing mental health issues, particularly in schools; however, it remains unclear how effective they are for reducing youth anxiety. This meta-analysis aimed to evaluate the efficacy and effect moderators of MBIs on anxiety outcomes in children and adolescents. Eligible studies were published randomised controlled trials (RCTs) of MBIs conducted with participants aged 18 years or younger, investigating anxiety outcomes using a well-validated anxiety scale. A systematic search of RCTs published through to February 2019 identified 20 studies for inclusion (n = 1582). A random effects model was used to synthesise MBI effects. Stratified meta-analyses as well as individual, random effects meta-regressions were performed to examine how effects varied by age group, intervention setting, control type, research location, and intervention dosage. Although, across all studies, there was a small beneficial effect of MBIs on anxiety post treatment (d = 0.26), this was significantly moderated by research location, with RCTs conducted in Iran producing large effects (d = 1.25), and RCTs conducted in Western countries demonstrating no significant beneficial effect compared to controls (very small, d = 0.05). Effects were non-significant at follow-up assessment points. Post-treatment effects were significant for MBIs conducted with children (d = 0.41) and for MBIs when compared to passive controls (d = 0.33), but non-significant for adolescents (d = 0.21), for MBIs conducted in schools (d = 0.30) and in clinics (d = 0.13), and when MBIs were compared to active controls (d = 0.12). Results suggest that MBIs are likely to have a small to medium, yet temporary effect in reducing anxiety symptoms in children (not adolescents), but amongst Western youth populations the most likely outcome, from RCTs to date, is that MBIs produce no beneficial effect in anxiety reduction. Results revealed a lack of evidence to support investment in school-based MBIs to address youth anxiety.

Mixed Results on the Efficacy of the CharacterMe Smartphone App to Improve Self-Control, Patience, and Emotional Regulation Competencies in Adolescents

Unprecedented levels of access to adolescents' time and attention provide opportunities to convert traditional character and socioemotional competencies interventions into behavioral intervention technologies. However, these new tools must be evaluated rather than assuming previously validated activities will be efficacious when converted to a mobile platform. Thus, we sought to design and provide initial data on the effectiveness of the CharacterMe smartphone app to build self-control and patience, which are built on underlying social-emotional regulation competencies, in a sample of 618 adolescents (M_age = 16.07, Female = 56.6%). We also sought to examine whether framing the app activities as having a transcendent (spiritual connection or moral/prosocial) rather than instrumental purpose would increase engagement and change in self-control, patience, and emotion regulation. Finally, we tested the impact of framing activities as building strengths vs. fixing weaknesses. Results highlight the difficulty of translating psychological interventions to behavioral intervention technologies. Overall, the CharacterMe smartphone app was unsuccessful in increasing self-control, patience, or emotion regulation in adolescents, with analyses showing no significant mean changes over time. Framing conditions and user engagement were largely not significant predictors of change in self-control, patience, and emotion regulation.

Effects of a School-Based Mindfulness Program for Young Children

Schools are an attractive setting for implementation of mindfulness-based programs because mindfulness practices, by their very nature, align with a wide range of core educational goals. The present study investigated the effects of an 8-week (16 session) school-based mindfulness program for young children across 8 classrooms (K through 2) using a quasi-experimental delayed-intervention control group design. Results indicated that the mindfulness program was associated with significant improvements in teacher ratings of externalizing and prosocial behaviors. Program outcomes were not associated with child sex or race/ethnicity, but did vary by grade. Descriptive analyses suggest that outcomes tended to be more positive in classrooms with higher levels of teacher and student engagement. Results of the present study add to the growing knowledge base on the positive effects of school-based mindfulness programs and point to a need for more rigorous inquiry into the extent to which students and teachers are engaged with mindfulness programs both during the program itself and in their day to day functioning.

The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study

BACKGROUND

Early life stress (ELS) has been linked to poor mental and physical health outcomes in adolescence and adulthood. Mindfulness reduces symptoms of depression and anxiety and improves cognitive and social outcomes in both youth and adults. However, little is known whether mindfulness can mitigate against the adverse neurobiological and psychological effects of ELS. This study aimed to examine the feasibility of conducting a group mindfulness intervention in adolescents with ELS and provide preliminary indication of potential effects on stress-related biomarkers and mental health symptoms.

METHODS

Forty adolescents were randomized to receive either eight sessions of Mindfulness-Based Stress Reduction for Teens in group format (MBSR-T; n = 21) or Treatment as Usual Control group (CTRL; n = 17). Outcomes were assessed at baseline and follow-up and included measures associated with neurobiological functioning (immune and endocrine biomarkers) and self-reported mental health (depressive) symptoms. Linear mixed effects models were used to assess the effects of group and time on these outcome measures.

RESULTS

Sixteen of the 21 adolescents completed the intervention, attending an average of 6.5 sessions. The model examining cortisol responses to stress induction revealed medium effects trending toward significance (Cohen's d = .56) for anticipatory cortisol levels in the MBSR-T relative to CTRL groups. No significant effects were found in models examining C-reactive protein or interleukin 6 inflammatory markers. The model examining depressive symptoms revealed a medium effect for symptom reduction (Cohen's d = .69) in the MBSR-T relative to CTRL groups.

CONCLUSIONS

This study demonstrated feasibility of conducting a group-based MBSR-T intervention for adolescents with ELS. There was some evidence for efficacy on a symptom level with potential subtle changes on a biological level. Future larger studies are needed to determine the efficacy of group-based mindfulness interventions in this population.

TRIAL REGISTRATION

Identifier # NCT03633903 , registered 16/08/2018.

Mindfulness and Self-Regulation in a Summer Camp Setting: An EBP Project

BACKGROUND

Guidelines for pediatric mental/behavioral health promotion call for preventative mental health services. Previous studies have found mindfulness an effective approach to addressing self-regulation/behavior concerns. Behavioral and self-regulation concerns had been identified in a summer camp program held in a large urban setting. Camp directors sought methods to address concerns, nurture the whole child and improve the overall program.

PURPOSE

The purposes of this evidence-based practice (EBP) project in a summer day-camp setting were to (1) implement an evidence-based mindfulness program for children and (2) evaluate the impact on child self-regulation skills and behavior.

METHODOLOGY

Two questions consistent with the purpose guided this project: 1) How can a mindfulness program be implemented in a summer camp setting 2) What impact does a mindfulness program have on self-regulation of school age participants in a camp setting? To achieve the purpose of this EBP project, an eight-week program guided by the Mindful Schools© curricula was implemented in a summer day camp program in a large urban setting. Descriptive statistics and qualitative methods were used for evaluation of the program.

RESULTS

We were able to show a decrease in emotional distress and assess the mindful strategies which most connected with a school age population. In addition, camp counselor responses illuminated the value of dyad instruction approach in which child and counselors engaged in the Mindful Schools© guided program.

CONCLUSIONS

Use of an evidenced-based programs allows for sustainability of programs in community settings outside of schools setting to broaden the reach of mental health promotion in a pediatric population.

Stress management training and gratitude journaling in the classroom: an initial investigation in Indian context

Stress and allied difficulties are pervasive among school students in present times. This concern is further magnified in the Indian context with the large represention of young people in the population and limited resources to match. The present study aimed to evaluate the impact of a classroom based stress management training and gratitude journaling intervention (Flinchbaugh et al., 2012) among Indian adolescents. The intervention curriculum was adapted to suit the study context. A total of 238 students (57% males) from Grades 7–9 participated in this study. Participants were recruited from two schools, and their age ranged from 11 to 14 years. In each participating school, students were randomised at the classroom level into three intervention groups (Stress Management Training, Gratitude Journaling, combination of both), and one control group. Using a pre-test – post-test design, intervention impact on measures of well-being, life satisfaction, perceived stress, meaning, and engagement in the classroom was evaluated. Results suggested limited effectiveness of stress management training and gratitude journaling among participants in the present context. Plausible explanations for these findings are discussed. The study emphasizes the need for customised interventions to obtain optimal outcomes among diverse populations.

Risk Assessment and Crisis Intervention for Youth in a Time of Telehealth

For the last decade, there has been growing concern regarding the rising rates of youth engagement in self-injury and suicide. The worldwide outbreak of the coronavirus disease 2019 (COVID-19) has elevated these concerns due to increased risk factors pertaining to social, family, economic, and health stressors, in addition to changes to typical routines and support systems. Unfortunately, there are many barriers to at-risk youth being able to access evidence-based mental health services including cost, lack of trained providers, transportation issues, and physical distancing due to the pandemic. Providing school-based prevention and intervention programs that promote social, emotional, and behavioral well-being helps to address many of these barriers. This article highlights important considerations to providing these services in a school-based telehealth modality. Symptom clusters that put youth at risk of harm to self are described. Best practice therapeutic modalities that can be disseminated in a school-based telehealth modality, such as cognitive behavior therapy, dialectical behavior therapy, and mindfulness-based approaches, are reviewed. Although there is growing empirical literature for these school-based prevention and intervention approaches, additional research is needed to determine how to best support at-risk youth remotely.

Mindfulness-Based Interventions for Adolescent Social Anxiety: A Unique Convergence of Factors

Social anxiety disorder (SAD) is a debilitating and often chronic psychiatric disorder that typically onsets during early adolescence. Cognitive behavior therapy (CBT), the current "gold-standard" treatment for SAD, tends to focus on threat- and fear-based systems hypothesized to maintain the disorder. Despite this targeted approach, SAD ranks among the least responsive anxiety disorders to CBT in adolescent samples, with a considerable proportion of individuals still reporting clinically significant symptoms following treatment, suggesting that the CBT-family of interventions may not fully target precipitating or maintaining factors of the disorder. This gap in efficacy highlights the need to consider new therapeutic modalities. Accordingly, this brief review critically evaluates the emergent literature supporting the use of mindfulness-based interventions (MBIs) for treating adolescent SAD. MBIs may be particularly relevant for addressing maintaining factors within this diagnosis, as they may target and interrupt cycles of avoidance and de-motivation. Despite limitations in the relative lack of randomized controlled trials (RCTs) on this topic, a unique convergence of factors emerge from the extant literature that support the notion that MBIs may hold particular promise for attenuating symptoms of SAD in adolescents. These factors include: (1) MBIs demonstrate the ability to directly engage symptoms of SAD; (2) MBIs also show consistent reduction of anxiety, including symptoms of social anxiety in adolescent populations; and (3) MBIs demonstrate high rates of feasibility and acceptability in anxious adolescent samples. We briefly review each topic and conclude that MBIs are an encouraging treatment approach for reducing symptoms of social anxiety in adolescents. However, given the lack of research within MBIs for adolescent SAD in particular, more research is needed to determine if MBIs are more advantageous than other current treatment approaches.

An Evaluation of Yoga and Meditation to Improve Attention, Hyperactivity, and Stress in High-School Students

Objective: Problems with attention and stress are common in children and predict academic difficulties and other behavioral and emotional problems. Mind-body interventions such as yoga and meditation improve attention and reduce stress. In this study, we examined the impact of Hatha yoga on attention and stress in ninth graders. Design: A total of 174 ninth graders from a Texas high school were enrolled in the study. Teachers assigned students to a yoga group (YG) or control group (CG) based on their class schedule. The YG participated in 25-min Hatha yoga classes twice weekly over 12 weeks (n = 123). The CG included 51 students. Student self-reports on measures of inattention and hyperactivity (the strengths and weaknesses of ADHD [attention-deficit/hyperactivity disorder] symptoms and normal behavior rating scale for ADHD) and stress (perceived stress scale) were obtained at baseline and at 12 weeks. Results: There were no significant differences in baseline levels of inattention (p = 0.86), hyperactivity (p = 0.25), and perceived stress (p = 0.28) between the YG and CG. Regarding inattention scores, there was a significant interaction of group and time (b = -1.09, standard error [SE] = 0.30, p < 0.001). Pairwise t-tests showed a significant reduction in inattention for the YG (d = 0.27) but a significant increase in inattention for the CG. Regarding hyperactivity, there was no significant interaction of group and time (b = -0.43, SE = 0.26, p = 0.1). Pairwise t-tests demonstrated a significant reduction in hyperactivity for the YG (d = 0.22), but not the CG. The interaction of group and time was not significant in predicting the slope of change in perceived distress (b = -0.93, SE = 1.19, p = 0.43). Pairwise t-tests did not show a significant reduction in perceived distress for either group. Conclusion: These findings suggest that Hatha yoga may improve attention and hyperactivity in high school students.

Feasibility of a school-based mindfulness program for improving inhibitory skills in children with autism spectrum disorder

BACKGROUND

Executive dysfunction is prevalent in children with autism spectrum disorder (ASD), including prominent difficulties in the two facets of inhibition, as well as with selective attention. School-based mindfulness has been used in typically-developing children to improve executive functioning, though this has not been investigated in children with ASD. Therefore, the purpose of this study was to examine the efficacy of a school-based mindfulness program for improving inhibition (prepotent response inhibition and interference control) and selective attention in children with ASD.

METHOD

Using a quasi-experimental, pre-post design, an eight week school-based mindfulness program (Mindful Schools;https://www.mindfulschools.org/), was administered to students with ASD (n = 27) at a private, not-for-profit school for children with special needs. The Walk/Don't Walk test and the Color-Word Interference test were used to evaluate prepotent response inhibition and interference control, respectively. Selective attention was measured using a cancellation test.

RESULTS

Significant improvements followed the intervention for prepotent response inhibition and interference control (medium effect sizes), as well as for overall selective attention (large effect size).

CONCLUSIONS

The study's findings demonstrate that school-based mindfulness holds promise for increasing specific executive functioning abilities in children with ASD.

Effectiveness of mindfulness-based interventions on anxiety for children and adolescents: A systematic review and meta-analysis

AIM

This paper aims to investigate the extent to which mindfulness-based interventions serve to reduce anxiety in children and adolescents. A heterogeneous sample was used, including clinical and non-clinical population.

METHODS

A literature search of controlled intervention studies published up to December 31, 2016, was carried out in PubMed, Lilacs, Cochrane, Embase, PsycInfo, Opengrey and Teseo databases. The effect size was calculated by Cohen's d. The Cochran Q statistic and the I² index were used for the study of heterogeneity. An analysis was conducted using the random effects model.

RESULTS

829 articles were identified, of which 18 were finally selected. Of these, only three had statistically significant effect sizes. The overall combined result obtained was .013, but it did not result statistically significant (CI95% [-.102, .128].) The Q statistic was statistically significant (Q [18] = 28.497, P = . 39) and the I² index was 40.34%, indicating a moderate heterogeneity.

CONCLUSIONS

This meta-analysis did not obtain statistically significant results that could provide conclusions. In general, the studies analysed are small, of low power and have a marked heterogeneity, which implies that the findings are provisional and need to be supported by more robust studies. Although it cannot be ruled out that mindfulness-based interventions are not effective in the infant-juvenile population, it is also possible that this effect could not be detected due to the limited number of available studies. Larger investigations are needed, with sufficient statistical power and designs that control the variables potentially moderating, to establish clear conclusions.

Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials

BACKGROUND

Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta-analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design.

METHODS

A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty-three independent studies including 3,666 children and adolescents were included in random effects meta-analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta-analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition.

RESULTS

Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen's d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only.

CONCLUSIONS

This meta-analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled-up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action.

Mind & body practices in the treatment of adolescent anxiety

Although anxiety is the most common mental health condition among adolescents in the United States, the current standards of practice for treatment are expensive, may be difficult to obtain, and potentially harmful. Although mind and body practices show great promise in the treatment of adolescent anxiety, financial constraints, lack of education, and structural barriers can hinder the integration of these practices into primary care.

Brief mindfulness training for negative affectivity: A systematic review and meta-analysis

OBJECTIVE

Over the last 10 years, there has been a dramatic increase in published randomized controlled trials (RCTs) of brief mindfulness training (from single-session inductions to multisession interventions lasting up to 2 weeks), with some preliminary indications that these training programs may improve mental health outcomes, such as negative affectivity. This meta-analysis aimed to evaluate whether brief mindfulness training reliably reduces negative affectivity.

METHOD

PubMed, PsycINFO, and the Mindfulness Research Monthly Newsletter were systematically searched for brief mindfulness intervention RCTs assessing negative affectivity outcomes (e.g., depression, rumination, anxiety, stress). Sixty-five RCTs, including 5,489 participants predominantly without experience in meditation (64.64% female, mean age = 24.62), qualified for the meta-analytic review.

RESULTS

The meta-analysis revealed a small but significant effect of brief mindfulness training on reducing negative affectivity compared to control programs (g = .21, p < .001). The overall effect size was significantly moderated by participant characteristics: community samples (g = .41, p < .001) produced larger training effects compared to student samples (g = .14, p = .001; Qbetween p = .03). No significant effect size differences were found between clinical and nonclinical samples. However, when accounting for publication bias, the overall effect size of brief mindfulness training programs on negative affectivity was significantly reduced (g = .04).

CONCLUSIONS

Brief mindfulness training programs are increasingly popular approaches for reducing negative affectivity. This meta-analysis indicates that brief mindfulness training modestly reduces negative affectivity. Quantitative analyses indicated the presence of publication bias (i.e., unpublished null effect studies), highlighting the need to continue rigorous evaluation of brief mindfulness interventions. (PsycINFO Database Record

Gender differences in response to a school-based mindfulness training intervention for early adolescents

Mindfulness training has been used to improve emotional wellbeing in early adolescents. However, little is known about treatment outcome moderators, or individual differences that may differentially impact responses to treatment. The current study focused on gender as a potential moderator for affective outcomes in response to school-based mindfulness training. Sixth grade students (N = 100) were randomly assigned to either the six weeks of mindfulness meditation or the active control group as part of a history class curriculum. Participants in the mindfulness meditation group completed short mindfulness meditation sessions four to five times per week, in addition to didactic instruction (Asian history). The control group received matched experiential activity in addition to didactic instruction (African history) from the same teacher with no meditation component. Self-reported measures of emotional wellbeing/affect, mindfulness, and self-compassion were obtained at pre and post intervention. Meditators reported greater improvement in emotional wellbeing compared to those in the control group. Importantly, gender differences were detected, such that female meditators reported greater increases in positive affect compared to females in the control group, whereas male meditators and control males displayed equivalent gains. Uniquely among females but not males, increases in self-reported self-compassion were associated with improvements in affect. These findings support the efficacy of school-based mindfulness interventions, and interventions tailored to accommodate distinct developmental needs of female and male adolescents.

Supporting Students: A GRADE Analysis of the Research on Student Wellness and Classroom Mental Health Support

Recommendations derived from research evidence regarding program implementation in school-based mental health [SBMH] require knowledge of the intervention outcomes as well as the potential to translate program components into schools. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) analysis was applied to major areas of the SBMH literature in addressing the areas of effectiveness and the strength of recommendation in implementation. Nine areas were addressed: emotional intelligence, stigma reduction, mindfulness, anxiety, depression, addictions, suicide prevention, trauma, and eating disorders. Ninety-eight studies were retrieved across the nine areas. Effect sizes based on reported outcomes and estimates on the strength of recommendation were generated in each of the nine areas of interest. These results provide an overview of the quality of the evidence that will be of relevance to school personal in making program selections.

ADHD and Emotion Dysregulation Among Children and Adolescents

Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.

Einfluss von achtsamkeitsbasierten Interventionen auf Exekutive Funktionen im Kindesalter

Zusammenfassung. Exekutive Funktionen (EF) haben eine große Bedeutung in der kindlichen Entwicklung. Ziel der vorliegenden Übersichtsarbeit war es, bisherige Untersuchungen zum Einfluss von achtsamkeitsbasierten Methoden auf die Exekutiven Funktionen von Kindern systematisch zusammenzufassen. In einer entsprechenden Literaturrecherche wurden insgesamt 331 Studien zum Thema identifiziert. Nach Anwendung der Einschlusskriterien (Exekutive Funktionen als abhängige Variable, achtsamkeitsbasiertes Training als unabhängige Variable, Vorhandensein einer Kontrollgruppe, Alter der Kinder ≤ 13 Jahre) verblieben 10 Arbeiten. Die untersuchten Achtsamkeitstrainings waren sehr heterogen und häufig von den Forschern selbst entwickelt. Die meisten Studien verglichen Achtsamkeitstrainings mit nicht aktiven Kontrollgruppen (9/10) und führten kein Follow-up durch (9/10). Die Ergebnisse weisen darauf hin, dass sich Kinder durch ein Achtsamkeitstraining im Vergleich zu einer Kontrollgruppe in ihrer Aufmerksamkeitsleistung, Inhibitionsleistung, kognitiven Flexibilität und ihrem Arbeitsgedächtnis verbesserten. Es konnte vereinzelt ein Zusammenhang zwischen niedrigen Ausgangswerten in den EF und stärkeren Effekten der Trainingsprogramme nachgewiesen werden.

Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents

BACKGROUND

Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011.

OBJECTIVES

To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents.

SEARCH METHODS

We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field.

SELECTION CRITERIA

We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE.

MAIN RESULTS

We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect.

AUTHORS' CONCLUSIONS

Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.

Assessing Fidelity of Implementation (FOI) for School-Based Mindfulness and Yoga Interventions: A Systematic Review

As school-based mindfulness and yoga programs gain popularity, the systematic study of fidelity of program implementation (FOI) is critical to provide a more robust understanding of the core components of mindfulness and yoga interventions, their potential to improve specified teacher and student outcomes, and our ability to implement these programs consistently and effectively. This paper reviews the current state of the science with respect to inclusion and reporting of FOI in peer-reviewed studies examining the effects of school-based mindfulness and/or yoga programs targeting students and/or teachers implemented in grades kindergarten through twelve (K-12) in North America. Electronic searches in PsychInfo and Web of Science from their inception through May 2014, in addition to hand searches of relevant review articles, identified 312 publications, 48 of which met inclusion criteria. Findings indicated a relative paucity of rigorous FOI. Fewer than 10% of studies outlined potential core program components or referenced a formal theory of action, and fewer than 20% assessed any aspect of FOI beyond participant dosage. The emerging nature of the evidence base provides a critical window of opportunity to grapple with key issues relevant to FOI of mindfulness-based and yoga programs, including identifying essential elements of these programs that should be faithfully implemented and how we might develop rigorous measures to accurately capture them. Consideration of these questions and suggested next steps are intended to help advance the emerging field of school-based mindfulness and yoga interventions.

Mindfulness Training in Primary Schools Decreases Negative Affect and Increases Meta-Cognition in Children

Studies investigating the feasibility and impact of mindfulness programs on emotional well-being when delivered by school teachers in pre-adolescence are scarce. This study reports the findings of a controlled feasibility pilot which assessed acceptability and emotional well-being outcomes of an 8-week mindfulness program (Paws b) for children aged 7–9 years. The program was delivered by school teachers within a regular school curriculum. Emotional well-being was measured using self-report questionnaires at baseline, post-training and 3 months follow-up, and informant reports were collected at baseline and follow-up. Seventy one participants aged 7–9 years were recruited from three primary schools in the UK (training group n = 33; control group n = 38). Acceptability of the program was high with 76% of children in the training group reporting ‘liking’ practicing mindfulness at school, with a strong link to wanting to continue practicing mindfulness at school (p < 0.001). Self-report comparisons revealed that relative to controls, the training group showed significant decreases in negative affect at follow-up, with a large effect size (p = 0.010, d = 0.84). Teacher reports (but not parental ratings) of meta-cognition also showed significant improvements at follow-up with a large effect size (p = 0.002, d = 1.08). Additionally, significant negative correlations were found between changes in mindfulness and emotion regulation scores from baseline to post-training (p = 0.038) and baseline to follow-up (p = 0.033). Findings from this study provide initial evidence that the Paws b program in children aged 7–9 years (a) can be feasibly delivered by primary school teachers as part of the regular curriculum, (b) is acceptable to the majority of children, and (c) may significantly decrease negative affect and improve meta-cognition.

Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study

Recurrent headaches cause significant burden for adolescents and their families. Mindfulness-based interventions (MBIs) have been shown to reduce stress and alter the experience of pain, reduce pain burden, and improve quality of life. Research indicates that MBIs can benefit adults with chronic pain conditions including headaches. A pilot nonrandomized clinical trial was conducted with 20 adolescent females with recurrent headaches. Median class attendance was 7 of 8 total sessions; average class attendance was 6.10 ± 2.6. Adherence to home practice was good, with participants reporting an average of 4.69 (SD = 1.84) of 6 practices per week. Five participants dropped out for reasons not inherent to the group (e.g., extracurricular scheduling); no adverse events were reported. Parents reported improved quality of life and physical functioning for their child. Adolescent participants reported improved depression symptoms and improved ability to accept their pain rather than trying to control it. MBIs appear safe and feasible for adolescents with recurrent headaches. Although participants did not report decreased frequency or severity of headache following treatment, the treatment had a beneficial effect for depression, quality of life, and acceptance of pain and represents a promising adjunct treatment for adolescents with recurrent headaches.

Review: Effectiveness of mindfulness in improving mental health symptoms of children and adolescents: a meta-analysis

BACKGROUND

Mindfulness-based interventions (MBIs) are increasingly used in the management of various mental health disorders in children and adolescents. However, there is limited evidence about the efficacy of various interventions used.

METHOD

A systematic review was performed to examine the effects of different MBIs on mental health symptoms and quality of life in both clinical and nonclinical samples of children and adolescents using data from only randomized control trials. The studies were also assessed for quality. Based on the type of MBI, study population, and control arm we had three comparisons for meta-analyses.

RESULTS

Fifteen studies were included in the qualitative analysis but only 11 trials with comparable interventions and controls were included for meta-analyses. Mindfulness-based stress reduction/mindfulness-based cognitive therapy arm was more effective than nonactive control in the nonclinical populations. Acceptance commitment therapy was comparable to active treatments in patients in the clinical range. Other MBIs were also effective improving anxiety and stress but not depression in nonclinical populations compared to nonactive control.

CONCLUSIONS

Mindfulness-based interventions can be effective in children and adolescents with mental health symptoms. As there were significant limitations these results must be interpreted with caution.

Assessment and treatment of anxiety disorders in children and adolescents

Recent advances in the developmental epidemiology, neurobiology, and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social, and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity, and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive behavioral therapy (CBT) for the treatment of these conditions in youth and suggest that the combination of psychotherapy + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy.

Inner resources for survival: integrating interpersonal psychotherapy with spiritual visualization with homeless youth

Homeless youth have particular need to develop inner resources to confront the stress, abusive environment of street life, and the paucity of external resources. Research suggests that treatment supporting spiritual awareness and growth may create a foundation for coping, relationships, and negotiating styles to mitigate distress. The current pilot study tests the feasibility, acceptability, and helpfulness of an interpersonal spiritual group psychotherapy, interpersonal psychotherapy (IPT) integrated with spiritual visualization (SV), offered through a homeless shelter, toward improving interpersonal coping and ameliorating symptoms of depression, distress, and anxiety in homeless youth. An exploratory pilot of integrative group psychotherapy (IPT + SV) for homeless young adults was conducted in a New York City on the residential floor of a shelter-based transitional living program. Thirteen young adult men (mean age 20.3 years, SD = 1.06) participated in a weekly evening psychotherapy group (55 % African-American, 18 % biracial, 18 % Hispanic, 9 % Caucasian). Measures of psychological functioning were assessed at pre-intervention and post-intervention using the General Health Questionnaire (GHQ-12), Patient Health Questionnaire (PHQ-9, GAD-7), and the Inventory of Interpersonal Problems (IIP-32). A semi-structured exit interview and a treatment satisfaction questionnaire were also employed to assess acceptability following treatment. Among homeless young adults to participate in the group treatment, significant decreases in symptoms of general distress and depression were found between baseline and termination of treatment, and at the level of a trend, improvement in overall interpersonal functioning and levels of general anxiety. High utilization and treatment satisfaction showed the intervention to be both feasible and acceptable. Offered as an adjunct to the services-as-usual model at homeless shelters serving young adults, interpersonal psychotherapy with spiritual visualization (IPT + SV) in group appears to be a feasible and potentially useful treatment option for promoting improved mental health.

Mindfulness-based interventions in schools-a systematic review and meta-analysis

Mindfulness programs for schools are popular. We systematically reviewed the evidence regarding the effects of school-based mindfulness interventions on psychological outcomes, using a comprehensive search strategy designed to locate both published and unpublished studies. Systematic searches in 12 databases were performed in August 2012. Further studies were identified via hand search and contact with experts. Two reviewers independently extracted the data, also selecting information about intervention programs (elements, structure etc.), feasibility, and acceptance. Twenty-four studies were identified, of which 13 were published. Nineteen studies used a controlled design. In total, 1348 students were instructed in mindfulness, with 876 serving as controls, ranging from grade 1 to 12. Overall effect sizes were Hedge's g = 0.40 between groups and g = 0.41 within groups (p < 0.0001). Between group effect sizes for domains were: cognitive performance g = 0.80, stress g = 0.39, resilience g = 0.36, (all p < 0.05), emotional problems g = 0.19 third person ratings g = 0.25 (both n.s.). All in all, mindfulness-based interventions in children and youths hold promise, particularly in relation to improving cognitive performance and resilience to stress. However, the diversity of study samples, variety in implementation and exercises, and wide range of instruments used require a careful and differentiated examination of data. There is great heterogeneity, many studies are underpowered, and measuring effects of Mindfulness in this setting is challenging. The field is nascent and recommendations will be provided as to how interventions and research of these interventions may proceed.

Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series

A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g=.38, 95% CI=.11 - .64) to large (Hedges' g=1.32, 95% CI=.61 - 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.

The contribution of mindfulness-based therapies for children and families and proposed conceptual integration

BACKGROUND

  Mindfulness is the development of a nonjudgmental accepting awareness of moment-by-moment experience. Intentionally attending to one's ongoing stream of sensations, thoughts, and emotions as they arise has a number of benefits, including the ability to react with greater flexibility to events and sustain attention. Thus the teaching of mindfulness-based skills to children and their carers is a potential means of improving family relationships and helping children achieve more positive developmental outcomes through increased ability to sustain attention and manage emotions. We provide a review of recent studies evaluating mindfulness-based interventions targeting children, adolescents, and families in educational and clinical settings.

METHOD

  Searches were conducted of several databases (including Medline, PsychINFO and Cochrane Reviews) to identify studies that have evaluated mindfulness-based interventions targeting children, adolescents or families published since 2009.

RESULTS

  Twenty-four studies were identified. We conclude that mindfulness-based interventions are an important addition to the repertoire of existing therapeutic techniques. However, large-scale, methodologically rigorous studies are lacking. The interventions used in treatment evaluations vary in both content and dose, the outcomes targeted have varied, and no studies have employed methodology to investigate mechanisms of change.

CONCLUSIONS

  There is increasing evidence that mindfulness-based therapeutic techniques can have a positive impact on a range of outcome variables. A greater understanding of the mechanisms of change is an important future direction of research. We argue that locating mindfulness-based therapies targeting children and families within the broader child and family field has greater promise in improving child and family functioning than viewing mindful parenting as an independent endeavor.