A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children

Mindfulness-Based Interventions in Schools: Assessing the Evidence Base

OBJECTIVE

Mindfulness-based interventions are increasingly being used in schools to improve students' mental, emotional, and behavioral development. Although many mindfulness programs exist, the types of programs that are effective for specific age groups remain unclear. In this systematic review, the authors used established rating criteria to describe the level of evidence for school-based mindfulness interventions.

METHODS

A search of major databases, gray literature, and evidence base registries was conducted to identify studies published between 2008 and 2022 that focused on mindfulness interventions within school settings. The authors rated mindfulness interventions as having high, moderate, or low levels of evidence based on the number and rigor of studies with positive outcomes.

RESULTS

Of the 24 interventions identified across 41 studies, three interventions-Learning to BREATHE, Mindfulness in School Project, and mindfulness-based stress reduction (MBSR)-received a rating of high level of evidence. Three interventions-Gaia Program, MindUP, and a blended version of MBSR and mindfulness-based cognitive therapy-received a rating of moderate level of evidence. The interventions rated as having a high level of evidence were conducted with middle or high school students, and interventions with moderate evidence were also conducted with elementary students, demonstrating effectiveness of mindfulness across a range of age groups. Few studies examined outcomes for underserved populations.

CONCLUSIONS

With greater use and more research, mindfulness interventions have the potential to promote student well-being and prevent mental health conditions.

Associations between mindfulness and symptom severity among adults living with chronic obstructive pulmonary disease (COPD)

BACKGROUND

Mindfulness-based interventions (MBI) benefit adults with chronic obstructive pulmonary disease (COPD) by helping them manage their symptoms and improve their quality of life. Little is known about their baseline mindfulness knowledge and practice and how these may relate to symptom management.

OBJECTIVES

To 1) compare symptom severity scores of depression, anxiety, dyspnea, fatigue, and insomnia between those who know and practice mindfulness and those who do not, and 2) construct phenotype profile characteristics of COPD patients based on their levels of mindfulness.

METHODS

339 community-dwelling adults (mean age 53.43±13.48 years, 61.28 % male, and 48.21 % White) completed an online cross-sectional survey study indicating their mindfulness knowledge, practice, level, and COPD symptom severity. After adjusting for multiple comparisons among the three groups, we used Kruskal-Wallis, Fisher's exact, and Chi-squared tests to compare variables' differences among these three mindfulness levels.

RESULTS

Participants who self-identified as knowledgeable about mindfulness (n = 315) reported significantly lower severity of dyspnea and fatigue. Participants who self-identified as current practitioners of mindfulness (n = 282) reported substantially lower symptom severity. Among the different mindfulness groups, levels of phenotype profile analysis showed statistically significant differences in demographic and clinical characteristics, including depressive symptoms, age, ethnicity, education level, and years living with COPD. We found no differences in gender or disease severity levels.

CONCLUSIONS

Community-dwelling adults with COPD who practiced mindfulness reported lower symptom severity than those who did not. This suggests the potential benefits of MBI integration as a complementary health approach to symptom management. The mindfulness level phenotype profile is critical to tailoring MBIs. It can guide the design and delivery of MBIs with optimal feasibility, acceptability, effectiveness, and sustained adherence for adults with COPD according to their mindfulness level profiles.

An exploratory cluster-randomized controlled trial on mindfulness yoga's effectiveness in school-refusing children: reductions in SCAS-C physical injury fears and pulse rate

Introduction

School refusal is one of the serious problems with children's mental health, and various studies have examined its prevalence and factors among students. Although many studies suggested that anxiety and depression are deeply associated with school refusal, there is little agreement as to effective interventions. The purpose of this paper is to evaluate the efficacy and safety of mindfulness yoga intervention in children with school refusal.

Method

This study is a multicenter, exploratory, open cluster-randomized controlled trial. 43 participants aged 10-15 years with school refusal were randomly assigned to a non-yoga group with treatment as usual (TAU) which includes cognitive behavioral therapy based on self-monitoring, or a yoga group (4-week mindfulness yoga program provided by video sessions + TAU). The primary outcome was symptoms of anxiety evaluated by Spence Children's Anxiety Scale-Children (SCAS-C). Participants were assessed in four time periods: a 2-week baseline (Day -14), a baseline (Day 1), a post-test after 4 weeks of treatment (Day 29), and an 8-week follow-up (Day 85). Statistical analysis was conducted by a linear mixed effect model using SAS version 9.4.

Results

43 participants were included in the Full-analysis set (FAS) (21 in the mindfulness yoga group and 22 in the non-yoga group). The estimates of SCAS-C at post-test adjusted for baseline values in each treatment group were 39.9 in the mindfulness yoga group and 39.4 in the non-yoga group. The between-group difference for the estimates was 0.4 (80%CI -4.8 to -5.6, p = 0.54), which indicated mindfulness yoga program has no significant effect on anxiety compared with TAU. However, on an exploratory analysis of the subscale of SCAS-C, significant improvement was observed on the Physical Injury Fears subscale. The pulse rate was significantly lower in the yoga group compared to the non-yoga group.

Conclusion

This study indicated the safety of a mindfulness yoga intervention for children with school refusal, but the effectiveness of the intervention for anxiety was limited. Further research is needed to determine the long-term effects of yoga and how it can best be integrated with other therapies.

Chanting and meditation: an 8-week intervention to promote executive functions in school-age children

The present study investigated the effectiveness of a newly developed 8-week meditation program, which included chanting and meditation, on executive functions (EFs) in school-age children. Twenty-five students assigned to an experimental group participated in the meditation program, engaging in daily and weekly activities for 8 weeks. Another 25 students served as a control group and participated in regular school activities. Pretest and posttest assessments included the n-back task for working memory, the go/no-go task for inhibition, and the Wisconsin Card Sorting Test (WCST) for cognitive flexibility. A mixed repeated measures ANOVA was conducted to analyze interaction effects, within-group differences, and between-group differences. The experimental group demonstrated greater improvement compared to the control group across several measures: (1) reaction time in the 1-back task, (2) correct responses in the no-go condition of the go/no-go task, and (3) percentage of correct responses, errors, perseverative errors, non-perseverative errors, perseverative responses, and conceptual level responses in the WCST (p < 0.001). These findings underscore the potential benefits of an 8-week school-based meditation program incorporating chanting and meditation for enhancing EFs in school-age children.

Differential effects of digital mindfulness-based interventions on creative potential and responsibility among middle school students

BACKGROUND

Creativity and responsibility are enhanced by meditation among adults, but such effects have not been studied in adolescents. Moreover, the determinants of the ethical effect (such as responsibility) of meditation are unclear.

AIMS

To address this gap by investigating the impact of digital in-class meditation programmes in middle school, focusing on intentions (self-centred vs. responsibility-centred), on adolescents' creative potential and sense of responsibility. These intentions are operationalized by different purpose-based meditations.

METHODS

We conducted a cluster randomized controlled trial involving 107 year 7 adolescents from six classes, assigning them to two experimental groups and an active control group. Pre- and post-intervention assessments were conducted over an 11-week period, including a creativity (EPoC) test comprising four exercises (graphic and verbal, divergent and convergent thinking), a responsibility and a mindfulness scale.

RESULTS

Our findings revealed no discernible effects on divergent thinking or self-reported mindfulness. However, we observed significant differences in graphic and verbal convergent creative thinking, as well as impacting responsibility scores, between a responsibility-centred meditation group and a self-centred meditation group. Moreover, distinctions were noted between control and self-centred meditation groups and between some classes. Effect sizes indicated that the interventions had a moderate but significant impact on the variables measured.

CONCLUSION

Our study reveals the effectiveness of digital meditation interventions in enhancing convergent creative thinking and responsibility among middle-school students. Notably, it shed new light on the importance of meditation intentions, which may be as significant as the form of meditation itself.

Mental Health Interventions in Middle Schools: A 10-Year Review of Research

Schools can play an important role in addressing growing concerns about adolescent mental health. Mental health of high school students has predominantly been the focus in literature with less emphasis on younger adolescents. This review identified articles published in the last decade that described evaluations of middle school-based mental health interventions and randomized participants to an intervention or control condition. Fourteen interventions met the inclusion criteria. About two-thirds of interventions were based on mindfulness or cognitive behavioral therapy. Many trials utilized racially diverse, low-income samples. All interventions were delivered to groups, and three contained a parent component. Five trials increased rigor by using an active control condition. Almost two-thirds of the interventions were effective (p < .10) in reducing at least one depression, anxiety, affect, or internalizing symptom outcome compared to a control group. This article provides information about intervention characteristics, efficacy, theoretical framework, and acceptability/feasibility.

Teachers' stress and training in a school-based mindfulness program: Implementation results from a cluster randomized controlled trial

School-based mindfulness trainings (SBMT) are a contemporary approach for intervening to promote students' social and emotional skills and well-being. Despite evidence from the larger field of evidence-based social and emotional learning programs demonstrating the importance of high-quality implementation, few studies have investigated factors impacting the implementation of SBMTs, particularly teacher-level influences. The present study addressed this issue by investigating whether teachers' stress, trust in their fellow teachers and principal, and expectations about the program at baseline predicted the quality of their implementation of a SBMT for students. In addition, we examined whether teachers' stress at baseline moderated the effect of training condition on implementation quality. Implementation quality was assessed via observations and teacher self-reports. Results from a sample of British secondary (middle-high) school educators (N = 81) indicated that teachers who felt more supported by their principals at baseline were later observed to implement the SBMT with greater quality, whereas teachers who had more positive expectations about the program felt more confident teaching the course in the future. Teachers' baseline stress moderated the effect of training condition on all measures of implementation quality; among teachers experiencing high stress at baseline, more intensive training led to higher quality implementation. Implications for practitioners and prevention researchers are discussed.

Short-term meditation training alters brain activity and sympathetic responses at rest, but not during meditation

Although more people are engaging in meditation practices that require specialized training, few studies address the issues associated with nervous activity pattern changes brought about by such training. For beginners, it remains unclear how much practice is needed before objective physiological changes can be detected, whether or not they are similar across the novices and what are the optimal strategies to track these changes. To clarify these questions we recruited individuals with no prior meditation experience. The experimental group underwent an eight-week Taoist meditation course administered by a professional, while the control group listened to audiobooks. Both groups participated in audio-guided, 34-min long meditation sessions before and after the 8-week long intervention. Their EEG, photoplethysmogram, respiration, and skin conductance were recorded during the mediation and resting state periods. Compared to the control group, the experimental group exhibited band-specific topically organized changes of the resting state brain activity and heart rate variability associated with sympathetic system activation. Importantly, no significant changes were found during the meditation process prior and post the 8-week training in either of the groups. The absence of notable changes in CNS and ANS activity indicators during meditation sessions, for both the experimental and control groups, casts doubt on the effectiveness of wearable biofeedback devices in meditation practice. This finding redirects focus to the importance of monitoring resting state activity to evaluate progress in beginner meditators. Also, 16 h of training is not enough for forming individual objectively different strategies manifested during the meditation sessions. Our results contributed to the development of tools to objectively monitor the progress in novice meditators and the choice of the relevant monitoring strategies. According to our findings, in order to track early changes brought about by the meditation practice it is preferable to monitor brain activity outside the actual meditation sessions.

Mindfulness-based interventions for preadolescent children: A comprehensive meta-analysis

Among the many social and emotional learning (SEL) interventions available, mindfulness-based interventions (MBIs) have become increasingly popular, particularly for preadolescent children who were once thought to not possess the metacognitive abilities or cognitive resources to benefit from such training. Although previous research syntheses indicate that MBIs show promise in promoting positive outcomes across a range of domains, the effectiveness of MBIs for preadolescent children may be masked by the effects of older children who have comprised the majority of samples in past meta-analyses. Hence, to better understand the impact of mindfulness-based training on preadolescent children (ages 6-12 years), the present study reviewed treatment effect estimates across a range of outcomes, including mindfulness, attention, metacognition and cognitive flexibility, emotional and behavioral regulation, academic achievement and school functioning, positive emotion and self-appraisal, negative emotion and subjective distress, externalizing problems, internalizing problems, social competence and prosocial behavior, and physical health. Thirty-two studies (nparticipants = 3640) were identified and included in a random-effects meta-analyses. The results from multiple meta-analytical analyses conducted in the present study suggest that preadolescents have experienced significant benefits across attention, emotional and behavioral regulation, positive emotion and self-appraisal, and social competence and prosocial behavior (g = 0.19 to 0.39). However, the overall effect was deemed small (g = 0.34). Due to the lack of comparison studies with SEL interventions, it remains unclear whether MBIs are as effective as traditional approaches in promoting healthy development and academic achievement for preadolescent children. Additionally, results from the present meta-analysis suggest various recommendations for future studies to ensure a continued growth in understanding how MBIs can be used with children.

The Challenge of Accounting for the Moderator Effect of Risk Exposure on the Effectiveness of Mindfulness-Based Treatments for Youth

Although many positive psychology interventions like mindfulness-based treatments (MBTs) for youth have been used with a wide array of risk exposed populations (children living in poverty, victims of violence, displaced persons, children with disabilities, etc.), the efficacy of MBTs with regard to the level and domain of risk exposure has been largely overlooked. This oversight contributes to a perception of positive psychology as being decontextualized. The purpose of this meta-analysis is to better understand how a young person's level and domain of risk exposure influences the efficacy of MBTs. Published studies were included if participants were children or adolescents, were RCTs or cluster RCTs, and focused on the effect of an MBT or an MBT component. Specifically, 58 studies were qualitatively analyzed and 42 were quantitatively analyzed. The qualitative analysis evidenced a lack of objectivity in the assessment of risk exposure, with many papers providing very little or no detail on participants' level or domain of risk exposure (whether threats to psychological wellbeing originate with the individual's biology or cognitions, or the social, built or natural environment). Our quantitative analysis showed that MBTs significantly improved main outcomes relative to the control conditions, with a small-to-moderate effect size. Where it was possible to identify the level of risk exposure, we found that MBTs positively moderated treatment response, with better response among those participants with a higher level of risk. We conclude that future Positive Psychology research will need to better account for risk exposure if the discipline is to improve our understanding of which populations benefit most from interventions that promote mindfulness.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41042-023-00145-y.

Promoting well-being in early adolescents through mindfulness: A cluster randomized controlled trial

OBJECTIVES

The Gaia program is a 12-week mindfulness intervention based on cultivating body, emotional, and ecological self-awareness, which has been shown to be effective in reducing children's and adolescents' internalizing problems at school. This paper presents the results of a cluster randomized controlled trial aimed at assessing the effectiveness of this program on improving psychological well-being, subjective well-being, and psychological distress in early adolescents.

METHODS

A sample of 195 early adolescent students (boys, n = 99; girls, n = 96) with a mean age of 11.49 years (standard deviation = 0.80) attending 12 middle school classes participated in the study. Seven Gaia instructors belonging to six schools led the program. Measures were administered at three time points, approximately every 3 months: 1 week before treatment, 1 week after treatment, and 3 months after treatment. We used a multilevel regression model to test whether treatment was effective in increasing psychological well-being and subjective well-being, and reducing psychological distress, as compared to a waiting-list control group.

RESULTS

The results showed that the Gaia program improved psychological well-being but not subjective well-being and psychological distress. Specifically, the Gaia program was effective in increasing personal growth and purpose in life, the key eudaimonic components of psychological well-being, in the experimental group whereas they decreased in the control group.

CONCLUSIONS

Findings from this study provide preliminary evidence that the Gaia program for early adolescents may improve the core eudaimonic components of psychological well-being from pretest to follow-up that, conversely, decrease in the control group.

Rural sixth-grade teachers' and students' perceptions of a mindfulness-based mental health curriculum

Introduction

Mindfulness-based interventions (MBIs) have the potential to improve students' mood, behavior and cognitive functioning; yet, little is known about the feasibility and acceptability of adapting such programs for rural middle schools.

Methods

An exploratory qualitative evaluation was conducted to examine the feasibility and acceptability of an initial trial delivery of AttuneEd®, a trauma-informed, mindfulness-based mental health curriculum. In this single-group design study, 10 weekly lessons were taught in a middle school located in a rural town in the pacific northwest during 6th grade students' P.E. classes. Three P.E. teachers, 26 6th grade teachers, and one school counselor attended trainings before and mid-curriculum implementation, where they provided qualitative feedback. A total of 160 students completed acceptability surveys before and after curriculum delivery.

Results

Three themes were identified from qualitative data: cultural considerations, teacher self-efficacy, and barriers and facilitators to student acceptability. Student acceptability ratings were high. Students reported, on average, that the classes helped them better understand themselves and others.

Conclusion

Some identified needs for future MBIs include (1) the need for culturally sensitive, trauma-informed delivery strategies; (2) teachers' desire for more support in content delivery; and (3) students' desire to have their own teachers deliver the curriculum. Findings elucidate the nuances associated with implementing an MBI in a rural middle school and have notable implications for development, scalability, and sustainability.

The contribution of mindfulness in the association between L2 learners' engagement and burnout

There has been recently a growing interest in L2 learners' engagement as a central factor in their success. However, not all L2 learners are engaged intellectually, passionately, and behaviorally in L2 learning and this can be due to their experience of burnout in language educational settings. On the other hand, L2 learners frequently encounter heightened degrees of burnout because of emotional and behavioral disengagement. To relieve the relationship between engagement and burnout, the influential technique known as mindfulness, as a coping mechanism for enhancing engagement and reducing burnout among L2 learners, has emerged. Given this conceptual model, the purpose of this paper is to argue the mediator role of mindfulness, in light of self-determination and self-control theory, between L2 students' engagement and burnout. A few directions for future inquiries are discussed following this review.

Effectiveness and mechanisms of change of a mindfulness-based intervention on elementary school children: A cluster-randomized control trial

Mindfulness-based interventions (MBIs) in the school context are increasingly widespread worldwide. The present study evaluates the effectiveness of a school-MBI (GrowingUp Breathing program) on children's socio-emotional and academic development. Three hundred thirteen elementary students from 7 to 12 years old from two schools in Madrid (Spain) participated. A cluster-randomized control trial was designed, assigning eight classrooms to the MBI-group (N = 155) and eight classrooms to the waiting-list control group (N = 158). Measures were evaluated at pre- and post-intervention in both groups and a 3-month follow-up was collected in the MBI-group. Children self-reported their mindfulness skills (i.e., dispositional mindfulness and psychological inflexibility) and well-being (i.e., anxiety and life satisfaction) and teachers evaluated children's social-emotional competence (i.e., emotion regulation, peer-relationship problems, and prosociality), well-being (i.e., emotional symptoms), and academic competence (i.e., student engagement and academic achievement). Mindfulness skills and emotional regulation were examined as potential mediators. Results revealed that children who received the MBI, compared to children in the WLC-group, improved their mindfulness skills, emotion regulation, prosociality, and emotional and behavioral engagement and decreased anxiety and peer-relationship problems. Positive changes in dispositional mindfulness led to reductions in children's anxiety and psychological inflexibility. Positive changes in emotional regulation led to improvements in prosociality and student engagement and decreased peer-relationships problems and emotional symptoms. Therefore, the results showed that a brief-MBI integrated in the Spanish regular school curriculum enhanced children's socio-emotional and academic development. Dispositional mindfulness and emotion regulation work as processes of change that underlie the intervention's impact.

Mindfulness-based programs and school adjustment: A systematic review and meta-analysis

Mindfulness-based programs (MBPs) are increasingly used in educational institutions to enhance students' mental health and resilience. However, reviews of the literature suggest this use may have outpaced the evidence base and further research is needed to better understand the mechanisms underlying these programs' effectiveness and which outcomes are being affected. The purpose of this meta-analysis was to investigate the strength of MBPs' effects on school adjustment and mindfulness outcomes while also considering the potential influence of study and program characteristics, including the role of comparison groups, students' educational level, the type of program being used, and the facilitator's training and previous mindfulness experience. Following a systematic review of five databases, 46 studies using a randomized controlled design with students from preschool to undergraduate levels were selected. At post-program, the effect of MBPs compared to control groups was (a) small for overall school adjustment outcomes, academic performance, and impulsivity; (b) small to moderate for attention; and (c) moderate for mindfulness. No differences emerged for interpersonal skills, school functioning, or student behaviour. The effects of MBPs on overall school adjustment and mindfulness differed based on students' educational level and the type of program being delivered. Moreover, only MBPs delivered by outside facilitators with previous experience of mindfulness had significant effects on either school adjustment or mindfulness. This meta-analysis provides promising evidence of the effectiveness of MBPs in educational contexts to improve students' school adjustment outcomes beyond typically assessed psychological benefits, even when using randomized controlled designs.

Effects of attention bias modification for anxiety: Neurophysiological indices and moderation by symptom severity

OBJECTIVE

Attention bias modification (ABM) aims to decrease anxiety symptom severity through the reduction of threat-related attention bias (AB). Individual differences in treatment response and poor measurement reliability of AB have called its clinical promise into question. The current study examined whether individual differences in anxiety severity at baseline moderated treatment response, and employed both behavioral and neurophysiological metrics of AB.

METHODS

Participants (N = 99) were randomly assigned to four weeks of ABM or placebo control training (PT). Self-reported anxiety symptom severity, and AB metrics and ERPs generated during the dot probe task were collected at baseline (Time 1), one-week post-intervention (Time 5), and at a three-month follow-up (Time 6).

RESULTS

ABM, relative to PT, reduced ERPs indexing attention discrimination (N170) and increased ERPs indexing salience tracking (P3). Increases in P3 were associated with ABM-related reductions in anxiety. Anxiety severity was reduced following ABM, but only among those with higher baseline anxiety symptom severity.

CONCLUSIONS

ABM effectively reduced symptom severity among those with higher levels of anxiety, and modulated neurophysiological indices of AB.

SIGNIFICANCE

Results provide evidence for attention-relevant ERPs as outcomes of ABM treatment responsivity and suggest that ABM may be most beneficial for those with more severe anxiety symptoms.

The effect of mindfulness-based intervention on neurobehavioural functioning and its association with white-matter microstructural changes in preterm young adolescents

Very preterm (VPT) young adolescents are at high risk of executive, behavioural and socio-emotional difficulties. Previous research has shown significant evidence of the benefits of mindfulness-based intervention (MBI) on these abilities. This study aims to assess the association between the effects of MBI on neurobehavioral functioning and changes in white-matter microstructure in VPT young adolescents who completed an 8-week MBI program. Neurobehavioural assessments (i.e., neuropsychological testing, parents- and self-reported questionnaires) and multi-shell diffusion MRI were performed before and after MBI in 32 VPT young adolescents. Combined diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) measures were extracted on well-defined white matter tracts (TractSeg). A multivariate data-driven approach (partial least squares correlation) was used to explore associations between MBI-related changes on neurobehavioural measures and microstructural changes. The results showed an enhancement of global executive functioning using parent-reported questionnaire after MBI that was associated with a general pattern of increase in fractional anisotropy (FA) and decrease in axonal dispersion (ODI) in white-matter tracts involved in executive processes. Young VPT adolescents with lower gestational age at birth showed the greatest gain in white-matter microstructural changes after MBI.

Delving into the role of mindfulness on the relationship among creativity, anxiety, and boredom of young EFL learners

Anxiety may contribute to agitation and distress in learners that can influence learning. Along with anxiety, boredom has been the focus of many recent investigations in the context of second language (L2) learning involving young learners. Anxiety and boredom would limit learners' imagination power, and can deter creativity, one of the indispensable skills in the 21st century. Mindfulness is another construct that is in line with creativity and its perspective to control anxiety is assured in literature. The proposed programs of mindfulness can influence creativity positively in the moment and over time. This is made possible by enhancing the level of the person's attention on daily activities which yields creative outcomes. In a world where stress and, often, distress undermine creativity, mindfulness emerges as an essential contributor to learners' success in educational practice. The current review focuses on young English as a foreign language (EFL) learners given that many believe stress and anxiety are commonplace among youth, leading to a decrease in creativity. Research findings reveal that mindfulness enhances creativity. Therefore, the improvement of students' well-being can be achieved by gradually incorporating mindfulness into the educational domain. Considering the important role of these factors in the language learning process, the purpose of this review is to examine the possible interactional effect of mindfulness in relation to creativity, learners' anxiety, and boredom in the context of L2 education among young learners. This is followed by proposing some suggestions for future research, as well as pedagogical implications.

Mitigating EFL students' academic disengagement: The role of teachers' compassion and mindfulness in China

There has newly been a lot of interest in higher education literature and policy on the notions of learner engagement and disengagement. Learner disengagement is a continuous difficulty in academic circumstances. To mitigate learners' disengagement, some factors seem interesting to be taken into consideration by scholars. One of them is mindfulness, defined as a resting strategy that is related to constructive influences when utilized as a coping mechanism for anxiety and apprehension. Furthermore, compassion is another factor that is regarded as a central dimension of the exercise of mindfulness. It refers to understanding how to be available, compassionate, and sympathetic towards oneself and others. Regarding the significance of these factors, the objective of this review is to investigate the role of mindfulness and compassion in reducing learners' educational disengagement in language education. Finally, future directions as well as educational implications for educational stakeholders are introduced following this review.

Characteristics of Mindfulness-Based Interventions in Schools: a Systematic Review in School Psychology Journals

Mindfulness-based interventions (MBIs) have been evaluated in terms of efficacy; however, little is known about implementation factors of MBIs in schools. The purpose of the current study was to systematically review MBI studies published in school psychology journals. This systematic review examined peer-reviewed MBI literature in nine school psychology journals from 2006 to 2020 to examine prevalence of MBI intervention studies, specific techniques taught in MBIs, if and how fidelity of MBI implementation was evaluated, and how mindfulness skills were measured for youth participating in MBIs. A total of 46 articles (out of 4415) were related to mindfulness and 23 articles (0.52%) focused on the implementation of MBIs in schools. Nine different mindfulness techniques were implemented as part of MBIs in studies with some of the most common including awareness, breathing, and meditation. This study also found scarce evidence of implementation fidelity, and limited use of mindfulness measures within MBI studies. Future research and limitations are also discussed.

Childhood maltreatment and suicidal ideation in Chinese children and adolescents: the mediating role of mindfulness

BACKGROUND

Childhood maltreatment (CM) has been associated with suicidal ideation (SI) in children and adolescents, yet the mediating role of mindfulness in this association remains unclear. This study aims to test the mediation of mindfulness in CM-SI association among a large sample of Chinese children and adolescents.

METHODS

A population-based cross-sectional study of 3455 children and adolescents aged 10-17 years from southwest China Yunnan province was conducted. Information from the participants was collected by using a comprehensive self-administered questionnaire. The Chinese version of the Childhood Trauma Questionnaire (CTQ), Five Facet Mindfulness Questionnaire (FFMQ), and the Beck Scale for Suicidal Ideation (BSSI) were used to measure CM, mindfulness and SI. Univariate and multivariate binary logistic regression models were used to estimate the crude and adjusted associations between CM, mindfulness and SI (one-week, one-year, lifetime). Pathway analysis was subsequently performed to test the mediation of mindfulness in CM-SI association.

RESULTS

The findings showed that mindfulness, CM and SI were significantly correlated with each other (p &lt; 0.05). Mindfulness is a significant mediator in CM-SI association, accounted for 7.5, 11.4, and 17.6% of the total associations for one-week SI, one-year SI, and lifetime SI, respectively. For the five types of CM, the highest level of mediation via mindfulness had been found for physical neglect (PN) and one-year SI (34.3%), followed by emotional neglect (EN) and one-year SI (30.2%), sexual abuse (SA) and one-year SI (25.4%).

CONCLUSIONS

Our study findings highlight the intervention potential of mindfulness in preventing CM associated suicidal risk. Future longitudinal studies are warranted to corroborate the effectiveness of mindfulness-based intervention for Chinese children and adolescents.

The effects of yoga on mental health in school-aged children: A Systematic Review and Narrative Synthesis of Randomised Control Trials

It is becoming increasingly common for frontline clinicians to see children and teenagers struggle with their mental health. Since mental health issues have increased over the past ten years in the UK, they are now the leading cause of disability and cost the British economy £105 billion annually. The review discusses the evidence base underpinning the effect of yoga on children's mental health and summarises the results of 21 research papers. The Cumulative Index to Nursing and Allied Health Literature, PsycINFO, ERIC, Web of Science, PubMed, Medline and Cochrane Library were searched through Ovid from January 2008 until May 2022. The keywords 'yoga OR mindfulness - AND school AND children OR child OR youth OR adolescent' were used. The search was limited to studies in the English language. The quality of each study was rated against Version 2 of the Cochrane risk-of-bias tool for randomised control trials and a set of inclusion and exclusion criteria. The evidence for yoga therapies in children is encouraging, although studies include methodological flaws such as small sample sizes and sparse information on interventions. This review has highlighted that yoga interventions may be implemented in schools as a preventative and therapeutic measure for mental health issues.

Understanding the Needs of Primary School Teachers in Supporting Their Students' Emotion Regulation

BACKGROUND

Accumulating evidence has underscored the importance of fostering children's emotion regulation (ER) within primary school settings and the role of teachers in such efforts. This study sought to assess the needs of teachers in supporting students' ER, through a better understanding of teachers' perceptions and use of healthy versus unhealthy ER strategies in the classroom.

METHODS

Primary school teachers (n = 212; 91% female) completed an online, researcher-developed needs assessment survey assessing their perceptions regarding the importance of ER instruction and challenges surrounding children's ER, as well as the perceived effectiveness and reported use of healthy and unhealthy ER strategies in the classroom.

RESULTS

Cochran's Q and chi-square analyses revealed misperceptions regarding the effectiveness of healthy and unhealthy strategies, as well as discrepancies between teachers' perceptions regarding the effectiveness of specific healthy strategies (eg, meditation) and their reported use of them.

CONCLUSIONS

While teachers recognize the growing importance of fostering ER in the classroom, the present findings suggest that there is a need for more professional development regarding the effectiveness and implementation of ER strategies in the primary school context. Efforts should be made to provide teachers with concrete recommendations for the implementation of ER strategies in the classroom.

Universal Mindfulness Training in Schools for Adolescents: a Scoping Review and Conceptual Model of Moderators, Mediators, and Implementation Factors

There is evidence that universal school-based mindfulness training (SBMT) can have positive effects for young people. However, it is unknown who benefits most from such training, how training exerts effects, and how implementation impacts effects. This study aimed to provide an overview of the evidence on the mediators, moderators, and implementation factors of SBMT, and propose a conceptual model that can be used both to summarize the evidence and provide a framework for future research. A scoping review was performed, and six databases and grey literature were searched. Inclusion and exclusion criteria were applied to select relevant material. Quantitative and qualitative information was extracted from eligible articles and reported in accordance with PRISMA-ScR guidelines. The search produced 5479 articles, of which 31 were eligible and included in the review. Eleven studies assessed moderators of SBMT on pupil outcomes, with mixed findings for all variables tested. Five studies examined the mediating effect of specific variables on pupil outcomes, with evidence that increases in mindfulness skills and decreases in cognitive reactivity and self-criticism post-intervention are related to better pupil outcomes at follow-up. Twenty-five studies assessed implementation factors. We discuss key methodological shortcomings of included studies and integrate our findings with existing implementation frameworks to propose a conceptual model. Widespread interest in universal SBMT has led to increased research over recent years, exploring who SBMT works for and how it might work, but the current evidence is limited. We make recommendations for future research and provide a conceptual model to guide theory-led developments.

Mindfulness-based school interventions: A systematic review of outcome evidence quality by study design

Objective

The purpose of this systematic review was to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth.

Methods

We evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust coding system for evidence-based guidelines. Coders rated each study numerically per study design as 1++ (RCT with a very low risk of bias) to 4 (expert opinion) and across studies for the corresponding evidence letter grade, from highest quality ('A Grade') to lowest quality ('D Grade') evidence.

Results

The highest quality evidence ('A Grade') across outcomes indicated that MBSIs increased prosocial behavior, resilience, executive function, attention and mindfulness, and decreased anxiety, attention problems/ADHD behaviors and conduct behaviors. The highest quality evidence for well-being was split, with some studies showing increased well-being and some showing no improvements. The highest quality evidence suggests MBSIs have a null effect on depression symptoms.

Conclusion

This review demonstrates the promise of incorporating mindfulness interventions in school settings for improving certain youth outcomes. We urge researchers interested in MBSIs to study their effectiveness using more rigorous designs (e.g., RCTs with active control groups, multi-method outcome assessment, and follow-up evaluation), to minimize bias and promote higher quality-not just increased quantity-evidence that can be relied upon to guide school-based practice.

Review: Meta-analysis on mindfulness-based interventions for adolescents' stress, depression, and anxiety in school settings: a cautionary tale

BACKGROUND

Mindfulness-based interventions (MBIs) have been applied in school settings for adolescents with symptoms of stress, depression, and anxiety; however, general conclusions of the efficacy of such interventions remain unclear. This meta-analysis reviewed randomized-controlled MBI trials for stress, depression, and anxiety in school settings.

METHODS

One hundred one records were included after removing duplicates. Nine studies met inclusion criteria, totalling 5046 adolescents aged 12-18. Eighteen comparisons between an MBI and a control group were analyzed.

RESULTS

The overall effect for symptoms of the 17 observations including stress, depression, and anxiety resulted in a significant improvement with a small effect size (k = 17, n = 3721, Hedge's g = .33, CI 95% .17-.49 p < .01). Subgroup analysis revealed that when MBIs were compared to an active control group effects were not significant (k = 5, n = 2753, Hedge's g = .27, CI 95% -.03-.57 p = .08), and when compared to an inactive control group the effect was significant with a small effect size (k = 5, n = 1065, Hedge's g = .38, CI 95% .02-.75 p < .05). Analysis of the interventions on a per symptom basis yielded a significant and moderate effect size for perceived stress (k = 7, n = 1116, Hedge's g = .55, CI 95% .31-.79 p < .01); however, there were no significant effects for depression (k = 6, n = 3172, Hedge's g = .20, CI 95% -.05-.44 p < .01) and anxiety (k = 4, n = 837, Hedge's g = .19, CI 95% -.14-.53 p = .25).

CONCLUSIONS

The impact of MBIs in school settings for adolescents yielded a significant improvement for stress, but did not for depression and anxiety. The effects were significant when compared to inactive controls, but not when compared to active controls. Implications of these findings are discussed.

English as a Foreign Language Teachers' Identity and Motivation: The Role of Mindfulness

Teaching is a career with a high rate of anxiety and burnout in all phases of teaching with specific challenges related to the feature of language education. The concept of motivation can be an important basic mechanism since educators who are not motivated are distressed because of the anxious characteristic of the education profession. Moreover, educator identity is a new issue that has built a perspective to examine educators' growth by thinking about who they are as well as how they perform what they perform in a specific situation. Recently, programs that are based on mindfulness are known as efficient interventions enhancing motivation and decreasing tension in people. Given the prominence of mindfulness in educational settings and its neglected role in foreign language learning, the contemporary review attempts to inspect the function of mindfulness on English as a foreign language (EFL) teachers' motivation and identity. Subsequently, some pedagogical recommendations for the educational representatives such as teachers and teacher trainers are offered.

Effectiveness of school-based preventive programs in suicidal thoughts and behaviors: A meta-analysis

BACKGROUND

Suicidal thoughts and behaviors (STBs) among adolescents have hardly decreased despite preventative efforts. School-based prevention programs could have a great reach, yet suicide prevention is not an easy topic to address. To increase acceptability of school-based suicide prevention, it is important to evaluate whether programs that target known risk factors of STBs, such as depression, could be equally effective.

METHODS

We conducted a systematic literature search in major electronic databases. Outcomes were suicidal ideation and behaviors. Multivariate random effects meta-regression-analyses were conducted.

RESULTS

Eleven primary studies met the inclusion criteria, totalling 23,230 participants. The post-test effect size was small for both suicidal ideation (g = 0.15) and suicidal behaviors (g = 0.30). Meta-regression indicated that targeting known risk factors of STBs was not a significant modifier of effect size for ideation, indicating equal effectiveness. However, it was significant modifier of effect for behaviors, but only one intervention targeted know risk factors. Effects at follow-up (3-12 months) were also significant but small for both outcomes.

LIMITATIONS

Substantial heterogeneity between studies was noted. Only few and small sample size studies could be included that targeted known risk factors of STBs. Therefore, these results should be interpreted with caution.

CONCLUSIONS

School-based prevention of STBs shows some promise within three months post-test assessments, and potentially also have effects that are sustained over time. More studies are needed to make conclusions regarding school-based interventions that target risk factors of STBs.

The Impact of Education and Implementation Tools on Pre-Service Teachers' Attitudes About Classroom-Based Mindfulness

A growing body of research suggests that incorporating classroom-based mindfulness interventions in elementary schools can lead to improvements in student behavior, self-regulation, and measures of mental health and wellness. This quality improvement project explored the impact of an educational intervention on pre-service teachers' perceptions, attitudes, and intentions to implement mindfulness interventions in their classrooms. A brief educational intervention and website resource were provided to multidisciplinary teaching credential students. Participants completed a pre- and post-intervention survey to evaluate their intentions to implement mindfulness practices, as well as their perceptions about the acceptability, reasonableness, and effectiveness of incorporating mindfulness interventions in the classroom. Significant differences in pre- to post-intervention survey scores indicate that exposure to mindfulness concepts, practices, and resources may increase the willingness of pre-service teachers to adopt these practices in their classrooms.

Exploring the Effects of Meditation Techniques Used by Mindfulness-Based Programs on the Cognitive, Social-Emotional, and Academic Skills of Children: A Systematic Review

There is evidence for the positive impact of mindfulness in children. However, little is known about the techniques through which mindfulness practice results in differential outcomes. Therefore, this study intended to systematically review the available evidence about the efficacy of meditation techniques used by mindfulness-based programs on cognitive, socio-emotional, and academic skills of children from 6 to 12 years of age. The review was registered on the PROSPERO database, and the literature search was conducted according to PICO criteria and PRISMA guidelines. The EBSCO databases were searched, and 29 studies were eligible: nine randomized controlled trials and 20 quasi-experimental studies. All the included randomized controlled trials were rated as having a high risk of bias. Overall, the evidence for mindfulness techniques improving cognitive and socio-emotional skills was reasonably strong. Specifically, for cognitive skills, results showed that all the interventions used "body-centered meditations" and "mindful observations." Regarding socio-emotional skills, although all the studies applied "body-centered meditations" and "mindful observations," "affect-centered meditations" were also frequent. For academic skills, just one quasi-experimental trial found improvements, thus making it difficult to draw conclusions. Further research is crucial to evaluate the unique effects of different meditation techniques on the cognitive, social-emotional, and academic skills of children. Systematic Review Registration: Identifier: RD42019126767.

Adaptation and Validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) in People Living with HIV in Myanmar

Objectives

Valid and reliable instruments for the measurement of mindfulness are crucial for people living with HIV. However, there was no Myanmar version of such an instrument.

Methods

We adapted the English version of the 12-item Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) based on standard cross-cultural procedures. By randomly sampling methods, a sample of 248 eligible people living with HIV was contacted from a closed Myanmar Facebook group; 159 PLHIV completed the initial 12-item version of the adapted survey.

Results

Three items were removed due to low item-to-total correlations of the corrected item-total correlation as well as having infit and outfit mean squares outside the range of 0.6 to 1.4. After deleting the 3 items, the three-factor structure was confirmed by confirmatory factor analysis, which indicated good model fit. The resultant 9-item CAMS-R in Myanmar (CAMS-R-M-2) achieved good internal reliability (Cronbach's α of 0.75 to 0.87, and the corrected item-total correlation ranged from 0.44 to 0.81). Construct validity of the scale was demonstrated by significant association with self-reported HIV stigma and social support levels (r = 0.63, and - 0.53). In Rasch analysis, the infit and outfit mean squares for each item ranged from 0.49 to 1.24, and the person reliability was 2.17 and the separation index was 0.83.

Conclusions

The 9-item CAMS-R-M-2 with a three-factor structure has good reliability and validity. Higher total scores and subscale score reflected greater mindfulness qualities in people living with HIV in Myanmar.

The mindfulness trajectories of addressing suicidal behaviour: A systematic review

BACKGROUND AND OBJECTIVES

Suicidal behaviour has been a persistent concern in medical as well as general settings. Many psychotherapeutic approaches have tried to address suicidal behaviour in different ways. Mindfulness-based interventions (MBIs) have garnered much attention in the last decade because of their treatment efficacy. This systematic review aimed to examine evidence-based research regarding the effectiveness of MBIs as a psychotherapy intervention on suicidality and to deliver suggestions that might help future research.

METHOD

The identification of literature was made through an extensive search of the electronic databases, to extract studies relating to the efficacy of MBIs on addressing suicidal behaviour. Additional researches based on library sources were searched manually. The studies' selection was based on a pre-determined inclusion and exclusion criteria as well as the quality of the studies.

RESULTS

The present review helped us identify 13 studies, including six randomised controlled trials, two controlled studies and five pre-post observational studies. The findings reported in the studies were mostly favourable to MBIs as an effective intervention strategy for suicidal behaviour.

CONCLUSION

MBIs show promising effects as an intervention for suicidal behaviour. However, large scale, high-quality trials with active control, and long term intervention efficacy studies are needed to understand the mechanisms through which MBIs reduce suicidal behaviour.

Mindfulness-Based Versus Story Reading Intervention in Public Elementary Schools: Effects on Executive Functions and Emotional Health

Introduction

In this study we compared the effects of a mindfulness-based intervention (MBI) with a story reading intervention (SI) on the executive functions and psychological profile of children in two different public schools in São Paulo, Brazil.

Methods

In this controlled clinical trial, 207 children aged 8 to 9 years old responded to the Five-Digit Test (FDT), stress levels, depression, anxiety, positive and negative affect, at baseline (T0) and 8 weeks later (T1). From T0 to T1, school 1 participated in MBI classes and school 2 in IS classes.

Results

In school 1 (MBI), children improved their scores on all tests except reading (errors) and counting (errors) compared with school 2. No differences were observed between groups in terms of emotional health.

Conclusion

It is feasible to implement MBI or SI in Brazilian public schools. Students in the MBI group presented broader effects in executive functions, while students in the SI group showed a trend toward reduced negative affect and depression symptoms.

School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis

Background

Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.

Objective

The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.

Design

This study comprised a systematic review, a network meta-analysis and an economic evaluation.

Data sources

The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.

Main outcomes

The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.

Review methods

Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.

Results

A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.

Limitations

The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.

Conclusions

There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.

Future work

Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.

Study registration

This study is registered as PROSPERO CRD42016048184.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.

Is There a Replication Crisis in Medical Education Research?

Scholars are increasingly aware that studies-across many disciplines-cannot be replicated by independent researchers. Here, the authors describe how medical education research may be vulnerable to this "replication crisis," explain how researchers can act together to reduce risks, and discuss the positive steps that can increase confidence in research findings. Medical education research contributes to policy and influences practitioner behavior. Findings that cannot be replicated suggest that the original research was not credible. This risk raises the possibility that unhelpful or even harmful changes to medical education have been implemented as a result of research that appeared defensible but was not. By considering these risk factors, researchers can increase the likelihood that studies are generating credible results. The authors discuss and provide examples of 6 factors that may endanger the replicability of medical education research: (1) small sample sizes, (2) small effect sizes, (3) exploratory designs, (4) flexibility in design choices, analysis strategy, and outcome measures, (5) conflicts of interest, and (6) very active fields with many competing research teams. Importantly, medical education researchers can adopt techniques used successfully elsewhere to improve the rigor of their investigations. Researchers can improve their work through better planning in the development stage, carefully considering design choices, and using sensible data analysis. The wider medical education community can help by encouraging higher levels of collaboration among medical educators, by routinely evaluating existing educational innovations, and by raising the prestige of replication and collaborative medical education research. Medical education journals should adopt new approaches to publishing. As medical education research improves, so too will the quality of medical education and patient care.

Systematic review and narrative synthesis of suicide prevention in high-schools and universities: a research agenda for evidence-based practice

Background

Youth suicide prevention in high-schools and universities is a public health priority. Our aim was to propose a research agenda to advance evidence-based suicide prevention in high-schools and universities by synthesizing and critically reviewing the research focus and methodologies used in existing intervention studies.

Methods

Fourteen databases were systematically searched to identify studies which evaluate suicide prevention interventions delivered on high-school or university campuses, with before and after measures. Data from included studies (n = 43) were extracted to identify what, where, how and for whom interventions have been tested. Narrative synthesis was used to critically evaluate research focus and methodology. Study quality was assessed.

Results

Research has focused primarily on selective interventions, with less attention on indicated and universal interventions. Most evidence comes from North America and high-income countries. The target of interventions has been: non-fatal suicidal behaviour; confidence and ability of staff/students to intervene in a suicidal crisis; suicide-related knowledge and attitudes; and suicide-related stigma. No studies included suicide deaths as an outcome, evaluated eco-systemic interventions, explored how context influences implementation, used multisite study designs, or focused explicitly on LGBTQ+ youth. Two studies evaluated digital interventions. Quality of the majority of studies was compromised by lack of methodological rigour, small samples, and moderate/high risk of bias. Interventions often assume the existence of an external well-functioning referral pathway, which may not be true in low-resource settings.

Conclusion

To advance evidence-based suicide prevention in educational settings we need to: conduct more high-quality clinical and pragmatic trials; promote research in low- and middle-income countries; test targeted interventions for vulnerable populations (like LGBTQ+ youth), evaluate interventions where death by suicide is the primary outcome; include translational studies and use implementation science to promote intervention uptake; evaluate the potential use of digital and eco-systemic interventions; and conduct multisite studies in diverse cultural settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11124-w.

Philosophy for children and mindfulness during COVID-19: Results from a randomized cluster trial and impact on mental health in elementary school students

BACKGROUND

Preliminary evidence suggests that the COVID-19 pandemic has had a negative impact on children's mental health. Given these problems can have significant impacts throughout the lifespan, preventing the negative repercussions of COVID-19 on children's mental health is essential. Philosophy for children (P4C) and mindfulness-based interventions (MBIs) show promise in this regard.

OBJECTIVE

The goal of the present study was to compare the impact of online MBI and P4C interventions on mental health, within the context of the COVID-19 pandemic. We used a randomized cluster trial to assess and compare the impact of both interventions on elementary school students' (N = 37) anxiety and inattention symptoms as well as on their basic psychological need satisfaction (BPN).

RESULTS

ANCOVAs revealed a significant effect of the P4C intervention on mental health difficulties, controlling for baseline levels. Participants in the P4C group showed lower scores on the measured symptoms at post-test than participants in the MBI group. Significant effects of the MBI on levels of BPN were also found. Participants in the MBI intervention reported greater BPN satisfaction at post-test than participants in the P4C intervention.

CONCLUSION

Results from this study suggest that, in the current context of the COVID-19 pandemic, a P4C intervention centered around COVID-19 related themes may be helpful to reduce mental health difficulties, that a MBI may be useful to satisfy BPN, and that both interventions were easy to offer online to elementary school students. Future work including a larger sample size and follow-up measures is warranted.

PUBLIC SIGNIFICANCE

Practice: Philosophy for children (P4C) and mindfulness-based interventions (MBIs) can be used to foster mental health in elementary school students, in the current COVID-19 context. Policy: As we do not anticipate that facilitators will be allowed in schools during the 2020-2021 school year and that children will, most likely, be attending school in the current COVID-19 context, policymakers who want to implement psychological support measures in elementary schools should consider an online modality, which has shown in this study to work well, be feasible, and yield positive results on youth mental health.

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.

Comparative Efficacy and Acceptability of Psychotherapies for Self-harm and Suicidal Behavior Among Children and Adolescents: A Systematic Review and Network Meta-analysis

IMPORTANCE

Self-harm and suicidal behavior are associated with substantial morbidity and mortality among children and adolescents. The comparative performance of psychotherapies for suicidality is unclear because few head-to-head clinical trials have been conducted.

OBJECTIVE

To compare the efficacy of psychotherapies for the treatment of self-harm and suicidality among children and adolescents.

DATA SOURCES

Four major bibliographic databases (PubMed, MEDLINE, PsycINFO, and Embase) were searched for clinical trials comparing psychotherapy with control conditions from inception to September 2020.

STUDY SELECTION

Randomized clinical trials comparing psychotherapies for suicidality and/or self-harm with control conditions among children and adolescents were included after a blinded review by 3 independent reviewers (A.B., M.P., and J.W.).

DATA EXTRACTION AND SYNTHESIS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed for data abstraction, and the Cochrane risk of bias tool was used to evaluate study-level risk of bias. Data abstraction was performed by 1 reviewer (A.B.) and confirmed by 2 independent blinded reviewers (J.W. and M.P.). Data were analyzed from October 15, 2020, to February 15, 2021.

MAIN OUTCOMES AND MEASURES

The primary outcomes were dichotomized self-harm and retention in treatment. The secondary outcomes were dichotomized all-cause treatment discontinuation and scores on instruments measuring suicidal ideation and depressive symptoms. Effect sizes were pooled using frequentist random-effects network meta-analysis models to generate summary odds ratios (ORs) and Cohen d standardized mean differences (SMDs). Negative Cohen d SMDs or ORs less than 1 indicated that the treatment reduced the parameter of interest relative to the control condition (eg, signifying a beneficial association with suicidal ideation).

RESULTS

The systematic search generated 1272 unique records. Of those, 44 randomized clinical trials (5406 total participants; 4109 female participants [76.0%]) from 49 articles were selected (5 follow-up studies were merged with their primary clinical trials to avoid publication bias). The selected clinical trials spanned January 1, 1995, to December 31, 2020. The median duration of treatment was 3 months (range, 0.25-12.00 months), and the median follow-up period was 12 months (range, 1-36 months). None of the investigated psychotherapies were associated with increases in study withdrawals or improvements in retention in treatment compared with treatment as usual. Dialectical behavioral therapies were associated with reductions in self-harm (OR, 0.28; 95% CI, 0.12-0.64) and suicidal ideation (Cohen d SMD, -0.71; 95% CI, -1.19 to -0.23) at the end of treatment, while mentalization-based therapies were associated with decreases in self-harm (OR, 0.38; 95% CI, 0.15-0.97) and suicidal ideation (Cohen d SMD, -1.22; 95% CI, -2.18 to -0.26) at the end of follow-up. The quality of evidence was downgraded because of high risk of bias overall, heterogeneity, publication bias, inconsistency, and imprecision.

CONCLUSIONS AND RELEVANCE

Although some psychotherapeutic modalities appear to be acceptable and efficacious for reducing self-harm and suicidality among children and adolescents, methodological issues and high risk of bias prevent a consistent estimate of their comparative performance.

The impact of mindfulness on suicidal behavior: a systematic review

INTRODUCTION

Mindfulness-based interventions (MBI) have been growing progressively as treatment options in the field of mental health. Aim: To assess the impact of mindfulness-based interventions for reducing suicidal thoughts and behaviors.

METHODS

A systematic review was performed in December 2020 using PubMed, PsycINFO, EMBASE, SciELO, Pepsic, and LILACS databases with no year restrictions. The search strategy included the terms ('mindfulness' OR 'mindfulness-based') AND ('suicide' OR 'suicidal' OR 'suicide risk' OR 'suicide attempt' OR 'suicide ideation' OR 'suicide behavior'). The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), CRD42020219514.

RESULTS

A total of 14 studies met all inclusion criteria and were included in this review. Most of the studies presented Mindfulness-Based Cognitive Therapy as the MBI assessed (n=10). An emerging and rapidly growing literature on MBI presents promising results in reduction of suicide risk, particularly in patients with MDD. Four studies assessing other MBI treatment protocols (Mindfulness-Based Stress Reduction; Daily Mindfulness Meditation Practice; Mind Body Awareness and Mindfulness-Based Cognitive Behavior Therapy) all demonstrated that MBI reduces factors associated with suicide risk.

CONCLUSION

MBI might target specific processes and contribute to suicide risk reduction.

Role of meditation to improve children's health: Time to look at other strategies

In the United States, it is reported that up to 7 million of the population practice some form of meditation with the main purpose of improving emotional wellbeing and reducing stress. As the prevalence of mental health conditions continues to climb, other forms of health management strategies, including meditation practices, are increasingly used in adults. The evidence continues to emerge for the use of meditation as a way of managing health conditions in adults as demonstrated in systematic reviews and randomised controlled trials. There is also growing evidence evaluating the use of meditation practices and their potential benefits for child and adolescent health. Studies have identified improvements in mood and mental health conditions, school attendance and attention in the classroom in children and adolescents. This article aims to provide a perspective on commonly evaluated meditation types, such as Transcendental Meditation and mindfulness-based stress reduction. The article also aims to discuss the available evidence for the use of meditation to improve health and general wellbeing of children, including the use of meditation programs in schools, the current downfalls and limitations to the existing literature around meditation, and important points that healthcare practitioners need to consider when discussing the use of meditation as an additional strategy to manage and improve health and wellbeing in children and adolescents.

Mindfulness training preserves sustained attention and resting state anticorrelation between default-mode network and dorsolateral prefrontal cortex: A randomized controlled trial

Mindfulness training can enhance cognitive control, but the neural mechanisms underlying such enhancement in children are unknown. Here, we conducted a randomized controlled trial (RCT) with sixth graders (mean age 11.76 years) to examine the impact of 8 weeks of school-based mindfulness training, relative to coding training as an active control, on sustained attention and associated resting-state functional brain connectivity. At baseline, better performance on a sustained-attention task correlated with greater anticorrelation between the default mode network (DMN) and right dorsolateral prefrontal cortex (DLPFC), a key node of the central executive network. Following the interventions, children in the mindfulness group preserved their sustained-attention performance (i.e., fewer lapses of attention) and preserved DMN-DLPFC anticorrelation compared to children in the active control group, who exhibited declines in both sustained attention and DMN-DLPFC anticorrelation. Further, change in sustained-attention performance correlated with change in DMN-DLPFC anticorrelation only within the mindfulness group. These findings provide the first causal link between mindfulness training and both sustained attention and associated neural plasticity. Administered as a part of sixth graders' school schedule, this RCT supports the beneficial effects of school-based mindfulness training on cognitive control.

Efectos de la meditación activa en indicadores físicos y psicoemocionales de estrés en estudiantes universitarios en Chile. Un estudio piloto

Introducción. Las múltiples exigencias académicas a las que los estudiantes universitarios se enfrentan les generan altos niveles de estrés; si bien el estrés puede ayudarles a afrontar tales exigencias, en muchos casos este puede causarles diversos problemas de salud.Objetivo. Evaluar si la implementación de la meditación activa en la rutina diaria de estudiantes universitarios de las ciencias de la salud tiene un efecto en sus indicadores físicos y psicoemocionales.Materiales y métodos. Estudio piloto exploratorio y cuantitativo realizado en una muestra de 22 estudiantes universitarios que aceptaron participar en un curso electivo de meditación activa de 3 meses (18 sesiones). A los participantes se les solicitó diligenciar el Cuestionario de Percepción Global de Estado (CPGE) ex ante y ex post al curso.Resultados. 18 participantes completaron el CPGE ex ante y ex post, pero solo 16 fueron válidos para el procesamiento de datos. La mayoría de estudiantes reportó una mejora respecto a su percepción sobre cómo enfrentar diferentes situaciones estresantes luego de completar el curso, por ejemplo, el 87.5% manifestó permanecer en un estado de relajación en situaciones estresantes; el 81%, una disminución del agotamiento mental, y el 81%, un mejor manejo de las situaciones estresantes.Conclusiones. La incorporación de la meditación activa en la rutina diaria de estos estudiantes disminuyó sus indicadores físicos y psicoemocionales de estrés, por lo que es necesario realizar nuevos estudios con muestras más grandes que permitan confirmar el efecto positivo de este tipo de cursos en la salud de los estudiantes universitarios, lo que sin duda repercutirá en un mejor rendimiento académico producto de un mejor estado mental.

Effects of School-Based Meditation Courses on Self-Reflection, Academic Attention, and Subjective Well-Being in South Korean Middle School Students

PURPOSE

The purpose of this study was to examine the effects of school-based meditation courses on middle school students' self-reflection, academic attention (ability to focus in classrooms), and subjective well-being.

DESIGN AND METHODS

The research design was a nonequivalent group comparison (n = 163) with pretest and post-test. The experimental group (n = 81) was given an eight-week meditation course and the control group (n = 82) was given other elective courses such as calligraphy and reading.

RESULTS

The experimental group showed significant increases in self-reflection (t = 2.536, p = .012) and academic attention (t = 2.767, p = .006), but subjective well-being did not increase significantly (t = 0.906, p = .367). Life satisfaction was the only subcomponent of subjective well-being that increased significantly (t = 2.438, p = .016); the other subjective well-being subcomponents did not show any significant changes.

CONCLUSIONS

Self-reflection and academic attention significantly increased in middle school students after an eight-week meditation course. Even though changes in subjective well-being were not significant, one of its subcomponents (life satisfaction) did show significant improvement. Self-reflection and subjective well-being were shown to be influential factors for academic attention (48.5% of the variance explained).

PRACTICE IMPLICATIONS

This study is meaningful in that it examined positive benefits of a meditation course in middle school students and explored the feasibility of such a course in a school system.

Classroom-Based Mindfulness Training Reduces Anxiety in Adolescents: Acceptability and Effectiveness of a Cluster-Randomized Pilot Study

OBJECTIVE

Many high school students experience a high degree of anxiety and perceived stress. This study examined whether a classroom-based mindfulness program or a wellness program were acceptable and effective as anxiety and stress reduction interventions based on students' self-reports.

DESIGN SETTING AND PARTICIPANTS

Thirteen health education classes (n=285 students, aged 14-16 years) were randomized by classroom to one of three conditions: mindfulness, wellness, or usual health class only (passive control/ waitlist), for 8 weeks.

OUTCOMES

Pre- and post-intervention scores compared self-reported measures of depression, anxiety and stress.

RESULTS

Complete data were available from nine classes (n=202 students). Post-intervention anxiety scores were reduced in students who received the mindfulness intervention compared to those who received only their usual health class (β=-0.07, SE=0.03, P≤0.001; 95% CI=-0.12, -0.02). No significant between group differences were found for depression or stress (P>0.4). Students' satisfaction with the mindfulness intervention they received withstood baseline credibility and expectancy effects: r=0.21, n=67, P=0.17 for credibility; r=-0.001, n=67, P=0.99 for expectancy. However, students' satisfaction with the wellness intervention they received was positively correlated with their pre-intervention expectations, r=0.42, n=47, P>0.001. Fifty-two percent of the 68 students assigned to mindfulness (n=35) used the iPad app for mindfulness home practice at least once; of those, 10% used it 10 or more times.

CONCLUSION

Eight weeks of classroom-based mindfulness, with limited home practice, reduced self-reported anxiety compared to usual health class, and withstood baseline expectancy effects in this group of high school students, a majority who come from high income families.

CLINICAL IMPLICATIONS

School- or community-based mindfulness may be an appropriate recommendation for adolescents who experience anxiety.

Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years

IMPORTANCE

Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth.

OBJECTIVE

This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community.

METHOD

The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research.

RESULTS

One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners.

CONCLUSIONS AND RECOMMENDATIONS

On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence.

WHAT THIS ARTICLE ADDS

When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.

Activity- and Occupation-Based Interventions to Support Mental Health, Positive Behavior, and Social Participation for Children and Youth: A Systematic Review

IMPORTANCE

Children and youth are often challenged to maintain well-being, positive behavior, and social participation.

OBJECTIVE

To identify evidence for occupational therapy interventions for children and youth with and at risk for mental health concerns.

DATA SOURCES

Articles published in English-language peer-reviewed journals between January 2010 and March 2017 identified through searches of MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane databases.

Study Selection and Data Collectio

: The methodology in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to complete the review. Of 5,310 articles screened by title and abstract, 357 were retrieved for full-text review, and 62 met inclusion criteria. Articles describing interventions that were activity or occupation based were included. Conference proceedings, non-peer reviewed publications, dissertations, theses, and presentations were excluded.

FINDINGS

Of the 62 studies included in the review, 20 (32%) were Level I studies, 22 (36%) were Level II studies, and 20 (32%) were Level III studies. Articles were categorized by type: outdoor camps, video and computer games, productive occupations and life skills, meditation, animal-assisted interventions, creative arts, play, sports, and yoga. Moderate to strong evidence supports the use of yoga and sports. Moderate-strength evidence supports the use of play and creative arts. Evidence for the use of animal-assisted interventions, meditation, video and computer games, and productive occupations was of low strength.

CONCLUSION AND RELEVANCE

Substantial evidence exists to support the use of activity- and occupation-based interventions to address the mental health, behavioral, and social participation concerns of children and youth. Occupational therapy practitioners should match the desired outcome of therapy with the appropriate intervention to provide the best and most effective services to their clients.

WHAT THIS ARTICLE ADDS

This review provides additional support for the use of activity- and occupation-based interventions (i.e., those that involve active participation) to improve the behavior, social participation, and mental health of children and youth.