The Effectiveness of the Learning to BREATHE Program on Adolescent Emotion Regulation

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.

BREATHE-T1D: Using iterative mixed methods to adapt a mindfulness-based intervention for adolescents with type 1 diabetes: Design and development

BACKGROUND

Negative affect is prevalent among adolescents with type 1 diabetes (T1D) and may impact diabetes self-management and outcomes through stress-related behaviors such as disordered eating.

METHODS

We describe the development of and design for the adaptation of a mindfulness-based intervention (MBI) for adolescents with T1D and negative affect. BREATHE-T1D is an MBI designed to target negative affect that has been tailored to address the unique lived experiences of adolescents with T1D. Qualitative interviews with stakeholders and participants were used to inform iterative adaptations to the intervention and control curricula over the course of the study. The primary aim of this paper is to describe the design, development, and protocol of the present pilot feasibility trial.

CONCLUSIONS

Iterative, qualitative methodology throughout the adaptation of an intervention is important for ensuring the resulting intervention is relevant and meaningful for the target population.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05268393.

Mobile-based mindfulness meditation intervention's impact on mental health among young male judo athletes in South Korea: a quasi-experimental study

Young athletes commonly encounter various mental health challenges due to the distinct pressures inherent in sports environments. This study investigates the effectiveness of mobile-delivered mindfulness meditation interventions in alleviating mental health indicators of depression, perceived stress, and anxiety, and enhancing self-esteem and resilience among young male judo athletes in South Korea. Pre- and post-test questionnaires were completed by 53 judo athletes. Participants were then allocated to the intervention group (N = 27; Mage = 13.77 [SD = 1.11]), which used a mobile meditation software program, or the control group (N = 27; Mage = 13.56 [SD = 1.05]). Data analysis compared intervention and control group scores using multiple statistical methods, including independent sample t-tests, paired sample t-tests, and 2 (time) × 2 (group) repeated measures analysis of variance. Following the intervention, the mindfulness group exhibited significant enhancements in the mental health indicators of depression (GMD = 2.74 [95% CI 0.90-4.56], Cohen's D = 0.84), perceived stress (GMD = 0.35 [95% CI 0.002-0.70], Cohen's D = 0.56), and anxiety (GMD = 0.2 [95% CI 0.001-0.40, Cohen's D = 0.56]. Self-esteem also had a significant increase (GMD = 0.55 [95% CI - 0.22 to - 0.88], Cohen's D = 0.95). The findings of this study underscore the potential benefits of mobile-delivered mindfulness meditation interventions in addressing mental health challenges among young male judo athletes. The significant enhancements observed in scores on measures of depression, perceived stress, anxiety, and self-esteem among participants in the mindfulness group highlight the effectiveness of such interventions in promoting mental health in sports settings.

Patterns and predictors of adolescent engagement in a mindfulness-based social-emotional learning program

INTRODUCTION

Although mindfulness-based interventions (MBIs) show promise for promoting positive youth development, little is known about student engagement in MBIs. Initial research presents mixed findings in MBI engagement related to participant characteristics, and there is a lack of research examining the influence of context on engagement, despite the critical role context plays in academic engagement. This study examines the contribution of student demographic characteristics and classroom context to MBI engagement.

METHODS

Survey engagement data were collected at three time points from 106 ninth grade students (Mage = 14.17 years, 60.4% female, 44.2% Black, 24.8% Hispanic/Latino) who participated in the Be CALM program during the 2021-2022 school year. Latent growth curve modeling was used to examine trajectory of student engagement and assess student and classroom predictors of engagement.

RESULTS

There was no overall change in the trajectory of student engagement, although variability was observed across classes. Identifying as Hispanic/Latino was associated with lower engagement (β = -.25, p = .008), although this did not appear to be related to program experience. Peer connections predicted engagement at the end of the program (β = .39, p < .001). Post hoc analyses suggested that student engagement may be related to teacher program delivery quality.

CONCLUSIONS

Student engagement in MBIs appears related to classroom context more than student characteristics, although further research with larger samples is needed to assess the link between engagement and program outcomes. Findings have implications for designing school-based MBIs and training school staff to deliver them in culturally responsive ways.

Stress Management Interventions Among U.S. High School Adolescents: A Meta-Analysis

BACKGROUND

Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed.

AIMS

The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents.

METHODS

Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge's g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators.

RESULTS

The pooled effects on reducing stress were -0.36. The interventions had small effects on decreasing anxiety (g = -0.31) and depression (g = -0.23). Long-term follow-up effects were -0.77 on perceived stress, -0.08 on anxiety, and -0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = -0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (-0.39 vs. -0.26) and depression (-0.36 vs. -0.17).

CONCLUSIONS

These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.

Do Adolescents Like School-Based Mindfulness Training? Predictors of Mindfulness Practice and Responsiveness in the MYRIAD Trial

OBJECTIVE

We explored what predicts secondary school students' mindfulness practice and responsiveness to universal school-based mindfulness training (SBMT), and how students experience SBMT.

METHOD

A mixed-methods design was used. Participants were 4,232 students (11-13 years of age), in 43 UK secondary schools, who received universal SBMT (ie, ".b" program), within the MYRIAD trial (ISRCTN86619085). Following previous research, student, teacher, school, and implementation factors were evaluated as potential predictors of students' out-of-school mindfulness practice and responsiveness (ie, interest in and attitudes toward SBMT), using mixed-effects linear regression. We explored pupils' SBMT experiences using thematic content analysis of their answers to 2 free-response questions, 1 question focused on positive experiences and 1 question on difficulties/challenges.

RESULTS

Students reported practicing out-of-school mindfulness exercises on average once during the intervention (mean [SD] = 1.16 [1.07]; range, 0-5). Students' average ratings of responsiveness were intermediate (mean [SD] = 4.72 [2.88]; range, 0-10). Girls reported more responsiveness. High risk of mental health problems was associated with lower responsiveness. Asian ethnicity and higher school-level economic deprivation were related to greater responsiveness. More SBMT sessions and better quality of delivery were associated with both greater mindfulness practice and responsiveness. In terms of students' experiences of SBMT, the most frequent themes (60% of the minimally elaborated responses) were an increased awareness of bodily feelings/sensations and increased ability to regulate emotions.

CONCLUSION

Most students did not engage with mindfulness practice. Although responsiveness to the SMBT was intermediate on average, there was substantial variation, with some youth rating it negatively and others rating it positively. Future SBMT developers should consider co-designing curricula with students, carefully assessing the student characteristics, aspects of the school environment, and implementation factors associated with mindfulness practice and responsiveness. SBMT teacher training is key, as more observed proficiency in SBMT teaching is associated with greater student mindfulness practice and responsiveness to SBMT.

Mindful Coping Power Effects on Children's Autonomic Nervous System Functioning and Long-Term Behavioral Outcomes

Mindful Coping Power (MCP) was developed to enhance the effects of the Coping Power (CP) preventive intervention on children's reactive aggression by integrating mindfulness training into CP. In prior pre-post analyses in a randomized trial of 102 children, MCP improved children's self-reported anger modulation, self-regulation, and embodied awareness relative to CP but had fewer comparative effects on parent- and teacher-reported observable behavioral outcomes, including reactive aggression. It was hypothesized that MCP-produced improvements in children's internal awareness and self-regulation, if maintained or strengthened over time with ongoing mindfulness practice, would yield improvements in children's observable prosocial and reactive aggressive behavior at later time points. To appraise this hypothesis, the current study examined teacher-reported child behavioral outcomes at a one-year follow-up. In the current subsample of 80 children with one-year follow-up data, MCP produced a significant improvement in children's social skills and a statistical trend for a reduction in reactive aggression compared with CP. Further, MCP produced improvements in children's autonomic nervous system functioning compared with CP from pre- to post-intervention, with a significant effect on children's skin conductance reactivity during an arousal task. Mediation analyses found that MCP-produced improvements in inhibitory control at post-intervention mediated program effects on reactive aggression at the one-year follow-up. Within-person analyses with the full sample (MCP and CP) found that improvements in respiratory sinus arrhythmia reactivity were associated with improvements in reactive aggression at the one-year follow-up. Together, these findings indicate that MCP is an important new preventive tool to improve embodied awareness, self-regulation, stress physiology, and observable long-term behavioral outcomes in at-risk youth. Further, children's inhibitory control and autonomic nervous system functioning emerged as key targets for preventive intervention.

Understanding Emotion Regulation Strategies Among Youths: A Qualitative Study

The period of youth encompasses a myriad of experiences that often elicit a range of emotions from the individual. This study was conducted to understand emotion regulation (ER) among youths, specifically to identify strategies employed by youths to regulate emotions, and to understand the perceived importance and impact of ER. Qualitative data were collected through one-to-one semi-structured interviews ( n = 25) and focus group discussions ( n = 11; total 70 participants) among youths aged between 15 and 24 years. Interviews were transcribed verbatim and inductive thematic analysis was used to analyze the data. ER strategies engaged by youths in this study were classified into the following themes: (1) developing emotional awareness and acceptance, (2) emotional catharsis, (3) calling for a timeout, and (4) positive thinking and reframing. Youths perceived the importance of regulating emotions as (1) ER contributes to rational thinking and decision-making, (2) poor ER worsens mental wellbeing, (3) ER provides stability in life, and has (4) relevance to current life stage and environment. Findings from this study illustrate the essential role of ER for youth’s healthy functioning and demonstrate the value of strengthening emotional regulatory capacities in them.

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.

A preliminary neuroimaging investigation of the effects of mindfulness training on attention reorienting and amygdala reactivity to emotional faces in adolescent and adult females

INTRODUCTION

Adolescence is a time of increased emotional reactivity and improving cognitive control. Mindfulness meditation training may foster adolescents' cognitive control and emotional regulation skills; however little is known about the impact of mindfulness training in adolescents compared to adults. We examined the effect of mindfulness meditation versus a closely matched active control condition (relaxation training) on behavioral and neural measures of cognitive control and emotional reactivity in a small group of adolescents and adults.

METHODS

Structural and functional magnetic resonance imaging data were collected before and after 8 weeks of training in 26 adolescent (12-14 years) and 17 adult (23-33 years) female participants in the United Kingdom while they completed an n-back task with emotional face distractors and an attentional control task. Participants of each group chose a class date/time and the classes were then randomly allocated to mindfulness or relaxation conditions.

RESULTS

Compared to relaxation training, mindfulness training led to an increase in the speed of reorienting attention across age groups. In addition, there was preliminary evidence for reduced amygdala response to emotional face distractors in adolescents after mindfulness training.

CONCLUSIONS

An 8-week mindfulness program showed similar facilitative effects in adolescent and adult females on the reorienting of attention, a skill that is repeatedly practiced during mindfulness meditation. Mindfulness also reduced left amygdala reactivity to emotional face distractors in adolescents only. Mindfulness meditation practice can therefore have a facilitative effect on female adolescents' attentional control, and possibly attenuate their emotional reactivity.

School-based interventions to improve emotional regulation skills in adolescent students: A systematic review

INTRODUCTION

Emotional regulation (ER) is a core variable involved in the onset and maintenance of mental health disorders; therefore, interventions targeting ER in adolescence represent a promising preventive action. The current systematic review provides a synthesis of the evidence on school-based interventions on ER in adolescent students.

METHODS

Six electronic databases (Medline, Psychology Database, Embase, Scopus, Psychinfo, and Web of Science) were searched. The methodological quality of the included studies was assessed by the Methodological Index for Nonrandomized Studies.

RESULTS

A total of 36 studies were identified. The interventions were based on different theoretic frameworks and focused on different components of ER. There were universal interventions that addressed the entire class, as well as interventions for a selected population of at-risk students. Only one-third of the studies were based on manualized programs. Small to moderate effect sizes were found for mental health and ER skills. Only a few studies assessed risky behaviors, and these studies showed a reduction with moderate to large effect size. Studies conducted on high-risk populations showed medium-high effect sizes on ER skills. In contrast, studies conducted on unselected samples of students showed greater variability in the outcome estimates. Acceptability analysis and attendance rates suggested that the interventions were well received by students. The lack of follow-up assessments and the absence of sample-size calculation were the most frequent methodological weaknesses.

CONCLUSIONS

The content of the present review could be useful for professionals involved in the planning of school psychological services. Overall, the findings of the current review support the applicability and beneficial effect of school-based intervention for adolescents. Moreover, the results clearly point out the utility of a multitiered model to structure coordinated and integrated preventive interventions and to optimize resources.

The implementation of an online mindfulness-based program for pediatric patients at a tertiary hospital in South America: a feasibility study protocol

Background

The prevalence of chronic and complex pediatric health conditions has quickly risen over the last decades. Chronic and complex health conditions make pediatric patients and their families more susceptible to many distressing events during their lifespan. Mindfulness-based interventions have become a popular intervention for individuals living with chronic illnesses and have been adapted for pediatric populations with good results, including online versions. This study intends to report an implementation protocol of an online mindfulness-based program for adolescents to address an important gap in stress relief and health promotion for pediatric patients.

Methods

In this article, we describe the rationale and design of an implementation study of an online mindfulness-based program for pediatric patients at a tertiary pediatric hospital in South America. Participants will be recruited during one year to participate in an eight-session online mindfulness-based program. To assess our primary aim of feasibility, we will exam recruitment, retention and participation rates. Participants will also complete a symptomatology evaluation (i.e., depression, anxiety, and stress symptoms) at baseline and immediately at post-treatment and fidelity will be evaluated by a structured questionnaire.

Discussion

This study will be the first known to assess the implementation of an online mindfulness-based program for a pediatric population at a tertiary pediatric center in South America under real-life conditions. This study will establish the feasibility of a novel intervention aimed at promoting mental health and positive coping strategies among pediatric patients with chronic and complex health conditions. Evidence from this study would be useful to patients, families, clinicians, and policymakers and will help to devise strategies of health promotion for the pediatric population, as well as serve as a model for a future trial to examine efficacy of the proposed intervention.

Trial registration

This research has been registered at Ensaiosclinicos.gov.br, identifier RBR-23trp87. Registered 25 February 2022—retrospectively registered.

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.

Social-emotional need satisfaction, prosocial motivation, and students' positive behavioral and well-being outcomes

This study investigated the extent to which students' social-emotional basic psychological need satisfaction (of social-emotional autonomy, social competence, relatedness with students, and relatedness with teachers) is associated with their prosocial motivation and, in turn, behavioral and emotional well-being outcomes. For motivation, autonomous prosocial motivation and controlled prosocial motivation (by way of introjected and external regulation) were examined. Behavioral outcomes comprised prosocial behavior and conduct problems reported by parents/carers, and emotional well-being were positive and negative affect reported by students. With data from 408 secondary school students (and their parents/carers), structural equation modeling showed that perceived autonomy was associated with lower negative affect. Perceived social competence was associated with greater autonomous prosocial motivation, lower external prosocial regulation, greater positive affect, and lower negative affect. Relatedness with teachers was associated with greater autonomous prosocial motivation. In turn, autonomous prosocial motivation was associated with greater prosocial behavior, whereas external prosocial regulation was associated with lower prosocial behavior. Introjected prosocial regulation was only associated with greater negative affect. The results hold implications for promoting social and emotional competence among students.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11218-022-09691-w.

Virtual mindfulness interventions to promote well-being in adults: A mixed-methods systematic review

BACKGROUND

With the onset of the COVID-19 pandemic, many have experienced drastic changes in their academic and social lives with ensuing consequences towards their physical and mental well-being. The purpose of this systematic review is to identify virtual mindfulness-based interventions for the well-being of adults aged 19 to 40 years in developed countries and examine the efficacy of these techniques/exercises.

METHODS

This mixed-methods systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines with a registered PROSPERO protocol. With a convergent integrated synthesis approach, IEEE Xplore, PsychInfo, Web of Science and OVID were searched with a predetermined criteria and search strategy employing booleans and filters for peer-reviewed and gray literature. Data screening and extraction were independently performed by two authors, with a third author settling disagreements after reconciliation. Study quality of selected articles was assessed with two independent authors using the Mixed Methods Appraisal Tool (MMAT). Studies were analyzed qualitatively (precluding meta and statistical analysis) due to the heterogeneous study results from diverse study designs in present literature.

RESULTS

Common mindfulness-based interventions used in the appraised studies included practicing basic mindfulness, Mindfulness-Based Stress Reduction (MBSR) programs, Mindfulness-Based Cognitive Therapy programs (MBCT) and the Learning 2 BREATHE (L2B) program.

CONCLUSION

Studies implementing mindfulness interventions demonstrated an overall improvement in well-being. Modified versions of these interventions can be implemented in a virtual context, so adults can improve their well-being through an accessible format.

Resilience and Family Socialization Processes in Ethnic Minority Youth: Illuminating the Achievement-Health Paradox

Youth in marginalized communities who "strive" to rise above adversity, including systemic racism and poverty, are considered "resilient." African-American, Latinx, and Asian-American youth often achieve admirable academic success despite limited social capital and high early life stress by adopting a "striving persistent behavioral style" (SPBS). SPBS may be supported by family socialization processes that facilitate reliance on self-regulation processes. Unfortunately, a young person's resilience in one domain (i.e., academic) can come at a cost in other domains, including physical and mental health morbidities that are under-identified and under-treated. Indeed, research suggests a link between SPBS in the face of adversity and later health morbidities among ethnic minority youth. Herein, we describe SPBS as an adaptation to minority stress that not only promotes social mobility but may also stoke physical and mental health disparities. We review how family processes related to academic, emotional, and ethnic-racial socialization can facilitate the striving persistent behavioral style. We emphasize the double bind that ethnic minority families are caught in and discuss directions for future research and clinical implications for individual and family-level interventions. While needed, we argue that individual and family-level interventions represent a near-term work around. Solutions and factors that shape the need for SPBS and its cost must be addressed structurally.

A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents

Emotion regulation (ER) is the ability to monitor, evaluate, and modify one's emotional responses to be appropriate for environmental demands. Poor ER has been considered a transdiagnostic risk factor for a range of internalizing and externalizing disorders and overall decreased well-being in adolescents. A range of evidence-based interventions exist which may improve ER. However, much of the intervention research to date does not include a measure of ER to assess change pre and post treatment, with limited information about the efficacy of these interventions in youth across a range of sample types. There is a clear need for a comprehensive review of the literature examining ER-focused interventions in adolescents with a wide range of presenting disorders. A literature search was originally conducted in January 2020 and an updated search was conducted in February 2021 which elicited 1245 articles, of which 605 were duplicates and were removed. Abstracts of the remaining 640 articles were screened with 121 articles being reviewed in full. Of note, 16 additional articles were identified through references and other sources during this process and were also included in the full review. Of the 137 articles reviewed in full, 41 studies were ultimately included in the present review. The present paper provides a descriptive review of intervention approaches and findings from community prevention programs, programs for war-affected youth, programs for clinical populations, and programs for incarcerated and delinquent adolescents. The overall pooled effect was significantly different from zero based on the pre/post effects [Hedge's g = 0.29, 95% CI (0.22, 0.36)] and the intervention/control effects [Hedge's g = 0.19, 95% CI (0.06-0.32)]. Although neither sex nor age significantly accounted for heterogeneity in effect sizes, there were significant findings for population type (clinical vs. community), with community samples having significantly lower effect sizes on average. Impacts of the different ER measures used and significant methodological variability (e.g., use of control groups, length of intervention) across included studies are discussed. Implications and suggestions for future research are reviewed, specifically, that additional understanding of moderators of effects are needed and that measures used to assess change in ER, both dysregulation and adaptive skill use, may need to more directly align with the intervention's focus and the strategies taught as part of the intervention.

The Effectiveness of Cognitive Behavioral Therapy Techniques for the Treatment of Substance Use Disorders: A Narrative Review of Evidence

ABSTRACT

Substance use disorders (SUDs) are characterized by a recurrent and maladaptive use of drugs and/or alcohol. Cognitive behavioral therapies (CBTs) comprise different types of interventions: traditional CBT and the more recent "third wave" behavior therapies, such as acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), and schema therapy (ST). We searched English-language articles published between 2014 and present. This review includes randomized controlled trials (RCTs), quasi-RCTs, pilot studies, and reviews of CBTs for SUDs available on PubMed. Results seem to indicate that CBT and MBCT are effective interventions for SUDs; however, the studies showed a high degree of heterogeneity, so no exhaustive conclusions could be outlined at this time. ACT and DBT in SUD management are limited to few studies and results are therefore inconclusive.

The role of mindfulness in associations among depression symptoms, sleep duration, and insulin resistance in adolescents

Sleep difficulties may be one explanatory factor in the association between depression and insulin resistance; yet, explicit tests of this hypothesis are lacking. We determined if there was an indirect effect of depression symptoms on insulin resistance through sleep duration in adolescents at risk for excess weight gain. We also investigated whether dispositional mindfulness moderated the interconnections among depression, sleep, and insulin resistance. Ninety adolescents (14.2 ± 1.6y; 50% female) at risk for excess weight gain (body mass index [BMI, kg/m2] z score 1.6 ± 0.6) participated in the cross-sectional, baseline phase of a health behaviors study. Depression was assessed with the Center for Epidemiologic Studies-Depression Scale, sleep duration with the Sleep Habits Survey, and mindfulness with the Mindful Attention and Awareness Scale. Homeostatic model assessment of insulin resistance was determined from fasting insulin and glucose. The product-of-coefficients method was used to test the indirect effect of depression on insulin resistance through sleep duration, accounting for age, sex, BMIz, puberty, and socioeconomic status (SES). Dispositional mindfulness was tested as a moderator of the associations among depression, sleep, and insulin resistance. There was a significant indirect effect of depression on insulin resistance through sleep duration, controlling for age, sex, BMIz, puberty, and SES, 95%CI [0.001, 0.05]. Dispositional mindfulness moderated the association between sleep duration and insulin resistance, such that lower sleep duration related to greater insulin resistance only among adolescents with lower mindfulness (p < .001). Short sleep may be one explanatory factor in the depression-insulin resistance connection in adolescents at risk for excess weight gain. Adolescents with poorer mindfulness and short sleep are at highest risk for insulin resistance, whereas higher mindfulness may be protective.

Mindful Coping Power: Comparative Effects on Children's Reactive Aggression and Self-Regulation

Coping Power (CP) is an evidence-based preventive intervention for youth with disruptive behavior problems. This study examined whether Mindful Coping Power (MCP), a novel adaptation which integrates mindfulness into CP, enhances program effects on children’s reactive aggression and self-regulation. A pilot randomized design was utilized to estimate the effect sizes for MCP versus CP in a sample of 102 child participants (fifth grade students, predominantly low-middle income, 87% Black). MCP produced significantly greater improvement in children’s self-reported dysregulation (emotional, behavioral, cognitive) than CP, including children’s perceived anger modulation. Small to moderate effects favoring MCP were also observed for improvements in child-reported inhibitory control and breath awareness and parent-reported child attentional capacity and social skills. MCP did not yield a differential effect on teacher-rated reactive aggression. CP produced a stronger effect than MCP on parent-reported externalizing behavior problems. Although MCP did not enhance program effects on children’s reactive aggression as expected, it did have enhancing effects on children’s internal, embodied experiences (self-regulation, anger modulation, breath awareness). Future studies are needed to compare MCP and CP in a large scale, controlled efficacy trial and to examine whether MCP-produced improvements in children’s internal experiences lead to improvements in their observable behavior over time.

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.

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.

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.

Predicción del rendimiento académico a través de la práctica de relajación-meditación-mindfulness y el desarrollo de competencias emocionales

Este estudio tiene un doble objetivo, por un lado, conocer las relaciones existentes entre REMIND (relajación, meditación y mindfulness) competencia emocional (CE) y rendimiento académico (RA) en adolescentes; por el otro, analizar si la CE hace el rol de mediador entre REMIND y RA. La muestra se compone de 1 120 estudiantes de educación secundaria y bachillerato (51.96% mujeres) con una media de edad de 14.27 (DE =1.64). El análisis estadístico consistió fundamentalmente en comprobar la adecuación de las variables en cada uno de los modelos de ecuación estructural propuestos. En primer lugar, se calcularon los modelos de medida para después calcular los modelos SEM. Los resultados mostraron unas buenas relaciones entre variables y unos indicadores de ajuste aceptables para los modelos de medida. Así mismo, en el modelo global la CE aparece también como mediador entre REMIND y RA. Se concluye que las influencias en el RA ejercidas por REMIND en los modelos analizados son indirectas, a través de las competencias emocionales. Como conclusión, se destaca la conveniencia de que los docentes ejerciten en el aula programas o, al menos, ejercicios de REMIND para potenciar las competencias emocionales del alumnado y mejorar su RA.

Learning to BREATHE "Plus": A Multi-Modal Adaptive Supplement to an Evidence-Based Mindfulness Intervention for Adolescents

Incorporating technological supplements into existing group mindfulness-based interventions (MBIs), particularly for use with adolescents, is an important next step in the implementation of MBIs. Yet there is little available content. Herein we present the development and content of a technological supplement for MBIs, which incorporates multiple technological elements to support (a) skill transfer from the group MBI to daily life, (b) the establishment of a formal mindfulness practice, and (c) the use of mindfulness during periods of high stress. A mixed-methods approach was used to develop this multi-method adaptive supplement. Findings about the use of this supplement will be disseminated scientifically and/or publicly as appropriate.

Effects of Preference on Outcomes of Preventive Interventions among Ethnically Diverse Adolescents At-Risk of Depression

Patient-centered care includes efforts to align treatment with patient preferences to improve outcomes and has not been studied in adolescent depression prevention. Within a school-based randomized trial, we examined the effects of offering a preference between two evidence-based preventive interventions for youth at risk of depression, Learning to BREATHE (L2B) and Interpersonal Therapy-Adolescent Skills Training. We examined the effects of 3 preference factors (assignment condition [preference vs. random], receipt of preferred program, and baseline program preference) on outcomes in a diverse sample of 111 adolescents (M age = 15.18 years, SD = .86): 81 (73%) girls, 45 (41%) White, 40 (36%) Asian American, 8 (7%) Latinx, 1 (1%) African American, and 17 (15%) multiracial or other race/ethnicity. Findings revealed little evidence that receiving a preferred intervention or being given a choice of interventions was linked to greater improvement or initial engagement. Further, analyses did not indicate that adolescents with baseline indications for a specific intervention would benefit more from that intervention; rather, adolescents with generally lower baseline functioning improved more regardless of the intervention received. However, receipt of L2B and a baseline preference for L2B were associated with greater improvements in about half of the outcomes examined, with effect sizes ranging from R 2 = 0.04 to 0.14. There was little support for the need to match interventions to adolescent preferences in school-based prevention efforts. Rather, the more scalable mindfulness-based intervention had stronger effects than the interpersonal intervention and may hold promise for diverse adolescents.

[Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind]

Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind Substance use disorders (SUD) are a major contributor to morbidity and mortality. They are typically initiated during adolescence and can have fatal implications for healthy development. Despite substantial scientific advances, there remains a need to prioritize research directed at reducing risks for SUD, particularly in vulnerable periods and populations from a developmental perspective. Research indicates that reward sensitivity, impulsivity, deficient self-regulation, and stress reactivity develop markedly in childhood and adolescence and play an important role in the initiation and maintenance of SUD. A growing number of research results suggest that these factors can be favorably influenced by mindfulness-based interventions and that mindfulness-based exercises can be successfully integrated into established prevention and treatment programs. In this paper we summarize the conceptual relationships between the development and maintenance of addiction disorders and mindfulness, discuss existing empirical findings with regard to childhood and adolescence, and present the aims, study designs and intervention models of the subprojects from the ongoing research network "IMAC-Mind: Improving Mental Health and Reducing Addiction in Childhood and Adolescence through Mindfulness: Mechanisms, Prevention and Treatment".

Mindful Awareness: Can a Neuro-Developmentally Timed Approach Prevent Youth Substance Misuse

Youth substance use remains a significant public health issue. Although there are numerous evidence-based substance use preventive interventions, room for program improvement remains. Mindfulness practice, due to its feasibility of implementation, capacity to promote neuro-networks associated with delayed substance use initiation and progression to substance use disorders, and efficacy in promoting protective and reducing risk factors associated with substance use, may constitute one strategy for increasing the effectiveness of substance use preventive interventions. However, mindfulness-based approaches to substance use prevention have yet to be systematically tested with youth. In this conceptual paper, we first define mindfulness and its potential, through practice, to strengthen neuro-circuitry associated with substance use disorders. We then review evidence supporting the effectiveness of mindfulness-based preventive interventions to promote protective factors and reduce risk factors known to predict youth substance use. Thus, a case is made for neuro-developmentally timed, mindfulness-based substance use preventive interventions, with the ultimate goal of preventing future substance misuse and associated health consequences.

Safe schools for teens: preventing sexual abuse of urban poor teens, proof-of-concept study - Improving teachers' and students' knowledge, skills and attitudes

Child sexual abuse (CSA) is a difficult form of abuse to detect, with the peak age of reports from 13 to 15 years old. The recent revision of the Philippine school curriculum provided an opportunity to incorporate an educational intervention for prevention of CSA. This study aimed to improve the teachers' and students' knowledge, skills and attitudes on disclosure, identification, and reporting of CSA. This research is a two-phase proof-of-concept cross-sectional study of 237 teachers and 1,458 Grade 7 students from 2 public high schools in metro Manila over a two-year period. Phase 1 involved in-service training curriculum for all teachers on the recognizing, recording, reporting, and referral (4R's) of child abuse and establishment of a referral and support system. Outcome measures included pre- and post-tests and number of CSA reports. Phase 2 involved implementation of eight student modules through the Health and Values Education subjects of the curriculum. Outcome measures were pre- and post-intervention measurement of abuse and module content. Training of teachers resulted in an increase in confidence for identifying CSA from 25% to 57%, and a decrease in apprehension of reporting CSA from 40% to 33%. The Safe Schools for Teens intervention significantly improved self-reported knowledge on abuse, dating violence, and how to help friends as well as on adolescent's impulse control and emotional clarity. There was a significant decline from pre- to post-intervention in self-reported experiences of dating violence which includes physical, sexual and emotional violence, t(793) = 3.363, p = 001 as well as a significant decline in self-reported experiences of emotional abuse from a dating partner, t(837) = 2.693, p = 0.008. The Safe Schools for Teens intervention increases awareness and reporting of child sexual abuse. The intervention also reduces dating violence highlighting that the mindfulness focused approach in connection with systems strengthening is useful for addressing adolescent violence.

A College First-Year Mindfulness Seminar to Enhance Psychological Well-Being and Cognitive Function

Mindfulness training (MT) has shown promise in improving psychological health among college students, yet has rarely been evaluated as an addition to the college academic curriculum. Here, we demonstrate the feasibility and effectiveness of a first-year MT seminar offered to residential students at a selective private university, evaluating its impact on psychological and cognitive functioning, in relationship to a comparable positive psychology seminar. The results suggest the potential for first-year programs that promote student well-being.

Interactions between anxiety subtypes, personality characteristics, and emotional regulation skills as predictors of future work outcomes

INTRODUCTION

This study examined long-term predictive links between different types of anxiety in late adolescence and work-related outcomes in young adulthood. The presence of adaptive personality traits and positive emotion regulation and coping skills were hypothesized to buffer these associations, reducing the negative effects of anxiety on future work outcomes.

METHODS

Hypotheses were tested using multi-reporter data from a community sample of 184 youth in the United States followed from ages 17-30. Trait anxiety, anxious arousal, rejection sensitivity, and implicit rejection were each examined in late adolescence as predictors of work-related ambition, work performance, job satisfaction, and career satisfaction in young adulthood. Conscientiousness, grit, emotion regulation (ER) and coping skills were examined as potential moderators.

RESULTS

Although trait anxiety was the only anxiety variable directly predictive of work outcomes in regression analyses, personality variables and ER skills interacted with multiple types of anxiety to predict work outcomes. Interestingly, findings reflected a pattern in which a combination of greater conscientiousness and greater anxiety, and greater ER skills and greater anxiety, predicted more positive work outcomes.

CONCLUSIONS

These findings not only suggest that the development of traits such as conscientiousness and ER skills may be helpful for youth with higher levels of anxiety, but also that higher levels of anxiety, when appropriately balanced by other qualities, may be adaptive for promoting positive career development for some youth.

Factors affecting the implementation of a whole school mindfulness program: a qualitative study using the consolidated framework for implementation research

BACKGROUND

Preventing the onset of poor mental health in adolescence is an international public health priority. Universal, whole school preventative approaches are valued for their reach, and anti-stigmatising and resilience building principles. Mindfulness approaches to well-being have the potential to be effective when delivered as a whole school approach for both young people and staff. However, despite growing demand, there is little understanding of possible and optimal ways to implement a mindfulness, whole school approach (M-WSA) to well-being. This study aimed to identify the determinants of early implementation success of a M-WSA. We tested the capacity of the Consolidated Framework for Implementation Research (CFIR), to capture the determinants of the implementation of a mental health intervention in a school setting.

METHODS

Key members of school staff (n = 15) from five UK secondary schools attempting to implement a M-WSA were interviewed at two-time points, 6 months apart, generating a total of 30 interviews. Interviews explored participants' attitudes, beliefs and experiences around implementing a M-WSA. Interview data were coded as CFIR constructs or other (non CFIR) factors affecting implementation. We also mapped school-reported implementation activity and perceived success over 30 months.

RESULTS

The CFIR captured the implementation activities and challenges well, with 74% of CFIR constructs identifiable in the dataset. Of the 38 CFIR constructs, 11 appeared to distinguish between high and low implementation schools. The most essential construct was school leadership. It strongly distinguished between high and low implementation schools and appeared inter-related with many other distinguishing constructs. Other strongly distinguishing constructs included relative priority, networks and communications, formally appointed implementation leaders, knowledge and beliefs about the intervention, and executing.

CONCLUSIONS

Our findings suggest key implementation constructs that schools, commissioners and policy makers should focus on to promote successful early implementation of mental health programs. School leadership is a key construct to target at the outset. The CFIR appears useful for assessing the implementation of mental health programs in UK secondary schools.

Can Schools Reduce Adolescent Psychological Stress? A Multilevel Meta-Analysis of the Effectiveness of School-Based Intervention Programs

Increased levels of psychological stress during adolescence have been associated with a decline in academic performance, school dropout and increased risk of mental health problems. Intervening during this developmental period may prevent these problems. The school environment seems particularly suitable for interventions and over the past decade, various school-based stress reduction programs have been developed. The present study aims to evaluate the results of (quasi-)experimental studies on the effectiveness of school-based intervention programs targeting adolescent psychological stress and to investigate moderators of effectiveness. A three-level random effects meta-analytic model was conducted. The search resulted in the inclusion of k = 54 studies, reporting on analyses in 61 independent samples, yielding 123 effect sizes (N = 16,475 individuals). The results indicated a moderate overall effect on psychological stress. Yet, significant effects were only found in selected student samples. School-based intervention programs targeting selected adolescents have the potential to reduce psychological stress. Recommendations for practice, policy and future research are discussed.

Mindfulness Interventions to Reduce Impact of Interparental Conflict on Adolescents

Exposure to frequent, intense, and poorly resolved interparental conflict puts adolescents at risk for problems in many domains, including internalizing and externalizing problems, and stress physiological dysfunction. Existing intervention strategies to target these adolescents focus almost solely on improving marital dynamics, for example, through relationship education or couples therapy. However, interventions that aim to enhance marital communication require high levels of parental commitment and motivation for change, and may be expensive and time-consuming. In the current paper, we argue that it is essential to also apply intervention strategies that directly promote the regulatory capabilities of adolescents to improve outcomes for youth from high-conflict homes. Mindfulness, or present-moment, nonjudgemental awareness, is associated with myriad positive outcomes in adults (e.g., lower levels of depression and anxiety, and greater emotion regulation). We propose that mindfulness interventions are an ideal intervention strategy for adolescents from high conflict homes. Mindfulness interventions may target the mechanisms whereby destructive marital interaction impacts youth, by providing distance between experiences and evaluations, training regulation of attention, and enhancing self-compassion and nonjudgement, as well as by enhancing relationships. We also provide an example of a specific intervention model designed to increase mindfulness in youth, Learning to Breathe (L2B).

Cognitive Behavioral Intervention for Youth at Risk for Conduct Problems: Future Directions

This article briefly overviews the history of cognitive behavioral intervention (CBI) for children displaying early signs, or actual diagnoses, of conduct disorders. A series of randomized control trials have identified evidence-based CBI programs for children with these behavior problems at various developmental stages from preschool through adolescence. Although it is critically important for the field to disseminate these existing programs as developed, we argue that it is important to also move beyond the existing evidence-based programs. Research should continue to test new comprehensive, multicomponent interventions, fueled by our evolving understanding of active mechanisms that contribute to children's externalizing behavior problems. The future of research in this area can also benefit from a focus on four central issues. First, research can address how single interventions can have meaningful impact on a range of transdiagnostic outcomes because the intervention mechanisms may affect those various outcomes. Second, rooted in implementation science, we are beginning to understand better how evidence-based programs can be disseminated in the real world, examining key issues such as the adequacy of training approaches and the role of therapist and organizational characteristics. Third, a major focus of research can be on how to optimize intervention outcomes, including a focus on microtrials, on tailoring of interventions, on examining rigorously how interventions are delivered, and on the integration of technology and of other approaches such as mindfulness training into CBI. Fourth, research can explore how the therapeutic relationship and the therapists' characteristics can play substantial roles in effective CBI with conduct problem children.

Mindfulness interventions in schools: Integrity and feasibility of implementation

Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integration of mindfulness-based programs in school settings has been at the forefront of implementation research. Recent reviews of studies evaluating the efficacy of school-based mindfulness programs have produced mixed findings, which may in part be due to methodological differences across studies to date, as well as adaptations of MBIs in order to implement them within school settings. For example, there are vast differences across studies in the content, delivery, and training requirements of school-based MBIs, which may influence both fidelity and efficacy. This systematic review aimed to synthesize the literature on the implementation of school-based MBIs and determine the degree to which the interventions align to standards for MBIs. A systematic search identified studies evaluating the effects of a school-based MBI on mental health outcomes in schools, utilizing quantitative and qualitative designs. The results draw comparison across the identified MBIs in relation to intervention integrity, and teacher training and competence according to existing standards. The findings indicate a poor alignment to all standards; for example, intervention integrity was indicated in 45% of studies that included core mindfulness practices, and standards of teacher training were met in 26% of studies. In addition, the feasibility design of studies is critiqued against recommended standards. Despite claims from many studies, feasibility has not yet been established for school settings. Feasibility studies have failed to adequately assess organizational factors that influence implementation. The lack of detail and consistency in reporting across studies is a particular limitation of the field of research, which may have disadvantaged the assessment of studies against stringent guidelines. The ongoing challenges to developing an evidence base for school-based MBIs as well as to implementation are discussed. Recommendations for future directions in implementation science of mindfulness interventions within a school context are provided.

Mixed-methods evaluation comparing the impact of two different mindfulness approaches on stress, anxiety and depression in school teachers

OBJECTIVES

This study compared the impact of two different 8-week mindfulness based courses (.b Foundations and Mindfulness-Based Stress Reduction (MBSR)), delivered to school teachers, on quantitative (stress, anxiety and depression) and qualitative (experience, acceptability and implementation) outcomes.

DESIGN

A mixed-methods design was employed. Matched-paired t-tests were used to examine change from baseline, with imputation conducted to account for those lost to follow-up. Qualitative methods involved 1:1 semistructured interviews (n=10). Thematic analysis was used to explore differences in experience between courses.

SETTING

Courses took place in UK primary schools or nearby leisure centres, 1:1 interviews took place via telephone.

PARTICIPANTS

44/69 teachers from schools in the UK were recruited from their attendance at mindfulness courses (.b and MBSR).

INTERVENTIONS

Participants attended either an MBSR (experiential style learning, 2 hours per week) or .b Foundations (more classroom focused learning, 1.5 hours per week) 8-week mindfulness course.

OUTCOME MEASURES

Stress (Perceived Stress Scale), anxiety and depression (Hospital Anxiety and Depression Scale) were evaluated in both groups at baseline (n=44), end of intervention (n=32) and 3-month follow-up (n=19).

RESULTS

Both courses were associated with significant reductions in stress (.b 6.38; 95% CI 1.74 to 11.02; MBSR 9.69; 95% CI 4.9 to 14.5) and anxiety (.b 3.36; 95% CI 1.69 to 5.0; MBSR 4.06; 95% CI 2.6 to 5.5). MBSR was associated with improved depression outcomes (4.3; 95% CI 2.5 to 6.11). No differences were found in terms of experience and acceptability. Four main themes were identified including preconceptions, factors influencing delivery, perceived impact and training desires/practical application.

CONCLUSION

.b Foundations appears as beneficial as MBSR in anxiety and stress reduction but MBSR may be more appropriate for depression. Consideration over implementation factors may largely improve the acceptability of mindfulness courses for teachers. Further research with larger samples is needed.

Mindfulness based intervention with an attentional comparison group in at risk young adolescents: a pilot randomized controlled trial

BACKGROUND

Risky behaviors are related to poor outcomes among young adolescents. This study piloted a mindfulness based intervention, Learning 2 Breath Mindfulness Curriculum, focusing on the feasibility of programming and intervention effects on coping, affect, and trait mindfulness among at-risk adolescents. Further, the mindfulness based intervention was compared to an attention intervention.

METHODS

Sixth-grade level female students in a boarding school for at-risk youth randomly allocated to either the mindfulness intervention (n = 12) or an attention intervention (n = 11) for six weeks. Outcomes (i.e., primary coping, positive affect, and trait mindfulness) were assessed before and after the interventions.

RESULTS

Intervention groups did not differ in demographics or outcomes at baseline. Twenty-two of 23 (95.7%) registered participants attended all of the sessions. Participants completed 86.4% of study tools. Separate repeated measures ANOVAs revealed no significant interactions among group and time for primary coping, positive affect, or mindfulness. However, positive affect did increase [F(1, 17) = 10.675, p = 0.005, partial η 2 = 0.39] over time for both groups and there was a slight increase in trait mindfulness over time (although not statistically significant; p = 0.095, partial η 2 = 0.155]). Primary coping did not change with time.

CONCLUSION

The mindfulness intervention utilized in the present study exhibited feasibility in this population. Although preliminary, mindfulness based interventions may contribute to positive affect among at-risk youth in a boarding school. Limitations and future directions are discussed.

Adolescent stress reactivity: Examining physiological, psychological and peer relationship measures with a group stress protocol in a school setting

INTRODUCTION

Adolescents experience enhanced social sensitivity and biopsychosocial changes that can be challenging. Much remains unknown about the effect of psychological characteristics and peer relationships on adolescents' physiological responses to stress, due in part to methodological limitations.

METHODS

To test how adolescents' peer relationships and psychological characteristics are associated with their physiological and psychological response to stress, we administered the Group Public Speaking Task for Adolescents (GPST-A) to 54 adolescents (n = 40 girls; Mage = 16.6 years) in two high schools in the United States. Salivary cortisol and alpha-amylase (sAA), and positive and negative affect were measured six times. Relationships among group members were measured, resulting in whole-network data. State and trait rumination, five factors of coping, and emotional reappraisal and suppression were measured along with symptoms of depression and anxiety.

RESULTS

Greater levels of negative evaluation and victimization among group members were associated with a steeper increase and decline in the negative affect response, yet not associated with the physiological response to stress. Greater positive affect was associated with decreased cortisol reactivity, whereas negative affect was associated with steeper cortisol and sAA reactivity. Rumination, disengagement coping, and depression symptoms were related to the physiological response to stress.

CONCLUSIONS

The GPST-A is feasible to administer in a school context with adolescents to collect both physiological and psychological stress responses. Findings from the present study suggest peer relationships are important for understanding adolescents' psychological response to stressors while psychological characteristics are important for adolescents' physiological response to stress.