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Galla B, Karanam A, Pelakh A, Goldberg SB. Adolescents do not benefit from universal school-based mindfulness interventions: a reanalysis of Dunning et al. (2022). Front Psychol 2024; 15:1384531. [PMID: 38939220 PMCID: PMC11210347 DOI: 10.3389/fpsyg.2024.1384531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
Are universal school-based mindfulness interventions an effective way to reduce risk for mental disorders and improve adolescents' lives? To answer this question, we reanalyzed data from Dunning et al.'s (2022) meta-analysis of randomized controlled trials of mindfulness interventions delivered to children and adolescents. Though Dunning et al. (2022) reported some benefits of universal mindfulness interventions, their analysis did not examine adolescents separately from children. Consequently, their conclusions may not entirely reflect the effectiveness of universal mindfulness interventions specifically for adolescents, a developmental period when mental disorders are known to increase. Using their open-access data tables, we tested impacts of 22 randomized controlled trials (N = 16,558) on eight outcome categories-anxiety/stress, attention, depression, executive functioning, mindfulness, negative behavior, social behavior, and wellbeing-at immediate post-test and longest follow-up. Our reanalysis shows that when compared to passive controls, mindfulness interventions significantly reduced trait mindfulness (d = -0.10). When compared to active controls, mindfulness interventions significantly improved anxiety/stress (d = 0.17) and wellbeing (d = 0.10). When compared to all controls combined, mindfulness interventions did not significantly improve any outcome (ds = 0.01 to 0.26). No effects of mindfulness interventions were observed at follow-up assessment. Overall, results of our analysis cast doubt about the value of existing school-based mindfulness interventions as a universal prevention strategy for adolescents.
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Affiliation(s)
- Brian Galla
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Aishwarya Karanam
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States
| | - Avital Pelakh
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, United States
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, United States
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Braun SS, Greenberg MT, Roeser RW, Taylor LJ, Montero-Marin J, Crane C, Williams JMG, Sonley A, Lord L, Ford T, Kuyken W. Teachers' stress and training in a school-based mindfulness program: Implementation results from a cluster randomized controlled trial. J Sch Psychol 2024; 104:101288. [PMID: 38871412 DOI: 10.1016/j.jsp.2024.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/21/2023] [Accepted: 01/23/2024] [Indexed: 06/15/2024]
Abstract
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.
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Affiliation(s)
- Summer S Braun
- Department of Psychology and Center for Youth Development and Intervention, The University of Alabama, McMillan Building, P.O. Box 870348, Tuscaloosa, Alabama, 35487, USA
| | - Mark T Greenberg
- Department of Human Development and Family Studies, The Pennsylvania State University, 119 Health and Human Development Building, University Park, Pennsylvania, 16802, USA
| | - Robert W Roeser
- Department of Human Development and Family Studies, The Pennsylvania State University, 119 Health and Human Development Building, University Park, Pennsylvania, 16802, USA
| | - Laura J Taylor
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Jesus Montero-Marin
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, United Kingdom; Parc Sanitari Sant Joan de Déu, C/ del Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Catherine Crane
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - J Mark G Williams
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Anna Sonley
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Liz Lord
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Douglas House 18b, Trumpington Road, Cambridge, CB2 8AH, United Kingdom
| | - Willem Kuyken
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
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Montero-Marin J, Hinze V, Crane C, Dalrymple N, Kempnich MEJ, Lord L, Slaghekke Y, Tudor K, Byford S, Dalgleish T, Ford TJ, Greenberg MT, Ukoumunne OC, Williams JMG, Kuyken W. Do Adolescents Like School-Based Mindfulness Training? Predictors of Mindfulness Practice and Responsiveness in the MYRIAD Trial. J Am Acad Child Adolesc Psychiatry 2023; 62:1256-1269. [PMID: 37236303 PMCID: PMC10935541 DOI: 10.1016/j.jaac.2023.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/30/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
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.
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Affiliation(s)
- Jesus Montero-Marin
- University of Oxford, Oxford, United Kingdom; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), Spain
| | | | | | | | | | - Liz Lord
- University of Oxford, Oxford, United Kingdom
| | | | - Kate Tudor
- University of Oxford, Oxford, United Kingdom
| | - Sarah Byford
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health - CIBERESP), Spain
| | - Tim Dalgleish
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
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Zhang L, Lopes S, Lavelle T, Jones KO, Chen L, Jindal M, Zinzow H, Shi L. Economic Evaluations of Mindfulness-Based Interventions: a Systematic Review. Mindfulness (N Y) 2022; 13:2359-2378. [PMID: 36061089 PMCID: PMC9425809 DOI: 10.1007/s12671-022-01960-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 11/16/2022]
Abstract
Objectives This study includes a systematic review of cost-effectiveness analyses (CEAs) and cost–benefit analyses (CBAs) of mindfulness-based interventions (MBIs). Methods A literature search was conducted using PubMed, Web of Science, JSTOR, and CINAHL for studies published between January 1985 and September 2021, including an original cost-related evaluation of an MBI. A qualitative assessment of bias was performed using the Drummond checklist. Results Twenty-eight mindfulness-based intervention studies (18 CEAs and 10 CBAs) were included in this review. Mindfulness-based stress reduction (MBSR) was less costly and more effective when compared with the usual care of cognitive behavioral therapy among patients with chronic lower back pain, fibromyalgia, and breast cancer. MBSR among patients with various physical/mental conditions was associated with reductions in healthcare costs. Mindfulness-based cognitive therapy (MBCT) was also less costly and more effective than the comparison group among patients with depression, medically unexplained symptoms, and multiple sclerosis. MBCT’s cost-effectiveness advantage was also identified among breast cancer patients with persistent pain, non-depressed adults with a history of major depressive disorder episodes, adults diagnosed with ADHD, and all cancer patients. From a societal perspective, the cost-saving property of mindfulness training was evident when used as the treatment of aggressive behaviors among persons with intellectual/developmental disabilities in mental health facilities. Conclusions Based on this review, more standardized MBI protocols such as MBSR and MBCT compare favorably with usual care in terms of health outcomes and cost-effectiveness. Other MBIs may result in cost savings from both healthcare and societal perspectives among high-risk patient populations.
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Tudor K, Maloney S, Raja A, Baer R, Blakemore SJ, Byford S, Crane C, Dalgleish T, De Wilde K, Ford T, Greenberg M, Hinze V, Lord L, Radley L, Opaleye ES, Taylor L, Ukoumunne OC, Viner R, Kuyken W, Montero-Marin J. Universal Mindfulness Training in Schools for Adolescents: a Scoping Review and Conceptual Model of Moderators, Mediators, and Implementation Factors. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:934-953. [PMID: 35267177 PMCID: PMC9343282 DOI: 10.1007/s11121-022-01361-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Kate Tudor
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Anam Raja
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Baer
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Sarah Byford
- Health Service and Population Research, King's College London, London, UK
| | | | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mark Greenberg
- Human Development and Family Studies, Penn State University, State College, USA
| | - Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Liz Lord
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lucy Radley
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Laura Taylor
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Russell Viner
- Institute of Child Health, University College London, London, UK
| | | | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, UK
- Teaching, Reseach & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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Kuyken W, Ball S, Crane C, Ganguli P, Jones B, Montero-Marin J, Nuthall E, Raja A, Taylor L, Tudor K, Viner RM, Allwood M, Aukland L, Dunning D, Casey T, Dalrymple N, De Wilde K, Farley ER, Harper J, Kappelmann N, Kempnich M, Lord L, Medlicott E, Palmer L, Petit A, Philips A, Pryor-Nitsch I, Radley L, Sonley A, Shackleford J, Tickell A, Blakemore SJ, Team TM, Ukoumunne OC, Greenberg MT, Ford T, Dalgleish T, Byford S, Williams JMG. Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. EVIDENCE-BASED MENTAL HEALTH 2022; 25:ebmental-2021-300396. [PMID: 35820992 PMCID: PMC9340028 DOI: 10.1136/ebmental-2021-300396] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Systematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health. OBJECTIVE The My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU). METHODS MYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11-14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included. FINDINGS Analysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI -0.05 to 0.06) for risk for depression; 0.02 (-0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (-0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed. CONCLUSIONS Findings do not support the superiority of SBMT over TAU in promoting mental health in adolescence. CLINICAL IMPLICATIONS There is need to ask what works, for whom and how, as well as considering key contextual and implementation factors. TRIAL REGISTRATION Current controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).
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Affiliation(s)
- Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Susan Ball
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Catherine Crane
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Poushali Ganguli
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Benjamin Jones
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Elizabeth Nuthall
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anam Raja
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Laura Taylor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Kate Tudor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Russell M Viner
- Population, Policy & Practice research programme, UCL Great Ormond St. Institute of Child Health, London, UK
| | - Matthew Allwood
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Louise Aukland
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Darren Dunning
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tríona Casey
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Nicola Dalrymple
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katherine De Wilde
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Eleanor-Rose Farley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jennifer Harper
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Nils Kappelmann
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Maria Kempnich
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Liz Lord
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Emma Medlicott
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Lucy Palmer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Ariane Petit
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Alice Philips
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Isobel Pryor-Nitsch
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Lucy Radley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anna Sonley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jem Shackleford
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Alice Tickell
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge, Cambridge, UK
- UCL Institute of Cognitive Neuroscience, London, UK
| | - The Myriad Team
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Obioha C Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, Exeter, Devon, UK
| | - Mark T Greenberg
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Sarah Byford
- King's College London, King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - J Mark G Williams
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
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Montero-Marin J, Taylor L, Crane C, Greenberg MT, Ford TJ, Williams JMG, García-Campayo J, Sonley A, Lord L, Dalgleish T, Blakemore SJ, Kuyken W. Teachers "Finding Peace in a Frantic World": An Experimental Study of Self-Taught and Instructor-Led Mindfulness Program Formats on Acceptability, Effectiveness, and Mechanisms. JOURNAL OF EDUCATIONAL PSYCHOLOGY 2021; 113:1689-1708. [PMID: 34912129 PMCID: PMC8647626 DOI: 10.1037/edu0000542] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
Mindfulness training (MT) is considered appropriate for school teachers and enhances well-being. Most research has investigated the efficacy of instructor-led MT. However, little is known about the benefits of using self-taught formats, nor what the key mechanisms of change are that contribute to enhanced teacher well-being. This study compared instructor-led and self-taught MT based on a book (Williams & Penman, 2011) in a sample of secondary school teachers. We assessed expectancy, the degree to which participants believed the intervention was effective, their program engagement, well-being and psychological distress, and evaluated whether mindfulness and self-compassion skills acted as mediators of outcomes. In total, 206 teachers from 43 schools were randomized by school to an instructor-led or self-taught course—77% female, mean age 39 years (SD = 9.0). Both MT formats showed similar rates of participant expectancy and engagement, but the instructor-led arm was perceived as more credible. Using linear mixed-effects models, we found the self-taught arm showed significant pre-post improvements in self-compassion and well-being, while the instructor-led arm showed such improvements in mindfulness, self-compassion, well-being, perceived stress, anxiety, depression, and burnout. Changes over time significantly differed between the groups in all these outcomes, favoring the instructor-led arm. The instructor-led arm, compared with the self-taught, indirectly improved teacher outcomes by enhancing mindfulness and self-compassion as mediating factors. Mindfulness practice frequency had indirect effects on teacher outcomes through mindfulness in both self-taught and instructor-led arms. Our results suggest both formats are considered reasonable, but the instructor-led is more effective than the self-taught. Trial registration: ISRCTN18013311. Mindfulness training enhances teachers’ well-being. This study compared two different mindfulness training formats with a sample of 206 secondary school teachers using an experimental design. Results suggested that teachers’ well-being was increased in both formats of delivery and both generated similar expectancy and engagement with the mindfulness practice; but the instructor-led format appeared to be more credible and effective and was also able to reduce teachers’ stress, anxiety, depressive symptomatology, and burnout. In contrast, the self-taught program might be useful for those teachers who cannot access or commit to an instructor-led program, provided they engage with mindfulness practice. This study suggests two forms for teachers to learn mindfulness, instructor-led and self-taught, as a way to support well-being, each with its own advantages.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna Sonley
- Department of Psychiatry, University of Oxford
| | - Liz Lord
- Department of Psychiatry, University of Oxford
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah-Jayne Blakemore
- Department of Psychology, University of Cambridge.,UCL Institute of Cognitive Neuroscience, London, United Kingdom
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Juul L, Frydenberg M, Beck MS, Fjorback LO. Stress-free Everyday LiFe for Children and Adolescents REsearch (SELFCARE): a protocol for a cluster randomised trial testing a school teacher training programme to teach mindfulness (".b"). BMC Psychol 2021; 9:31. [PMID: 33597044 PMCID: PMC7890857 DOI: 10.1186/s40359-021-00530-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a call for sustainable, evidence-based interventions in schools to promote mental health in schoolchildren. Our primary aim of this trial is to evaluate the effectiveness in vulnerable pupils of a school teacher training programme to teach mindfulness (".b" programme) as a part of compulsory class room teaching in Danish schools on the pupils' self-reported mental health at 6-month follow-up. Our secondary aim is to evaluate the effectiveness of the school teacher training programme to teach the ".b"-programme as a part of compulsory class room teaching among the total pupil population on the pupils' self-reported mental health at 3 and 6 months after baseline. METHODS The pragmatic cluster two-armed randomised controlled trial includes 110 municipal or private schools from all five regions in Denmark; 191 school teachers and approximately 2000 pupils at 11-15 years of age. Exclusion criteria; for schools: < 100 pupils; for pupils: parental opt out. Our intervention consists of (A) a school teacher training programme and (B) the ".b"-programme delivered as part of compulsory class room teaching in schools to pupils at the age of 11-15 years. The pupils in the control schools receive education as usual. Our primary study population is the vulnerable subgroup with a Strengths and Difficulties Questionnaire (SDQ) total difficulties score > 80% percentile at baseline (approximately 400 pupils). The primary outcome is change in the SDQ total score by the pupils. We also evaluate the effectiveness among the total pupil study population and in girls and boys, respectively and use other measures on mental health. Data will be analysed with repeated measurement models taken clusters into account. DISCUSSION This large-scale trial will estimate the effectiveness of a population-based strategy on mental health in Danish schoolchildren. The trial evaluates the effect of a school teacher training programme, where teachers are trained in teaching the ".b" programme. The ".b" programme will be taught as a part of compulsory class room teaching. The intervention takes implementation issues into account. Effectiveness will be evaluated both in a vulnerable subgroup and among the total population. Trial registration number ClinicalTrials.gov Identifier: NCT04208113, registered December 23 2019, https://clinicaltrials.gov/ct2/show/NCT04208113 .
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Affiliation(s)
- Lise Juul
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Gudrunsvej 78, 3, 8220, Brabrand - Aarhus, Denmark.
| | | | - Michelle Sand Beck
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Gudrunsvej 78, 3, 8220, Brabrand - Aarhus, Denmark
| | - Lone Overby Fjorback
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Gudrunsvej 78, 3, 8220, Brabrand - Aarhus, Denmark
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Evans A, Griffith GM, Crane RS, Sansom SA. Using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) in Supervision. Glob Adv Health Med 2021; 10:2164956121989949. [PMID: 33614255 PMCID: PMC7868458 DOI: 10.1177/2164956121989949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/29/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
The Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) is a useful framework for supporting teacher development in the context of mindfulness-based supervision (MBS). It offers a framework that enhances clarity, develops reflexive practice, gives a structure for feedback, and supports learning. MBS is a key component of Mindfulness-Based Program (MBP) teacher training and ongoing good practice. Integrating the MBI:TAC within the MBS process adds value in a number of ways including: offering a shared language around MBP teaching skills and processes; framing the core pedagogical features of MBP teaching; enabling assessment of developmental stage; and empowering supervisees to be proactive in their own development. The paper lays out principles for integrating the MBI:TAC framework into MBS. The supervisor needs awareness of the ways in which the tool can add value, and the ways it can inadvertently interrupt learning. The tool enables skills clarification, but the learning process needs to remain open to spontaneous experiential discovery; it can enable structured feedback but space is also needed for open reflective feedback; and it can enable conceptual engagement with the teaching process but space is needed for the supervisee to experientially sense the teaching process. The tool needs to be introduced in a carefully staged way to create optimal conditions for learning at the various stages of the MBP teacher-training journey. Practical guidance is presented to consolidate and develop current practice. The principles and processes discussed can be generalized to other forms of reflective dialogue such as mentoring, tutoring and peer reflection groups.
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Affiliation(s)
- Alison Evans
- School of Psychology, Bangor University, Bangor, UK
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Baer R, Crane C, Montero-Marin J, Phillips A, Taylor L, Tickell A, Kuyken W. Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples. Mindfulness (N Y) 2020; 12:763-774. [PMID: 33747251 PMCID: PMC7920887 DOI: 10.1007/s12671-020-01547-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Evidence-based mindfulness programs have well-established benefits, but the potential for harmful effects is understudied. We explored the frequency and severity of unpleasant experiences and harm in two nonclinical samples participating in an adaptation of mindfulness-based cognitive therapy (MBCT) for the general population. METHODS Study 1 included 84 schoolteachers; study 2 included 74 university students. Both studies were uncontrolled. Participants completed self-report questionnaires about psychological symptoms before and after the 8-week mindfulness course. After the course, they responded to a survey designed for this study that included Likert ratings and free-text questions about unpleasant experiences and harm. All data were collected online. RESULTS In both samples, about two-thirds of participants reported unpleasant experiences associated with mindfulness practice during the course. Most participants (85-92%) rated these experiences as not at all or somewhat upsetting; some indicated that difficult experiences led to important learning or were beneficial in some way. The proportion of participants reporting harm from the mindfulness course ranged from 3 to 7%. The proportion showing reliable deterioration on symptom questionnaires ranged from 2 to 7%. Those reporting harm and those showing reliable deterioration on questionnaires were largely separate subgroups; only one participant fell in both. CONCLUSIONS Findings highlight the need for mindfulness teachers to manage expectations about benefits and difficulties that may occur in mindfulness-based programs and to work skilfully with participants experiencing difficulties. Experiences of harm may not be captured by symptom questionnaires and should be explicitly assessed in other ways. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12671-020-01547-8.
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Affiliation(s)
- Ruth Baer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Catherine Crane
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Alice Phillips
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Laura Taylor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Alice Tickell
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - The MYRIAD team
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
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