A randomized controlled evaluation of a secondary school mindfulness program for early adolescents: Do we have the recipe right yet?
Introduction
Mindfulness presents as a promising transdiagnostic approach for mental health disorders, given its potential to counteract a number of shared risk factors for anxiety, depression and eating disorders (Johnson, Burke, Brinkman, & Wade, 2016a). Robust evidence exists in adults for the benefits of mindfulness-based interventions (MBIs) across this group of pathologies (Khoury et al., 2013). More recently, MBIs have been enthusiastically embraced in schools and are widely disseminated (Semple, Droutman, & Reid, 2017), but there are insufficient methodologically robust studies to make definitive conclusions about efficacy.
In mainstream secondary schools, only three large randomized controlled trials (RCTs) of MBIs have been conducted. Raes, Griffith, Van der Gucht, and Williams (2014) tested an 8-week MBCT-informed curriculum (N = 408, Mage 15.4 years; mixed sex; external facilitator) finding improvements in depression at post intervention and 6-month follow-up (Cohen's d ≥ 0.25). Atkinson and Wade (2015) investigated a 3-session mindfulness intervention with a body image focus (N = 347, Mage 15.7 years; female; external facilitator), with improvements across a range of eating disorder risk factors at 6 months (d ≥ 0.47), but no improvements in negative affect. A third study evaluated the manualized .b (“Dot be”) Mindfulness in Schools curriculum, which had previously shown promising results in a controlled study (Kuyken et al., 2013; N = 522, Mage 14.8 years, mixed sex, class teacher delivery), demonstrating reductions at 3 months for depression, stress and wellbeing (d ≥ 0.25). The replication RCT (Johnson et al., 2016a; N = 308, Mage 13.6 years, mixed sex, external facilitator) showed no improvements across a wide range of outcomes at post-intervention or 3-month follow-up (d < 0.28).
Several hypotheses for the lack of replication of the .b curriculum exist. First, that the ideal dosage or active ingredients necessary to successfully translate adult MBIs for youth remain unknown. Second, although an early adolescent group was deliberately targeted, prior to the escalating stressors of mid-late adolescence (Kuyken et al., 2013), it may be that older adolescents respond better. Third, inadequate program adherence in the replication trial may have impacted results i.e., the curriculum was shortened by one lesson, students were not supplied with a user friendly version of the home practice manual, and an external facilitator was used (Johnson et al., 2016a). Therefore, the main aim of the current study was to conduct a tighter replication of the .b curriculum. A secondary aim was to test whether increased “dose” might be achieved by inviting parents to take part in the intervention, to stimulate discussion of mindfulness at home together and remind students to do home practice. Three small controlled trials of MBIs (Bögels et al., 2008, Semple et al., 2010, van der Oord et al., 2012) have included parents in MBIs for children, evidencing medium to large effect size improvements in attention, behavior problems and anxiety in these clinical samples. However, there have been no experimental comparisons that isolate the effect of parental involvement, nor has this been tested in community samples. We predicted that our outcome measures would show improvement at 12 month follow-up (the longest to date in a youth MBI study) in the mindfulness group with parental involvement compared to the mindfulness group without, due to higher levels of home practice compliance, and that both of these groups would show improvement compared to the control group.
Section snippets
Participants
Four urban coeducational secondary schools (one private, three public) participated. The mean age of the 555 students who participated was 13.44 (SD = 0.33); 45.4% were female. Power analysis showed that to detect a Cohen's d effect size of 0.25 (Kuyken et al., 2013, Raes et al., 2014), with a power level of 0.80, 127 participants per group were required (Hedeker, Gibbons, & Waternaux, 1999).
Design
A cluster (class based) randomized controlled design was used, with assignment to mindfulness,
Description of participants
Fig. 1 shows the flow of participants through the study. Only five parents (0.9%) actively requested that their child's data not be used for this research project. Participating schools represented a broad range of socioeconomic (SES) demographics as measured on the Index of Community Socio-Educational Advantage (ICSEA), whereby 1000 represents the mean, with a standard deviation of 100 (Australian Curriculum Assessment and Reporting Authority, 2012), ranging from 959 to 1144 (M = 1061.50, SD
Discussion
This study retested the 9-week .b mindfulness program in young adolescents with tighter adherence than a previous RCT which obtained null results (Johnson et al., 2016a). We found no differences in outcomes between any of the groups at any time point. The one main effect of group, where levels of Acting with Awareness were lower in both mindfulness groups compared to the control group, did not translate into any improvements in psychological functioning. Examination of a range of moderators did
Conclusion
In a second randomized controlled design evaluating the impact of a school-based mindfulness program in early adolescents, with tighter adherence to the curriculum and additional measures to increase student dosage between lessons via parents and class teachers, we again found no improvements on any outcome measure at post intervention or during a 12-month follow-up. Further research is required to identify the optimal age, content and length of programs delivering mindfulness to adolescents.
Acknowledgements
This study was funded by a Flinders University Australian Postgraduate Award and a scholarship provided by the Fraser Mustard Centre, Telethon Kids Institute and Department of Education and Child Development. There were no conflicts of interest.
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