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

Adverse Childhood Experiences, Resilience and Mindfulness-Based Approaches: Common Denominator Issues for Children with Emotional, Mental, or Behavioral Problems

US children with emotional, mental, or behavioral conditions (EMB) have disproportionate exposure to adverse childhood experiences (ACEs). There are theoretic and empirical explanations for early and lifelong physical, mental, emotional, educational, and social impacts of the resultant trauma and chronic stress. Using mindfulness-based, mind-body approaches (MBMB) may strengthen families and promote child resilience and success. This paper examines associations between EMB, ACEs, and protective factors, such as child resilience, parental coping/stress, and parent-child engagement. Findings encourage family-centered and mindfulness-based approaches to address social and emotional trauma and potentially interrupt cycles of ACEs and prevalence of EMB.

Mindful Parenting Training in Child Psychiatric Settings: Heightened Parental Mindfulness Reduces Parents' and Children's Psychopathology

Mindful parenting training is an application of mindfulness-based interventions that allows parents to perceive their children with unbiased and open attention without prejudgment and become more attentive and less reactive in their parenting. This study examined the effectiveness of mindful parenting training in a clinical setting on child and parental psychopathology and of mindfulness as a predictor of these outcomes. Seventy parents of 70 children (mean age = 8.7) who were referred to a mental health care clinic because of their children's psychopathology participated in an 8-week mindful parenting training. Parents completed questionnaires at pre-test, post-test and 8-week follow-up. A significant decrease was found in children's and parents' psychopathology and a significant increase in mindful parenting and in general mindful awareness. Improvement in general mindful awareness, but not mindful parenting, was found to predict a reduction in parental psychopathology, whereas improvement in mindful parenting, but not general mindful awareness, predicted the reduction of child psychopathology. This study adds to the emerging body of evidence indicating that mindful parenting training is effective for parents themselves and, indirectly, for their children suffering from psychopathology. As parents' increased mindful parenting, but not increased general mindfulness, is found to predict child psychopathology, mindful parenting training rather than general mindfulness training appears to be the training of choice. However, RCTs comparing mindful parenting to general mindfulness training and to parent management training are needed in order to shed more light on the effects of mindful parenting and mechanisms of change.

The effectiveness of mindful parenting programs in promoting parents' and children's wellbeing: a systematic review

BACKGROUND

The rationale for undertaking this review was to investigate a potential strategy to address the rising prevalence of child and adolescent mental health disorders. The central tenants of mindful parenting appear to be emotional awareness, emotional regulation, attention regulation, intentionality and non-judgmental acceptance.

OBJECTIVES

The primary objective of this review was to systematically evaluate the effectiveness of mindful parenting programs in promoting children's, adolescents' and parents' wellbeing, particularly in relation to the intensity of symptoms associated with internalizing (depression, anxiety, stress) and externalizing (conduct) disorders. The secondary objective was to evaluate how effective mindful parenting programs are in improving emotional regulation, attention regulation, quality of the parent-child relationship, resilience and mindfulness of the children, adolescents and parents.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Children aged between 0 and 18 years and their parents who have completed a mindful parenting program were the focus of this review.

TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST

Mindful parenting programs included in this review had a minimum duration of one to two hours per week for 6 to 8 weeks, delivered in a group format, by a facilitator with appropriate training. It included parenting programs that drew upon mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-based cognitive behavior therapy, dialectical behavior therapy or acceptance commitment therapy. The comparator was the control or waitlist conditions.

TYPES OF STUDIES

This review focused on randomized controlled trials evaluating the effectiveness of mindful parenting programs.

OUTCOMES

Primary outcomes were wellbeing or intensity of symptoms associated with internalizing disorders (depression, anxiety, stress) and externalizing disorders (conduct disorders) in children, adolescents and parents. Secondary outcomes were emotional regulation, quality of the parent-child relationship, resilience and mindfulness of the children, adolescents and parents.

SEARCH STRATEGY

Eight databases were searched for studies evaluating mindful parenting programs from 1997 to November 2014. A three-step search strategy was utilized to retrieve both published and unpublished studies written in English from PubMed, PsycINFO, EMBASE, Scopus, Psychological and Behavioral Sciences Collection, CINAHL, Cochrane Library and ProQuest Dissertations and Theses databases. A logic grid was developed for each of the eight databases to identify the indexing terms and synonyms for the keywords "mindful" and "parenting".

METHODOLOGICAL QUALITY

Methodological limitations included small sample sizes leading to lack of statistical power, multiple testing leading to increased alpha errors in addition to information bias caused by a lack of blinding in the implementation and assessment phase.

DATA EXTRACTION

The data extraction process entailed using the standardized data extraction form from Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument to extract data from the selected studies.

DATA SYNTHESIS

The heterogeneity of the samples, the measurement tools and outcomes measured precluded data synthesis through meta-analysis. Conclusions on intervention effects were based on comparisons of the overall statistical significance of the outcomes data.

RESULTS

The search yielded 1232 articles, from which seven randomized controlled trials met the inclusion criteria. The findings indicate mindful parenting programs may reduce parental stress, increase parents' emotional awareness of their 10-14-year-old children and reduce preschool children's symptoms associated with externalizing disorders. A recurring finding was that the mindful parenting programs reduced parents' emotional dismissal of their adolescents and preschoolers.

CONCLUSIONS

At present, there is insufficient evidence to conclude that mindful parenting programs can improve parents' and children's wellbeing because of the methodological quality of the few studies that met the inclusion criteria.

IMPLICATIONS FOR PRACTICE

Although there is currently insufficient evidence, mindful parenting programs are increasingly used in a variety of contexts. It may not be appropriate for psychotic or severely traumatized individuals.

IMPLICATIONS FOR RESEARCH

Future studies could make a significant contribution to the field by designing studies with sufficient sample sizes, adequate statistical power as well as blinding participants, facilitators and assessors.

Therapeutic applications of mindfulness in paediatric settings

Mindfulness is a meditation practice defined as a specific way of paying attention. It has been adapted from Buddhist traditions to Western secular use (e.g. in stress reduction, health promotion, treatment of psychological disorders). Despite its widespread application in adult populations, mindfulness remains a neglected topic in the psychological interventions designed for children and adolescents with psychological disorders and/or chronic physical conditions. In paediatric settings, a parent-child perspective may be useful in facilitating processes of adaptation and in improving paediatric outcomes. However, the delivery of mindfulness interventions in paediatric settings raises a number of issues and challenges, which include the developmental appropriateness of mindfulness exercises, the introduction of a parent-child perspective, and specific considerations to condition, treatment and caregiving.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

[Mindfulness-based intervention in attention-deficit-/hyperactivity disorder (ADHD)]

This paper reviews the current literature on mindfulness-based interventions in the treatment of attention-deficit/hyperactivity disorder (ADHD). Mindfulness means paying attention and being aware of the experiences occurring in the present moment, and it is usually developed by the practice of meditation. Research shows that mindfulness training is associated with improved attention systems and self-regulation, and that it therefore fosters those skills that are underdeveloped in individuals with ADHD. Although only few studies have investigated the effectiveness of mindfulness training in ADHD (many of which showing methodological limitations), the findings do suggest that mindfulness may be useful in ADHD interventions.

Modifying the risk associated with an impulsive temperament: a prospective study of drug dependence treatment

The evidence linking the personality trait of impulsivity and substance misuse is well established. Importantly, impulsivity not only predicts substance misuse problems but has an association with duration in treatment, likelihood of completing treatment and time to relapse. Treatment that focuses on increasing awareness and acceptance of thoughts and emotions may potentially address impulsive behaviour and in this respect improve treatment outcomes for substance misuse. The current paper investigated the relationship between the facet of impulsivity that taps into poor inhibitory control and treatment outcome. In addition, there was a specific focus on ascertaining the impact of an increase in awareness and attentional control measured in 144 adult substance users receiving treatment in a residential therapeutic community. Impulsivity predicted poorer treatment outcome (measured as drug use severity). Increases in awareness and acceptance of emotions and thoughts during treatment were related to better outcome although this was not associated with baseline levels of impulsivity. Clinical and theoretical implications are discussed.

Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled feasibility study

BACKGROUND

Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness among young people.

AIMS

To assess the acceptability and efficacy of a schools-based universal mindfulness intervention to enhance mental health and well-being.

METHOD

A total of 522 young people aged 12-16 in 12 secondary schools either participated in the Mindfulness in Schools Programme (intervention) or took part in the usual school curriculum (control).

RESULTS

Rates of acceptability were high. Relative to the controls, and after adjusting for baseline imbalances, children who participated in the intervention reported fewer depressive symptoms post-treatment (P = 0.004) and at follow-up (P = 0.005) and lower stress (P = 0.05) and greater well-being (P = 0.05) at follow-up. The degree to which students in the intervention group practised the mindfulness skills was associated with better well-being (P<0.001) and less stress (P = 0.03) at 3-month follow-up.

CONCLUSIONS

The findings provide promising evidence of the programme's acceptability and efficacy.

An evaluation of the parents under pressure programme: a study protocol for an RCT into its clinical and cost effectiveness

BACKGROUND

Many babies in the UK are born to drug-dependent parents, and dependence on psychoactive drugs during the postnatal period is associated with high rates of child maltreatment, with around a quarter of these children being subject to a child protection plan. Parents who are dependent on psychoactive drugs are at risk of a wide range of parenting problems, and studies have found reduced sensitivity and responsiveness to both the infant's physical and emotional needs. The poor outcomes that are associated with such drug dependency appear to be linked to the multiple difficulties experienced by such parents.An increase in understanding about the crucial importance of early relationships for infant well-being has led to a focus on the development and delivery of services that are aimed at supporting parenting and parent-infant interactions. The Parents under Pressure (PuP) programme is aimed at supporting parents who are dependent on psychoactive drugs or alcohol by providing them with methods of managing their emotional regulation, and of supporting their new baby's development. An evaluation of the PuP programme in Australia with parents on methadone maintenance of children aged 3 to 8 years found significant reductions in child abuse potential, rigid parenting attitudes and child behaviour problems.

METHODS/DESIGN

The study comprises a multicentre randomised controlled trial using a mixed-methods approach to data collection and analysis in order to identify which families are most able to benefit from this intervention.The study is being conducted in six family centres across the UK, and targets primary caregivers of children less than 2.5 years of age who are substance dependent. Consenting participants are randomly allocated to either the 20-week PuP programme or to standard care.The primary outcome is child abuse potential, and secondary outcomes include substance use, parental mental health and emotional regulation, parenting stress, and infant/toddler socio-emotional adjustment scale.

DISCUSSION

This is one the first UK studies to examine the effectiveness of a programme targeting the parenting of substance-dependent parents of infants and toddlers, in terms of its effectiveness in improving the parent-infant relationship and reducing the potential for child abuse.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number Register: ISRCTN47282925.

The neglected role of positive emotion in adolescent psychopathology

Adolescence is a developmental period characterized by elevated stress, heightened risky behaviors, and increases in psychopathology. Emotion dysregulation is a hypothesized contributor to negative outcomes and to the onset of psychopathology during adolescence. However, the dysregulation of negative emotion has been the focus of research while the literature on positive emotion in adolescent psychopathology is limited. This review highlights both the development of normative and dysregulated positive emotion during adolescence. First, the literature on normative adolescent emotional development and on negative emotional regulation is briefly reviewed, followed by a discussion of current theories of positive emotion, which are grounded in the adult literature. From a developmental perspective, the dimension of approach motivation within positive emotion is emphasized throughout and frames the review. This conceptualization guides organization of literatures on normative experiences of positive emotion in adolescence and the role of dysregulated positive emotion in adolescent psychopathology, specifically adolescent depression, anxiety, bipolar disorder, externalizing disorders and eating disorders. Last, future directions in the study of adolescent positive emotion and its regulation and the implications of highlighting approach motivation in normative and dysregulated positive emotion in adolescence are detailed.