Healthy Learning Mind - a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial

A Qualitative Microanalysis of the Immediate Behavioural Effects of Mindfulness Practices on Students’ Self-Regulation and Attention

The study examined the immediate effects of mindfulness practices on students’ attention and self-regulation during mathematical problem-solving tasks. Participants were 15 4th-grade Finnish students and their teacher. Data were collected during six study sessions of mathematical problem-solving, with and without mindfulness practices. The sessions were video-recorded, and children responded to the Freiburg mindfulness inventory and the cognitive and affective mindfulness scale-revised. A qualitative video micro-analysis focused on coding the observable behaviours related to attention and self-regulation. Self-report instruments were scored and tabulated for comparison. The findings indicate microbehavioural changes indicating positive effects of mindfulness practices on students’ self-regulation, with higher signs of engagement and lower signs of disengagement after mindfulness practices. This study enlightens the use of mindfulness practices in school routines and discusses the impacts of these practices while evidencing that future research on the topic is needed.

Uptake of and Motivational Responses to Mental Health-Promoting Practices: Comparing Relaxation and Mindfulness Interventions

Background

Comparative analyses of alternative interventions within the same trial enable acceptability and fidelity of each to be investigated more critically. In addition, whereas so far studies have focused on efficacy evaluations, more understanding is needed on motivational factors influencing the uptake of mental health-promoting practices rather than solely their effects.

Purpose

This study investigates whether the motivational responses to a mindfulness intervention are different from a relaxation intervention. We compare social cognitions outlined by the reasoned action approach and their roles in practice uptake, self-reported reasons for non-practice, and experienced benefits.

Methods

In a cluster-randomized trial (ISRCTN18642659; N = 3134), 12–15-year-old participants were given a 9-week intervention and followed up to 52 weeks. Main statistical analyses included t-tests, mixed ANOVAs, path models, and chi-square tests.

Results

Social cognitions in the mindfulness arm were slightly more positive immediately post-intervention, but recipients mostly responded similarly to the two interventions in the longer term. While attitudes, norms, intention, and self-efficacy were relatively high post-intervention, most of them slightly decreased by 26 weeks. Main reasons for non-practice in both arms included not finding the exercises helpful, no felt need, boringness of exercises and forgetting. The most common benefits experienced by practicing respondents were stress management and concentration ability. Better sleep was a more frequently reported benefit in the relaxation arm, but no other major differences emerged.

Conclusion

This study offers an example of comparing motivational responses to experimental and active control arm interventions, a potentially helpful approach in improving intervention adherence.

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.

Healthy Learning Mind (HLM): Cluster Randomized Controlled Trial on A Mindfulness Intervention, Moderators and Association with Perceived Socioeconomic Status, and Comparison to Other National Data

Background

This paper presents the baseline characteristics and their moderators in the Healthy Learning Mind (HLM)– school-based cluster-randomized controlled trial.

Objectives

The paper evaluates the state of various measures of well-being, their moderators and how these results compare to national and global norms/population studies.

Methods

Data were collected from all participants prior to the intervention and further analyzed by gender, grade and perceived socioeconomic status, including standardized measures for resilience, depressive symptoms and socioemotional functioning; health-related quality of life, dispositional mindfulness, satisfaction with life, compassion/self-kindness, self-rated health and morning tiredness.

Results

Participating 2793 students (1425 girls, 1368 boys), ages 12 to 15 years, filled in the questionnaires. The outcomes were in line with previous research, demonstrating gender differentiation and lower wellbeing among older children and adolescents.

Conclusions

All outcomes were associated with perceived socioeconomic status, suggesting that perceived low socioeconomic status should be addressed as a serious risk factor and included as a moderator in similar trials.

Effects of school-based mindfulness intervention on health-related quality of life: moderating effect of gender, grade, and independent practice in cluster randomized controlled trial

Object

We investigated the impact of a school-based 9-week mindfulness program vs. active control program (relaxation) and inactive control group on children’s self-reported Health-Related Quality of Life (HRQoL) moderated by gender, grade, and independent practice.

Method

In total 3519 (50/50% boys/girls) Finnish students aged 12–15 years from 56 schools were randomized into mindfulness intervention, active, and inactive control groups. HRQoL was measured at baseline, at 9 weeks, and at 26 weeks and analyzed with multilevel linear modeling.

Results

Significant improvement on HRQoL was found (β = mean difference) (β = 1.587, 95% CI 0.672–2.502, p < 0.001) after 9 weeks and at 26 weeks of follow-up among students in the mindfulness group as compared to the active control group. Moderating effects on HRQoL were found for gender, grade, and independent practice: girls, 7th and 8th grade students, and students with regular independent mindfulness practice benefited most.

Conclusions

Gender and developmental stage may moderate the effects of mindfulness interventions on HRQoL and offer guidance in designing effective promotive interventions for children and adolescents.

Trial Registration Information

Healthy Learning Mind—a school-based mindfulness and relaxation program: a study protocol for a cluster randomized controlled trial (RCT) ISRCTN18642659 retrospectively registered on 13 October 2015. The full trial protocol can be accessed at http://rdcu.be/t57S.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02868-4.

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")

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 .

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.

The Effects of School-based Mindfulness Intervention on Executive Functioning in a Cluster Randomized Controlled Trial

Executive functions (EFs) are essential for student's learning and classroom functioning. The current cluster randomized controlled trial examines the effects of mindfulness intervention vs. active control program (i.e., relaxation) focusing on the main EFs (i.e., working memory, response inhibition, cognitive processing, cognitive flexibility and verbal fluency). A total of 131 students from 6th grade and 8th grade (median age 12 and 15) from four comprehensive schools participated. The schools were to equal shares randomized to intervention and active control groups, i.e., groups who underwent a 9-week mindfulness practice or relaxation program, respectively. Participants completed a cognitive test-package at baseline/pre-intervention, post-intervention at 9 weeks and follow-up at 6 months. Both intervention and active relaxation-based control groups improved on a majority of EF measures at both 9 weeks and 6 months. There was no significant difference between the mindfulness intervention group and the active control program in EFs. The current study suggests that mindfulness intervention and active control program do not differ in their effects to EFs, although both may have positive outcomes. Further research with both active and inactive control groups is needed to map the potential benefits of similar programs for cognitive functioning.

The youth concussion awareness network (You-CAN) - a school-based peer-led intervention to improve concussion reporting and social support: the protocol for a cluster randomized trial

Background

Concussion prevalence is increasing in the pediatric population, and is a matter of public health concern. Concussion symptoms can be physical, cognitive, emotional and behavioural, and last longer in high school aged youth than adults. Concussions are underreported in youth due to their lack of knowledge, social environment, perceived outcomes of reporting, norms, and self-efficacy. The Youth Concussion Awareness Network (You-CAN) is a school-based peer-led program designed to increase high school students’ intent to report a concussion, and provide social support to a peer. This study aims to investigate whether participation in You-CAN, a program grounded in service learning principles, impacts concussion knowledge, attitudes, intent to report a suspected concussion to an adult, and intent to provide social support to a peer. Secondary aims include assessing the implementation fidelity and acceptability of the intervention.

Methods

This longitudinal study will use a cluster randomized trial design. Three high schools from six randomly selected Canadian school boards will participate and be randomized to three study arms: (1) You-CAN led by school staff; (2) You-CAN led by school staff and research team; and (3) untreated comparison group. Intervention arms 1 and 2 will deliver the You-CAN program and create a Concussion Council at their school. The Concussion Council will deliver a concussion awareness campaign and participate in an online showcase with other participating schools. In addition, arm 2 will have monthly video-calls with the research team. A survey based on the Theory of Planned Behaviour will be administered school-wide with all arms (1, 2, 3) at two time points (beginning {T₀} and end {T₁} of the school year). Exit interviews will be completed with the Concussion Councils and participating school staff.

Discussion

This study will provide evidence of the effectiveness of a school-based peer-led concussion program on increasing concussion knowledge, attitudes, subjective norms, perceived behavioural control, intent to report a concussion to an adult, and intent to provide social support to a peer amongst Canadian high school students. It will also provide important information about the implementation and acceptability of the You-CAN program for high school students and staff.

Trial registration

This trial is registered with the ISRCTN registry (ISRCTN64944275, 14/01/2020, retrospectively registered).

Healthy learning mind - Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial

BACKGROUND

Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial.

METHODS

Finnish school children and adolescents (N = 3519), aged 12-15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26).

RESULTS

Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=-0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (β=-1.37, SE 0.69, p = 0.049) and at T26 (β=-1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation.

LIMITATIONS

The inactive control group was smaller than the intervention and active control groups, reducing statistical power.

CONCLUSIONS

A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.

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.