Mindfulness involves a conscious focus on and awareness of your present state of mind and surroundings, without judgment or reaction. Mindfulness is rooted in Buddhism and was developed in the 1970’s as a therapeutic intervention for stress in adults by Jon Kabat-Zinn, who founded the Mindfulness-Based Stress Reduction Clinic at the University of Massachusetts Medical School. Over the past several decades, the practice of mindfulness has evolved into a booming billion dollar industry, with growing claims that mindfulness is a panacea for host of maladies including stress, depression, failures of attention, eating disorders, substance abuse, weight gain, and pain.
Not all of these claims, however, are likely to be true. A recent critical evaluation of the adult literature on mindfulness identifies a number of weaknesses in the extant research, including a lack of randomized control groups, small sample sizes, large attrition rates, and inconsistent definitions of mindfulness. Moreover, a systematic review of intervention studies found insufficient evidence for a benefit of mindfulness on attention, mood, sleep, weight control, or substance abuse.
That said, there is empirical evidence that mindfulness offers a moderate benefit for anxiety, depression, and pain, at least in adults. Can mindfulness also be used as an effective tool for mitigating depression and anxiety in teens? Some research suggests it can, but the research is plagued by the same shortcomings identified in the adult literature (e.g., lack of a randomized control group, small sample sizes). In an effort to address these limitations, Catherine Johnson, Christine Burke, Sally Brickman, and Tracey Wade conducted a large-scale study including a randomized control group to assess the benefits of mindfulness training in teens.
They evaluated the efficacy of mindfulness training in 308 middle and high school students (average age 13.6 yrs) from diverse socio-economic backgrounds. The students were enrolled in 17 different classes across 5 different schools. Students opted in to the study, and were randomly assigned to the control group or the mindfulness training group. Students in the control group received no mindfulness training but instead participated in community projects or received lessons in pastoral care. Students in the mindfulness group completed 8 weeks of training in the .b (“Dot be”) Mindfulness in Schools curriculum, which is based on the “gold standard” Mindfulness Based Stress Reduction (MBSR) intervention for adults. The training sessions varied in length from 35 to 60 min and were administered once a week. All mindfulness training was conducted by the same certified instructor. Beyond the weekly training sessions, teens in the mindfulness group were encouraged to practice mindfulness techniques at home and were given manuals to assist in this practice.
All participants were assessed at three different time points: a baseline taken one week before the intervention, a post-test measure taken a week after the sessions were over, and a follow-up assessment administered about 3 months later. The study included measures of anxiety and depression, weight and shape concerns, well-being, emotional dysregulation, self-compassion, and mindfulness. Participants were also asked to report their compliance with home practice, and to provide an evaluation of the intervention. Attrition rates were low (just 16 percent at follow up) and comparable for both groups.
Despite the numerous outcome measures employed in the study, there was no evidence of any benefit for the mindfulness group at either the immediate post-test or the follow up. In fact, anxiety was higher at the follow up for males in the mindfulness group relative to males in the control group. The same was true for participants with low baseline depression and low baseline weight concerns; mindfulness training led to an increase in anxiety in these individuals over time.
The careful design and implementation of this study addressed a number of shortcomings from previous studies, as the authors used a large and diverse multi-site sample, a randomized control group, an age-appropriate mindfulness curriculum, a certified trainer, and a plethora of outcome measures. The fact that this carefully-controlled investigation showed no benefits of mindfulness for any measure, and furthermore indicated an adverse effect for some participants, indicates that mindfulness training is not a universal solution for addressing anxiety or depression in teens, nor does it qualify as a replacement for more traditional psychotherapy or psychopharmacology, at least not as implemented in this school-based paradigm.
Before we reject mindfulness for adolescents altogether, it is important to consider a few limitations of the study. The traditional MBSR training that has been effective in reducing depression and anxiety in adults involves 20 to 26 hours of formal training, including one 6-hour session, 8 weekly 2-hour sessions, and daily 45 min practice sessions at home. By contrast, because the training offered by Johnson and colleagues was adapted to fit the school schedule, the sessions lasted only 35-60 minutes each, for a total of 4.5 – 8 hours of training. Johnson and colleagues also shortened the initial introductory session, which is designed to help participants understand why mindfulness can be beneficial. The participants also reported very low compliance rates with home practice (26 percent during the 8-week training period and 13 percent at follow up). All of this may well have undercut the potential benefits, and it is possible that a more intensive training intervention, with consistent home practice, could yield better results.
As the parent of any teenager can attest, adolescence can be a bumpy ride. Emotional, psychological, and cognitive maturity do not always keep pace with reproductive and physical development, and so it is not surprising that depression and anxiety tend to emerge during adolescence. In some cases these conditions may become chronic, affecting physical health, social life, and academic success. Effective treatment is thus not only important for addressing teens’ immediate needs for well-being, but also for their long-term outcomes. Universal school-based prevention programs are appealing because they are relatively low-cost and can be administered to a broad range of students during key developmental windows. To many, mindfulness may seem like the perfect candidate for such school-based interventions, as it has been promoted by practitioners, the media, corporations like Google and Target, and even governmental and educational agencies. The findings from Johnson and colleagues join a growing number of studies in suggesting the need for greater scientific rigor in mindfulness research and a more careful analysis of paradigms and procedures: a more mindful approach to mindfulness.