Item ID : 2684

Zenner, C., Herrnleben-Kurz, S. and Walach, H. (2014). Mindfulness-based interventions in schools – a systematic review and meta-analysis. Frontiers in Pyschology, 5 (1), 1-20

Item ID : 2684

Zenner, C., Herrnleben-Kurz, S. and Walach, H. (2014).  Mindfulness-based interventions in schools – a systematic review and meta-analysis. Frontiers in Pyschology, 5 (1), 1-20

This paper is a rigorous state-of-the art meta-analysis of school-based mindfulness interventions (MBI’s). It allows a bird’s eye view of 24 such interventions describing their pedagogical features, ways of implementation, outcomes, pros and cons.

The authors base the understanding of mindfulness on Kabat-Zinn’s (2005) rendition, that they define as: “capacity to stay willfully present with one’s experiences, with a non-judgmental or accepting attitude, engendering a warm and friendly openness and curiosity” (p. 1). They acknowledge the east-Asian origins of mindfulness and suggest that it can be cultivated by various techniques. Formally however, it is cultivated through stillness and movement-based meditational practices. “These techniques help steady the mind and train its attentional capacity, while also increasing its breadth of focus. Practitioners are instructed to focus their attention on the present moment using an “anchor,” for instance, the breath. When the mind drifts away, the focus is gently brought back to the present moment experience. The practitioner tries to simply observe his or her experience of the present moment without judging or modifying it” (p. 1).

The authors review some of the recent MBI research and point to benefits of practice associated with health, stress-reduction, attention, self-compassion and other.

Mindfulness seems to be the opposite of mind-wandering (Smallwood and Schooler, 2006). Mind-wandering was associated with the default-mode network (DMN) (the area in the brain that is activated when the cognitive system remains idle). Higher activity in the DMN itself was associated with “increased negative affect and to the rate of mistakes in attentional and other tasks (Smallwood et al., 2011)” (p. 2). It is therefore natural to assume “that reducing mind-wandering and improving attentional capacities could be beneficial in many respects, and might be one of the generic mechanisms through which mindfulness-based approaches work (Carmody, 2009)” (p. 2).

Adaptations of the practice to youth and children have shown: to ameliorate ADHD symptoms (Van der Oord et al., 2012; Weijer-Bergsma et al., 2012), reduce symptoms of depression in minority children (Liehr and Diaz, 2010), reducte anxiety and increase social skills in students with learning disorders (Beauchemin et al., 2008), decrease hostility and general emotional discomfort, improve 1academic performance, interpersonal relations, stress-reduction, and physical health (qualitatively assessed), among “at-risk” and HIV-positive youth (Sibinga et al., 2011). Initial conceptual frameworks were proposed to explain why MBI’s are beneficial for children and youth and how mechanisms might work (Mind and Life Education Research Network (MLERN), 2012; Zelazo and Lyons, 2012). “School appears to be an appropriate setting for such interventions, since children spend a lot of time there and interventions can be brought directly to groups of children in areas of need as part of a preventive approach at little cost (Weare and Nind, 2011)” (p. 2).

In the following the authors describe an educational rationale for the inclusion of mindfulness in the curriculum: “Mindfulness can be understood as the foundation and basic pre-condition for education. Children need to learn to stop their mind wandering and regulate attention and emo- tions, to deal with feelings of frustration, and to self-motivate. Mindfulness practice enhances the very qualities and goals of education in the 21st century. These qualities include not only attentional and emotional self-regulation, but also prosocial dispositions such as empathy and compassion, self-representations, ethical sensitivity, creativity, and problem solving skills. They enable children to deal with future challenges of the rapidly changing world, ideally becoming smart, caring, and committed citizens (Shapiro et al., 2008; Mind and Life Education Research Network (MLERN), 2012)” (p. 2). Current reports of just how much students suffer from mental disorders, ADHD, behavioral problems, anxiety, stress and depression (US Department of Health and Human Services, and Centers for Disease Control and Prevention, 2013), make such interventions called for, “Schools are therefore confronted with the task of not only being institutions for formal education, but also a place that provides tools for preventing disorders and fostering personal development and well-being in children…MBIs in schools are seen as an approach to tackle these challenges, because prevention and education can be provided simultaneously, addressing a wide range of needs and unfulfilled potentials of students.” (p. 2).

The aim of this research was to provide depth to the empirical reviews of MBI’s that recurrently suggest a need for more precision, more data, and more rigorous methodologies. They also aimed to explore whether there are domains in which MBI’s were most effective. The authors thus set out to conduct a meta-analysis to explore as many MBI’s as possible that were implemented in schools with pupils between k-1 to k-12, and yielded quantitative data referring to psychological findings. They insisted that these researches will enable them to attribute outcomes strictly to mindfulness rather than other forms of interventions or other factors. In order to handle the huge amount of data, the authors developed a rigorous statistical method by which to correlate the diverse interventions in terms of sample size, pre-post measures, in-group difference and other. The details of their data-collection methodology are described at length in the paper.

The authors collected 207 studies, and ran them through their selection criteria leaving them with 24 of which 13 were published in peer-reviewed journals and 3 were in press. Others were mostly MA or PhD dissertations. The papers covered population of diverse continents with a total of 1348 students instructed in mindfulness and 876 serving as comparison ages 6-19. There is however great variety between studies in terms of numbers of participants (12 to 216), setting and intervention.

The theoretical framework of most MBI’s links these to previously existing mindfulness programs such as MBSR, MBCT, DBT, ACT, 100%, some link to positive psychology 38%, and/or to social-emotional learning 25%. The authors offer a table in which they describe various components as they appeared in the different programs. These include, breath awareness,100%, working with thoughts and emotions, 88%, psycho-education 83%,  awareness of senses and practices of daily life, 83%, group discussion 75%, body-scan, 58%, home practice, 50%, kindness practices 46 %, body-practices like yoga 25%, and other. Programs varied in intensity spanning between 4 to 24 weeks, with 45 min. once a week in most programs. In total, interventions varied from 160 to 3700 min of practice, with a median of 420 min.

The rate of satisfaction of students from these programs is extremely high (89% in Broderick and Metz, 2009; Metz et al., 2013). 81% in Anand and Sharma (in press). Some programs include home practice, and bring data of the extent to which students complied with this requirement.

The meta-analysis yielded a significant effect mostly on cognitive performance followed by resilience, and stress measures. They seem to be small and not significant in reg. to emotional problems. “Taken from a bird’s eye view, mindfulness-based training in a school context has effects that are seen mostly in the cognitive domain, but also in psychological measures of stress, coping, and resilience. Acceptance seems to be high with few reported adverse events or incidents. There were some hints that implementation was not always without difficulties. It is important to keep in mind that the analysis referring to feasibility is very limited due to methodological issues” (p. 16). The authors indicate based on their very rigorous examination, “that one of the most important factors for the variation across studies is the amount of practice that a mindfulness based program has introduced.” (p. 16).

Despite the rigorousness involved here, the authors acknowledge various limitations of their study: the great diversity across studies, differences in programs that were mandatory compared to those that were voluntary, skill of teachers and other. These can all substantially affect measures. In addition, these are different programs many of which are not manualized. Concomitantly, many tests for students are only partially validated. Motivation for practice is hard to gauge compared to adults engaging in MBSR for example. Overall the authors claim, “The precise role the element of mindfulness really plays is unknown, as is the extent of the effect that can be attributed to non-specific intervention factors, such as perceived group support, the specialty, and novelty of the intervention, of taking time out in school and at home, or of generic resting and relaxing” (p. 17).

The authors turn to some recommendations as to the furthering of research. They sum the paper claiming that “What is also clear from our study is that implementing and studying mindfulness-based interventions in schools is a promising avenue” (p. 18). In accordance with Roeser et al (2012) they recommend training teachers in mindfulness. “They could then promote mindfulness in their pupils through teaching mindfully, and through teaching mindfulness directly in diverse settings. For if mindfulness is to be established in a school- based framework it will have to be teachers who are the agents and ambassadors of change. This might be a good resource for teachers’ own resilience and prevention of burnout, in addition to being, very likely, the best way of delivering mindfulness in schools.” (p. 18).

“Our analysis suggests that mindfulness-based interventions for children and youths are able to increase cognitive capacity of attending and learning by nearly one standard deviation and yield an overall effect size of g = 0.40.The effect is stronger in studies where more mindfulness training and home practice has been implemented. However, results might be slightly biased by the “small study effect” (Sterne et al., 2000),… MBIs carry the promise of improving learning skills and resilience…” (p. 18).

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