The MYRIAD study, the largest mindfulness study ever, and just published, has trialled a particular approach to mindfulness training as a universal intervention. It was a very large, well-designed English study that included over 8,300 children between the ages of 11 and 13. It was run by a high-quality research team with a big budget.
The results were mostly negative.
Therefore, the MYRIAD trial results pose a clear challenge to the generally high levels of confidence and enthusiasm for using mindfulness practices in school programs—which often bring with them strong claims of being ‘evidence- based’. In this study, the mindfulness intervention did not do any better than Treatment as Usual (established social and emotional learning training).
The study’s authors concluded: Universal SBMT is not recommended in this format in early adolescence. Future research should explore social−emotional learning programmes adapted to the unique needs of young people.
So how do we interpret the results? This week we take a deep dive, and also include recently published studies examining mindfulness in schools programs that did record positive findings. My own limited experience with young children in schools has been very positive, so it would be good to hear comments from any teachers or parents with their own direct experiences, but first
Thought for the day
Acquire inner peace
And a thousand persons around you
Will find peace.
St. Seraphim of Sarov, 18th Century Russian Hermit
Clearly, we cannot ignore the MYRIAD study; its results do fly in the face of a good body of research attesting to the positive benefits of school-based mindfulness programs for adolescent mental health and behaviour problems (see the results of three evidence-based review papers below). So, what conclusion are we to take from the MYRIAD study? Is it that mindfulness does not work, or that mindfulness works but not for people of this age group, or that mindfulness works but the program delivered was not a good program, or that the research was poorly done and therefore delivered a false finding? Well, the research team were high quality and it was a thoroughly designed and well thought through study, so it is unlikely to be the latter. Then let us explore the other possibilities.
There seem to be several issues: 1. The results could be accurate and a warning signal.
2. The study focused upon children 11 – 13. So it really says nothing clear about younger children or adolescents aged 15 – 16 etc. It may be children in primary school could usefully be grouped together, and be considered separately from those in secondary or tertiary education, but this remains to be seen.
3. The real challenge for running mindfulness programs for children is to make them interesting, relevant and to contextualise them to their lives and what is important to them. It seems many children in this study did not like the practice and did not spend time doing it.
It appears, those who did like it, and did practice, did gain significant benefits. Perhaps they needed to be engaged better, or the children will need an opt out clause, or maybe mindfulness interventions are particularly challenging to deliver successfully to whole cohorts of students rather than just those who self-select to do it.
4. This study taught one style of mindfulness to over 8,000 children. Previous studies, where results were positive, were much smaller and may have adapted more to their limited audiences. It may be one learning from this study is the need for more prior consultation and then to adapt promotion and methodology to fit individual schools, communities and children. This is a need experienced in most public health initiatives. In other words, if mindfulness is to be adopted widely, there may be a need to be flexible with delivery and teaching styles.
5. The training provided for teachers in this study was comprehensive. Many current programs have much lighter trainings. It seems likely a high level of training is likely to be important. Some studies have shown results are better when programs are presented by external experts, rather than internal teachers.
6. There was a small increase in some negative outcomes (e.g. more reporting of attentional problems, more obsessional traits, becoming less mindful) for some participants in the mindfulness group. Whether that is a negative outcome of the mindfulness intervention or simply an outcome of students being more aware of something they were previously not noticing is a question that is hard to answer. If the children are becoming more aware of what they were previously not noticing, then the solution is not necessarily to stop teaching them mindfulness but rather to help them to gently but mindfully work with these challenges. Possible responses to this observation might be to include better support for those students who are really struggling, and that the way we work with children be adapted to different needs.
Finally, whether this paper answers all the questions or whether it raises more questions than answers (e.g. why this program did not work, what kinds of school-based programs do work for adolescents and why?) is hard to say. It certainly cannot be ignored, but it is likely to provide a lot of impetus to naysayers, and at the same time be a challenge to people delivering whole of school mindfulness programs to reflect long and hard on what they are delivering and how they do it.
It is clear much more research is needed – soon.
ACKNOWLEDGEMENTS
Gratitude to Professor Craig Hassed of Monash University’s Centre for Consciousness and Mindfulness Studies, and Assoc-Professor Nicholas Van Dam of the University of Melbourne’s Contemplative Studies Centre for their assistance in collating and reviewing this post.
RECENT RESEARCH
Here are recently published studies examining mindfulness in schools programs that did record positive findings.
Meta-analysis of Randomized Controlled Studies (RCTs) shows Mindfulness-Based Interventions improve the mental health and wellbeing of youth – 2019.
Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials.
In this study, a systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty-three independent studies including 3,666 children and adolescents were included. Across all RCTs the research found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen's d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only.
Conclusions: This meta-analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology.
Dunning DL et al. Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials. J Child Psychol Psychiatry. 2019 Mar;60(3):244-258.
Update for the Dunning meta-analysis – 2022
The previous meta-analysis from this team (2019), suggested that MBPs show promising effectiveness, but highlighted a lack of high-quality, adequately powered randomised controlled trials (RCTs). This updated meta-analysis assesses the-state-of the-art of MBPs for young people in light of new studies.
Sixty-six RCTs, involving 20 138 participants (9552 receiving an MBP and 10 586 controls), were identified. Compared with passive controls, MBPs were effective in improving anxiety/stress, attention, executive functioning, and negative and social behaviour. Compared against active controls, MBPs were more effective in reducing anxiety/stress and improving mindfulness. In studies with a follow-up, there were no significant positive effects of MBPs. No consistent pattern favoured MBPs as a universal versus selective intervention.
Conclusions The enthusiasm for MBPs in youth has arguably run ahead of the evidence. While MBPs show promising results for some outcomes, in general, the evidence is of low quality and inconclusive. We discuss a conceptual model and the theory-driven innovation required to realise the potential of MBPs in supporting youth mental health.
Dunning D, Tudor K, Radley L, et al. Do mindfulness-based programmes improve the cognitive skills, behaviour and mental health of children and adolescents? An updated meta-analysis of randomised controlled trials. Evidence-Based Mental Health 2022;25:135-142.
Mindfulness leads to less disruptive behaviour - 2017
The purpose of this meta-analytic review was to add to the literature by synthesizing single-case research on Mindfulness-Based Interventions (MBIs) with children and adolescents. Specifically, the effect of MBIs on youths’ disruptive behaviour was examined in 10 studies published between 2006 and 2014. Results indicated that, on average, MBIs had a medium effect on disruptive behaviour during treatment. The average effect of MBIs during maintenance phases was larger. Potential moderators of intervention effects were also explored. Implications for future research and practice regarding MBIs with youth and in schools are discussed.
Klingbeil D et al. (2017). Effects of Mindfulness-Based Interventions on Disruptive Behavior: A Meta-Analysis of Single-Case Research. Psychology in the Schools. 54. 10.1002/pits.21982.
How well do Mindfulness-Based Interventions work for school children? - 2022
This systematic review published in 2022 set out to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth.
The researchers evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust coding system for evidence-based guidelines. The highest quality evidence ('A Grade') across outcomes indicated that MBSIs increased prosocial behaviour, resilience, executive function, attention and mindfulness, and decreased anxiety, attention problems/ADHD behaviours and conduct behaviours.
The highest quality evidence for well-being was split, with some studies showing increased well-being and some showing no improvements. The highest quality evidence suggests MBSIs have a null effect on depression symptoms.
Conclusion: This review demonstrates the promise of incorporating mindfulness interventions in school settings for improving certain youth outcomes. The authors urge researchers interested in MBSIs to study their effectiveness using more rigorous designs (e.g., RCTs with active control groups, multi-method outcome assessment, and follow-up evaluation), to minimize bias and promote higher quality - not just increased quantity - evidence that can be relied upon to guide school-based practice.
Phan ML et al. Mindfulness-based school interventions: A systematic review of outcome evidence quality by study design. Mindfulness (N Y). 2022 Jul;13(7):1591-1613.