Abstract
Purpose of Review:
Adolescents are vulnerable to mental health issues, affecting approximately 14% globally. Mindfulness interventions have shown effectiveness in addressing these issues and offer positive benefits across various domains. This review explores the outcomes of mindfulness therapy for adolescents with mental health problems.
Collection and Analysis of Data:
This scoping review followed PRISMA-ScR guidelines. Articles were searched from several databases (Science Direct, PubMed, Scopus, Emerald, and Proquest) based on inclusion and exclusion criteria, focusing on clinical trials of mindfulness therapy for adolescents (2014–2024). After critical appraisal using JBI tools, 11 out of 13 articles were included. Results showed that Mindfulness interventions for adolescents with mental health issues effectively reduced various psychological symptoms. Two categories of outcomes were identified: (a) emotional and cognitive disorders, and (b) behavioral and physical disorders.
Conclusions:
Mindfulness therapy has been shown to be effective in improving emotional, cognitive, behavioral, and physical functioning in adolescents, including reductions in stress, depression, anxiety, emotional dysregulation, ADHD symptoms, sleep disturbances, and maladaptive behaviors.
Introduction
Adolescence is a unique and critical period of individual development. According to the World Health Organization (WHO), adolescents are defined as individuals aged 10–19 years. During this time, adolescents undergo significant physical, emotional, and social changes. Factors such as poverty, abuse, or violence can make adolescents vulnerable to mental health issues. 1 Adolescents with mental health problems are more prone to social exclusion, discrimination, and stigma, negatively impacting their willingness to seek help. Additionally, they may face academic challenges, risky behaviors, physical health issues, and human rights violations. 2
The WHO reports that one in seven adolescents (14%) globally experiences mental health disorders, with most cases undetected or untreated. 1 In Europe, this figure reaches 20% of the total prevalence of other diseases worldwide. 3 In Indonesia, the Indonesia National Adolescent Mental Health Survey (I-NAMHS) revealed that one in three adolescents aged 10–17 years experiences mental health issues, equating to approximately 15.5 million adolescents with mental health problems and 2.45 million diagnosed with mental disorders. Commonly reported disorders include anxiety (a combination of social phobia and generalized anxiety disorder), followed by major depressive disorder (1.0%), behavioral disorders (0.9%), post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD) (both 0.5%). 4
These concerns highlight the importance of effective interventions to reduce the burden of mental health disorders among adolescents. Unmanaged mental health disorders can lead to more severe issues in the future, negatively impacting adolescents’ long-term lives. 5 These concerns highlight the importance of effective interventions to reduce the burden of mental health disorders among adolescents. Unmanaged mental health disorders can lead to more severe issues in the future, negatively impacting adolescents’ long-term lives. One effective intervention is mindfulness. According to Gu et al. 6 and mindfulness involves deliberately focusing attention on the present moment without judgment. Mindful individuals can focus on what matters rather than react impulsively to sudden situations, and they are better able to accept emotions nonjudgmentally, leading to more tolerant responses to stress. 7
Mindfulness encompasses five aspects: observing (the ability to notice and be aware of internal and external stimuli), describing (labeling and expressing observations through words), acting with awareness (fully engaging in the present moment), nonjudging of inner experience (a noncritical stance toward arising thoughts and feelings), and nonreactivity to inner experience (allowing thoughts and feelings to arise without becoming entangled). 8 Essentially, mindfulness trains individuals to be present, observe, feel, and accept occurrences without judgment or criticism. It helps individuals to become more aware of their feelings and better express them to others. 9
Mindfulness has been widely used to help individuals address various mental health problems and provide positive benefits across different domains, including cognition, psychological stress, coping abilities, and resilience. Numerous studies demonstrate that mindfulness practice reduces symptoms of anxiety and depression, enhances emotional well-being, and improves quality of life. 9 At each developmental stage, mindfulness may yield different effects, particularly among adolescents. However, no scoping review has specifically addressed mindfulness therapy for adolescents with mental health issues. Therefore, a scoping review on the outcomes of mindfulness therapy for adolescents with mental health issues is essential. This review aims to identify the outcomes of mindfulness therapy for adolescents with mental health issues.
Methods
Design
This study employed a scoping review approach following the PRISMA-ScR guidelines (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews) checklist and explanation. 10
Data Sources and Search Strategy
The authors (BJS, IA, HZ, KA, AH) conducted a literature search across electronic databases, including Science Direct, PubMed, Scopus, Emerald, and ProQuest. The search utilized the PICO framework: Population (P): adolescents with mental disorders, Intervention (I): mindfulness therapy, Comparison (C): control group, and Outcome (O): all outcomes. The research question guiding this review was: “What are the outcomes of mindfulness therapy for adolescents with mental health issues?” Boolean operators (AND/OR) were used to combine search terms, such as “mindfulness therapy” OR “mindfulness-based interventions” OR “mindfulness” AND “mental disorders” OR “mental health” OR “mental health treatment” AND “adolescents” OR “teens.” Secondary searches were conducted through hand searching. Detailed search strategies are presented in Table 1.
Literature Search.
Eligibility Criteria
Eligibility was restricted to articles published between 2014 and 2024, written in English, focusing on clinical trials of mindfulness therapy as an intervention for adolescents (mean age 10–19 years) with mental disorders. Articles discussing mindfulness therapy combined with other interventions, qualitative studies, observational studies, descriptive studies, case studies, pilot studies, preliminary studies, and feasibility studies were excluded.
Article Selection
Initially, all authors established search strategies and screened articles in five electronic databases. Duplicates were removed using the Rayyan software. Titles and abstracts were reviewed by authors IA, KA, and AH, according to eligibility criteria. Relevant studies were included, while irrelevant ones were excluded. Full-text articles were reviewed by all authors. Discrepancies were resolved through discussion until consensus was achieved. Quality assessment was conducted on relevant articles.
Quality Assessment
The quality of articles was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for randomized controlled trials (RCT). 11 All 11 selected articles met the inclusion criteria.
Data Extraction and Synthesis
Data were extracted using Microsoft Excel and presented in tables. Extracted data included authors, publication year, country, study design, participants, type of therapy, instruments, and outcomes. The findings were synthesized narratively to summarize the types of mindfulness therapies, the research instruments used, and the benefits categorized by study outcomes (Table 2).
Data Extraction.
Results
A total of 1035 articles were identified from five databases. After duplicates were removed, 1007 articles were screened based on title and abstract, excluding 983 articles. Twenty-four full-text articles were reviewed, out of which 16 were excluded due to accessibility, intervention focus, target population, and study design. Three additional articles were identified through hand searching. After critical appraisal using the JBI tool, 11 articles were included in this scoping review (Figure 1).
PRISMA Flow Diagram. 15
The studies included in this scoping review were conducted in various countries, including the Netherlands, Los Angeles, China, Canada, Spain, the United States, Australia, Sweden, and Belgium. All articles selected for the scoping review utilized an RCT design, with diverse respondents, such as adolescents experiencing ADHD, depression, anxiety, stress, rumination, and other psychological issues (Table 2).
Types of Mindfulness Therapy
The types of mindfulness therapy identified in this scoping review include mindfulness-based stress reduction (MBSR), family-based mindfulness intervention (MYMind), mindfulness-based cognitive therapy (MBCT), informal and formal mindfulness-based programs (MBP), taming the adolescent mind (TAM), mindfulness apps, training for mindfulness and resilience (TMR), and mindfulness group training for adolescents (MGTA).
Mindfulness-based Stress Reduction (MBSR)
Three studies described MBSR programs for adolescents with mental disorders. The MBSR program in the studies by Diaz-Gonzalez et al. (2018) and Vohra et al. (2019) consisted of eight weekly sessions incorporating meditation, yoga, breathing exercises, and reflection techniques. In another study 12 MBSR was delivered through the Learning to BREATHE (L2B) curriculum consisting of six core themes: Body awareness, Reflection, Emotion, Attention, Tenderness, and Habit, delivered across 12 sessions focusing on meditation, breathing, and reflection.
Family-based Mindfulness Intervention (MYMind)
Two studies discussed the implementation of MYMind therapy. Both studies employed a similar structure of eight sessions over eight weeks for parents and their adolescent children. The therapy included exercises supported by workbooks and meditation practices.13,14
Mindfulness-based Cognitive Therapy (MBCT)
The MBCT program described in the study by Liu et al. (2024) integrates mindfulness principles with cognitive therapy. It spans eight sessions over four weeks and employs techniques, such as meditation and body scanning.
Informal and Formal Mindfulness-based Programs (MBP)
Formal mindfulness programs, as adapted in the study by Mettler et al. (2024), are based on MBSR and the Learning to BREATHE curriculum. These programs consist of weekly 45-minute sessions over a four-week period, including meditation and other structured exercises. Informal mindfulness, in contrast, is more flexible and integrated into adolescents’ daily activities, such as brushing teeth or transitioning between classes, requiring minimal time commitment.
Taming the Adolescent Mind (TAM)
The TAM intervention in the study by Tan and Martin (2015) was implemented over five weeks. It involved meditation exercises and activities designed to enhance awareness and emotional regulation, including breathing techniques, sitting meditation, and body awareness exercises.
Mindfulness App
The study by Webb et al. (2022) explored the use of a mindfulness app, CARE, which provided self-guided mindfulness exercises over a three-week period. Participants reported their mood and anxiety levels after completing the sessions. 16
Training for Mindfulness and Resilience (TMR)
The TMR program consists of eight weekly sessions, each lasting two hours, delivered in a group setting. The sessions focus on themes, such as mindfulness, acceptance, and anxiety management skills. 17
Mindfulness Group Training for Adolescents (MGTA)
The MGTA program includes practice sessions that focus on breathing, meditation, and mindful awareness of physical and emotional experiences, supported by social interactions among participants. This therapy is conducted over an eight-week period. 18
Outcomes of Mindfulness Therapy
Findings from the 11 studies included in this research indicate that mindfulness therapy effectively reduces various psychological symptoms in adolescents with mental disorders. Researchers identified two categories of outcomes achievable through mindfulness interventions: (a) Emotional and Cognitive Disorders, (b) Behavioral and Physical Disorders.
Emotional and Cognitive Disorders
Based on this scoping review, the outcomes of mindfulness therapy in the category of emotional and cognitive disorders include stress (general and academic), depression, anxiety, emotional regulation (including negative affect and anger), rumination, psychological functioning, self-esteem, psychological flexibility, and resilience. Each of these outcomes was measured using various instruments.
The most frequently assessed outcomes across the studies included in this scoping review were general stress, academic stress, depression, and anxiety. Five out of the eleven studies measured stress as an outcome of mindfulness therapy for adolescents with mental disorders. Overall, these five studies demonstrated positive effects of mindfulness therapy in reducing stress. Three of these studies employed a similar measurement tool, the perceived stress scale (PSS). 12 One study used a different instrument, the depression anxiety stress scale (DASS-21), to measure stress outcomes. 21 Another study measured two different levels of stress: general stress using the PSS, and academic stress using ‘‘The Stress of School Performance’’ (seven items) and ‘‘School Attendance’’ (three items) subscales of the adolescent stress questionnaire (ASQ). 22 In measuring the outcome of depression, five studies reported that mindfulness therapy led to a significant reduction in depressive symptoms in adolescents with mental disorders. Three of these studies used a similar instrument, the DASS-21.18,21,23 Two other studies used the instruments the behavior assessment system for children, second edition (BASC-2) 20 and the patient health questionnaire (PHQ-4). 22 Additionally, five studies evaluated anxiety as an outcome of mindfulness therapy for adolescents with mental disorders, and all reported a reduction in anxiety following the intervention. The instruments used to measure anxiety varied across the studies, including the state-trait anxiety inventory for children, the state-trait anxiety inventory, 19 DASS-21, 21 beck youth inventories (BYI), 17 BASC-2, 20 and PHQ-4. 22
Other outcomes measured in the studies included in this scoping review were emotional regulation (including negative affect and anger), rumination, psychological functioning, self-esteem, psychological flexibility, and resilience.
Four studies that measured emotional regulation in adolescents with mental disorders reported improved emotional regulation using the emotional regulation questionnaire (ERQ).12,20 Additionally, there were reports of reduced anger based on the BYI 17 and decreased negative affect measured by the international positive and negative affect schedule-short form (I-PANAS-SF) 22 following mindfulness therapy. Rumination was measured in the study by Webb et al. (2022) using the Ecological Momentary Assessment of State Rumination, which showed a reduction in rumination levels in adolescents after mindfulness therapy. The outcomes of psychological functioning, self-esteem, and psychological flexibility were measured in the study by Tan and Martin (2015) using the child behavior checklist (CBCL) for psychological functioning, the Rosenberg Self-Esteem Scale for self-esteem, and the avoidance and fusion questionnaire for youth (AFQ-Y8) for psychological flexibility. The results indicated improvements in psychological functioning, self-esteem, and psychological flexibility after mindfulness therapy. Finally, resilience, the last outcome in the emotional and cognitive disorder category, was evaluated in a study by Laundy et al. (2021) using the resilience scale 10 (RS10), which showed an increase in resilience among adolescents following mindfulness therapy.
Behavioral and Physical Disorders
Based on this scoping review, the outcomes of mindfulness therapy in the category of behavioral and physical disorders included ADHD symptoms (including attention control), sleep disturbances, smartphone addiction, somatization, adaptability, and disruptive behavior. Three of the eleven studies measured the effect of mindfulness therapy on ADHD symptoms (including attention control) in adolescents with mental disorders, showing a reduction in ADHD symptoms and improvement in attention control. These three studies used different measurement instruments: ADHD symptoms were measured using the behavior rating inventory of executive function (BRIEF) 12 and Conners—3rd Edition 14 while attention control was measured using the attentional control scale-adapted (ACS). 22 Sleep disturbances and smartphone addiction were measured in the study by Liu et al. (2024) using the Pittsburgh Sleep Quality Index (PSQI) and the Chinese version of the Smartphone Addiction Scale-Short Version. The results indicated a reduction in both outcomes following mindfulness therapy. Somatization and adaptability were measured in the study by Vohra et al. (2019) using the BASC-2 and child acceptance and mindfulness measure (CAMM), with significant improvements in adolescent internalizing problems, including somatization, and increased adaptability after mindfulness therapy. The last outcome in the category of behavioral and physical disorders, disruptive behavior, was evaluated in the study by Laundy et al. (2021) using the BYI. The results showed a reduction in disruptive behavior in adolescents after receiving mindfulness therapy.
Discussion
Emotional and Cognitive Disorders
Mindfulness therapy for adolescents can have a positive impact on improving an individual’s ability to maintain emotional balance, cope with stress, and manage social interactions more effectively. 24 The goal of mindfulness intervention is to cultivate awareness and acceptance of thoughts and feelings, including being sensitive to thought patterns and bodily experiences that occur when someone feels anxious or stressed. 25 Mindfulness therapy is effective in reducing stress, sadness, anxiety, rumination, and depression. Additionally, it also provides benefits in emotion regulation, such as reducing emotional disturbances that affect cognitive functioning.26–28 Additionally, this therapy helps with emotional regulation by lowering emotional disturbances that affect cognitive function.26–28 Mindfulness therapy includes training that focuses on breathing consciously and focusing attention away from distractions. It also involves training that affects multiple brain networks simultaneously through parasympathetic dominance, which results in a relaxation response. 29 Cyniak’s 30 research findings, mindfulness therapy can serve as a buffer against the detrimental effects of psychological flexibility. People who are more mindfulness also typically have lower psychological flexibility. These findings support the notion that people with psychological flexibility can benefit from greater mindfulness. Furthermore, mindfulness therapy and self-compassion play a role as mediators in improving resilience to psychological stress. Specifically, individuals with higher levels of mindfulness and self-compassion tend to have better resilience, which then contributes to a reduction in psychological stress over the next one to two years. 31 Additionally, mindfulness therapy is effective in improving self-esteem because it helps redirect an individual’s attention away from feelings of low self-worth and negative thoughts about themselves.32,33
Behavioral and Physical Disorders
Mindfulness therapy can enhance self-control, reduce impulsivity, and improve the behavior of adolescents with mental disorders, as well as aid in self-regulation, attention focus, and behavior control, leading to positive effects on physical well-being and daily activity management. 34 Mindfulness therapy has been shown to improve effectiveness in managing mood, depression, sleep problems, somatization, and reduce ADHD symptoms.35–37 Mindfulness also helps increase awareness, particularly in adolescents with smartphone addiction, by engaging cognitive and behavioral processes, thus helping to transform poor habits into better self-regulation.38–40 Mindfulness also helps individuals avoid overreacting to negative emotions, which can reduce somatization symptoms such as physical pain or discomfort, often arising due to psychological stress. 37 Kroska et al. (2018) who explain that mindfulness therapy can help individuals accept their experiences without judging or trying to suppress unpleasant emotions and bodily sensations. 41 Furthermore, Porter et al. (2024) mention that children participating in mindfulness interventions are better able to focus their attention and show significant improvements in symptoms of inattention and hyperactivity. Mindfulness therapy teaches self-regulation strategies by shifting attention from negative triggers to neutral sensations, such as the feeling in the soles of the feet, thus preventing the escalation of problematic behaviors. A study by Felver et al. (2022) demonstrated that mindfulness therapy effectively reduces disruptive behaviors. Additionally, mindfulness can support the adaptation process in adolescents. 42 This is because mindfulness enhances adaptability at the biological level by supporting the development of prefrontal brain structures and improving socio-cognitive skills. 43
Conclusion
This study demonstrates that mindfulness therapy holds broad effectiveness in addressing various emotional, cognitive, behavioral, and physical issues among adolescents. The intervention has been shown to significantly reduce both general and academic-related stress, as well as symptoms of depression, anxiety, and ruminative tendencies. Moreover, mindfulness improves emotional regulation, particularly in managing negative affect and anger, while also enhancing other psychological dimensions, such as self-esteem, psychological flexibility, and resilience. These improvements equip adolescents with essential internal resources to navigate developmental stressors and social-academic challenges during the transition to adulthood.
In addition to its psychological benefits, mindfulness also contributes significantly to behavioral and physical improvements. The intervention has proven effective in reducing ADHD symptoms, notably by enhancing attentional control and decreasing impulsivity. Furthermore, mindfulness practice supports better sleep quality, decreases problematic smartphone use, reduces somatization symptoms, and improves adaptive functioning while mitigating disruptive behaviors. Based on these findings, mindfulness therapy may be considered a holistic approach suitable for integration into adolescent mental health programs across various settings, including educational, clinical, and community-based contexts.
Strength and Limitation
This scoping review demonstrates several methodological strengths. First, the review included only articles published within the last 10 years, ensuring that the findings reflect current evidence and align with the latest developments in mindfulness-based interventions. Second, the application of strict and well-defined inclusion criteria ensured that only studies with RCT designs were incorporated, thereby enhancing the quality of evidence and strengthening the validity of the conclusions drawn. Third, in addition to evaluating the outcomes of mindfulness interventions, this review also detailed the instruments used to measure each outcome. This information provides a valuable reference for future researchers in selecting appropriate measurement tools for related studies. Last, the use of the JBI Critical Appraisal Checklist contributed to a more rigorous, transparent, and consistent article selection process, further supporting the methodological robustness of the review.
Nevertheless, this review has several limitations that should be acknowledged. The included studies utilized a wide variety of mindfulness interventions, such as MBCT, MBSR, MYmind, and digital applications, with differing durations, frequencies, and delivery formats. This heterogeneity may limit the generalizability of findings and pose a risk of bias when interpreting the overall effectiveness of the interventions. Additionally, limited access to certain relevant full-text articles led to the exclusion of potentially eligible studies. This may introduce selection bias, as only accessible and available studies were ultimately reviewed and analyzed by the authors.
Footnotes
Acknowledgements
We would like to express our sincere gratitude to Gadjah Mada University for its invaluable support in providing access to various electronic databases necessary for this research. We also thank the journal editor and reviewers for their helpful comments, which have greatly improved the quality of this manuscript.
Authors Contribution
All authors contributed to the conceptualization and design of the study. Brian Joel Sapulette: conceptualization, methodology, data curation, validation, writing the original draft, writing review and editing. Ida Ayu Mas Prabhasuari: conceptualization, methodology, data curation, writing the original draft, writing review and editing. Humairatun Zakiyah: conceptualization, methodology, data curation, validation, writing the original draft, writing review and editing. Kiki Amanda Fatmawati: conceptualization, methodology, data curation, writing the original draft, writing review and editing. Alessandra Hernanda Soselisa: conceptualization, methodology, data curation, writing the original draft, writing review and editing. Sri Warsini: conceptualization, methodology, data curation, validation, writing review and editing.
Data Availability
The data used in this study are available in the article and can be accessed for verification or further analysis.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
This study was conducted without external funding. The authors are independently responsible for all costs associated with the research and publication process.
Statement of Informed Consent and Ethical Approval
This study did not involve human participants, and therefore, ethical approval was not required.