Taming the Adolescent Mind: Preliminary report of a mindfulness-based psychological intervention for adolescents with clinical heterogeneous mental health diagnoses

Abstract

Background:

Mindfulness-based interventions such as Mindfulness-based Stress Reduction (MBSR) and Mindfulness Cognitive Behavior Therapy (MCBT) have been used to treat adults with psychiatric disorders. This article describes initial modification and development of a mindfulness-based intervention group program for adolescents with psychiatric disorders. It was hypothesized that the intervention would improve mindfulness, mental health outcomes and decrease psychological distress and symptoms.

Method:

Adolescents from a mental health clinic attended a 5-week group pilot mindfulness-based intervention. Adolescents and parents completed questionnaires at pre- and post-intervention and at 3-month follow-up. Baseline measures indicated moderate to severe range of mental health symptoms.

Results:

After the intervention, adolescents reported significant decreases in psychological distress and increases in mindfulness and self-esteem. Qualitative data revealed the intervention to be engaging and beneficial. Parents also reported significant overall improvements of adolescents’ functioning.

Conclusions:

These promising preliminary results suggest that the intervention was feasible, acceptable and offered positive impact on mental health problems, and the intervention warrants further research in a randomized controlled study.

Keywords

Stress mental health disorders mindfulness-based intervention and adolescents

Introduction

A substantial number of adolescents suffer from emotional or behavioral disorders (Verhulst, Van der Ende, Ferdinand, & Kasius, 1997) which can hamper their present and future functioning and wellbeing (Costello, Angold, & Keeler, 1999; Sawyer, Arney, Bahurst, Clark, Graetz, Kosky, et al., 2001). Further, rates of adolescent psychiatric disorders appear to be rising in many western countries (Maughan, Iervolino, & Collishaw, 2005).

In Australia, for example, the prevalence rate of mental health problems for adolescents aged 13–17 years is 14% and, importantly, two thirds of people with anxiety and depression never access effective treatment (Sawyer, et al., 2001). Healthy adolescents are a key resource for the future well-being of society. Mental health problems impose severe personal and financial burdens on families and the community (AIHW, 2010). Mindfulness-based therapies are increasingly popular in the treatment of psychological problems in adult populations. However, the use and effectiveness of mindfulness-based approaches in adolescents have not been well explicated.

The ability to modulate responses to stress is increasingly found to contribute to overall adjustment (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001; Greenberg, 2006). Adolescents’ ability to regulate their emotional responses and cope with stressors influences their level of risk for maladaptive developmental trajectories (Compas, et al., 2001). Indeed, emotional regulatory capabilities have been shown to mediate the relationship between exposure to stress and youth outcomes in multiple studies (Sandler, Tein, Mehta, Wolchik, & Ayers, 2000; Wolchik, Tein, Sandler, & Ayers, 2006). As such, training adolescents to better modulate their stress responses and emotional states has been the focus of many interventions for treatment and prevention of psychopathology (Clarke, Hawkins, Murphy, Sheeber, Lewinshohn, & Seeley, 1995; Kendall, Flannery-Schroeder, Panichelli-Mindel, Southam-Gerow, Henin, & Warman, 1997) and may be particularly well suited to youths facing mental health challenges. Intervening in emotional regulation may help to modify the underlying stress-response system and deflect problematic trajectories.

Mindfulness has been conceptualized as ‘awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment’ (Kabat-Zinn, 1994, p. 4). Unlike cognitive behavioral therapy (CBT), mindfulness-based therapy requires minimal mental loading on language and cognitions. In CBT, patients are taught to observe, challenge and dispute faulty schemas or cognitions. Mindfulness training posits a number of facets such as intentional awareness, non-reactivity, describing, and present-moment nonjudgmental attitudes toward experiences regardless of their valence (Baer, Smith, Hopkins, Krietmeyer, & Toney, 2006). Approximately 50% of adolescents seen in mental health clinics also have language impairment (Im-Bolter & Cohen, 2007). It would appear that cognition-based programs may not be as acceptable, appropriate or as useful as might be wished. Mindfulness-based interventions may therefore be well placed as an adjunctive treatment for adolescents with mental health problems, whatever their intellectual or language ability.

Striving for efficient, effective use of mental health resources is an ongoing goal. Young people need to feel comfortable accessing service, knowing they will be understood and accepted, knowing that there are programs meaningful to them and effective for their particular problems. Mindfulness group-based intervention may potentially increase the number of adolescents able to access and utilize treatment as compared to standard psychological treatments delivered on an individual basis and demanding cognitive skill. This has practical implications for attendance and engagement, as adolescents are notoriously reticent in seeking treatment and difficult to engage. Mindfulness-based approaches may have the advantage of being able to reach approximately 8–12 adolescents in a group at one time, and therefore contribute to efforts toward efficiency.

Mechanisms of change

As mindfulness interventions have gained popularity, efforts have been made to formally operationalize the properties and elucidate precise mechanisms of action (Baer, 2003; Bishop, Lau, Shapiro, et al., 2004; Shapiro, Carlson, Astin, & Freedman, 2006). Although, it is beyond the scope of the current paper to explore these issues in depth, it is nonetheless important to briefly examine the construct of mindfulness, along with potential mechanisms of action, in order to more precisely situate the current research.

Several mechanisms have been posited to underlie the efficacy of mindfulness-based approaches in the treatment of psychopathology. These include increased awareness, along with the ability to see one’s thoughts and emotions from a decentered perspective: as transitory experiences rather than never-ending states or indications of absolute truth (Segal, Williams, & Teasdale, 2002). Mindfulness may also reduce distress through acceptances, and then reduction of rigid attempts to control or suppress one’s thoughts and emotions (Roemer & Orsillor, 2007). In addition, mindfulness may function as a form of ‘exposure’ or graded ‘flooding’ of internal experiences (Baer, 2003; Hayes, Stroshl, & Wilson, 1999).

Several experimental studies point to the benefits of mindfulness practice on awareness and attentional capacity. Jha, Krompinger, and Baime (2007) examined various attentional subsystems, including alerting, orienting and conflict monitoring in both seasoned and novice meditators. Attentional systems were measured before and after an 8-week course in mindfulness-based stress reduction (MBSR) for 17 meditation-naïve participants and results were compared with control participants after an 8-week time period. The MBSR participants demonstrated improved orienting compared to the control group.

Evidence has also accumulated to suggest that mindfulness interventions are effective in achieving improvement in various areas of physical and psychological functioning. For example, several studies have demonstrated the effectiveness of mindfulness interventions in the treatment of depression (Ma & Teasdale, 2004; Segal, Williams, & Teasdale, 2002), anxiety (Kabat-Zinn, 1994), trauma (Follette, Palm & Pearson, 2006), attention-deficit hyperactivity disorder (Zylowska, Ackerman, Yang, Futrell, Horton, & Hale, 2007) and psychosis (Bach & Hayes, 2002; Gaudiano & Herbert, 2006).

Mindfulness meditation has also been incorporated into specific manualized treatment protocols/programs such as Dialectical Behavioral Therapy (DBT; Linehan, 1993) where mindfulness training is applied to patients with borderline personality disorders. In the medical field, MBSR programs have been successfully used with a variety of patients suffering from a range of physical ailments, including chronic pain (Kabat-Zinn, 1982, Kabat-Zinn, Lipworth, Burney & Sellers, 1986) and cancer (Specca, Carlson, Goodey, & Angen, 2000; Tacon, McComb, Caldera, & Randolph, 2003). It has been shown to improve mood and quality of life. Brown, Ryan and Creswell (2007) have provided a detailed review on the salutary effects and evidence of mindfulness intervention.

Mindfulness-based interventions for adolescents

Research into the use of mindfulness interventions for adolescents is in its infancy compared to adult populations. A literature search of mindfulness interventions for adolescents in PsychINFO, CINAHL, Science Direct and Medline revealed three group-based intervention studies of mindfulness interventions for adolescents with psychiatric diagnoses (Biegel, Brown, Shapiro, & Schubert, 2009; Bootzin & Stevens, 2005; Wall, 2005). Of these studies, only one used a randomized control trial (Biegel et al., 2009). No study utilized validated mindfulness measures in evaluation and few included third party measures and outcomes. The current study attempts to investigate the feasibility of applying a modified, adolescent-focused mindfulness program to suit a clinically mixed diagnoses outpatient population and evaluate change using validated adolescent mindfulness and third party measures.

Adapting mindfulness-based interventions for adolescents

Mindfulness-based intervention dictates no explicit instruction in changing the nature of thinking or emotional reactivity, but requires the balance of present moment attention and acceptance with a non-judgmental openness to all experiences, regardless of their valence. The adaptation of mindfulness-based intervention in our program, Taming the Adolescent Mind, adheres to these principles. The treatment used in this study was based on the adult MBSR protocol, but modified to suit adolescents’ developmental needs. These modifications include shortened meditation exercises, from 45 minutes to 10 minutes, and brief and frequent exercises were encouraged rather than a single meditative mindfulness session. In addition, a range of age-appropriate mindfulness-based activities such as mindful drawing, mindful eating, mindful listening to music and sculpting were incorporated. These exercises were introduced to acknowledge adolescents’ need for movement, to incorporate mindfulness practices with the broad range of activities that are already part of their repertoires. It was anticipated that the modified exercises offered opportunities for emotional release and affect regulation. Unlike the adult program, there was no daylong weekend retreat at the end of the adolescent program. Participants were encouraged to practice mindfulness meditation and exercises at home on a daily basis. In order to further enhance protocol and compliance, participants received handouts and one weekly reminder about homework practice via mobile phone text messages. Adolescents recorded formal mindfulness instructions on their mobile phones, which meant increased accessibility and availability. Furthermore, participants received session handouts, which included limited text, language that targeted for a sixth grade reading level, large font size, cartoons and pictures.

The key components in the program were for participants to master ROAM (R: regulate attention, O: observe inside (i.e. body, sensations, etc) and outside (i.e. environment), A: acceptance without judgments, and finally M: be mindful), refer to Figure 1 for program outline.

Figure 1.

Taming the Adolescent Mind program outline.

The format for each weekly session was set out in the manual, characterized by two formal mindfulness exercises (at the start and at the end of each session), a review of homework practice, followed by group discussions of session themes. Mindfulness skills training activities were experientially designed to enhance awareness of one’s body and mind, to teach participants to notice automatic reactions with consciously chosen responses, and to bring greater awareness and skill to interpersonal communications. Experiential exercises allowed participants to experience mindfulness practices through various materials (for example, food, plasticine, movement, drawing), see Table 1 for session details.

Table 1.

Details of sessions in the Taming the Adolescent Mind program.

Session 1: Introduction ROAM - learning to regulate attention

• Introductions, establishing a safe, respectful and supportive milieu.

• Group rules around listening, respect, communication and confidentiality negotiated and established.

• Overview of the program provided to parents and adolescents separately.

• Mindful eating exercise, followed by discussion of the reactions to the exercise. Discussion of the definition and usefulness of mindfulness training and practice, and importance of regulating attention, clarify purpose of the group, and expectations.

• Discussion about the struggle of controlling problems.

• Deep breathing meditation

Session 2: Observer of present moment

• Mindful listening, visualizations, and mindfulness of breath exercises.

• Discussion on mindlessness and over-thinking versus mindfulness.

• Key point here is to facilitate skills of observing ‘what is happening inside their body and outside (situation)’ with less engagement or evaluation of problematic thoughts or emotions.

Session 3: Acceptance

• Body scan and mindful drawing activity of an unpleasant event or experience.

• Discussion of noticing unpleasant sensations and observing these sensations without judgments, but with curious observer acceptance.

• Shared discussion of examples of difficulties experienced in the week, of how application of mindfulness may be utilized in these instances.

Session 4: Being mindful

• Mindful eating and mindful sculpting activity of accepting and noticing unpleasant event, or experience.

• Consolidating mindfulness exercises and practice.

• Discussion of accepting both positive and negative experiences, participants were encouraged to share with the group how they might have incorporated these in the week (cultivation of mindfulness in all activities)

Session 5: Mindfulness and beyond

• Sitting practice and mindful eating exercises.

• Discussion of adolescent’s plan for continued cultivation of mindfulness in daily living, learning of experiences during the intervention.

• Closing celebration.

Method

Design

As a prelude to a randomized controlled and larger program, this preliminary trial used a single-group, longitudinal design. Adolescents and parents completed measures at pre-post intervention, and at 3-month follow-up. In addition, adolescents completed weekly homework logs after each of the five sessions and completed a satisfaction survey at the end of the program.

Recruitment and participants

Participants were recruited from existing case lists and were outpatients of the Child and Youth Mental Health Service, Brisbane, Australia. Case managers referred participants diagnosed with a mental health disorder, age range between 13–17 years and excluded participants with acute suicidality, acute substance use, acute psychosis, organic brain impairment and previous mindfulness-based experience. All adolescents were diagnosed by a child psychiatrist using the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), published by the World Health Organisation. Fifteen adolescents met the criteria and were approached to participate in the study. Of these, 10 Caucasian participants consented and they formed a single group. Participants’ education level ranged from Year 9–12 of high school. Of the participants, the average age was 15.7 years (standard deviation (SD)=1.07; range=14–17), 70% were female, and 50% continued with psycho-pharmacological treatment. The diagnosis across the participants was as follows: affective mood disorders (n=4), stress and adjustment disorders (n=4), phobic disorder (n=1), obsessive-compulsive disorder (n=1).

Procedure

All study procedures were approved by the Royal Children’s Hospital Medical Ethics Board and all participants and parents signed an informed consent form. Both participants and parents attended the first session. While participants completed pre-intervention measures, parents were introduced to the program, detailing the background, rationale, expectations and mindfulness practice. They then completed parent measures. At the final session, all participants and parents completed post-intervention measures. Adolescents were encouraged to return to 3-month follow-up, and were told they would receive a $20 gift voucher for their efforts. At the three-month follow-up, all participants and parents returned to complete follow-up measures, followed by a ‘booster’ session.

Measures

Adolescents completed the Depression Anxiety Stress Scale (DASS-21; Lovibond & Lovibond, 1995), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Children’s Acceptance and Mindfulness Measure (CAMM; Greco, Baer, & Smith, 2011) and Avoidance and Fusion Questionnaire for Youth (AFQ-Y8; (Greco, Lambert, & Baer, 2008). In addition, adolescents’ satisfaction with the intervention was assessed post-intervention, with four Likert scale questions (1: strongly disagree to 5: strongly agree, with 3 being neutral) and five open-ended comments designed for this study. Adolescents were asked to indicate by rating whether they would recommend the program to another adolescent with mental health problems, about their satisfaction level and the usefulness of the program. The open-ended questions inquired about (a) how helpful the program was, (b) to name one thing they learned from the program, (c) what they liked most about the program and (d) any recommendations for improvement to the program. Parents completed the Child Behavior Checklist (CBCL; Achenbach, 1991), designed to obtain multi-axial data on emotional, behavioral, social and academic competencies in adolescents.

Facilitator and intervention

The program known as Taming the Adolescent Mind is a 5-week, one-hour group intervention. The facilitator who developed the adolescent program is an experienced registered clinical psychologist. At each session, the adolescent received handouts outlining the presented skills, participated in experiential exercises and group discussions. At homework review, adolescents also discussed openly within the group how they had applied the skills outside the training sessions. The facilitator conducted the mindfulness training using a detailed protocol that outlined session plans.

Results

Participant characteristics

Ten participants signed up, one dropping out after session one due to social phobia and anxiety. Treatment completion was defined as attending at least three of the five sessions, including the final session. Those who missed sessions had valid reasons (i.e. sick, school excursion and school exams) and received a half-hour ‘catch-up’ session in the following week. On the basis of this, 90% of participants completed the treatment program.

Statistical analyses

We analyzed mindfulness and psychological functioning each with a one-way repeated measures analysis of variance (ANOVA) using time (pre- and post intervention and follow-up) as the independent variable, dependent variables were psychological distress, self-esteem, mindfulness and psychological inflexibility. We followed up significant effects using post hoc pairwise t-tests to investigate significant differences between pre- and post-intervention, between pre-intervention and follow-up, and between post-intervention and follow-up. Each set of dependent variables with their means and standard deviations for each time point are presented in Table 2.

Table 2.

Comparing mean scores over time.

Measure	Pre	Post	Follow-up	P	Effect size d
DASS 21 total	68.00±34.70	58.67±32.65	43.78±31.84	<0.01	0.28
DASS 21 stress	24.60±11.55	20.20±12.60	13.00±10.68	<0.01	0.36
DASS 21 anxiety	19.60±11.73	13.60±13.13	6.20±9.64	<0.01	0.48
DASS 21 depression	23.80±12.84	18.40±12.64	12.00±7.18	<0.01	0.42
Self esteem (RSE)	11.20±6.07	13.56±5.27	15.11±7.17	<0.02	-0.42
Mindfulness (CAMM)	15.50±7.26	21.44±4.04	21.67±8.14	<0.03	-1.04
Psychological inflexibility (AFQ-Y8)	20.20±9.03	14.56±7.91	11.20±6.07	<0.01	0.66
CBCL total (Parent)	60.20±8.12	53.11±11.77	53.11±11.55	<0.01	0.70

AFQ: Avoidance and Fusion Questionnaire for Youth; CAMM: Children’s Acceptance and Mindfulness Measure; CBCL: Child Behavior Checklist; DASS: Depression Anxiety Stress Scale; RSE: Rosenberg self-esteem.

Psychological distress

All participants completed the DASS-21 at pre-post intervention and 3-month follow-up. Before intervention, the mean total score was 68.00 (SD=34.70). Post intervention mean score was 58.67 (SD=32.65). At 3-month follow-up, mean score was 43.78 (SD=31.84). A repeated measures ANOVA revealed a significant effect of time, F(1, 8)=16.77, p<0.01, η2=0.67, such that psychological distress decreased significantly from post-intervention to follow-up, t(8)=6.18, p<0.01, and from pre-intervention to follow-up, t(8)=4.09, p<0.01.

Self-esteem

Before intervention, the mean total score was 11.20 (SD=6.07). The post intervention mean score was 13.56 (SD=5.27), and at 3-month follow-up this increased to 15.11 (SD=7.17). A significant effect of time was found for self-esteem, F(1, 8)=7.95, p<0.02, η2=0.5, such that it increased significantly from pre- to post intervention, t(8)=2.24, p<0.05, and from pre-intervention to follow-up, t(8)=2.82, p<0.02, but not from post intervention to follow-up.

Mindfulness

A significant effect of time was observed for mindfulness, F(1, 8)=7.14, p<0.03, η2=0.47. Results indicated a significant increase in CAMM scores from pre- to post-intervention, t(8)=2.8, p<0.02, and from pre-intervention to follow-up, t(8)=2.67, p<0.03, but not from post-intervention to follow-up.

Psychological inflexibility

A significant effect of time was found for psychological inflexibility as measured by AFQ-Y8, F(1, 8)=6.62, p<0.01, η2=0.45, such that it decreased significantly from pre-intervention to post intervention, t(8)=2.97, p<0.02, and overall from pre-intervention to follow-up, t(8)=2.57, p<0.03, but not from post intervention to follow-up.

Parent measures

Due to the heterogeneous nature of the sample, analyses were conducted using the CBCL total scores. Significant improvement was reported by parents on CBCL total scores, F(1,8)=5.65, p<0.05, η2=0.41, decreasing significantly from pre-post intervention, t(8)=2.38, p<0.04, and from pre- intervention to follow-up, t(8)=2.37, p<0.05. At post intervention, there was a downward trend of mean scores towards the normative range of scores (60.20 at pre-intervention to 53.11 at post intervention), with improvement tapering off at 3-month follow-up.

Patient satisfaction and treatment acceptability

All nine participants completed satisfaction surveys at post-intervention. Each item was rated 1–5, strongly disagree to strongly agree with 3 as the neutral point of the scale. Participants reported a high level of satisfaction with the Taming the Adolescent Mind program (M=4.1, SD=0.6). They also rated positively on the usefulness of the program (M=4.4, SD=0.5). Table 3 outlines participant written comments.

Table 3.

Feasibility and acceptability of Taming the Adolescent Mind program.

Theme	%	N=9
How has the program helped you?
• Sleep better	11	1
• More relaxed, less angry, controlling my emotions better, stress less, removed tension	89	8
Name one thing you have learnt from the program….
• Be more aware of spamming thoughts, noticing, think more clearly	44	4
• Breathe and relax, do one thing at a time	11	1
• Accept my problems, increase control	44	4
Taming the Adolescent Mind program is ….
• Useful, helpful and relaxing	56	5
What would you change about the program?
• Nothing to change	100	9
• Wanted more sessions	44	4
Would you recommend the program to friends in similar situation as you? All participants said “yes”.	100	9
Rate how satisfied were you with the program (scores of 4 and above, out of 5)	89	8
Rate how effective was the program in helping you deal with stress (scores of 4 and above, out of 5)	78	7

Mindfulness practice postPost-intervention

At the 3-month follow-up, all nine participants completed a questionnaire on mindfulness practice, with 89% reporting continued mindfulness practice since the intervention ended. Forty-four percent continued to practice mindfulness at least twice a week, 22% practiced three and four times per week respectively, and 11% practiced once a week.

Discussion

Consistent with the hypotheses, adolescents with a psychiatric diagnosis who attended a 5-week, group-based mindfulness program reported a significant decrease in psychological distress, symptoms and psychological inflexibility. Furthermore an increase in mindfulness and improvement in self-esteem were evident and continued at the 3-month follow-up. Parent reports revealed a significant reduction of behavioral problems and psychological symptoms.

Findings from this study are consistent with previous work by Biegel et al. (2009), where improvements in mental health outcomes of the mixed clinical U.S. adolescent sample were achieved from pre-to post interventions and with positive results maintained at follow-up. However, of note, their mindfulness-based intervention was conducted over an 8-week period, whereas in the current study similar results were achieved, despite it being only a 5-week group intervention.

Reviews of previous mindfulness-based intervention studies for adolescents have not included mindfulness-process measures. The present study specifically measured whether adolescent participants actually developed mindfulness skills. With the availability of age-appropriate mindfulness measures, such as CAMM (Greco et al., 2011) and AFQ-Y8 (Greco et al., 2008), we were able to demonstrate a significant increase in mindfulness in the participants at post-intervention. As predicted, participants improved overall from pre- to post intervention in mindfulness along with and reductions in psychological distress and psychological inflexibility. This trend is consistent with findings from adult studies (Baer, 2003).

Results of this preliminary study of a mindfulness-based intervention in a heterogeneous group of adolescent psychiatric outpatients are promising. They suggest that the Taming the Adolescent Mind program is an acceptable and credible treatment. Overall, high patient satisfaction was encouraging, with no patient reporting adverse effects of therapy. A number of positive comments were offered and patients reported that they would refer a friend with a similar problem to the group intervention. In addition, 90% completed the program, an attrition rate unusually low for this population. Anecdotal reports from parents and participant’s caseworkers were uniformly positive and no dissatisfaction was expressed with the intervention at any time.

An important factor in considering the success of the intervention is teaching adolescents to incorporate brief, but frequent mindfulness exercises in varied ways (drawing, music, breathing, body scan, mindful eating, movements, sculpting, etc) and the ease of these exercises in their daily activities. It provided each participant an opportunity to create an individualized program of ongoing daily mindfulness practice. The direct experience of observing their physiology or emotions represents a significant and immediately experienced change, enabling them to gain some level of control over the intensity of psychological arousal symptoms and to create a more relaxed state from which they can view symptoms of reoccurrence with more equanimity. This is supported by a significant reduction in psychological inflexibility scores (AFQ measure) and a significant increase in mindfulness awareness scores (CAMM measure).

This study provides preliminary evidence that adolescents in psychological distress can improve their symptoms using a mindfulness approach. It contributes an evaluated study to the literature on adolescent mindfulness research, which has been limited to date. Importantly, it demonstrates that these exercises though brief, when incorporated frequently into their daily activities can be effective for adolescents and that they continue to utilize the strategies after the formal intervention is completed.

Limitations

A number of limitations in this study must be acknowledged. First, the results must be interpreted with caution as the data, though complete, were gathered from a small number of patients. Second the lack of a control group (or even a wait-list control group) was not deemed ethically or practically viable for this preliminary study, which involved a 5-week adapted intervention focusing on young patients in a mental health setting. Given the limited resources available in a busy community mental health clinic, we chose to conduct this pilot to gather data on the feasibility of the Taming the Adolescent Mind group program in a challenging and distressed group of mental health adolescents. Third, expectations of positive outcomes from group participants and related factors involving increased attention (as opposed to mindfulness training per se) may have affected internal validity. On the other hand, the increase in mindfulness measures, significant third party (parent) reports, data drawn from a clinical sample and the adolescents’ responses to the qualitative questions regarding the mindfulness program, seem to diminish this possibility.

Fourth, participants and assessor were not blind to treatment condition due to pragmatic limitations. However, importantly, participants and assessors were unaware of the direction and extent of change in mindfulness when assessing mental health symptoms. At present this study offers tantalizing proof of concept and tentative support for the notion that mindfulness meditation and training may contribute to better mental health outcomes for adolescents with severe and complex clinical presentations across a range of psychiatric diagnoses. Limitations should be considered in the context of the strengths of the study, including the low attrition rates, high response rate over the three assessment points, multiple sources of data (adolescents and parents) from a clinical sample, program developer facilitator, the use of well-validated measures to assess change in mindfulness, the examination of both negative and positive outcomes and the use of follow-up assessment to examine the medium-term effects of the intervention.

Finally, in the light of recent publicly funded time-limited mental health treatments in Australia, these data may contribute to the debate of cost-efficient and time-efficient psychological treatments. Given that these promising findings are preliminary and to our knowledge, the first published evaluation of an intervention for adolescents using formal adolescent mindfulness measures, the next stage of our research entails a large randomized control trial, currently underway. Future research may also benefit from use of extensive qualitative data in the form of semi-structured in-depth interviews. Such data have the potential to reveal much about the subjective impressions of mindfulness meditation with regard to both process and outcomes.

Footnotes

Declaration of Conflicting Interests

None declared.

Funding

The first author acknowledges the contribution of Royal Children’s Hospital Foundation Scholarship - Clinical Innovation, and thank the Executive Management, Division of Child and Youth Mental Health Services (CYMHS), and North-West CYMHS team for their support in the project.

Author biographies

Lucy Tan is a Senior Clinical Psychologist of several decades of experience. She consults in both public and private health sectors. She has been a fortunate recipient of several awards recognizing clinical innovation and is a current researcher at Psychiatry Division, School of Medicine, The University of Queensland, Brisbane, Australia. In her spare time, she enjoys long distance running and playing the Chinese harp.

Graham Martin OAM is the Director of Child and Adolescent Psychiatry, The University of Queensland, and Clinical Director of Child and Youth Mental Health Services, Children’s Health Services, Queensland. His research interests are in Early Intervention and Promotion of Mental Health with special reference to prevention of suicide in young people. He has received many awards, including the Medal of the Order of Australia (OAM, 2006) for his tireless work in youth suicide prevention. He is also the Editor-in-Chief for the journal Advances in Mental Health and serves on several boards and committees. He holds a Nidan black belt in Goju Ryu Karate.

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