A controlled trial of mindfulness training in schools

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A controlled trial of mindfulness training in schools:
The importance of practice for an impact on well-being
Felicia A. Huppert a & Daniel M. Johnson b
a Department of Psychiatry and the Well-being Institute, University of Cambridge,
Cambridge, UK
b Faculty of Science and T echnology, Queensland University of T echnology, Brisbane,
Queensland, Australia
Version of record first published: 03 Aug 2010.
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The Journal of Positive Psychology Vol.5,No.4,July 2010,264–274
A controlled trial of mindfulness training in schools:The importance of practice for an
impact on well-being
Felicia A.Huppert a *and Daniel M.Johnson b
a
Department of Psychiatry and the Well-being Institute,University of Cambridge,
Cambridge,UK;b Faculty of Science and Technology,Queensland University of Technology,
Brisbane,Queensland,Australia
(Received 17September 2009;final version received 10March 2010)
We report the results of a short programme of mindfulness training administered to adolescent boys in a classroom tting.Intervention and control groups (N ¼155)were compared on measures of mindfulness,resilience and psychological well-being.Although the overall differences between the two groups failed to reach significance,we found that within the mindfulness group,there was a significant positive association between the amount of individual practice outside the classroom and improvement in psychological well-being and mindfulness.We also found that the improvement in well-being was related to personality variables (agreeableness and emotional stability).Most students reported enjoying and benefiting from the mindfulness training,and 74%said they would like to continue with it in the future.The results of this preliminary study are encouraging.Further work is needed to refine the training programme and undertake a definitive randomid controlled trial,using both subjective and objective outcome measures,with long-term follow-up.Keywords:well-being;education;mindfulness;adolescents;intervention
Introduction
In recent years,there has been a growing acceptance that schools should not only provide children w
ith a formal education but should also consider the well-being of the child as a whole.For the most part,this new approach has focud on identifying and manag-ing mental health problems,bullying and antisocial behaviour within the school context,and there have been many encouraging findings (e.g.Vreeman &Carroll,2007;Weissberg &Kumpfer,2003).However,if our interest is in the well-being of all children,we need to go beyond the alleviation of symptoms or problem behaviours,and consider approaches which can benefit all children.The alarmingly low rates of well-being,both objective (e.g.health,educational attainment)and subjective (e.g.life satisfaction)among children in economically advantaged countries,such as the UK and the US (UNICEF,2007)make this issue not only timely,but also urgent.
In this article,we focus on the subjective aspects of well-being.We define well-being as the combination of feeling good and functioning well (Huppert,2009;Keyes,2002).Feeling good includes positive emotions,such as happiness,contentment,interest and affection.Functioning well includes a n of autonomy or lf-determination (i.e.the ability to make choices),competence and lf-efficacy (i.e.capability in under-taking daily activities),resilience in the face of challenge or adversity which involves the awareness and management of thoughts and feelings and positive relationships,which encompass empathy and kind-ness (e.g.Ryan &Deci,2001;Ryff &Singer,1998).
So how can we increa the well-being of children in the school context?There are many possible approaches,some focusing on increasing confidence and lf-esteem,some on increasing resilience and others on improving social and emotional skills.For example,programmes on social and emotional learn-ing have become widespread throughout North America and are mandatory in state schools in the UK and Australia.Most approaches,such as all tho bad on cognitive behaviour therapy (CBT),were originally developed for the treatment or prevention of disorder,but can be applied as a universal intervention to enhance the well-being of all children,rather than being targeted at problem groups.Nevertheless,where the effectiveness of such interventions has been eval-uated,the outcome measures are usually negative (e.g.the reduction of depressive symptoms or bullying)rather than positive (the enhancement of positive feelings and positive functioning).A ca in point is the highly regarded,well-evaluated Penn Resiliency
*Corresponding author.Email:fah2@cam.ac.uk
ISSN 1743–9760print/ISSN 1743–9779online ß2010Taylor &Francis
DOI:10.1080/
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骨折后怎样恢复得快Program (Gillham et al.,2007).The 12-lesson pro-gramme has been found to substantially reduce the incidence of depression and problem behaviours among adolescents,but to date,effects on the enhancement of well-being have not been published.
A promising approach to enhancing the well-being of children in school,which may have benefits for many aspects of well-being,is to provide training in mindfulness.As described in the Mental Health Foundation Report 2010:‘Mindfulness is a way of paying attention.It means consciously bringing aware-ness to our experience,in the prent moment,without making judgements about it’.Usually,we pay little attention to our experience;rather we are swept away by thoughts and feelings,external events,interactions with others,or memories about the past and hopes and fears about the future.Most of the time,we are on automatic pilot,caught up in our experience and reacting automatically,especially when we are under pressure.In contrast,staying consciously aware of what is happening allows us to e and experience things ‘as they really are’and have choice over how we respond.With mindfulness,we deliberately obrve and accept what is happening right now,in our bodies,minds and the world around us,with an attitude of gentle curiosity.
In experiential terms,mindfulness has a calming and centring effect.By focusing on an object,such as the breath,the busy,buzzing,sometimes scattered mind,becomes clearer.In this state,nsations,thou
ghts and feelings enter conscious awareness,but their obssive or ‘hooked’quality is reduced when they are obrved with interest and curiosity,and then let go.Reduced anxiety and a n of calm ari from not judging what goes on in the mind or in the external world,but simply accepting the experience as it is.
In light of our understanding of the principles and experience of mindfulness practice,we can hypothesi that mindfulness training has the potential to enhance well-being in a number of ways.With respect to positive feelings,the central practice of being in the prent provides an opportunity to increa such feelings through savouring on-going experiences.The practices of calming the mind and obrving experi-ences with curiosity may be directly linked to feelings of contentment and interest.
With respect to positive functioning,the mindful-ness practice of learning to respond rather than to react could enhance the n of autonomy or lf-determination,through the incread ability to make choices.Incread choice can lead to a greater n of lf-efficacy,while competence could be incread through the training of attention regulation.Training in the conscious control of attentional resources (maintaining,lecting and shifting)is likely to have beneficial effects on learning,problem solving,deci-sion-making and other cognitive process.
The awareness and acceptance of our thoughts and
feelings including painful ones may have direct benefits for emotion regulation,which is a key part of resilience.
Benefits of mindfulness for interpersonal relation-ships may derive from veral aspects of the practice.Responding rather than reacting may reduce negative interpersonal behaviours,such as anger or aggression.Incread awareness of the behaviour and feelings of others may lead to greater appreciation of positive behaviours,such as affection,generosity or humour,and an incread understanding of the other’s difficul-ties,such as sadness,anger or confusion.Further,it is often said that being kinder and more accepting of onelf leads to greater kindness,acceptance and empathy towards others (e.g.Baer,2003;Mental Health Foundation,2010).
Mindfulness practices are congruent with much of the theory and practice in positive psychology.Positive psychology is a broad umbrella,which is fundamen-tally concerned with the scientific understanding and promotion of what makes life go well (Seligman,2002).A large body of rearch within positive psychology has focud on evidence for the benefits of positive emotions and how to increa them (Fredrickson,2001;Lyubomirsky,King,&Diener,2005).Another strand of res
earch and practice within positive psy-chology concerns resilience,and encompass the widely ud Penn Resiliency Program (Gillham et al.,
2007;Reivich &Shatte
,2003).Positive psychology is also concerned with interpersonal aspects of well-being,and interventions have been developed which promote kindness,gratitude and forgiveness (e.g.Emmons &McCullough,2002;McCullough &vanOyen Witvliet,2005).While interventions in pos-itive psychology are often quite focud on a particular outcome,a mindfulness approach can influence a range of the outcomes.In a recent review of positive psychology interventions,Sin and Lyubomirsky (2009)included a large number of studies which ud mind-fulness training.
Studies of mindfulness-bad interventions in adults,including a number of good quality randomid controlled trials,confirm the benefits of such training across a wide range of outcomes.Evidence for the benefits of mindfulness training in adults has been summarid in veral major reviews and meta-analys (Baer,2003;Grossman,Niemann,Schmidt,&Walach,2004;Irving,Dobkin,&Park,2009;Mental Health Foundation,2010;Salmon et al.,2004).Mindfulness interventions are usually administered to adults in
the form of mindfulness-bad stress reduc-tion (MBSR;Kabat-Zinn,Lipworth,&Burney,1985)or mindfulness-bad cognitive therapy (MBCT;Segal,Williams,&Teasdale,2002),both of which typically involve an 8-week programme with group ssions of around 2h per week and individual daily home
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practice of around 40min per day,usually guided by listening to a CD.
The specific benefits of mindfulness for cognitive function include improvements in focud and lective attention (e.g.Jha,Krompinger,&Baime,2007;Tang et al.,2007).Benefits for mental health such as the reduction of symptoms of distress have been demon-strated in both clinical and non-clinical populations (e.g.Jha et al.,2007;Ma &Teasdale,2004;Speca,Carlson,Goodey,&Angen,2000;Williams,Kolar,Reger,&Pearson,2001).There is also evidence of the enhancement of well-being including positive mood
(Nyklıc
ek &Kuijpers,2008;Shapiro,Oman,&Thoren,2008),lf-esteem and optimism (Bowen et al.,2006)and lf-compassion and empathy (Shapiro,Astin,Bishop,&Cordova,2005;Shapiro,Brown,&Biegel,2007;Shapiro,Schwartz,&Bonner,1998).Mindfulness-bad interventions have also shown substantial benefits for physical health,includ-ing the management of chronic pain (e.g.Grossman,Tiefenthaler-Gilmer,Raysz,&Kesper,2007;Morone,Greco,&Weiner,2008),improved neuroendocrine and immune functioning (Davidson et al.,2003;Tang et al.,2007)and improvements in health-related behaviours,such as reductions in binge eating (Kristeller &Hallett,1999)and substance misu (Bowen et al.,2006).
Far less rearch has been undertaken with children or adolescents,but in light of the cognitive,emotional and social benefits of mindfulness meditation in adults,its application within the school context is becoming more widespread (he report by the Garrison Institute Report,2005).However,in the published literature,there has been little systematic evaluation of the effects of mindfulness training in children.A recent review by Burke (2010)summaris the limited evidence published to date regarding children and adolescents.We focus here on the latter group,in whom mood is known to be volatile,and for whom there is evidence of low levels of satisfaction with school compared to younger children (New Economics Foundation,2004).
Almost all the published rearch with adolescents has targeted tho with problems,including learning difficulties (Beauchemin,Hutchins,&Patterson,2008),conduct disorder (Singh et al.,2007)and externalising disorders,such as attention deficit and autistic spec-trum disorders (Bogels,Hoogstad,van Dun,De Shutter,&Restifo,2008;Zylowska et al.,2007).The studies report a range of benefits in attention and emotion regulation and improvement in social skills,but the samples are very small (ranging from 3to 34),there are no control groups and the results are mostly non-quantitative.One study which provided mindfulness training to children without specific problems involved a 5-week modified MBSR interven-tion with children aged 11–13(Wall,2005).Participants reported feeling calmer after the ssions,
but the evidence was anecdotal and the mindfulness training was combined with Tai Chi,so it is not possible to know to what extent the improvement was the result of the mindfulness training.While anecdotal or qualitative information is a valuable starting point,a convincing demonstration of the benefits of such training requires (1)that the group which practid mindfulness shows greater benefits than a comparison group which did not undertake the mindfulness train-ing and (2)that the effects of the training be measured in a quantifiable manner.
This study aimed to advance our understanding of the effects of mindfulness training in adolescents
by administering a modified MBSR cour in a school context,measuring relevant variables pre-and post-intervention,and comparing changes on the vari-ables in class which had received the mindfulness training versus class which had not.Sample size was relatively large (total recruited N ¼173)and both qualitative and quantitative measures were ud.The outcome measures we cho to examine were mindful-ness,resilience and psychological well-being.The were measured using standard scales developed for adults,since we could find no appropriately validated measures for adolescents.Additional outcome mea-sures included the extent of individual practice outside of lesson time and the pupils’evaluations of the training programme and its effects on them.
It is widely acknowledged that for any intervention we should not assume that ‘one size fits all’.We were therefore interested to know whether characteristics of individual students might be related to the effectiveness of mindfulness training.Becau well-being is one of our principal outcome measures,and there is known to be a strong association between well-being and per-sonality (De Neve &Cooper,1998;Diener &Lucas,1999;Steel,Schmidt,&Schultz,2008),we decided to include a baline measure of personality using the five-factor model (McCrae &Costa,1987).The ques-tion we addresd was whether the type of personality influenced an adolescent’s receptiveness to,or the effects of,mindfulness training.
Methods
Participants and study design
Fourteen-and fifteen-year-old students from two independent (fee-paying)boys’schools participated in this study.The two schools were lected becau religious education teachers in each school,who were long-standing mindfulness practitioners,were keen to train pupils in this practice and participate in a rearch study.A total of 173students were recruited from 11religious education class.The preponderance of the sample was white British,with ethnic minorities accounting for about 5%of the sample (mainly ethnic
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Chine from Hong Kong).Six of the class were normally taught by one of the above teachers and were allocated to the mindfulness intervention.Five class,which were normally taught by other teachers,acted as controls.The parents of students in both the mindful-ness and control groups were informed about the study.The parents of one student refud connt,and a parent of another student expresd some rervations,so the two pupils were not included in the study.
The mindfulness training was bad on the programme developed by Kabat-Zinn and coworkers at the University of Massachutts Medical School (Kabat-Zinn,2003).It comprid four 40min class,one per week,which prented the principles and practice of mindfulness meditation.The mindfulness class covered the concepts of awareness and accep-tance,and the mindfulness practices included bodily awareness of contact points,mindfulness of breathing and finding an anchor point,awareness of sounds,understanding the transient nature of thoughts and walking meditation.The mindfulness practices were built up progressively,with a new element being introduced each week.In some class,a video clip was shown to highlight the practical value of mindful awareness (e.g.‘The Last Samurai’,‘Losing It’).Students in the mindfulness condition were also provided with a specially designed CD,containing three 8min audio files of mindfulness exercis to be ud outside the classroom.The audio files reflected the progressive aspects of training which the students were receiving in class.Students were encouraged to undertake daily practice by listening to the appropriate audio files.During the 4-week training period,students in the control class attended their normal religious studies lessons.
All participants completed a short ries of online questionnaires before and after the 4-week intervention period.This took place in a computer room either 1week before the first training ssions
or at the start of the first ssion (baline)and 1week after the conclusion of the ssions (follow-up),and took around 15min.
Measures
The questionnaires were lected in order to measure the effect of mindfulness training on changes in mindful awareness,resilience and well-being.Short questionnaires were chon to maximi the likelihood of completion.
To measure mindfulness,the Cognitive and Affective Mindfulness Scale-Revid (CAMS-R;Feldman,Hayes,Kumar,Greeson,&Laurenceau,2006)was ud.This scale was chon as it is designed to cover the four domains commonly identified as being key to mindfulness:the ability to regulate
attention;an orientation to the prent or immediate experience;awareness of experience and an attitude of acceptance towards experience.The scale consists of 12items answered on a 4-point Likert scale ranging from 1(rarely/not at all)to 4(almost always).Sample items include ‘I am easily distracted’and ‘I am able to focus on the prent moment’.The scale was found to be reliable in this study (Cronbach’s alpha at time 1¼0.612and at time 2¼0.646),and has been shown to have good re
liability and validity with a large (N ¼548)student sample (Feldman et al.,2006).
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To measure resilience,the Ego-Resiliency Scale (ERS;Block &Kremen,1996)was ud.The scale is commonly ud as a measure of psychological resil-ience,defined as the capacity to modify respons to changing situational demands,especially frustrating or stressful encounters (Tugade &Fredrickson,2004).The scale consists of 14items answered on a 4-point Likert scale ranging from 1(does not apply at all)to 4(applies very strongly).Sample items include ‘I enjoy dealing with new and unusual situations’and ‘I get over my anger at someone reasonably quickly’.The scale was found to have good reliability in this study (Cronbach’s alpha at time 1¼0.656and at time 2¼0.743),and has been shown to have good reliability and validity with a moderate-sized (N ¼104)student sample (Block &Kremen,1996).
To measure well-being,the Warwick–Edinburgh Mental Well-being Scale (WEMWBS;Tennant et al.,2007)was ud.The scale is designed to capture a broad conception of well-being including affective-emotional aspects,cognitive–evaluative dimensions and psychological functioning.The scale consists of 14items answered on a 5-point Likert scale ranging from 1(none of the time)to 5(all of the time).Sample items include ‘I’ve been feeling optimistic about the future’and ‘I’ve been feeling clo to other people’.The scale focus entirely on the positive aspects of mental health,including p
ositive emotions,satisfying interpersonal relationships and positive functioning.The scale was found to be reliable in this study (Cronbach’s alpha at time 1¼0.745and at time 2¼0.830),and has been shown to have good validity,internal consistency and test–retest reliability with a large (N ¼354)sample of students and a very large (N ¼2075)sample of the general population (Tennant et al.,2007).描写雪的优美段落
To measure personality,the Big-Five personality dimensions (McCrae &Costa,1987)were assd.The measure extraversion,agreeableness,conscien-tiousness,emotional stability and openness to experi-ence.The measure ud was the Ten-Item Personality Inventory (TIPI;Gosling,Rentfrow,&Swann,2003),which is designed to measure personality in situations where the u of longer personality instruments is not practical.The scale consists of 10items (two for each personality dimension)answered on a 7-point Likert
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scale ranging from 1(disagree strongly)to 7(agree strongly).Sample items include ‘I e mylf as extraverted,enthusiastic’and ‘I e mylf as critical,quarrelsome’.The five sub-scales have been shown to have moderate internal consistency (as a function of only having two items per sub-scale)and good test–retest reliability and validity with a very large (N ¼1813)sample of university students (Gosling et al.,2003;McCrae &Costa,1987).Personality was measured only at baline becau it is regarded as a stable trait.In this study,the internal consistencies (Cronbach’s alpha)were as follows:extraversion ¼0.57;agreeableness ¼0.11;conscientiousness ¼0.49;emotional stability ¼0.56and openness to experience ¼0.26.
At follow-up,participants in the mindfulness con-dition were also asked a ries of questions about the number of times they had practid mindfulness outside of class,how much they felt they had learned during the cour,how much they enjoyed the cour,how helpful they found it,whether the training cour was the right length and whether they thought they would continue to practice mindfulness.
Data analysis
Statistical analysis was conducted on participants who did not have missing data on the questionnair
es.One hundred and fifty-five participants had complete data at baline and 134at follow-up (78in the mindfulness and 56in the control condition).Missing data only occurred when a participant provided data at time 1,but not time 2or vice versa .Imputation is not an advisable method for dealing with missing data in this circumstance,so we ud listwi deletion.Baline data were analyd by analysis of variance (ANOVA).Analysis of change post-training utilid a residualid difference measure rather than simple difference scores,as recommended by Zumbo (1999)and Williams and Zimmerman (1983),who judged residualid differ-ences to provide a more reliable indicator of change.1
Results
Baline comparisons
To test whether there were any pre-existing differences on the outcome measures between the control and mindfulness groups,a one-way independent groups ANOVA was run using the time 1scores for mindfulness,resilience and well-being.No significant differences were found,indicating that there were no pre-existing differences on the measures between the two groups (CAMS-R:F (1,153)¼0.483,ns;ERS:F (1,153)¼0.606,ns;and WEMWBS:F (1,153)¼0.612,ns).Since there were n
o significant group differences,the baline data for the 155students were combined to evaluate how 14-or 15-year-old boys score on the questionnaires,which were originally developed for adults (Table 1).It can be en that this sample performed on average at the middle or upper end on all the scales,and inspection of the frequency distributions (not shown)indicates that for all mea-sures,there was a relatively normal distribution of scores.Pearson bivariate correlation coefficients were calculated for each pair of outcome measures at baline.Unsurprisingly,all the measures were found to be significantly related such that greater mindfulness was associated with greater resilience (r ¼0.33;p 50.01)and greater well-being (r ¼0.40,p 50.01),and greater resilience was associated with greater well-being (r ¼0.55,p 50.01).
We also explored the relationship between person-ality and the psychological measures at baline.A ries of standard multiple regression analys was performed,incorporating all five personality variables (extraversion,agreeableness,conscientiousness,emo-tional stability and openness to experience)for each of the psychological measures (CAMS-R,ERS and WEMWBS).The results are reported in Table 2.
土木工程学To interpret this table,we note that in multiple regression,the  weights indicate the slope of the regression line and the direction (positive or negative)of the relationship;this is expresd as the cha
nge in the standardid outcome measure associated with one standard deviation (SD)change in the predictor
Table 1.Baline data on the lf-completion questionnaires (N ¼155).
Mean
SD Median Obrved range
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Possible range
Mindfulness (CAMS-R)30.9  4.531.020–4112–48Resilience (ERS)
39.8  4.940.026–5114–56Well-being (WEMWBS)49.5  5.949.031–6514–70Personality (TIPI)Extraversion 9.5  2.610.02–142–14Agreeableness 8.8  1.99.03–142–14Conscientiousness 9.8  2.810.02–142–14Emotional stability 9.7  2.710.02–142–14Openness to experience
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