Program

Dec 21, 2012

OVERVIEW

Mindfulness-based stress reduction (MBSR) trains individuals to direct their attention to an event or experience while avoiding evaluative thought or judgment, with the goal of alleviating stress and stress-related outcomes.  MBSR was implemented with adolescents in an outpatient psychiatric program who had received a psychological diagnosis.  Adolescents in the treatment group received MBSR, plus their usual psychiatric care.  Controls received their usual psychiatric care.  The evaluation showed that adolescents in the treatment group experienced improvements, compared with the control group, in social, occupational, and psychological functioning, as well as in perceived stress, state and trait anxiety, self-esteem, sleep quality, and four of six psychological symptoms: depression, obsession-compulsion, somatization, and interpersonal sensitivity.  There were no impacts on two psychological symptoms (anxiety or hostility), or on participants’ mindfulness, psychotherapy visits, hospitalizations, or medications.

DESCRIPTION OF PROGRAM

Target population: Adolescents who have received a psychological diagnosis.

This psychoeducational program, geared towards adolescents with psychological diagnoses, involves eight weeks of two-hour classes.  Classes, which are led by Master’s-level instructors trained in MBSR, are based on a training manual. Classes involve practicing attending to daily events, as well as practicing Hatha yoga and three types of meditation (body scan meditation, walking meditation, and sitting meditation).  The program also includes at-home practice assignments, and classroom presentations related to self-image, life transitions, self-harming behaviors, communication, and interpersonal relationships.  Participants receive a workbook to reinforce class material, and a CD to facilitate meditation.

The core elements of the MBSR program are intention (effort toward mindful attention), attention (ability to experience what is happening in the moment), and attitude (non-judgmental openness). The theory underlying the program is that MBSR promotes acceptance, awareness, and an emotional disengagement from events or experiences that cause stress and stress-related outcomes, including depression, anxiety, sleep difficulties, and low self-esteem.

EVALUATION OF PROGRAM

Study 1: Biegel, G. M., Brown, K.W., Shapiro, S. L., & Schubert, C. M. (2009). Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77(5), 855-866.

Evaluated population: Adolescents aged 14-18 who were currently or previously under psychiatric care were recruited from a hospital outpatient department of child and adolescent psychiatry. Those who were currently abusing substances, or who currently or previously had a psychiatric or neurological disorders that would severely limit study participation, were excluded.

The evaluation included 102 adolescents; 50 participants were assigned to the treatment group, and 52 were assigned to the control group.  The sample was predominantly female (74 percent).  Nearly half (45 percent) were white, and more than one-quarter (28 percent) were Hispanic; six percent of the sample were Asian, three percent were black, one percent were Native American, and 17 percent were of mixed racial/ethnic descent. The average age of participants was 15 years.  Nearly half (49 percent) had a mood disorder, and 30 percent had an anxiety disorder.

Approach: Random assignment to the treatment or control group was conducted using blind selection of condition numbers, and assignment was not revealed to participants until completion of the baseline measures.  MBSR was delivered in conjunction with participants’ usual psychiatric treatment. The control group was placed on a waitlist and received treatment as usual–In this case group, psychotherapy and psychotropic medication management. Thirty-nine of the 50 participants (78 percent) in the treatment group completed the program.  All cases were analyzed in an intent-to-treat design.

Treatment- and control-group measures were obtained at three points: pretest (baseline), posttest (eight weeks after pretest, immediately following program completion), and follow-up (three months following the posttest). The evaluation relied on self-reported outcome measures of perceived stress, distress, state and trait anxiety, self-esteem, sleep quality, and psychological symptoms (depression, anxiety, obsession-compulsion, somatization, interpersonal sensitivity, and hostility).  The evaluation also used medical records to document psychotherapy visits, mental health hospitalizations, and mental health medication.  Additionally, the evaluation drew participant diaries, in which participants responded weekly to questions regarding their mindfulness practices. Finally, the evaluation used posttest and follow-up clinical assessments of social, occupational, and psychological functioning (all by clinicians who were unaware of participants’ baseline diagnoses).

Results: At both the eight-week post-test and the three-month follow-up, adolescents in the MBSR treatment group were found to have significant (or marginally significant) improvements compared with the control group in  social, occupational, and psychological functioning scores, and in perceived stress, state and trait anxiety, self-esteem, sleep quality, and four of six psychological symptoms: depression, obsession-compulsion, somatization, and interpersonal sensitivity.  There were no impacts on the remaining two psychological symptoms (anxiety or hostility), nor were there impacts on the levels of participants’ psychotherapy visits, hospitalizations, or medications.

Effect-size estimates showed small to medium effects among the treatment group at posttest, and medium to large effects at the three-month follow-up.  Among those who completed the program, boys were more likely to show improvement than were girls.

Study 2: Brown, K. W., West, A. M., Loverich, T. M., & Biegel, G. M. (2011). Assessing adolescent mindfulness: Validation of an adapted mindful attention awareness scale in adolescent normative and psychiatric populations. Psychological Assessment, 23, 1023-1033. doi:10.1037/a0021338

Evaluated Population:  See Study 1 (above).

Approach:  See Study 1 (above).  In addition to the outcomes measured in the previous study, this evaluation measured mindfulness (i.e., a receptive state of attention where one becomes an observer of the present moment) at baseline, post-test, and follow-up.

Results:  While participants in the MBSR condition showed significant improvement in mindfulness from pre-test to follow-up, no differences in mindfulness were found when compared with the control group at post-test or follow-up.  The authors note that those in the MBSR group had significantly lower mindfulness at baseline, which may account for the lack of significant impact, when compared with treatment-as-usual.

SOURCES FOR MORE INFORMATION

References

Biegel, G. M., Brown, K.W., Shapiro, S. L., & Schubert, C. M. (2009). Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77(5), 855-          866.

Brown, K. W., West, A. M., Loverich, T. M., & Biegel, G. M. (2011). Assessing adolescent mindfulness: Validation of an adapted mindful attention awareness scale in adolescent normative and psychiatric populations. Psychological Assessment, 23, 1023-1033. doi:10.1037/a0021338

Website

 http://www.umassmed.edu/cfm/stress/index.aspx

Manual

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell.

KEYWORDS: Adolescents, Youth, Males and Females (Co-ed); Clinic-Provider-Based; Manual is Available; Skill Training; Anxiety Disorders/Symptoms; Depression/Mood Disorders; Other Mental Health; Self-Esteem/Self-Concept

Program information last updated 12/21/12.