There’s a wealth of information available on the internet for teachers who want to introduce mindfulness into their classrooms; and indeed, why wouldn’t you when the purported benefits for your class include reducing mental health issues, developing compassion, reducing anxiety and increasing attention? Here we will introduce the concept of mindfulness, take a look at the available literature on whether it is actually beneficial and ask, if it is beneficial, why that might be.
What is mindfulness?
The term mindfulness refers to a state of mind where the practitioner has heightened awareness of internal and external experiences that are occurring at the present moment in time. The way that mindfulness is developed varies, but typically it’s done through a secular meditation practice (i.e., one without any religious associations), where sessions are gradually increased in length and time is spent with eyes closed, focusing on internal experiences (such as breath) and external experiences (such as environmental sounds). The concept of mindfulness is thought to have been first brought to the west by Jon Kabat-Zinn in the late 1970s, who described it as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience”[i].
The evidence base appears increasingly fragile
Over the last few years, there has been a proliferation of studies into mindfulness with children and young people. A review and meta-analysis of the literature published in 2014[ii] found just 13 studies published in peer-reviewed journals. Of those, children were randomly allocated to groups in only four studies. Since then, a large-scale project called MYRIAD, funded by the Wellcome Trust[iii], has come to fruition as of 2022. A meta-analysis in connection with this project[iv] found 66 randomised controlled trials of mindfulness interventions with children and young people, demonstrating the rapid growth in mindfulness research over the past 7 years. Therefore, we may now be in a better position to evaluate the effectiveness of mindfulness interventions in schools.
The results of this meta-analysis revealed ongoing issues in the mindfulness literature which merit discussion before making judgments about intervention effectiveness. They identified that around half of the 66 studies analysed were characterised by publication bias, meaning that studies which reported positive effects were likely to have been favoured over those reporting less promising effects. As early as 2012, commentators noted that the enthusiasm for mindfulness outpaced the strength of the available evidence[v], a concern which is repeated by the authors of the new meta-analysis[iv]. They note that the evidence of bias suggested the effects of mindfulness interventions with children and young people to be generally overestimated, and that the overall quality of evidence in the included studies based on the GRADE criteria was ‘low’ or ‘very low’. The trustworthiness of findings in the general mindfulness literature base therefore appears to be called into question.
With that said, the meta-analysis did find some statistically significant effects of mindfulness on post-intervention outcomes (i.e., differences likely to be real). A distinction emerged between effects when mindfulness was compared to a passive control – such as a waitlist or ‘teaching as usual’ – versus an active control, where some other intervention was put into place as a comparator, similar to a placebo group in a drug trial. An active control condition for mindfulness might be something like relaxation or yoga. Results compared to an active control are generally more convincing because they evidence that the intervention in question is likely to be superior to others of a similar type or just the boost you sometimes get from doing something new or being in a ‘trial’.
While a range of outcomes (executive functioning, social behaviours and anxiety/stress symptoms) were found to demonstrate change compared to passive controls, the only effect mindfulness demonstrated when compared to active controls were reductions in anxiety and stress symptoms. However, the size of this effect was small[vi], and there was no evidence of any effects compared to either passive or active control groups at later follow-up. If the effects were real, they did not persist. This finding agrees with prior reviews, which have consistently found small effect sizes of school-based mindfulness interventions over the past decade[ii].
The findings of the meta-analysis were mirrored in the main MYRIAD trial[vii]. This study was the largest of its kind to date, with 85 participant schools randomised to either a universal (i.e., whole-school) mindfulness intervention, or teaching as usual. It was also methodologically robust, with a high degree of intervention fidelity showing that mindfulness was being implemented consistently in the intended way. This was a much improved metric on prior studies, in which lack of treatment integrity and a poor standard training teachers in how to implement mindfulness were consistently demonstrated[viii]. The authors note that all schools randomised to the control condition were also offering some form of structured social-emotional learning (SEL) provision as part of normal curriculum, which means that non-treated schools also had the possibility of improving the skills that mindfulness was supposed to be targeting.
Overall, analysis of data from 8,376 participants with a mean age of 12 revealed no evidence that the mindfulness intervention was superior to normal SEL provision on any outcome. In fact, children in the mindfulness training group demonstrated marginally worse outcomes at post-intervention and follow-up on outcomes including self-reported hyperactivity/inattention, panic symptoms, and teacher-rated emotional symptoms. It’s possible that this could be because in some vulnerable children, a side-effect of focusing on internal states encourages rumination. While no intervention-related adverse effects on child participants were reported, these findings do put a significant dampener on the long-standing enthusiasm for universal mindfulness-based interventions in schools.
Can mindfulness be useful?
The claim for mindfulness is that it allows children to take active control of their own attention. Mindfulness has been described as the opposite of mind-wandering[ix], and mind-wandering is linked to the activity of the default-mode network (the network of brain regions active when we are not engaged in a primary cognitive task). Crucially, the greater the activity is in the default-mode network, the worse we are at paying attention and performing cognitive tasks[x]; by contrast, meditation leads to reduced activity of the default-mode network[xi]. A link is therefore proposed between mindfulness meditation and children’s developing ability to engage their attention and stop mind wandering.
The findings from the MYRIAD project relate to a specific type of mindfulness-based intervention, conducted on a universal basis in schools. Considerable individual variability has long been acknowledged in how participants respond to mindfulness-based interventions[xii], which is also evident in the intervention acceptability ratings produced by students in the main MYRIAD trial[vii]. These ratings showed extreme reporting at the high and low end of the scale, indicating that some children found the intervention easy and helpful, and some found it difficult to engage with and boring. In addition, engagement with mindfulness outside of the school sessions was low. These figures could potentially hold some explanatory power, for level of programme engagement may be related to the strength of intervention effects[xiii]. Therefore, while mindfulness may not work well as a universal intervention, it could still be a feasible option as a targeted intervention, which will benefit some children. There’s also some indication that children who start off with greater difficulty controlling their attention show more immediate gains from mindfulness interventions[xvi], meaning that mindfulness could be a potential tool in supporting those children most at risk from academic failure.
In addition, there is a distinction between ‘state’ mindfulness, which is a transient frame of mind, and ‘trait’ mindfulness, which is a longer-term disposition. The level of regularity in engagement in state mindfulness has been linked to longer-term improvements in trait mindfulness and reductions in psychological distress[xiv]. Trait mindfulness has in turn been found to predict more positive learning behaviours, lower test anxiety and mind-wandering in college students[xv]. Issues of how to promote mindfulness engagement, both within and outside of the constraints of the programme, therefore may be key to unlocking the potential for positive effects of mindfulness interventions in schools. The challenge is to be able to identify which children may benefit.
This one is complicated. The purported benefits of universal mindfulness intervention provision don’t appear to stand up to findings from the MYRIAD trial. That is not to say that mindfulness may not prove beneficial as a targeted intervention, and benefits of routine practice appear fairly sound. The issue on a whole-school basis is that lack of interest or engagement on the part of students appears to negate any potential benefits. At the very least, practising mindfulness in schools is low-cost, relatively easy to implement, and for those showing an interest who don’t have prior mental health problems, it may be beneficial with negligible risk.
Adele Diamond and Kathleen Lee have written an excellent summary of interventions that support the development of executive functions in children: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159917/
The Mindfulness Initiative provides a guide to implementing mindfulness in schools: https://www.themindfulnessinitiative.org/implementing-mindfulness-in-schools-an-evidence-based-guide
[i] Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10, 144-156.
[ii] Zenner, C., Herrnleben-Kurz, S., & Walach, H. (2014). Mindfulness-based interventions in schools—a systematic review and meta-analysis. Frontiers in Psychology, doi: 10.3389/fpsyg.2014.00603
[iv] Dunning, D., Tudor, K., Radley, L., Dalrymple, N., Funk, J., Vainre, M., Ford, T., Montero-Marin, J., Kuyken, W., & Dalgleish, T. (2022). Do mindfulness-based programmes improve the cognitive skills, behaviour and mental health of children and adolescents? An updated meta-analysis of randomised controlled trials. Evidence Based Mental Health, 25(3), 135–142. https://doi.org/10.1136/ebmental-2022-300464
[v] Greenberg, M. T. and Harris, A. R. (2012), Nurturing mindfulness in children and youth: Current state of research. Child Development Perspectives, 6, 161–166. https://doi.org/10.1111/j.1750-8606.2011.00215.x
[vi] Estimates of effect size give an indication of the real-world difference that the intervention made. Here, the value for Cohen’s dis given; for this measure, 0.2 is defined as a small effect, 0.5 as a medium effect and 0.8 as a large effect. A value less than 0.2 indicates that the overall effect was negligible.
[vii] Kuyken, W., Ball, S., Crane, C., Ganguli, P., Jones, B., Montero-Marin, J., Nuthall, E., Raja, A., Taylor, L., Tudor, K., Viner, R. M., Allwood, M., Aukland, L., Dunning, D., Casey, T., Dalrymple, N., De Wilde, K., Farley, E.-R., Harper, J., … Williams, J. M. G. (2022). Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: The MYRIAD cluster randomised controlled trial. Evidence Based Mental Health, 25(3), 99–109. https://doi.org/10.1136/ebmental-2021-300396
[viii] Emerson, L.-M., de Diaz, N. N., Sherwood, A., Waters, A., & Farrell, L. (2019). Mindfulness interventions in schools: Integrity and feasibility of implementation. International Journal of Behavioral Development, 44(1), 62-75. https://doi.org/10.1177/0165025419866906
[ix] Mrazek, M. D., Smallwood, J., & Schooler, J. W. (2012). Mindfulness and mind-wandering: finding convergence through opposing constructs. Emotion, 12 (3), 442-448. https://doi.org/10.1037/a0026678
[xi] Garrison, K. A., Zeffiro, T. A., Scheinost, D., Constable, R. T., & Brewer, J. A. (2015). Meditation leads to reduced default mode network activity beyond an active task. Cognitive, Affective and Behavioural Neuroscience, 15 (3), 712-720. https://doi.org/10.3758/s13415-015-0358-3.
[xiii] Sciutto, M. J., Veres, D. A., Marinstein, T. L., Bailey, B. F., & Cehelyk, S. K. (2021). Effects of a school-based mindfulness program for young children. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-021-01955-x
[xiv] Kiken, L. G., Garland, E. L., Bluth, K., Palsson, O. S., & Gaylord, S. A. (2015). From a state to a trait: Trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Personality and Individual Differences, 81, 41–46. https://doi.org/10.1016/j.paid.2014.12.044
[xv] Kuroda, Y., Yamakawa, O., & Ito, M. (2022). Benefits of mindfulness in academic settings: Trait mindfulness has incremental validity over motivational factors in predicting academic affect, cognition, and behavior. BMC Psychology, 10(1). https://doi.org/10.1186/s40359-022-00746-3
[xvi] Flook, L., Smalley, S. L., Kitil, J., Galla, B. M., Kaiser-Greenland, S., Locke, J., Ishijima, E., & Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26,70–95, https://doi.org/10.1080/15377900903379125