Mindfulness, the practice of bringing your attention to your body in the present moment without judgement, has been around for centuries. Mindfulness based interventions (MBIs) are being used to tackle all sorts of problems from ADHD (Cairncross et al, 2016) to substance misuse (Witkiewitz et al, 2010).
In adults, there is evidence that mindfulness practice may improve some thinking skills (Lao et al, 2016) including control of thoughts, memory and attention (Chiesa et al, 2011). MBIs can prevent depression relapse (Kuyken et al, 2016), reduce stress and anxiety, and may improve physical health and emotional wellbeing (Geiger et al, 2016).
Schools and families are keen to reduce the impact of the increasingly pressured education environment on children. Mindfulness holds great promise, but can it really improve children’s thinking and wellbeing? And if so, does that help children to behave well in class and do better in school?
Maynard and colleagues (2017) carefully reviewed the evidence for MBIs for children in schools. They did a very thorough search of databases, relevant websites and conference records and contacted experts. They found 65 relevant studies of MBIs. Out of all the evidence found, 44 studies were well designed; in that the researchers assigned children or whole classes to either get MBI or not. Those who didn’t get MBI were put on a waiting list or just continued with their normal school activities. This means that the two groups (“got MBI”, “didn’t get MBI”) can be compared to see what effect MBIs have independent of any changes that would happen anyway without MBI. This is especially important for children because they will naturally develop thinking skills and social skills as they get older and also learn and practice these skills at school.
Despite many of the studies being well designed, most were not actually carried out to the highest standards. This may have led to overestimating or underestimating how much of an impact MBIs had on children.
All of the studies involved groups of children learning and practicing mindfulness together. There were differences between the studies in how long the children were taught for (4 to 28 weeks), how often (once every two weeks to five times a week) and how many sessions they did (6 to 125).
Does it work?
The author’s conclusions are slightly different to my own. They conclude that:
There is some indication that MBIs can improve cognitive and socio-emotional outcomes, but no support for improvement in behavior or academic achievement.
My interpretation of the evidence presented is that, as the authors say, there is a small effect of MBIs on helping children to feel good and improve their thinking skills. However, based on the forest plots it seems, to me at least, that there may well be a small positive effect on behaviour and academics too, but these results were not statistically significant and studies were of low quality. Without more and better quality studies we can’t say for sure whether or not MBIs might help children behave better or do better in school tests.
These findings make sense because MBIs directly target thinking skills and managing feelings and these are the skills directly impacted. Behaviour and school results are less likely to be affected because they are not targeted directly by MBIs.
What should schools do now?
The evidence isn’t good quality so schools should be cautious and not rush to spend lots of time and money on MBIs. Mindfulness based interventions may be of some benefit but won’t fix all the problems and stresses children face at school. I would like to say that if teachers and pupils like practicing mindfulness then it’s no harm to give it a try, but actually we don’t know that because not a single one of the studies measured potential harms. Instead schools interested in MBIs could take the opportunity to partner with researchers to help them to rigorously evaluate the impact of mindfulness in their school.
What should researchers do next?
There are not enough good quality randomised controlled trials. Before any firm conclusions can be drawn, high quality trials need to be conducted. There is also a need to address the developmental readiness of children to engage in mindfulness practice. Mindfulness practice involves relatively complex thinking skills and children may not actually be able to develop these skills till they are older.
What should policy makers do?
There has been an upswing in interest in mindfulness at a policy level, especially in the UK where members of parliament are offered mindfulness courses. The evidence for mindfulness in schools is not as strong as the evidence in adults and so policy makers should avoid assuming that children will benefit in the same way as adults.
Before any widespread adoption of mindfulness in schools or education policy, rigorous trials need to be funded. Trials should pay careful attention to the developmental readiness of children of different ages to engage with mindfulness, the potential negative effects and analysis of the costs of widespread implementation of these programmes in the context of the small benefits.
There is also a concern about the level of training needed to teach mindfulness.
Essentially, children’s thinking skills can improve and children feel better for practicing mindfulness. These are both great reasons to introduce children to practicing mindfulness.
The lack of strong evidence either way for behaviour and academics isn’t so important to me for two reasons:
- First, improving school work or compliance with rules for classroom behaviour isn’t what mindfulness sets out to do so it’s unfair to expect this to be achieved. To my mind any improvement in these more distal outcomes can be regarded as a happy coincidence, great if it does happen, not important if it doesn’t.
- Second, we should value helping children feel good and developing their thinking skills in and of itself. Children’s wellbeing should be at the heart of everything schools do. MBIs may be a great addition to the school day to support children’s general wellbeing.
Maynard BR, Solis MR, Miller VL, Brendel KE. (2017) Mindfulness-based interventions for improving cognition, academic achievement, behavior, and socioemotional functioning of primary and secondary school students (PDF). Campbell Systematic Reviews 2017:5 DOI: 10.4073/csr2017.5
Cairncross M, Miller CJ. (2016) The Effectiveness of Mindfulness-Based Therapies for ADHD A Meta-Analytic Review. Journal of attention disorders, 1087054715625301. [PubMed abstract]
Witkiewitz K, Bowen S. (2010) Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of consulting and clinical psychology, 78(3), 362.
Lao SA, Kissane D, Meadows G. (2016) Cognitive effects of MBSR/MBCT: A systematic review of neuropsychological outcomes. Consciousness and Cognition, 45, 109-123. [PubMed abstract]
Chiesa A, Calati R, Serretti A. (2011) Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clinical psychology review, 31(3), 449-464.
Geiger PJ, Boggero IA, Brake CA, Caldera CA, Combs HL, Peters JR, Baer RA. (2016) Mindfulness-based interventions for older adults: a review of the effects on physical and emotional well-being. Mindfulness, 7(2), 296-307.
Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, Hayes R, Huijbers M, Ma H, Schweizer S, Segal Z, Speckens A, Teasdale JD, Van Heeringen K, Williams M, Byford S, Byng R, Dalgleish T. (2016) Efficacy and moderators of mindfulness-based cognitive therapy (MBCT) in prevention of depressive relapse: An individual patient data meta-analysis from randomized trials. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.0076 Published online April 27, 2016.
Mindfulness-based cognitive therapy can prevent recurrent depression
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I really appreciate your analysis, Jennifer. In addition, we contacted the Campbell Review’s authors to ask why a particular study showing academic benefit was not included, and they admitted that this omission was a mistake. However, as you say, we need higher quality trials. And we shouldn’t need to justify wellbeing for its own sake.
That’s interesting to hear Jamie. What study was omitted from the Campbell review and has Brandy Maynard agreed to include it in a future update?
Andre: ∗Franco Justo,C.,Mañas,I.,Cangas,A.J.,and Gallego,J.(2011b).Exploring the effects of a mindfulness program for students of secondary school. Int.J.Knowl. Soc. Res. 2, 14–28.doi:10.4018/jksr.2011010102.
I’m told that this is an RCT of reasonable quality, and its abstract says: “In the experimental group we can observe a significant increase of academic performance as well as an improvement in all the self-concept dimensions, and a significant decrease in anxiety states and traits.”
It apparently would have met Prof Maynard’s criteria had they have found it. These things happen, I’m sure. No mention of an update though.
Thanks for sharing the missing paper. It certainly looks relevant to the Campbell review and it’s a shame that it wasn’t considered for inclusion. As you say, these things happen even with the best reviews, especially if the studies are published in journals that don’t get indexed on the big databases.
Looking at the Franco et al (2011) RCT, I doubt it would have had much impact on the overall findings of the Maynard review. The sample size is small (n=61) and there are a few issues that would increase the risk of bias of this study (e.g. uncertainty regarding baseline variables, unclear randomisation, no mention of blinding, short follow-up).
In short, the MYRIAD study due to report in late 2021 will be filling a lot of knowledge gaps! Until then, we will have to live with the uncertainty around the efficacy and safety of mindfulness in schools.
That’s helpful. Thanks, André. Agreed.
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