School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial?

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BackgroundSystematic reviews suggest school-based mindfulness training (SBMT) shows promise in promoting student mental health.ObjectiveThe My Resilience in Adolescence (MYRIAD) Trial evaluated the effectiveness and cost-effectiveness of SBMT compared with teaching-as-usual (TAU).MethodsMYRIAD was a parallel group, cluster-randomised controlled trial. Eighty-five eligible schools consented and were randomised 1:1 to TAU (43 schools, 4232 students) or SBMT (42 schools, 4144 students), stratified by school size, quality, type, deprivation and region. Schools and students (mean (SD); age range=12.2 (0.6); 11–14 years) were broadly UK population-representative. Forty-three schools (n=3678 pupils; 86.9%) delivering SBMT, and 41 schools (n=3572; 86.2%) delivering TAU, provided primary end-point data. SBMT comprised 10 lessons of psychoeducation and mindfulness practices. TAU comprised standard social-emotional teaching. Participant-level risk for depression, social-emotional-behavioural functioning and well-being at 1 year follow-up were the co-primary outcomes. Secondary and economic outcomes were included.FindingsAnalysis of 84 schools (n=8376 participants) found no evidence that SBMT was superior to TAU at 1 year. Standardised mean differences (intervention minus control) were: 0.005 (95% CI −0.05 to 0.06) for risk for depression; 0.02 (−0.02 to 0.07) for social-emotional-behavioural functioning; and 0.02 (−0.03 to 0.07) for well-being. SBMT had a high probability of cost-effectiveness (83%) at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. No intervention-related adverse events were observed.ConclusionsFindings do not support the superiority of SBMT over TAU in promoting mental health in adolescence.Clinical implicationsThere is need to ask what works, for whom and how, as well as considering key contextual and implementation factors.Trial registrationCurrent controlled trials ISRCTN86619085. This research was funded by the Wellcome Trust (WT104908/Z/14/Z and WT107496/Z/15/Z).

“…28 In a further paper, we explore potential moderators (eg, student age), mechanisms (eg, participants' engagement) and implementation facilitators (eg, teacher competency). 29…”

Section: Discussionmentioning

confidence: 99%

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

Kuyken

Ball

Crane

et al. 2022

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“…More at-risk individuals may have compromised ability and motivation to engage with MBPs and may need more support. 22 This updated meta-analysis had several strengths, including the large increase in studies and participants, and the continued focus on RCTs. We also included analysis of follow-up assessments, and exploratory examination of key moderators.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…More at-risk individuals may have compromised ability and motivation to engage with MBPs and may need more support. 22 …”

Section: Conclusion and Clinical Implicationsmentioning

confidence: 99%

Do mindfulness-based programmes improve the cognitive skills, behaviour and mental health of children and adolescents? An updated meta-analysis of randomised controlled trials

Dunning

Tudor

Radley

et al. 2022

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QuestionMindfulness-based programmes (MBPs) are an increasingly popular approach to improving mental health in young people. Our previous meta-analysis suggested that MBPs show promising effectiveness, but highlighted a lack of high-quality, adequately powered randomised controlled trials (RCTs). This updated meta-analysis assesses the-state-of the-art of MBPs for young people in light of new studies. It explores MBP’s effectiveness in active vs passive controls; selective versus universal interventions; and studies that included follow-up.Study selection and analysisWe searched for published and unpublished RCTs of MBPs with young people (<19 years) in PubMed Central, PsycINFO, Web of Science, EMBASE, ICTRP, ClinicalTrials.gov, EThOS, EBSCO and Google Scholar. Random-effects meta-analyses were conducted, and standardised mean differences (Cohen’s d) were calculated.FindingsSixty-six RCTs, involving 20 138 participants (9552 receiving an MBP and 10 586 controls), were identified. Compared with passive controls, MBPs were effective in improving anxiety/stress, attention, executive functioning, and negative and social behaviour (d from 0.12 to 0.35). Compared against active controls, MBPs were more effective in reducing anxiety/stress and improving mindfulness (d=0.11 and 0.24, respectively). In studies with a follow-up, there were no significant positive effects of MBPs. No consistent pattern favoured MBPs as a universal versus selective intervention.ConclusionsThe enthusiasm for MBPs in youth has arguably run ahead of the evidence. While MBPs show promising results for some outcomes, in general, the evidence is of low quality and inconclusive. We discuss a conceptual model and the theory-driven innovation required to realise the potential of MBPs in supporting youth mental health.

“…In the absence of a no intervention or passive control condition it is not possible to draw definitive conclusions on which of these explanations is most valid. First, it may be that either MT does not have a differential effect on this proposed mechanism of action, or that both MT and Psy-Ed affect this mechanism, or that the effect is delayed beyond the postintervention time point, or that it affects subgroups differently 28. Second, it may be that the version of MT used here—.b—is actually benign and does not deliver sufficient training in key mindfulness skills to impact our outcomes.…”

Section: Discussionmentioning

confidence: 97%

“…First, it may be that either MT does not have a differential effect on this proposed mechanism of action, or that both MT and Psy-Ed affect this mechanism, or that the effect is delayed beyond the postintervention time point, or that it affects subgroups differently. 28 Second, it may be that the version of MT used here—.b—is actually benign and does not deliver sufficient training in key mindfulness skills to impact our outcomes. We selected .b due to its encouraging results in our pilot trial.…”

Section: Discussionmentioning

confidence: 98%

The impact of mindfulness training in early adolescence on affective executive control, and on later mental health during the COVID-19 pandemic: a randomised controlled trial

Dunning

Ahmed

Foulkes

et al. 2022

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BackgroundPrevious research suggests that mindfulness training (MT) appears effective at improving mental health in young people. MT is proposed to work through improving executive control in affectively laden contexts. However, it is unclear whether MT improves such control in young people. MT appears to mitigate mental health difficulties during periods of stress, but any mitigating effects against COVID-related difficulties remain unexamined.ObjectiveTo evaluate whether MT (intervention) versus psychoeducation (Psy-Ed; control), implemented in after-school classes: (1) Improves affective executive control; and/or (2) Mitigates negative mental health impacts from the COVID-19 pandemic.MethodsA parallel randomised controlled trial (RCT) was conducted (Registration: https://osf.io/d6y9q/; Funding: Wellcome (WT104908/Z/14/Z, WT107496/Z/15/Z)). 460 students aged 11-16 years were recruited and randomised 1:1 to either MT (N=235) or Psy-Ed (N=225) and assessed preintervention and postintervention on experimental tasks and self-report inventories of affective executive control. The RCT was then extended to evaluate protective functions of MT on mental health assessed after the first UK COVID-19 lockdown.FindingsResults provided no evidence that the version of MT used here improved affective executive control after training or mitigated negative consequences on mental health of the COVID-19 pandemic relative to Psy-Ed. No adverse events were reported.ConclusionsThere is no evidence that MT improves affective control or downstream mental health of young people during stressful periods.Clinical implicationsWe need to identify interventions that can enhance affective control and thereby young people’s mental health.