A Randomized Trial Evaluating School-Based Mindfulness Intervention for Ethnic Minority Youth: Exploring Mediators and Moderators of Intervention Effects
The study examined the efficacy of a school-based mindfulness intervention on mental health and emotion regulation outcomes among adolescents in a wait-list controlled trial. The study also explored mediators and moderators of intervention effects. A total of 145 predominantly ethnic minority (Asian and Latino) 9th grade students with elevated mood symptoms were randomized to receive a 12-week mindfulness intervention at the start of the academic year, or in the second semester of the year. Students completed measures of emotion regulation and mental health symptoms at baseline, post-intervention, and 3-month follow-up. Intent-to-treat analyses revealed significant treatment effects of the mindfulness intervention for internalizing symptoms and perceived stress at post-treatment. Pooled pre-to-post treatment analyses of the entire sample revealed a small effect size for attention problems, medium for internalizing and externalizing problems, and large for perceived stress. We also found a small effect size for cognitive reappraisal, medium for expressive suppression, emotional processing, emotional expression, and rumination and large for avoidance fusion. Mediation analyses showed that treatment effects on internalizing symptoms and perceived stress were mediated by reductions in expressive suppression and rumination. Moderation analyses revealed that treatment effects were larger among youth with more severe problems at baseline for internalizing problems, externalizing problems, and perceived stress. However, for attention problems, students with lower severity at baseline appeared to have larger treatment gains. The study provided evidence that mindfulness intervention was beneficial for low-income ethnic minority youth in reducing perceived stress and internalizing problems, and improving emotion regulation outcomes. Furthermore, mindfulness training was associated with reduced mental health symptoms via improvements in emotion regulation.
KeywordsSchool-based intervention Mindfulness Ethnic minority youth Depression Emotion regulation
This study was funded by the Spencer Foundation (Grant #201600077; 2015–2017, $49,909 direct costs; PI: Joey Fung).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The authors attest that they have complied with ethical standards, including, but not limited to, oversight by the Institutional Review Board of the Fuller Theological Seminary and University of California, Los Angeles.
Informed assent was obtained by all study participants and informed consent was obtained by participant parents/guardians.
- Abela, J. R. Z., Vanderbilt, E., & Rochon, A. (2004). A test of the integration of the response styles and social support theories of depression in third and seventh grade children. Journal of Social and Clinical Psychology, 23(5), 653–674. https://doi.org/10.1521/jscp.23.5.653.50752.CrossRefGoogle Scholar
- Achenbach, T. M. (1991). Manual for the youth self-report and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
- Beauchemin, J., Hutchins, T. L., & Patterson, F. (2008). Mindfulness meditation may lessen anxiety, promote social skills, and improve academic performance among adolescents with learning disabilities. Complementary Health Practice Review, 13(1), 34–45. https://doi.org/10.1177/1533210107311624.CrossRefGoogle Scholar
- Betts, J., Gullone, E., & Allen, J. S. (2009). An examination of emotion regulation, temperament, and parenting style as potential predictors of adolescent depression risk status: A correlational study. British Journal of Developmental Psychology, 27(2), 473–485. https://doi.org/10.1348/026151008X314900.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1037/a0016241.CrossRefPubMedGoogle Scholar
- Broderick, P. C. (2013). Learning to Breathe: A mindfulness curriculum for adolescents to cultivate emotion regulation, attention, and performance. New Harbinger Publications.Google Scholar
- Cohen, S., Kamarck, T., & Mermelstein, R. (1994). Perceived stress scale. Measuring stress: A guide for health and social scientists.Google Scholar
- Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658–670. https://doi.org/10.1037/0022-006X.74.4.658.CrossRefPubMedGoogle Scholar
- Elkin, I., Gibbons, R. D., Shea, M. T., Sotsky, S. M., Watkins, J. T., Pilkonis, P. A., & Hedeker, D. (1995). Initial severity and differential treatment outcome in the National Institute of Mental Health treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology, 63(5), 841–847. https://doi.org/10.1037/0022-006X.63.5.841.CrossRefPubMedGoogle Scholar
- Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). New York: Guilford Press.Google Scholar
- Gudiño, O. G., Lau, A. S., Yeh, M., McCabe, K. M., & Hough, R. L. (2009). Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by problem type? Journal of Emotional and Behavioral Disorders, 17(1), 3–16. https://doi.org/10.1177/1063426608317710.CrossRefGoogle Scholar
- Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
- Horowitz, J. L., Garber, J., Ciesla, J. A., Young, J. F., & Mufson, L. (2007). Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs. Journal of Consulting and Clinical Psychology, 75(5), 693–706. https://doi.org/10.1037/0022-006X.75.5.693.CrossRefPubMedGoogle Scholar
- Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., Scott, M., & Schonlau, M. (2010). Children’s mental health care following hurricane Katrina: A field trial of trauma-focused psychotherapies. Journal of Traumatic Stress, 23, 223–231. https://doi.org/10.1002/jts.20518.PubMedPubMedCentralGoogle Scholar
- Jazaieri, H., McGonigal, K., Jinpa, T., Doty, J. R., Gross, J. J., & Goldin, P. R. (2014). A randomized controlled trial of compassion cultivation training: Effects on mindfulness, affect, and emotion regulation. Motivation and Emotion, 38(1), 23–35. https://doi.org/10.1007/s11031-013-9368-z.CrossRefGoogle Scholar
- Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.Google Scholar
- Keune, P. M., Bostanov, V., Hautzinger, M., & Kotchoubey, B. (2011). Mindfulness-based cognitive therapy (MBCT), cognitive style, and the temporal dynamics of frontal EEG alpha asymmetry in recurrently depressed patients. Biological Psychology, 88(2), 243–252. https://doi.org/10.1016/j.biopsycho.2011.08.008.CrossRefPubMedGoogle Scholar
- Larsen R. J., & Prizmic Z. (2004). Affect regulation. In R. F. Baumeister RF, & K. D. Vohs (Eds), Handbook of self-regulation: Research, theory, and applications (pp. 40–61). New York: Guilford Press.Google Scholar
- Lau, A. S., Guo, S., Tsai, W., Nguyen, D. J., Nguyen, H. T., Ngo, V., & Weiss, B. (2016). Adolescents’ stigma attitudes toward internalizing and externalizing disorders: cultural influences and implications for distress manifestations. Clinical Psychological Science, 4(4), 704–717.CrossRefPubMedPubMedCentralGoogle Scholar
- Luoma, J., & Hayes, S. C. (2003). Cognitive defusion. In W. T. Donohue, J. E. Fisher, & S. C. Hayes (Eds.), Empirically supported techniques for cognitive behavior therapy: A step-by-step guide for clinicians (pp. 71–78). New York: Wiley.Google Scholar
- McCarty, C. A., Violette, H. D., Duong, M. T., Cruz, R. A., & McCauley, E. (2013). A randomized trial of positive thoughts and action program for depression among early adolescents. Journal of Clinical Child and Adolescent Psychology, 42(4), 554–563. https://doi.org/10.1080/15374416.2013.782817.CrossRefPubMedPubMedCentralGoogle Scholar
- Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017.
- Michl, L. C., McLaughlin, K. A., Shepherd, K., & Nolen-Hoeksema, S. (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology, 122(2), 339–352. https://doi.org/10.1037/a0031994.CrossRefPubMedPubMedCentralGoogle Scholar
- Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical Psychology Review, 31(3), 371–382. https://doi.org/10.1016/j.cpr.2011.01.008.CrossRefPubMedPubMedCentralGoogle Scholar
- Pescosolido, B. A., Jensen, P. S., Martin, J. K., Perry, B. L., Olafsdottir, S., & Fettes, D. (2008). Public knowledge and assessment of child mental health problems: Findings from the National Stigma Study-Children. Journal of the American Academy of Child & Adolescent Psychiatry, 47(3), 339–349. https://doi.org/10.1097/CHI.0b013e318160e3a0.CrossRefGoogle Scholar
- Schonert-Reichl, K., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive and social-emotional development through a simple-to-administer school program for elementary school children: A randomized controlled trial. Developmental Psychology, 51(1), 52–66. https://doi.org/10.1037/a0038454.CrossRefPubMedPubMedCentralGoogle Scholar
- Semple, R. J., Lee, J., Rosa, D., & Miller, L. F. (2010). A randomized trial of mindfulness-based cognitive therapy for children: Promoting mindful attention to enhance social-emotional resiliency in children. Journal of Child and Family Studies, 19(2), 218–229. https://doi.org/10.1007/s10826-009-9301-y.CrossRefGoogle Scholar
- Singh, N. N., Lancioni, G. E., Winton, A. S., Singh, J., Curtis, W. J., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31(6), 749–771. https://doi.org/10.1177/0145445507300924.CrossRefPubMedGoogle Scholar
- Soto, J. A., Perez, C. R., Kim, Y. H., Lee, E. A., & Minnick, M. R. (2011). Is expressive suppression always associated with poorer psychological functioning? A cross-cultural comparison between European Americans and Hong Kong Chinese. Emotion, 11(6), 1450–1455. https://doi.org/10.1037/a0023340.CrossRefPubMedGoogle Scholar
- Stanton, A. L., Parsa, A., & Austenfeld, J. L. (2002). The adaptive potential of coping through emotional approach. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology (pp. 148–158). New York: Oxford University Press.Google Scholar
- Stoep, A., Mccauley, E., Thompson, K. A., Herting, J. R., Kuo, E. S., Stewart, D. G., et al. (2005). Universal emotional health screening at the middle school transition. Journal of Emotional and Behavioral Disorders, 13(4), 213–223. https://doi.org/10.1177/10634266050130040301.CrossRefPubMedPubMedCentralGoogle Scholar
- Su, J. C., Lee, R. M., Park, I. J., Soto, J. A., Chang, J., Zamboanga, B. L., et al. (2015). Differential links between expressive suppression and well-being among Chinese and Mexican American college students. Asian American Journal of Psychology, 6(1), 15–24. https://doi.org/10.1037/a0036116.CrossRefGoogle Scholar
- Tsai, W., Nguyen, D. J., Weiss, B., Ngo, V., & Lau, A. S. (2017). Cultural differences in the reciprocal relations between emotion suppression coping, depressive symptoms and interpersonal functioning among adolescents. Journal of Abnormal Child Psychology, 45(4), 657–669. https://doi.org/10.1007/s10802-016-0192-2.CrossRefPubMedGoogle Scholar
- Tull, M. T., Gratz, K. L., & Lacroce, D. M. (2006). The role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non-clinical sample of uncued panickers. Cognitive Behaviour Therapy, 35(2), 74–87. https://doi.org/10.1080/16506070500466730033.CrossRefPubMedGoogle Scholar
- Verstraeten, K., Vasey, M. W., Raes, F., & Bijttebier, P. (2009). Temperament and risk for depressive symptoms in adolescence: Mediation by rumination and moderation by effortful control. Journal of Abnormal Child Psychology, 37(3), 349–361. https://doi.org/10.1007/s10802-008-9293-x.CrossRefPubMedGoogle Scholar
- Yeh, M., McCabe, K., Lambros, K., Hough, R., Landsverk, J., Hurlburt, M., & Culver, S. (2005). Racial/ethnic representation across five public sectors of care for youth with EBD: Implications for students in school settings. In P. Clough et al. (Eds.), Handbook of emotional and behavioural difficulties (pp. 195–221). Thousand Oaks, CA: Sage Publications.CrossRefGoogle Scholar