Mindfulness programs for schools are popular. We systematically reviewed the evidence regarding the effects of school-based mindfulness interventions on psychological outcomes, using a comprehensive search strategy designed to locate both published and unpublished studies. Systematic searches in 12 databases were performed in August 2012. Further studies were identified via hand search and contact with experts. Two reviewers independently extracted the data, also selecting information about intervention programs (elements, structure etc.), feasibility, and acceptance. Twenty-four studies were identified, of which 13 were published. Nineteen studies used a controlled design. In total, 1348 students were instructed in mindfulness, with 876 serving as controls, ranging from grade 1 to 12. Overall effect sizes were Hedge's g = 0.40 between groups and g = 0.41 within groups (p < 0.0001). Between group effect sizes for domains were: cognitive performance g = 0.80, stress g = 0.39, resilience g = 0.36, (all p < 0.05), emotional problems g = 0.19 third person ratings g = 0.25 (both n.s.). All in all, mindfulness-based interventions in children and youths hold promise, particularly in relation to improving cognitive performance and resilience to stress. However, the diversity of study samples, variety in implementation and exercises, and wide range of instruments used require a careful and differentiated examination of data. There is great heterogeneity, many studies are underpowered, and measuring effects of Mindfulness in this setting is challenging. The field is nascent and recommendations will be provided as to how interventions and research of these interventions may proceed.
Evidence supports that MBSR improves mental health and MBCT prevents depressive relapse. Future RCTs should apply optimal design including active treatment for comparison, properly trained instructors and at least one-year follow-up. Future research should primarily tackle the question of whether mindfulness itself is a decisive ingredient by controlling against other active control conditions or true treatments.
Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching mindfulness meditation and mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Fibromyalgia is a clinical syndrome with chronic pain, fatigue, and insomnia as major symptoms. Efficacy of MBSR for enhanced well-being of fibromyalgia patients was investigated in a 3-armed trial, which was a follow-up to an earlier quasi-randomized investigation. A total of 177 female patients were randomized to one of the following: (1) MBSR, (2) an active control procedure controlling for nonspecific effects of MBSR, or (3) a wait list. The major outcome was health-related quality of life (HRQoL) 2 months post-treatment. Secondary outcomes were disorder-specific quality of life, depression, pain, anxiety, somatic complaints, and a proposed index of mindfulness. Of the patients, 82% completed the study. There were no significant differences between groups on primary outcome, but patients overall improved in HRQoL at short-term follow-up (P=0.004). Post hoc analyses showed that only MBSR manifested a significant pre-to-post-intervention improvement in HRQoL (P=0.02). Furthermore, multivariate analysis of secondary measures indicated modest benefits for MBSR patients. MBSR yielded significant pre-to-post-intervention improvements in 6 of 8 secondary outcome variables, the active control in 3, and the wait list in 2. In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most. Effect sizes were small compared to the earlier, quasi-randomized investigation. Several methodological aspects are discussed, e.g., patient burden, treatment preference and motivation, that may provide explanations for differences. In a 3-armed randomized controlled trial in female patients suffering from fibromyalgia, patients benefited modestly from a mindfulness-based stress reduction intervention.
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