Acceptability and Effectiveness of a Cluster-Randomized Pilot Study
Johnstone, J.M., Ribbers, A., Jenkins, D., Atchley, R., Gustafsson, H., Nigg, J.T., Wahbeh, H. and Oken, B. (2020). Classroom-Based Mindfulness Training Reduces Anxiety in Adolescents: Acceptability and Effectiveness of a Cluster-Randomized Pilot Study. Journal of Restorative Medicine, 10(1).
Objective: Many high school students experience a high degree of anxiety and perceived stress. This study examined whether a classroom-based mindfulness program or a wellness program were acceptable and effective as anxiety and stress reduction interventions based on students’ self-reports.
Design, setting, and participants: Thirteen health education classes (n=285 students, aged 14–16 years) were randomized by classroom to one of three conditions: mindfulness, wellness, or usual health class only (passive control/waitlist), for 8 weeks.
Outcomes: Pre- and post-intervention scores compared self-reported measures of depression, anxiety and stress.
Results: Complete data were available from nine classes (n=202 students). Post-intervention anxiety scores were reduced in students who received the mindfulness intervention compared to those who received only their usual health class (β=−0.07, SE=0.03, P≤0.001; 95% CI=−0.12, −0.02). No significant between group differences were found for depression or stress (P>0.4). Students’ satisfaction with the mindfulness intervention they received withstood baseline credibility and expectancy effects: r=0.21, n=67, P=0.17 for credibility; r=−0.001, n=67, P=0.99 for expectancy. However, students’ satisfaction with the wellness intervention they received was positively correlated with their pre-intervention expectations, r=0.42, n=47, P<0.001. Fifty-two percent of the 68 students assigned to mindfulness (n=35) used the iPad app for mindfulness home practice at least once; of those, 10% used it 10 or more times.
Conclusion: Eight weeks of classroom-based mindfulness, with limited home practice, reduced self-reported anxiety compared to usual health class, and withstood baseline expectancy effects in this group of high school students, a majority who come from high income families.
Clinical implications: School- or community-based mindfulness may be an appropriate recommendation for adolescents who experience anxiety.