Carisa Perry-Parrish

School-based mindfulness instruction for urban male youth: A small randomized controlled trial

OBJECTIVES Mindfulness-based stress reduction (MBSR) has been shown to improve mental health and reduce stress in a variety of adult populations. Here, we explore the effects of a school-based MBSR program for young urban males. PARTICIPANTS AND METHODS In fall 2009, 7th and 8th graders at a small school for low-income urban boys were randomly assigned to 12-session programs of MBSR or health education (Healthy Topics-HT). Data were collected at baseline, post-program, and three-month follow-up on psychological functioning; sleep; and salivary cortisol, a physiologic measure of stress. RESULTS Forty-one (22 MBSR and 19 HT) of the 42 eligible boys participated, of whom 95% were African American, with a mean age of 12.5 years. Following the programs, MBSR boys had less anxiety (p=0.01), less rumination (p=0.02), and showed a trend for less negative coping (p=0.06) than HT boys. Comparing baseline with post-program, cortisol levels increased during the academic terms for HT participants at a trend level (p=0.07) but remained constant for MBSR participants (p=0.33). CONCLUSIONS In this study, MBSR participants showed less anxiety, improved coping, and a possible attenuation of cortisol response to academic stress, when compared with HT participants. These results suggest that MBSR improves psychological functioning among urban male youth.

A Small Mixed-Method RCT of Mindfulness Instruction For Urban Youth

OBJECTIVE We aimed to explore the specific effects of mindfulness-based stress reduction (MBSR) for urban youth by comparing it with an active control program, designed to control for time, positive peer-group experience, and positive adult instructor. METHODS Patients between the ages of 13-21 years who received primary pediatric care at our urban outpatient clinic were eligible for study participation. Those who were interested were consented and randomly assigned to an eight-week program of MBSR or Healthy Topics (HT), a health education curriculum. To increase sensitivity to outcomes of interest, mixed methods were used to assess psychological symptoms, coping, and program experience. Analysis of variance and regression modeling were used; interviews were audio-taped, transcribed, and coded for key themes. RESULTS A total of 43 (26 MBSR, 17 HT) youths attended one or more sessions, of whom 35 [20 MBSR (77%), 15 HT (88%)] attended the majority of the sessions and were considered completers. Program completers were African American, 80% female, with average age of 15.0 years. Statistical analysis of survey data did not identify significant post-program differences between groups. Qualitative data show comparable positive experiences in both programs, but specific differences related to MBSR participants׳ use of mindfulness techniques to calm down and avoid conflicts, as well as descriptions of internal processes and self-regulation. CONCLUSIONS Compared with an active control program, MBSR did not result in statistically significant differences in self-reported survey outcomes of interest but was associated with qualitative outcomes of increased calm, conflict avoidance, self-awareness, and self-regulation for urban youths. Importantly, based on qualitative results, the HT program functioned as an effective active control for MBSR in this sample, facilitating a more rigorous methodological approach to MBSR research in this population. We believe the promising effects elucidated in the qualitative data have the potential for positive affective and behavioral outcomes.

Children's emotion regulation across and within nations: A comparison of Ghanaian, Kenyan, and American youth

This research examined national, regional, developmental, and gender differences in childrens reported management of anger and sadness. Participants (8-15 years) were 103 Ghanaian children from a village setting, 142 Ghanaian children from a middle-class urban context, 106 Kenyan children from an impoverished urban context, and 170 children from the United States in lower to middle-class urban areas (58.8% Caucasian). Children completed the Childrens Anger and Sadness Management Scales (Zeman, Shipman, & Penza-Clyve, 2001) to assess emotion management (i.e., effortful control, over control, under control). Comparisons across nations indicated that Ghanaian youth reported more overt anger expression than youth from Kenya and the United States and less anger inhibition than Kenyan youth. U.S. children reported less overt expression and more constraint over sadness than Kenyan and Ghanaian children, although Kenyans reported being calmer when experiencing sadness than Ghanaian and American youth. Comparing Ghanaian regional contexts, village children reported more anger control than urban children. Regardless of nationality, boys reported more control over sadness than girls who reported more under control of sadness and more over control of anger than boys. Future research is needed to build on these descriptive, preliminary findings examining under-studied cross-national contexts.

A Comparison of Urge Intensity and the Probability of Tic Completion During Tic Freely and Tic Suppression Conditions.

Tic-suppression-based treatments (TSBTs) represent a safe and effective treatment option for Chronic Tic Disorders (CTDs). Prior research has demonstrated that treatment naive youths with CTDs have the capacity to safely and effectively suppress tics for prolonged periods. It remains unclear how tic suppression is achieved. The current study principally examines how effective suppression is achieved and preliminary correlates of the ability to suppress tics. Twelve youths, ages 10 to 17 years, with moderate-to-marked CTDs participated in an alternating sequence of tic freely and reinforced tic suppression conditions during which urge intensity and tic frequency were frequently assessed. Probability of tics occurring was half as likely following high-intensity urges during tic suppression (31%) in contrast to low-intensity urges during tic freely conditions (60%). Age was not associated with ability to suppress. Intelligence indices were associated with or trended toward greater ability to suppress tics. Attention difficulties were not associated with ability to suppress but were associated with tic severity. In contrast to our “selective suppression” hypothesis, we found participants equally capable of suppressing their tics regardless of urge intensity during reinforced tic suppression. Tic suppression was achieved with an “across-the-board” effort to resist urges. Preliminary data suggest that ability to suppress may be associated with general cognitive variables rather than age, tic severity, urge severity, and attention. Treatment naive youths appear to possess a capacity for robust tic suppression. TSBTs may bolster these capacities and/or enable their broader implementation, resulting in symptom improvement.

Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders

BACKGROUND Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed. METHOD Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach. RESULTS Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed. LIMITATIONS Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results. CONCLUSIONS The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship.

Mindfulness-Based Approaches for Children and Youth

Mindfulness meditation is a useful adjunct to behavioral and medical interventions to manage a range of symptoms, including psychological and physical responses to stress, anxiety, depression, and disruptive behavior. Mindfulness approaches can be taught to children, adolescents, and their parents to improve self-regulation, particularly in response to stress. Mindfulness may be particularly relevant for youth and families who have an increased risk for exposure to chronic stress and unique stressors associated with medical and/or social-contextual considerations. Moreover, mindfulness parenting techniques can augment traditional behavioral approaches to improve children׳s behavior through specific parent-child interactions. A growing body of empirical studies and clinical experience suggest that incorporating mindfulness practices will enable clinicians to more effectively treat youth and their families in coping optimally with a range of challenging symptoms.

Anger Regulation and Social Acceptance in Early Adolescence: Associations with Gender and Ethnicity.

Anger regulation among adolescents is important to investigate given theoretical and empirical support for its critical association with peer relationships. This study examined two aspects of anger regulation (i.e., inhibition, dysregulation) using self-report and peer-nominations and their associations with social acceptance among 163 Black and White adolescents ( X ¯ = 13.87 years). We explored gender and ethnicity differences in anger regulation predicting peer acceptance. Self-reports and peer-nominations of anger regulation were significantly correlated. Within-gender ethnicity differences in anger regulation were found: White girls reported higher levels of anger inhibition than Black girls, and Black girls reported higher levels of anger dysregulation than White girls. For all adolescents, self-reports and nominations of anger inhibition were associated with higher levels of social acceptance, whereas nominations of anger dysregulation predicted lower social acceptance. The results indicate the importance of considering gender and ethnicity in adolescents’ anger management within peer contexts.

Improving self-regulation in adolescents: current evidence for the role of mindfulness-based cognitive therapy

Mindfulness-based cognitive therapy (MBCT) was introduced in 1995 to address the problem of recurrent depression. MBCT is based on the notion that meditation helps individuals effectively deploy and regulate attention to effectively manage and treat a range of psychological symptoms, including emotional responses to stress, anxiety, and depression. Several studies demonstrate that mindfulness approaches can effectively reduce negative emotional reactions that result from and/or exacerbate psychiatric difficulties and exposure to stressors among children, adolescents, and their parents. Mindfulness may be particularly relevant for youth with maladaptive cognitive processes such as rumination. Clinical experience regarding the utility of mindfulness-based approaches, including MBCT, is being increasingly supported by empirical studies to optimize the effective treatment of youth with a range of challenging symptoms. This paper provides a description of MBCT, including mindfulness practices, theoretical mechanisms of action, and targeted review of studies in adolescents.

Emotional and behavioral functioning in children with bladder exstrophy–epispadias complex: A developmental perspective

OBJECTIVE To evaluate the emotional and behavioral functioning of children with bladder exstrophy-epispadias complex (BEEC), taking into account developmental and gender considerations. This study also sought to overcome methodological limitations of previous studies evaluating psychological well-being of children with BEEC. METHODS Eighty-six children were consecutively evaluated using the parent report version of the Behavior Assessment System for Children during visits to a multidisciplinary urology clinic. RESULTS Results indicated normative emotional and behavioral functioning across the sample. However, there was a significant effect of age, such that older children consistently had worse internalizing symptoms and adaptive functioning. Males tended to have more externalizing problems as they aged, and also tended to have lower levels of adaptive functioning but this was independent of age. The level of psychological impairment was unrelated to the specific type of BEEC, and was also unrelated to whether or not the patient had undergone continence surgery. CONCLUSION Children with BEEC have a greater likelihood of experiencing a wide range of emotional and behavioral problems as they reach adolescence. These findings point to the need to prevent potential psychological distress by intervening with these children before they become clinically impaired.

Mindfulness instruction for HIV-infected youth: a randomized controlled trial

ABSTRACT HIV-infected youth experience many stressors, including stress related to their illness, which can negatively impact their mental and physical health. Therefore, there is a significant need to identify potentially effective interventions to improve stress management, coping, and self-regulation. The object of the study was to assess the effect of a mindfulness-based stress reduction (MBSR) program compared to an active control group on psychological symptoms and HIV disease management in youth utilizing a randomized controlled trial. Seventy-two HIV-infected adolescents, ages 14–22 (mean age 18.71 years), were enrolled from two urban clinics and randomized to MBSR or an active control. Data were collected on mindfulness, stress, self-regulation, psychological symptoms, medication adherence, and cognitive flexibility at baseline, post-program, and 3-month follow-up. CD4+ T lymphocyte and HIV viral load (HIV VL) counts were also pulled from medical records. HIV-infected youth in the MBSR group reported higher levels of mindfulness (P = .03), problem-solving coping (P = .03), and life satisfaction (P = .047), and lower aggression (P = .002) than those in the control group at the 3-month follow-up. At post-program, MBSR participants had higher cognitive accuracy when faced with negative emotion stimuli (P = .02). Also, those in the MBSR study arm were more likely to have or maintain reductions in HIV VL at 3-month follow-up than those in the control group (P = .04). In our sample, MBSR instruction proved beneficial for important psychological and HIV-disease outcomes, even when compared with an active control condition. Lower HIV VL levels suggest improved HIV disease control, possibly due to higher levels of HIV medication adherence, which is of great significance in both HIV treatment and prevention. Additional research is needed to explore further the role of MBSR for improving the psychological and physical health of HIV-positive youth.