Lindsey Webb

School-based mindfulness instruction: an RCT

BACKGROUND AND OBJECTIVE: Many urban youth experiencesignificant and unremitting negative stressors, including those associated with community violence, multigenerational poverty, failing educational systems, substance use, limited avenues for success, health risks, and trauma. Mindfulness instruction improves psychological functioning in a variety of adult populations; research on mindfulness for youth is promising, but has been conducted in limited populations. Informed by implementation science, we evaluated an adapted mindfulness-based stress reduction (MBSR) program to ameliorate the negative effects of stress and trauma among low-income, minority, middle school public school students. METHODS: Participants were students at two Baltimore City Public Schools who were randomly assigned by grade to receive adapted MBSR or health education (Healthy Topics [HT]) programs. Self-report survey data were collected at baseline and postprogram. Deidentified data were analyzed in the aggregate, comparing MBSR and HT classes, by using regression modeling. RESULTS: Three hundred fifth- to eighth-grade students (mean 12.0 years) were in MBSR and HT classes and provided survey data. Participants were 50.7% female, 99.7% African American, and 99% eligible for free lunch. The groups were comparable at baseline. Postprogram, MBSR students had significantly lower levels of somatization, depression, negative affect, negative coping, rumination, self-hostility, and posttraumatic symptom severity (all Ps < .05) than HT. CONCLUSIONS: These findings support the hypothesis that mindfulness instruction improves psychological functioning and may ameliorate the negative effects of stress and reduce trauma-associated symptoms among vulnerable urban middle school students. Additional research is needed to explore psychological, social, and behavioral outcomes, and mechanisms of mindfulness instruction.

Comparison of three interventions in the treatment of malnutrition in hospitalised older adults: A clinical trial

Aim: The objective of the present study was to determine the most effective method for providing oral nutrition support to hospitalised older adult patients with malnutrition using clinical and patient-centred measures. Methods: The present study involved consecutive assignment of 98 inpatients assessed as malnourished (Subjective Global Assessment B or C) to conventional commercial supplements (traditional, n = 33), MedPass (n = 32, 2cal/mL supplement delivered 60mL four times a day at medication rounds) or mid-meal trolley (n = 33, selective snack trolley offered between meals) for two weeks. Weight change, supplement compliance, energy and protein intake (3-day food records), quality of life (EQ-5D), patient satisfaction and cost were evaluated. Results: Weight change was similar across the three interventions (mean ± SD): 0.4 ± 3.8% traditional; 1.5 ± 5.8% MedPass; 1.0 ± 3.1% mid-meal (P = 0.53). Energy and protein intakes (% of requirements) were more often achieved with traditional (107 ± 26, 128 ± 35%) and MedPass (110 ± 28, 126 ± 38%) compared with mid-meal (85 ± 25, 88 ± 25%) interventions (P = < 0.01). Overall quality-of-life ratings (scale 0-100) improved significantly with MedPass (mean change, 12.4 ± 20.9) and mid-meal (21.1 ± 19.7) interventions, however, did not change with traditional intervention (1.5 ± 18.1) (P = 0.05). Patient satisfaction including sensory qualities (taste, look, temperature, size) and perceived benefit (improved health and recovery) was rated highest for mid-meal trolley (all P < 0.05). Conclusions: Patients achieved recommended intake with supplements (MedPass or traditional), and despite lower cost, higher satisfaction and quality of life with selective mid-meal trolley did not achieve recommended energy and protein intake. Future research is warranted for implementing a combination of strategies in providing oral nutrition support.

Beyond screening: A review of pediatric primary care models to address maternal depression

Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers’ depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.

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.

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.

Mindfulness-Based Therapies

Mindfulness meditation has been described as a useful adjunct to behavioral and medical interventions in the effective management of a range of psychological symptoms, including emotional responses to stress, anxiety, depression, and disruptive behavior. Mindfulness approaches can be taught to children, adolescents, and their parents to help reduce negative emotional reactions that result from and/or exacerbate psychiatric difficulties and exposure to stressors. This focus may be particularly relevant for African American youth and their families who have an increased risk for exposure to chronic stress and unique stressors associated with social-contextual considerations. Moreover, mindfulness parenting techniques can augment traditional behavioral approaches to improve children’s behavior through specific forms of mindful parent–child interactions. A growing body of empirical studies and clinical experience suggest that the incorporation of mindfulness meditation will enable clinicians to more effectively treat youth and their families in coping optimally with a range of challenging symptoms. This chapter provides a description of mindfulness approaches, theoretical mechanisms of action, literature review, a sample script for a beginning mindfulness exercise, and case studies.