With Mindfulness being perceived as the popular for practical and easy to access therapeutic practice in counselling today. Self-help magazines propose 10 minutes of Mindfulness to a clearer mind to reduce anxiety, Mindfulness for your teen magazines available on the high street. Mindfulness and its practice are seen as the cure-all; self-administered therapy that any can access in any way shape or form; from digital apps to mindfulness playlists to Instagram feeds: mindfulness is the zeitgeist of popular culture. But is it really a suitable therapy for all?
On this essay I wish to look at Mindfulness practice with adolescents and children. I am currently undertaking CPD training in providing mindfulness and compassion-based therapies to children as I seek to undertake my placement in the next year. After studying Self-compassion via Compassion Focused Therapy (CFT) and implementing various aspects into my own daily life I have seen the emotional benefits. This also piqued my interest into mindfulness, and after recognising through personal reflection my scepticism to its practice as a spiritual activity, I have sought to understand it in a more scientific and research-based practice for therapeutic benefit.
Mindfulness has multiple and varying definitions, but a common consensus is that of it being a process of openly attending, with awareness, to one’s present moment experience (Brown, Ryan and Creswell, 2007). There is an increasing awareness of the use of mindfulness and evidence since the 1990s suggests that mindfulness interventions can increase well-being and cognitive performance (Cresswell, 2017).
Many of the studies into mindfulness and its benefits have previously been based around adult studies, with limited studies into its outcomes with adolescents and children. However, studies over the past decade have actively engaged with mindfulness training and children, both within and external to the education system. Many of the studies into mindfulness with adolescents show benefits of increasing attention and awareness, (Brown et al, 2007) and how it can counteract a student’s distraction by a proliferation of social media activity, shown to influence academic achievement (Hollis & Was, 2016).
Some have sought to demonstrate that there is a causal link between mindfulness-based interventions (MBIs) and academic attainment. This evidence via meta-analyses of MBIs in schools has shown some potential benefits but also revealed that more research is needed.
A meta-analysis into mindfulness in adolescents by David A. Klingbeil et al., (2015). Confirmed prior findings from prior meta-analysis, providing stronger evidence that MBIs have small but positive therapeutic effects across different settings and that treatment provided in a school setting was similar to that in a clinical environment. Furthermore, it also suggested that school-based interventions were to offer MBIs as a subtype of social-emotional learning (Lawlor, 2016), with MBIs teaching self-awareness and self-management whilst also learning about social awareness, responsible decision making and interpersonal relationship skills. This as a system could then help mindfulness be a skill that would be likely to bring about positive change in students.
One study in 2015, Laura S. Bakosh, Jutta M. Tobias Mortlock, Dawn Querstret, Linda Morison (2018) completed a randomised trial over 16 volunteer primary aged classrooms in the United States, found improvements in those classes where a 10 minute audio track was played, and additional creative tools and reflective journaling were encouraged in comparison to just a stand alone audio. It could also be noted within this study that there was a greater increase in the results for social studies in the lower economic school.
Sixteen voluntary classes is hardly an adequate sample size to draw meaningful conclusions from, but is suggestive of a potentially fruitful area for additional research on a wider scale. Looking at these results, there is also no note of a possible therapeutic change for the teacher, who could choose to participate or not in the session. As an uncontrolled variable this is concerning. As previous studies into mindfulness in adults have shown consistent benefits, I have to consider that the teacher within these classrooms would have benefited from the MBIs. This may have affected the teaching practices on the day with the teacher being more mindful of their interactions with the class. This I believe may have also been at play, in a similar regard to the study by Moreira, H., Carona, C., Silva, N., Nunes, J., & Canavarro, M. C. (2016) who found that parents who engage in mindful parenting with their offspring have children who have lower social anxiety levels. So should have the teacher engaged in a more mindful way of teaching there may be a unseen and un-recorded change in behaviour within the class room.
Duncan et al.(2009), defined mindful parenting as a parental practice that, through skills, sought to enhance the moment to moment awareness in the parent-child relationship. Being a mindful parent requires being fully present when interacting with the child, with an attitude of acceptance, compassion and kindness while being sensitive and responding to the child’s needs (Bogels & Restifo, 2014) in accordance with own parenting values and goals (Duncan et al., 2009)
Helena Moreira et al, (2016) study into maternal attachment styles and its influence on mindful parenting found that mothers who had a secure attachment with their own primary carer were more mindful in their interactions with their own offspring. Conversely those with an insecure attachment were less mindful in their parenting style and were more likely to display dysfunctional parental behaviours. This also reflected several studies which have proposed that parental behaviours are mainly influenced by a parents own attachment to their own parents (Cohen et al., 2009).
Moreira further, considered that secure attachment is a primary factor in the care and supporting of the relationship with one’s children (Gillath et al., 2005; Jones et al., 2015), but it is also part of a secure relationship with oneself. (Gilbert & Procter, 2006) proposed that self-compassion could serve as a mediator between attachment styles and mindful parenting. Studies into self-compassion and attachment have shown that a positive and reassuring experience from an early age help develop attachment security (Milkulincer & Shaver, 2007) and allow an individual to cultivate self-compassion (Gilbert, 2005: Gilbert and Procter, 2006, Gillath et al, 2005). This could be considered a beneficial skill set that can work along side mindfulness training and social-cognitive learning in many age groups. Being that self-compassion skills can be taught via CFT and encouraged in a person this could lead to more mindful and compassionate interactions between others and self.
Matthew D. Thurston et al, (2017) study into self-view in regard to social anxiety disorder found that those participants in the study who also had Cognitive Behaviour Group Training (CBGT) alongside Mindfulness Stress Based Reduction (MSBR) had a decreased negative self-view and increased positive self-view. They conclude that an increase and development in the ability to see oneself in a positive mind-set were shared within the therapeutic process for MBSR and CBGT for use with social anxiety.
The link between secure attachment and social anxiety in adolescents cannot however be over looked especially with the connection of emotional dysregulation and maternal attachment. (Milkuliencer et al (2005). Research into mindfulness with its use in regard to emotional dysregulation have shown to effectively reduce symptoms of social anxiety (Aldao, Jaraieri, Goldin & Gross, 2014; Norton, Abbott, Norberg & Hunt 2015) however many of these studies have concentrated on adults.
Victoria K. Hambour, Melanie. J Zimmer-Gembeck, Sarah Clear, Susan Rowe, Elina Avdagic (2018) study into emotional regulation and mindfulness in adolescents sought to find a connection between dispositional mindfulness and mindfulness on emotional regulation. Gross (1998) defined emotional dysregulation as involving the inability to influence personal emotional experiences and how and when they were experienced and expressed. This includes limited impulse control along with access to regulation strategies, difficulties engaging with goal directed behaviour, alongside lack of emotional awareness with a lack of clarity and non-acceptance of responses (Gratz and Romer, 2004).
Dispositional mindfulness has also been described as a personality trait (Baer, Smith, Hopkins, Krietmeyer, & Toney, 2006; Brown, Ryan, & Creswell, 2007). Characteristics of dispositional mindfulness are being able to act with awareness, observing and describing experiences in a non-judgemental way and the ability to not react to inner experiences (Baer et al., 2006). Hambour et al. (2018) research found that adolescents with emotion dysregulation who used MBIs reported higher social anxiety symptoms in comparison to those who had dispositional mindfulness. This has been found in a study by Hambour et al (2018) into Mindfulness and social anxiety with emotionally dysregulated adolescents. Considering M.D. Thurston et al, (2017) study, a combination of MBSR with CBGT and could offer a bridging gap of skills for those who struggle with social anxiety.
Although there are limited studies into parental attachment styles and it’s correlation to levels of dispositional mindfulness. Studies have shown that there is a connection. Moreira at al (2016) suggested that it could be that anxious or avoidant parents were less able to bring a mindful approach to their interactions in the parent /child relationship.
On a personal reflection I have some experience with secure and insecure parenting styles within my own parental relationships. The relationship with my mother has a significance, but growing up I had a stronger connection to my father. My mums own mother had died when my mum was aged 4 and I remember frequently hearing her say statements to me as ‘I don’t know how to be a mum’ ‘ I am sorry I let you down.’ And others focusing on her insecurities in a role as a mother. As a primary school teacher and as a foster mother she had no issue sitting within those roles, but as a mother herself that connection to her own children was I feel tainted by this insecurity. My relationship with my father is strong and resilient and there is grace and understanding shown in our interactions. He was the primary carer for us children when my mother returned to work, doing the school run, cooking and housework. He took on the role of primary carer in the home for my mother to return to teaching after having children. He was also the parent who chastised and did punishment, my mother delegated it to him, he also was the one who offered comfort and support in emotional times, my mother would shy away from personally expressing emotions frequently pushing them away and the flip side those who showed them. This I see reflected in work on attachment by primarily Milkuliencer, Shaver,Gillath & Nitzberg, 2005 and Rholes et 1997.
This reflection is personally very emotive as it explains why even now as an adult I can sometimes sit in a very mindful and present calmness but when life throws a curve ball I can lose my head, become over emotional and feel very insecure in the situation. It also explains why when I engage in creative and making processes I feel calmed. My dad and I would make and create, do DIY and engage in lots of talking while listening to the radio and albums. I see how those actions have become behaviours that bring a sense of soothing to me, whilst also a connection to others and how I engage in them in an open mindedness without judgement.
Hambour el al, (2018) Findings suggested that teaching strategies to regulate emotions may be more beneficial to reduce social anxiety in adolescents with emotion dysregulation than mindfulness practices - which could lead to overreactions and excessive ruminations over emotions and events. Moving forward Hambour et al. (2018), also suggested that the metacognitive skills that typically develop in early adulthood which lead to greater self-awareness, self-regulation and self-reflection (Ciesla et al.,2012; Davidson& Kasznik,2015: Trowbridge & Lawson, 2016) may not be present in the participants who were aged between 12 and 15.
Looking at the studies along with my own CPD has made me consider the benefits of teaching stress management through CBT based techniques alongside Mindfulness as a way of helping children and adolescents learn to have greater self-awareness, while also learning skills and strategies to help reduce stress and anxiety around life events and everyday activities. This could be seen as beneficial to the socio-cognitive development of skills that L. Bakosh et al. (2018) eluded to benefit academic performance while engaging in their tech-based MBIs, alongside journaling and reflection.
I noted that none of the studies mentioned the interactions and characteristics of those presenting the sessions and even in conclusions, nothing of a therapeutic relationship were mentioned. It would be easy to assume that all studies across all age demographics presented MBIs in a similar fashion, however in reality that isn’t the case. As language used and presentation to a child would be very different to that of an adult. It is also an oversight to assume that one type of therapy would provide the same outcomes for all. Norcross 1995, in his paper “Dispelling the dodo bird verdict” noted that Yalom (****) saw that where there was self-noting on change, it did not mean that the outcomes were the same for each individual; merely that there had been an improvement in symptoms. Further that within a study of various therapies, the role of the individual therapist also has a part to play in varying outcomes even if all materials are presented in a similar method. L, Bakosh’s et al, (2018) study suggests that the use of tech-based mindfulness interventions could offer teaching staff access to MBI’s without the need of trained and experienced mindfulness practitioners within the school setting. Thus offering ease of access and affordability across the education setting. In fact, however, Crane et al, 2011: Kabat-Zinn, 2003 suggested that a person would have to go through significant training to become proficient in passing on mindfulness skills to others.
This however, makes me question the need for practitioners who offer more than just facilitating the MBI’s, but other competencies such as unconditional positive regard and non-judgemental attitude to the client within the Mindfulness practice. As a counsellor in training familiar with Rogers (1965)**** necessary conditions, I believe that the therapeutic relationship between client and therapist has significant value in therapeutic process, as society seeks to increase social connections and interactions and direct them between people, clients, sales via digital media. We as councillors need to seek ways to engage with this practice while also maintaining a balance to encourage the therapeutic process on a one-to-one, personal level without data and media intervention.
Goldberg et al 2013, study into the therapeutic alliance between smokers in a smoking cessation program found that the therapeutic relationship did have a bearing on the willingness of participants to engage with the programme and the goals. This could be an area to be considered for study further as having beneficial outcomes when engaging with clients.
The therapeutic alliance as an area requires further research to what it brings to therapeutic outcomes as well as the therapies in their own right. As I found studies were limited. However, as a counsellor in training I see the significance of the therapeutic relationship within my own personal therapy, to be able to access a space of unconditional positive regard, a non-judgemental environment and confidentially brings a level of trust and openness to the space myself and my therapist inhabit. This, I have to question, in place within the school environment? Is a stressed teacher able to access and engage on an individual basis with their students, in those necessary conditions to assist in a beneficial therapeutic change with significant learning across a room of 30 children?
As the UK government rolls out mindfulness across the school system, as a way of promoting an interest in mental health in students, there will be an increase in availability to access further studies with mindfulness and a adolescents. This may further our understanding of how it as a therapy works for children. It would however, be wise to also consider a question which is repeated through these studies. Ciesla et al (2012) question whether mindfulness theory is appropriate for the adolescent age group in regard to meta-cognitive development, stating that ‘to be mindful an individual must posses a mature capacity to be self-aware and an ability to regulate one's thoughts, feelings and behaviour.’ and that these skills may be limited in adolescents. Those who have issues with emotional dysregulation, and possibly those who are primary school age who have not reached the stage of cognitive development to embrace a mindful attitude.
I see MBIs as an additional skill set for healthy interaction with self, environment and others. It is an all-inclusive technique, open to anyone irrespective of age, social demographic, gender, culture or financial background. And the teaching of mindfulness could be seen as beneficial on many levels. However as seen in studies it would be naive to roll out mindfulness to all in a hope that it benefits every age group or individual in a similar manner. Results in studies, although limited in size and depth have suggested when standing alone mindfulness for adolescents is not as beneficial for all as prior adult studies suggest.
However, as a skill to learn and to implement it has benefits on both personal and social interactions for an individual. When combined with other therapeutic techniques such as CBT and CFT it may leave a greater impact and significant changes as other skills work alongside it while reducing issues such as social anxiety and leaving individuals more capable to deal with stressful events. However, I think mindfulness training and implementation needs to be thoughtfully delivered and tailored to different age groups. That those presenting training in its methodology have an awareness of issues that may arise, are able to implement support, provide psycho education for those who are affected and direct to further help and assistance though appropriate channels when needed. In regard to this essay I have seen how mindfulness is beneficial, but we as therapists are only just starting to touch the surface of understanding of how it affects and influences adolescents and children. As more studies transpire over the next few years hopefully we will be able to see how and where it can be developed to further assist those who actively seek to engage in a mindful therapeutic practice.