shonin, e., van gordon, w., & griffiths, m. d. (2012). the health benefits of mindfulness-based...

7/28/2019 Shonin, E., Van Gordon, W., & Griffiths, M. D. (2012). The health benefits of mindfulness-based interventions for c

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96 Education and Health Vol.30 No. 4, 2012

Witkiewitz, & Bowen, 2010). Meta-analyticalfindings also indicate moderate success for thedirect treatment of various somatic illnessessuch as chronic pain, psoriasis, coronary heartdisease, fibromyalgia, and cancer (Baer, 2003).

Whilst there is debate surrounding the mostappropriate age to introduce mindfulness

practice to children and adolescents, there issome evidence that supports the utilization ofMBIs for school-age populations (see review byBurke, 2010). In one of the first randomizedcontrolled trials (RCTs) of MBSR foradolescents, outpatients aged approximately 15years old (n=102) with mood, anxiety, and otherpsychiatric disorders demonstrated significantimprovements in levels of anxiety, depression,somatic distress, self-esteem, and sleep quality

(Biegel, Brown, Shapiro, & Schubert, 2009).More recently, in an RCT of a 12-weekmindfulness and yoga intervention involving 97school-age children (with an average age ofapproximately 10 years), those who received themindfulness training showed significantimprovements compared to the control group inproblematic responses to social stress includingreductions in thought rumination, intrusivethoughts, and emotional arousal (Mendelson, et

al, 2010). The intervention was also found to beacceptable to students, teachers, and schooladminstrators. In a controlled study of anintervention known as Mindfulness Education(a teacher-taught classroom-based manualized10-lesson program involving breath awarenessand attentive listening exercises) involving 246adolescents (with an average age ofapproximately 13.5 years), those who receivedthe Mindfulness Education program

demonstrated significant improvements inoptimism and teacher-rated classroom socialcompetent behaviours (Schonert-Reichl, &Lawlor, 2010).

In addition to the health-related benefits ofMBIs for school-aged children, there ispreliminary evidence to suggest thatmindfulness practice also improves cognitivefunction. For example, elementary schoolchildren (n=64) aged 7- to 9-years who

undertook an eight-week MBI consisting of two30-minute sessions per week showed significantimprovements in metacognition and executivefunction (Flook, et al, 2010). These outcomes areconsistent with findings in adult populationswhere mindfulness practice has been shown to

improve selective and executive attention aswell as working memory capacity (see reviewby Chiesa, et al, 2011).

A change in cognitive perspective due toparticipants adopting a more present-orientatedattentional focus has been recognized as animportant mechanism underlying such changes

(Baer, 2003). A greater perceptual distance frommaladaptive cognitive processes makes it easierfor children and adolescents to let go of andsimply observe their thoughts and feelings aspassing phenomena. Other proposedmechanisms for MBIs include: (i) greaterexposure to thoughts and feelings leading toreduced fear/anxiety responses as elicited byexternal stimuli, (ii) reduced autonomic arousalleading to greater levels of calm and relaxation,

and (iii) greater self-awareness leading toimproved psychosocial coping strategies (Baer,2003).

Cost-effectiveness is a particular strength ofMBIs which can be delivered with as little as 3.2facilitator hours per participant (i.e., based on atotal of 32 intervention hours delivered by onefacilitator to 10 participants). Compared topharmacotherapy, reports of adverse side-effects following MBIs are also uncommon. A

further strength of MBIs is their versatility. Thisrelates to their suitability for treating a widevariety of health problems as well as the ease atwhich the structure of MBIs can be modified tosuit the needs of different population groups.For example, for the teaching of children andadolescent groups, it is recommended that MBIsundergo the following adjustments: (i) a greateruse of explanation and rationale, (ii) integrationof age-group specific practices such as

mindfulness of sounds (involving mindfullistening to different genres of music) andmindful texting, (iii) use of appropriatemetaphors (e.g., using the example of thedifficulty in getting a puppy to sit still as ameans of explaining the concept ofmindlessness and the wandering mind), (iv) agreater variety and shorter duration ofmindfulness practices in order to avoidboredom (e.g., practice session lengths of 110

minutes duration), and (v) the engagement ofparents and carers (Thompson, & Gauntlett-Gilber, 2008).

Weaknesses of mindfulness researchAlthough there is evidence of the efficacy of


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MBIs, their wider acceptance as viablealternative treatments has been hindered by asignificant lack of methodological rigour. Manyof the studies (including those of children andadolescents) have small sample sizes.Furthermore, heterogeneity in terms of how thevarious MBIs conceptualize mindfulness, as

well as differences in program structure (i.e.,length of program, duration of weekly sessions,quantity of psycho-education, amount ofphysical exercise/yoga-type activities, anddifferences in levels of experience andcompliance/supervision of course facilitators)limits the validity of collective findings.

Few MBI studies adequately control forpotential confounding factors such asconcurrent psychopharmacology, concomitant

psychotherapy, and/or illness severity althoughthese concurrent conditions are typically lesspronounced in child and adolescent samples(Klainin-Yobas, Cho & Creedy, 2012). In fact,even where an RCT design is employed, few ofthe studies are particularly robust (e.g., due tofactors such as insufficient details to enablereplication, an overall lack of transparency, anabsence of justification of sample sizes, etc.).Coupled with a general lack of information

concerning the structure of control-groupinterventions, specificity in terms of controldesign presents a further notable limitation.Furthermore, there is a relative scarcity of long-term follow-up data evaluating the maintenanceeffects of MBIs in both adolescent and adultsamples.

Other issues in mindfulness researchInconsistency in the use and misuse of

Buddhist concepts also threatens the longer-term credibility of MBIs. For example, withinthe psychological literature, mindfulnessmeditation is generally viewed as beingsynonymous with a technique known as insightmeditation. Although a small number ofBuddhist approaches appear to share this view,the more traditional perspective is that insightmeditation refers to a subtle form of meditativeanalysis that can permit a penetration into the

empty nature of self and reality. Confusion inthis respect is probably the reason why the vitalrole of insight meditation (in relation to its moretraditional depiction) has been largelyoverlooked in the design of MBIs, and in the

medical and psychological literature moregenerally.

A further concern relates to the level ofexperience (and therefore the credibility andaptitude) of teachers and facilitators of MBIs. Inaddition to being entirely unregulated (i.e.,there is no central accrediting body), MBI

facilitators may have as little as one yearsmindfulness experience following completion ofa single eight-week course (Mental HealthFoundation, 2009). Cullen (2011), in reference tothe stream of mindfulness teachings recentlyintroduced by Western psychologists, states thatMBIs are their own new lineage. Lineage is aparticularly important term and concept withinBuddhism. This essentially relates to theauthenticity of the Buddhist teachings (or

Dharma) in the sense that there should be anunbroken chain of transmission flowing fromteacher to student that can be traced back to thehistorical Buddha (or to another fully realizedbeing).

However, within Buddhism, and in additionto the direct receiving of transmissions from anaccomplished meditation master, lineage canonly be said to be truly intact when theteachings are eventually brought to life at the

point of realization. In order to effect such arealization, authentic Buddhist mastersgenerally undergo decades of focussedmeditation training and invariably endure greathardships prior to teaching the Dharma.Therefore, claims that MBIs constitute anauthentic lineage in the traditional Buddhistsense, are at best, totally unrealistic. Tohighlight this point further, the telephone oremail delivery of MBIs as implemented in a

number of recent mindfulness studies canhardly be said to be in the spirit of traditionalBuddhist transmission (e.g., Salmoirage-blotcher, et al, 2012; Gluck, & Maercker, 2011).

Students more accustomed to Buddhistprinciples have been shown to conceptualizemindfulness in different ways compared withstudents from non-Buddhist backgrounds(Christopher, Charoensuk, Gilbert, Neary, &Pearce, 2009). Thus, there are issues relating to

the cross-cultural validity of existent measuresof mindfulness, and it is currently unclearwhether Westernized versus Buddhistapproaches to meditation and mindfulnessinvolve different mediating mechanisms.


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Concluding commentsInterest into the health applications of MBIs

has increased substantially in the last ten yearsincluding for children and adolescents. MBIsappear to represent a cost-effective, acceptable,and non-invasive means of treating a broadspectrum of medical and psychological

illnesses. There is also preliminary evidence ofthe acceptability and salutary health effects ofMBIs in children and adolescent populationgroups. However, regardless of the growingbody of evidence signifying the potential meritsof MBIs, future studies should aim to addresssome of the methodological issues thatcurrently hinder their wider acceptance asrobust alternative interventions. Furthermore and perhaps of greater importance there is an

urgent need for greater continuity, clarity, andconsistency in terms of the identity of MBIs.Clinicians and researchers of secularizedmindfulness meditation should be mindful ofthe need to respect and safeguard thecredibility, heritage, and ethical values not onlyof clinical practice in general but also of theBuddhist teachings.

References

Baer, R. (2003). Mindfulness training as a clinical intervention: Aconceptual and empirical review. Clinical Psychology: Scienceand Practice, 10, 125-143.

Biegel, G.M., Brown, K.W., Shapiro, S.L., & Schubert, C.M.(2009). Mindfulness-based stress reduction for the treatment ofadolescent psychiatric outpatients: A randomized controlled trial.Journal of Consulting and Clinical Psychology, 77, 855-866.

Burke, C. A. (2010). Mindfulness-based approaches withchildren and adolescents: A preliminary review of currentresearch in an emergent field. Journal of Child and FamilyStudies, 19, 133-144.

Chiesa, A., Calati, R., & Serretti, A. (2011). Does mindfulnesstraining improve cognitive abilities? A systematic review ofneuropsychological findings. Clinical Psychology Review, 31,

449-464.Christopher, M. S., Charoensuk, S., Gilbert, B. D., Neary, T., &Pearce, K. L. (2009). Mindfulness in Thailand and the UnitedStates: A case of apples versus oranges? Journal of ClinicalPsychology, 65, 590-612.

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Flook, L., Smalley, S.L., Kitil, M.J., Galla, B., Kaiser-Greenland,S., Locke, et al. (2010). Effects of mindful awareness practiceson executive functions in elementary school children. Journal ofApplied School Psychology, 26, 7095.

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Mendelson, T., Greenberg, M.T., Dariotis, J.K., Feagans Gould,L., Rhoades, B.L., & Leaf, P.J. (2010). Feasibility and

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