Adapting Mindfulness-Based Stress Reduction to the Positive Youth Development Setting: A Pilot Study

Nicole Shechtman, William Penuel, Center for Technology in Learning, SRI International
Gina Biegel, Kaiser Permenente Contact: nicole.shechtman@sri.com
This project was funded by SRI International,
a non-prot research institute in Menlo Park, CA.
Abstract
Positive youth development (PYD) programs, in complement to formal education, have evolved to address the
strong need to help adolescents develop key personal and social resources needed for resilience to the stress
faced by youth living in low-income urban neighborhoods. The Mindfulness-Based Stress Reduction (MBSR)
program, with a nearly 30-year history, has demonstrated in a multitude of studies benets closely aligned
with the objectives of many PYD programs. This pilot study investigated the feasibility of implementing a
version of MBSR within the context of an afterschool program to enhance PYD competencies for high-poverty
adolescents. A quasi-experimental pretest/posttest design compared 9 treatment participants engaged in the
program with a comparison group composed of 9 students in the same afterschool program. Results showed
that treatment participants, compared to those in the comparison group, had a greater reduction in negative
affect, trait anxiety, and hostility, and a greater increase in self-esteem. Furthermore, students reported that the
program was useful to them, and student writing assignments indicate learning of key MBSR learning goals.
Quantitative pilot results must be interpreted with some cautions described in the conclusion. The poster also
addresses lessons learned about the issues involved in adapting MBSR to PYD settings.
Research Aims
To investigate the feasibility of and conduct a preliminary investigation of the impacts of implementing a version of
MBSR within the context of an afterschool programto enhance PYD competencies for high-poverty adolescents. A
randomassignment design was not feasible in this setting.
Introduction
American adolescents in the 21st century are faced with a variety of unprecedented challenges. As the
world becomes increasingly complex, technical, multicultural, and competitive, young adults also face a
weakening of family and informal community support that was once available. Young people who live in
high-risk, high-poverty neighborhoods are particularly vulnerable.
Positive youth development (PYD) programs, in complement to formal education, have evolved to address
the strong need to help adolescents develop key personal and social resources needed for resilience to the
stress faced by youth living in low-income urban neighborhoods (National Research Council, 2002).
Core to PYD program objectives are the development of psychological, emotional, and social resources,
including competencies such as resilience; managing, regulating, and communicating feelings effectively;
understanding the perspective of others; self-awareness; negotiating negative interpersonal interactions
and participating in positive ones; and attaining important roots of mature moral development.
The Mindfulness-Based Stress Reduction (MBSR) program (see Kabat-Zinn, 1990), with a nearly 30-year
history, has demonstrated in a multitude of studies with adults (and some with children and adolescents)
benefits closely aligned with the objectives of many PYD programs.
Benefits of developing such skills among adults include increased resilience in the face of stress, increased
psychological and physiological well-being, reduced symptoms of psychological distress, enhancement of
cognitive performance in school, management of academic-related stress, and development of the whole
person.
The fundamental skills of mindfulness practice entail two complementary components:
1. self-regulation of attention to maintain an awareness of current moment experience
2. an orientation to experience that cultivates an attitude of curiosity and acceptance about what arises in
the present moment (Bishop et al., 2004)
Setting, Recruitment, and Participants
High school students in an urban PYD afterschool program whose mission is to help underserved students
gain admission to college
The course was offered as one of several academic and enrichment courses in this program
Treatment students recruited on the basis of their selection of this course for the Fall 2009 semester
Only female students chose to take the course.
Comparison students recruited from other classes offered at the
same time. Selected only female students.
Both groups compensated for participation with credits toward
college scholarship funds
Treatment Comparison
N 9 9
Ethnicity
African American 6 1
Hispanic/Latina 3 6
Asian/Pacic Islander 0 1
White 0 0
Mixed 0 1
Age / Grade 16.0 / 10.6 14.9 / 9.6
Procedure & Measures
Self-report measures were administered at baseline prior to the rst class for the treatment group and at the
beginning of the semester for the comparison group. Post-test measures were administered at the end of the
semester to both groups. Previously validated self-report measures used in prior mindfulness studies with
adolescents were selected to test specic hypothesized impacts:
Increased positive affect and decreased negative affect (PANAS, Watson et al., 1988; State Trait Anxiety
Inventory, Spielberger et al., 1970)
Increased efficacy in emotion regulation and productive responses to stress (Difficulties in Emotion
Regulation Scales, Gratz & Roemer, 2004)
Decreased perceived stress in everyday life (Perceived Stress Scale, Cohen et al., 1983; Severity of
Everyday Problems Scale, adapted from Problem Questionnaire Seiffege-Krenke, 1995)
Increased self-esteem (Rosenberg Self-Esteem Scale, Crandal, 1973)
Increased mindfulness in everyday life (Mindful Attention Awareness Scale, Brown & Ryan, 2003)
Increased psychological well-being (Brief Symptoms Inventory, Derogatis, 1975).
Lessons Learned: Design Considerations for Adapting
to the PYD Program Setting
Compared to formal school settings, students are accustomed to less structure and accountability.
Many PYD programs take place in noisy settings, where interruptions are frequent.
PYD programs sometimes tend to prioritize academic goals over enrichment goals, often leading students
to face competing demands, such as tutoring at the same time as the MBSR-T class.
PYD courses sometimes tend not to assign additional homework, working at odds with an essential
MBSR-T element, the development of an at-home practice.
Therefore, in contrast to programs in formal school settings, adolescent clinical settings, and adult settings,
strong emphases must be placed on building a classroom culture that supports engagement, high expectations
and accountability for attendance and participation, and strong boundaries and limit-setting.
Conclusions
This program piloted an adaptation of the MBSR program for the PYD setting. Results of a quasi-experimental
impact study showed that treatment participants, compared to those in the comparison group, had a greater
reduction in negative affect, trait anxiety, and hostility, and a greater increase in self-esteem. Furthermore,
students reported that the program was useful to them, and student writing assignments indicate learning
of key MBSR learning goals. Quantitative pilot results must be interpreted with caution, as there was some
evidence of self-selection bias into the treatment group, the ethnic and age compositions of the two groups
were somewhat different, and when signicance levels were corrected for for false discovery rate for multiple
comparisons, they were found to be only marginally signicant.
This pilot study provides both evidence of the feasibility of implementing MBSR in the PYD setting and design
considerations for further adaptation. Future directions will entail incorporating more supports specically geared for
the PYD environment and examining impacts at larger scale using randomassignment experimental research design.
Several ndings are of note:
Compared to published norms of similar populations, the students in this PYD program
are significantly higher in baseline State/Trait Anxiety and Perceived Stress. This is not
surprising, given that the program is intended to serve high-poverty adolescents who
are faced with unusually challenging life circumstances.
The pretest means were statistically different for the treatment and comparison groups
on three variables: State and Trait Anxiety, and Self-Esteem. These variables indicate
that the treatment group started out somewhat higher in anxiety and lower in self-esteem.
There may have been some self-selection bias into the program. Furthermore, the ethnic
and age compositions of the two groups were not identical.
The treatment group, compared to the comparison group, showed statistically
significant decreases in negative emotion, trait anxiety, and hostility, and an increase in
self-esteem. These findings must be interpreted with caution. To correct for the possibility
of inflated Type I error rates from multiple comparisons, we applied the false discovery
rate procedure of Benjamini and Hochberg (1995). When this highly conservative
procedure was applied, these four variables reached only marginal significance.
Scales Scale Max
Published
Norms1
Pretest
Mean (SD) N=18
Treatment Difference
Mean (SD) N=9
Comparison Difference
Mean (SD) N=9 t
Positive and Negative Affect
PANAS
Positive 5 3.3 (.7) 3.1 (.5) -.14 (.6) -.10 (.5) -.18
Negative 5 2.0 (.7) 2.5 (.7) -.34 (.4) .26 (.5) -2.9*
Calm 5 - 3.0 (.8) .22 (.6) -.37 (1.0) 1.5
State Anxiety 80 40.5 (12.9) 46.1 (11.6) -5.5 (10.2) 3.3 (9.2) -1.9
Trait Anxiety 80 41.0 (10.6) 47.7 (12.6) -3.8 (8.3) 3.5 (5.8) -2.2*
Perceived Stress
Perceived Stress Scale 40 14.2 (6.2) 23.2 (5.2) -2.9 (5.4) 1.1 (6.1) -1.4
Severity of Everyday Problems Scale 40 - 22.7 (6.5) 1.8 (7.0) 1.8 (4.3) 0.0
Emotion Regulation
Difculties in Emotion Regulation Scales
Nonacceptance of Emotional Responses 30 - 12.2 (5.2) 1.3 (2.4) 1.1 (3.4) .16
Impulse Control Difculties 30 - 14.4 (4.7) -.89 (4.9) -.94 (5.7) .02
Lack of Emotional Awareness 30 - 17.1 (5.9) -.05 (7.1) 2.7 (5.3) -.92
Lack of Emotional Clarity 30 - 14.2 (4.1) -.55 (3.9) -.67 (2.4) .072
Self-Esteem
Rosenberg Self-Esteem Scale 40 - 27.6 (6.3) 2.6 (3.0) -3.1 (5.0) 3.0**
Mindfulness in Everyday Life
Mindful Attention Awareness Scale 6 3.8 (.7) 4.1 (1.0) -.50 (1.1) -.26 (.8) -.53
Mental and Physical Health
Brief Symptoms Inventory
Depression 24 - 8.7 (5.5) -.44 (5.7) 1.7 (3.4) -.96
Hostility 20 - 7.6 (4.8) -1.7 (3.8) 1.9 (1.9) -2.6*
Somatic Complaints 72 - 20.4 (11.7) -3.9 (15.2) 1.4 (6.2) -.97
* p < .05; ** p < .01. 1When available, norms are from the population most similar to female adolescents.
Program Parameters
Curriculum was an adapted version of MBSR-T (Biegel, 2009), based closely on the
adult MBSR curriculum (see Kabat-Zinn, 1990). MBSR-T has been used successfully in
clinical settings with adolescents (Biegel et al., 2009).
Overarching goals: To provide teenagers with skills to tap into their own inner capacity
to cope positively with challenging life events, focus their attention productively, gain
understanding of themselves and others, and enjoy everyday life.
Classes met weekly for 1.5 hours
Facilitated by trained MBSR leaders
Curriculumactivities include: (1) didactic learning, (2) experiential mindfulness practices, (3)
group discussion of experiences, (4) at-home mindfulness practices for homework.
Students are provided with a workbook and CD with guided mindfulness practices.
Week Goals and Topics Mindfulness Practices
1 Examining Stress and Introduction to Mindfulness
Introductions, norms, expectations
How do you dene stress?
Teens top stressors today
Mindfulness of the ve senses
Mindful raisin eating
2 Foundations of Mindfulness
What is mindfulness
Mindfulness qualities
Mind-body connection
Mindful stretching
Body-scan meditation
3 Working with What Is
Being with all emotions (read the Guest House by Rumi)
Living in the present moment
Informal practice
Sitting practice
Yoga
4 Cultivating Self-Care and Awareness of Positive Experience
Awareness of pleasant experiences
Self-care vs. being selsh
What things do you do to care for yourself?
Working with things you cant control
Walking meditation
Sitting meditation
5 Working with Thoughts and Unpleasant Events
Awareness of unpleasant experiences
Judgments of self and others
Mindful stopping
Yoga
Body-scan meditation
6 Coping Strategies, Letting Go, and Forgiveness
Unhelpful vs. helpful coping strategies
Mindfulness in school
Letting go and forgiveness
Short breathing meditation
Yoga
7 Building Mindful Resilience
What is My Purpose?
What are my strengths and weaknesses?
How to approach scary things?
Trust exercise in dyads
Walking meditation
8 Review and Intentions for the Future
What did you get out of the class?
Set intentions going forward
Things that nourish and drain you
Sitting meditation
Curriculum Overview
Less judgmental, Less stressed out person, More happy with
myself, Very honest, More caring, More kind
This class was amazing. I mean the subjects we talked about in this class
made me feel as if a bus had hit me, allowing me to look at things in a totally
different way. It allowed me to let go and think positive and let me be free
and comfortable with my disability. I can only see myself succeeding from
this point. I ama better thinker, a better friend, a better learner, and have allowed
myself to care about the careless. I believe this class helped me to grow and that
the different exercises I learned here will be with me for the rest of my life.
I learned to OPEN MY EYES and not spend so much time trying to escape the
uncomforts of life and stare my monsters in the eye. With this I can CHANGE
my situations for the better. Even if I cannot ease my struggles Ill have the
strength to endure themand grow fromthe experience. I learned that when I
saw, I wouldnt see / And what I touched, I couldnt feel / My body witnessed all
the beauty in the world / That my mind and soul were absent for.
References
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, B, 57, 289300.
Biegel, G. M. (2009). The stress reduction workbook for teens: Mindfulness skills to help you deal with stress. Oakland, CA: Instant Help Books.
Biegel, G., Brown, K. W., Shapiro, S, & Schubert, C. M. (2009). Mindfulness-Based Stress Reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77(5), 855-866.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational denition. Clinical Psychology: Science and Practice, 11(3), 230-241.
Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Bantam Dell.
National Research Council & Institute of Medicine (2002). Community programs to promote youth development. Washington, DC: National Academy Press.
Research Design
Aquasi-experimental pretest/posttest design comparing treatment participants engaged in the programwith a
comparison group composed of students in the same afterschool programattending other classes at the same time.
Hypotheses Tested
Hypotheses were based on ndings in prior research on mindfulness in adults and adolescents.
Treatment participants, compared to those in the comparison group, will experience:
Increased positive affect, efficacy in emotion regulation and productive responses to stress, self-esteem,
mindfulness in everyday life, and psychological well-being
Decreased negative affect, perceived stress in everyday life, and somatic complaints
Mindfulness-Based Stress Reduction for Teens (MBSR-T) Program
Results
Something I got out of this class is learning how to care about others even when I
dont think I care about meBefore I started this class I was a kind of bad troubled
teen with many angry problems that I needed help with. Now I can sometimes
control my anger with some music and Imlearning to be more respectful to others
now and staying out of trouble as possible. This class is amazing. It seems like
every day I come here Imlearning something new even though it was kind of
boring. But its really helping me grow as a young lady. Thanks for everything.
Ive been able to accept others as they are. Before, I used to judge others aloud
and only consider my own views. It seems as if Ive matured as a person and have
become more aware about the world around me. My self-esteem has grown and I
no longer tear myself down as much. I think more realistically and catch my mind
when it wanders, especially in negative thoughts. Im a lot more patient with people
and put myself in their shoes. Ive realized that I can accomplish anything, I just
have to control my mind into staying focused. Almost every time I get out of this
class I feel proud and calm. Im proud that I was able to be mindful and live in the
moment. Im calm because my stress really does seem to disappear and I realize
that all my worries arent so much of big deal.
Recruitment Poster
Writing Assignment