Adapting Mindfulness-Based Stress Reduction to the Positive Youth Development Setting: A Pilot StudyNicole 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-profit research institute in Menlo Park, CA.

AbstractPositive 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 benefits 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 AimsTo investigate the feasibility of and conduct a preliminary investigation of the impacts of implementing a version of MBSR within the context of an afterschool program to enhance PYD competencies for high-poverty adolescents. A random assignment 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 experience2. 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 ComparisonN 9 9

EthnicityAfrican American 6 1Hispanic/Latina 3 6Asian/Pacific Islander 0 1White 0 0Mixed 0 1

Age / Grade 16.0 / 10.6 14.9 / 9.6

Procedure & MeasuresSelf-report measures were administered at baseline prior to the first 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 specific 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.

ConclusionsThis 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 significance levels were corrected for for false discovery rate for multiple comparisons, they were found to be only marginally significant.

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 specifically geared for the PYD environment and examining impacts at larger scale using random assignment experimental research design.

Several findings 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 MaxPublished

Norms1Pretest

Mean (SD) N=18Treatment Difference

Mean (SD) N=9Comparison Difference

Mean (SD) N=9 tPositive and Negative Affect

PANAS Positive 5 3.3 (.7) 3.1 (.5) -.14 (.6) -.10 (.5) -.18Negative 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) -1.9Trait Anxiety 80 41.0 (10.6) 47.7 (12.6) -3.8 (8.3) 3.5 (5.8) -2.2*

Perceived StressPerceived Stress Scale 40 14.2 (6.2) 23.2 (5.2) -2.9 (5.4) 1.1 (6.1) -1.4Severity of Everyday Problems Scale 40 - 22.7 (6.5) 1.8 (7.0) 1.8 (4.3) 0.0

Emotion RegulationDifficulties in Emotion Regulation Scales

Nonacceptance of Emotional Responses 30 - 12.2 (5.2) 1.3 (2.4) 1.1 (3.4) .16Impulse Control Difficulties 30 - 14.4 (4.7) -.89 (4.9) -.94 (5.7) .02Lack of Emotional Awareness 30 - 17.1 (5.9) -.05 (7.1) 2.7 (5.3) -.92Lack of Emotional Clarity 30 - 14.2 (4.1) -.55 (3.9) -.67 (2.4) .072

Self-EsteemRosenberg Self-Esteem Scale 40 - 27.6 (6.3) 2.6 (3.0) -3.1 (5.0) 3.0**

Mindfulness in Everyday LifeMindful Attention Awareness Scale 6 3.8 (.7) 4.1 (1.0) -.50 (1.1) -.26 (.8) -.53

Mental and Physical HealthBrief Symptoms Inventory

Depression 24 - 8.7 (5.5) -.44 (5.7) 1.7 (3.4) -.96Hostility 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• Curriculum activities 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 Practices1 Examining Stress and Introduction to Mindfulness

• Introductions, norms, expectations• How do you define stress?• Teens top stressors today

• Mindfulness of the five 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 selfish• What things do you do to care for yourself?• Working with things you can’t 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 am a 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 I’ll have the strength to endure them and grow from the experience. I learned that when I saw, I wouldn’t see / And what I touched, I couldn’t feel / My body witnessed all the beauty in the world / That my mind and soul were absent for.

ReferencesBenjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. !"#$%&'(")(*+,(-".&'(/*&*01*02&'(/"20,*.3 B, 57, 289–300.Biegel, G. M. (2009). 4+,(1*$,11($,5#2*0"%(6"$78""7()"$(*,,%19(:0%5)#'%,11(170''1(*"(+,';(."#(5,&'(60*+(1*$,11<(Oakland, CA: Instant Help Books.Biegel, G., Brown, K. W., Shapiro, S, & Schubert, C. M. (2009). Mindfulness-Based Stress Reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. !"#$%&'(")(="%1#'*0%>(&%5(='0%02&'(?1.2+"'">.3(@@(5), 855-866.Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. ='0%02&'(?1.2+"'">.9(/20,%2,(&%5(?$&2*02,3(AA(3), 230-241.Kabat-Zinn, J. (1990).(B#''(=&*&1*$";+,(C0D0%>9(E10%>(*+,(F015"G(")(H"#$(I"5.(&%5(:0%5(*"(B&2,(/*$,113(?&0%3(&%5(J''%,11<(New York, NY: Bantam Dell.National Research Council & Institute of Medicine (2002). ="GG#%0*.(;$">$&G1(*"(;$"G"*,(."#*+(5,D,'";G,%*<(Washington, DC: National Academy Press.

Research DesignA quasi-experimental pretest/posttest design comparing treatment participants engaged in the program with a comparison group composed of students in the same afterschool program attending other classes at the same time.

Hypotheses TestedHypotheses were based on findings 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 don’t think I care about me…Before 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 I’m learning 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 I’m learning something new even though it was kind of boring. But it’s really helping me grow as a young lady. Thanks for everything.

I’ve 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 I’ve 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. I’m a lot more patient with people and put myself in their shoes. I’ve 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. I’m proud that I was able to be mindful and ‘live in the moment.’ I’m calm because my stress really does seem to disappear and I realize that all my worries aren’t so much of big deal.

Recruitment Poster

Writing Assignment