Taming the adolescent mind: Examining the clinical efficacy of a mindfulness-based intervention for adolescents with mixed mental health disorders

nnn The mental health field is witnessing rapid scientific advancement of a new generation of behavioural and cognitive therapies, such as Acceptance and Commitment Therapy (ACT; Hayes, Stroshl, a Wilson, 1999), Dialectical Behavioural Therapy (DBT; Linehan, 1993) and mindfulness-based therapies (Kabat-Zinn, 1994; Segal, Williams, a Teasdale, 2002), sometimes known as the lthird-waver of psychological therapies. These approaches focus on the development of acceptance, mindfulness and openness to experiences. It differs from standard cognitive behavioural therapy (CBT), which aims at symptom reductions or reducing problematic ways of thinking. The most notable difference is in the conceptualisation and treatment of private events such as thoughts, feelings, memories and physical bodily sensations. Rather than targeting and attempting to alter the content, frequency and/or form of private events directly (as in traditional CBT models), acceptance-based therapies seek to alter the context and function of internal phenomena so as to diminish their behavioural impact.nnnn nnn Mindfulness meditation has gained widespread attention in both clinical and empirical psychology during the last two decades due to an increasing body of evidence supporting its beneficial effects in the medical field. Initially propelled by the introduction of the Mindfulness-Based Stress Reduction (MBSR) program by Jon Kabat-Zinn in 1979 as a method of teaching stress management to chronic pain patients, it quickly gained popularity.nnn However, a review of the relevant literature revealed that initial effectiveness studies examining mindfulness-training programs were based on data interpretation, rather than examination of actual processes. Mindfulness measurements or instruments were lacking and not widely used in earlier studies. Consequently, assumptions regarding the active ingredients of mindfulness programs were often made prematurely. Also lacking were studies of mindfulness treatment programs for adolescents.nnn In addressing some of the gaps in the empirical literature, this dissertation details three studies. First, how does mindfulness relate to positive mental health such as self-esteem and resiliency in healthy adolescents? To date, mindfulness research has largely been based on outcome studies with clinical samples. Study 1 examined the relationships between mindfulness, self-esteem, resiliency and mental health symptoms in a sample of 106 healthy adolescents. Results illustrated moderate to large effect sizes for mindfulness and negative mental health symptoms (anxiety, depression, stress and cognitive inflexibility). Furthermore, a higher level of mindfulness was associated with higher levels of resiliency and self-esteem after controlling for age.nnn Second, do adolescents benefit from mindfulness training interventions and how is this best delivered? Currently, there exists a plethora of studies and programs for adults but few exist for adolescents. A treatment manual was developed in age appropriate language and mindfulness activities to match adolescentsr developmental needs. Study 2, a longitudinal design pilot study, was conducted to test a 5-week mindfulness-based group treatment program, known as Taming the Adolescent Mindc(TAM; Tan 2013) for adolescents (13 n 18 years) with psychiatric disorders. Ten adolescents of a community mental health clinic participated in the study. Results indicated a significant reduction in their mental health symptoms (d = 0.28), and an increase in mindfulness and self-esteem. Qualitative data indicated the programrs feasibility and acceptability.nnn Having examined mindfulness and its correlates in Study 1 and encouraged by the findings in Study 2, a randomised controlled trial (RCT) in Study 3 investigated the clinical efficacy of mindfulness intervention and its mediating role in relation to mental health outcomes. A sample of 108 participants was recruited from three community mental health clinics and randomised into two groups (control vs. treatment). The control group received treatment as usual (TAU) and the adolescents in the experiment condition received treatment as usual plus mindfulness training (TAU+Mindfulness). Results demonstrated that at post-intervention, adolescents in the mindfulness condition experienced significant decreases in mental distress, compared to control group (d = 0.43), and these gains were maintained and enhanced at 3-month follow-up (d = 0.78). Parents or carers of young people in the mindfulness condition also reported significant improvement in their adolescentrs psychological functioning. Outcomes from 3-month follow-up data were also promising, suggesting significant improvement for adolescents in mindfulness condition. Improvements increased in magnitude for all study variables (self-esteem, parentsr report, mindfulness, psychological inflexibility and mental health) but resiliency. Finally, mediation analyses concluded mindfulness mediated mental health outcomes.nnn Taken together this dissertation contributed the following. First, a further understanding of mindfulness and its relationships to mental health outcomes in adolescents. As previous studies focused only on clinical samples and negative mental health outcomes, this research examined mindfulness and its correlates in both positive (self-esteem and resiliency) and negative mental health states (depression, anxiety, stress and psychological inflexibility) in both healthy and clinical adolescents population. Second, in addressing the lack of mindfulness-based treatment programs available for children and adolescents, an age-appropriate mindfulness-based treatment was developed and manualised, pilot tested and demonstrated a proof of concept. Next, it was further subjected to rigorous investigation by way of a RCT. Finally, the findings in this dissertation offered enhancements to the empirical literature by examining the clinical efficacy of mindfulness-based intervention and its meditating effect on mental health outcomes in adolescents, using age-appropriate mindfulness measurements.