Skip to main content

Supporting Youth Mental Health Through a Health Coaching Intervention with a Mindfulness Component: A Pilot Randomized Controlled Trial During COVID-19



Youth mental health has declined since the COVID-19 pandemic began. Health coaching and mindfulness-based intervention may support therapeutic processes that promote resilience in the face of risk factors for adverse mental health outcomes. Building Resilience for Healthy Kids (HK) is a school-based intervention designed to support mental health through targeting these processes.


In this study, we tested HK in a pilot randomized controlled trial. Specifically, we examined intervention effects on the theoretically-informed therapeutic processes of emotion regulation, mindfulness, self-efficacy, and resilience and the clinical outcomes of depression and anxiety symptoms. The trial took place between April and June 2021, offering an opportunity to assess the impact of HK in the context of COVID-19.


Participants were early adolescents (N = 230), randomized to HK or assessment-only. Participants in the intervention condition received weekly one-on-one sessions with health coaches. All youth completed validated self-report measures at baseline and post-intervention.


Linear mixed effects models indicated that participants who received HK had a greater reduction in emotion regulation difficulties, relative to assessment-only controls (d = 0.84, large effect). Follow-up analyses revealed that youth who endorsed negative affectivity at baseline experienced more benefits than those who did not, and youth who attended more HK sessions increased in self-efficacy, in addition to improved emotion regulation. Intervention effects did not reach significance for other outcomes.


Findings suggest that HK may support youth in reducing difficulties in emotion regulation, which are precursors to the development of mental health concerns in adolescence.


NCT04202913, 12/16/2019.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  • APA. (2013). American Psychiatric Association. Diagnostic and statistical manual (DSM-5) (5th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • Appelhans, B. M., French, S. A., Martin, M. A., Lui, K., & Janssen, I. (2022). Attenuated efficacy of pediatric obesity treatment during the COVID-19 pandemic. Obesity (Silver Spring, Md.), 30(1), 45–49.

    Article  PubMed  Google Scholar 

  • Bates, D. M. (2010). lme4: Mixed-effects modeling with R.

  • Berkel, C., Mauricio, A. M., Schoenfelder, E., & Sandler, I. N. (2011). Putting the pieces together: An integrated model of program implementation. Prevention Science, 12, 23–33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bozer, G., & Jones, R. J. (2018). Understanding the factors that determine workplace coaching effectiveness: A systematic literature review. European Journal of Work and Organizational Psychology, 27(3), 342–361.

    Article  Google Scholar 

  • Broderick, P. C., & Frank, J. L. (2014). Learning to BREATHE: An intervention to foster mindfulness in adolescence. New Directions for Youth Development, 2014(142), 31–44.

  • Burckhardt, R., Manicavasagar, V., Shaw, F., Fogarty, A., Batterham, P. J., Dobinson, K., & Karpin, I. (2018). Preventing mental health symptoms in adolescents using dialectical behaviour therapy skills group: A feasibility study. International Journal of Adolescence and Youth, 23(1), 70–85.

    Article  Google Scholar 

  • Burton, A. L., Brown, R., & Abbott, M. J. (2022). Overcoming difficulties in measuring emotional regulation: Assessing and comparing the psychometric properties of the DERS long and short forms. Cogent Psychology, 9(1), 2060629.

    Article  Google Scholar 

  • Carminucci, J., Hodgman, S., Rickles, J., & Garet, M. (2021). National Survey of Public Education’s Response to COVID-19: Student Attendance and Enrollment Loss in 2020–2021. American Institutes of Research.

  • Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 1–9.

    Article  Google Scholar 

  • Center on the Developing Child (2015). The Science of Resilience (InBrief). Retrieved from

  • Centers for Disease Control (2022, March 31). New CDC data illuminate youth mental health threats during the COVID-19 pandemic [Press release]

  • Cooper, D., Yap, K., & Batalha, L. (2018). Mindfulness-based interventions and their effects on emotional clarity: A systematic review and meta-analysis. Journal of Affective Disorders, 235, 265–276.

    Article  PubMed  Google Scholar 

  • Corbett, B. A., White, S., Lerner, M., Preacher, K. J., Klemencic, M. E., Simmons, G. L., Pilkington, J., Gable, P., Gioia, A., & Key, A. P. (2023). Peers, play, and performance to build social salience in autistic youth: A multisite randomized clinical trial. Journal of Consulting and Clinical Psychology, 91(7), 411–425.

    Article  PubMed  Google Scholar 

  • Daniel, S. K., Abdel-Baki, R., & Hall, G. B. (2020). The protective effect of emotion regulation on child and adolescent wellbeing. Journal of Child and Family Studies, 29(7), 2010–2027.

    Article  Google Scholar 

  • Deci, E. L., & Ryan, R. M. (1985). The general causality orientations scale: Self-determination in personality. Journal of Research in Personality, 19(2), 109–134.

  • Deci, E. L., & Ryan, R. M. (2012). Motivation, personality, and development within embedded social contexts: An overview of self-determination theory. The Oxford Handbook of Human Motivation, 18(6), 85–107.

  • Gnambs, T., & Hanfstingl, B. (2016). The decline of academic motivation during adolescence: An accelerated longitudinal cohort analysis on the effect of psychological need satisfaction. Educational Psychology, 36(9), 1691–1705.

    Article  Google Scholar 

  • Gonçalves, S. F., Chaplin, T. M., Turpyn, C. C., Niehaus, C. E., Curby, T. W., Sinha, R., & Ansell, E. B. (2019). Difficulties in emotion regulation predict depressive symptom trajectory from early to middle adolescence. Child Psychiatry & Human Development, 50(4), 618–630.

    Article  Google Scholar 

  • Grant, A. M., Green, L. S., & Rynsaardt, J. (2007). A randomised controlled study of 360 degree feedback based workplace coaching with high school teachers. Third Australian Evidence-Based Coaching Conference. University of Sydney, Australia.

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.

    Article  Google Scholar 

  • Greco, L. A., Baer, R. A., & Smith, G. T. (2011). Assessing mindfulness in children and adolescents: development and validation of the Child and Adolescent Mindfulness Measure (CAMM). Psychological Assessment, 23(3), 606. doi: PMID: 21480722.

  • Guessoum, S. B., Lachal, J., Radjack, R., Carretier, E., Minassian, S., Benoit, L., & Moro, M. R. (2020). Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Research, 113264,

  • Hagspiel, M. (2023). rciplot; Plot Jacobson-Truax reliable change indices (R package version 0.1.1).

  • Hastings, S. E., Swales, M. A., Hughes, J. C., Jones, K., & Hastings, R. P. (2022). Universal delivery of a dialectical behaviour therapy skills programme (DBT STEPS-A) for adolescents in a mainstream school: Feasibility study. Discover Psychology, 2(1), 21.

    Article  Google Scholar 

  • Hickey, G., McGilloway, S., O’Brien, M., Leckey, Y., Devlin, M., & Donnelly, M. (2018). Strengthening stakeholder buy-in and engagement for successful exploration and installation: A case study of the development of an area-wide, evidence-based prevention and early intervention strategy. Children and Youth Services Review, 91, 185–195.

    Article  Google Scholar 

  • Hoeltje, C. O., Silbum, S. R., Garton, A. F., & Zubrick, S. R. (1996). Generalized self-efficacy: Family and adjustment correlates. Journal of Clinical Child Psychology, 25(4), 446–453.

    Article  Google Scholar 

  • Howell, D. C. (2013). Statistical methods for psychologists (8th Edition.). Wadsworth.

  • Hussong, A. M., Midgette, A. J., Thomas, T. E., Coffman, J. L., & Cho, S. (2021). Coping and mental health in early adolescence during COVID-19. Research on Child and Adolescent Psychopathology, 49(9), 1113–1123.

    Article  PubMed  PubMed Central  Google Scholar 

  • IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp. Source:

  • Irwin, D. E., Stucky, B., Langer, M. M., Thissen, D., DeWitt, E. M., Lai, J. S., Varni, J. W., Yeatts, K., & DeWalt, D. A. (2010). An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment Care and Rehabilitation, 19(4), 595–607.

    Article  PubMed  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.

    Article  PubMed  Google Scholar 

  • Jefferies, P., McGarrigle, L., & Ungar, M. (2019). The CYRM-R: A rasch-validated revision of the child and youth resilience measure. Journal of Evidence-Based Social Work, 16(1), 70–92.

    Article  PubMed  Google Scholar 

  • Johnson, C., Burke, C., Brinkman, S., & Wade, T. (2016). Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents. Behaviour research and therapy, 81, 1–11.

    Article  PubMed  Google Scholar 

  • Karing, C., & Beelmann, A. (2021). Evaluating the implementation and effectiveness of a low-dose mindfulness-based intervention in a student sample: A randomized controlled trial. Mindfulness, 12, 1438–1450.

    Article  Google Scholar 

  • Klingbeil, D. A., Renshaw, T. L., Willenbrink, J. B., Copek, R. A., Chan, K. T., Haddock, A., Yassine, J., & Clifton, J. (2017). Mindfulness-based interventions with youth: A comprehensive meta-analysis of group-design studies. Journal of School Psychology, 63, 77–103.

  • Kuby, A. K., McLean, N., & Allen, K. (2015). Validation of the child and adolescent mindfulness measure (CAMM) with non-clinical adolescents. Mindfulness, 6(6), 1448–1455.

    Article  Google Scholar 

  • Kuyken, W., Weare, K., Ukoumunne, O. C., Vicary, R., Motton, N., Burnett, R., Cullen, C., Hennelly, S., & Huppert, F. (2013). Effectiveness of the mindfulness in schools programme: Non-randomised controlled feasibility study. The British Journal of Psychiatry: The Journal of Mental Science, 203(2), 126–131.

    Article  PubMed  Google Scholar 

  • Lappalainen, P., Lappalainen, R., Keinonen, K., Kaipainen, K., Puolakanaho, A., Muotka, J., & Kiuru, N. (2023). In the shadow of COVID-19: A randomized controlled online ACT trial promoting adolescent psychological flexibility and self-compassion. Journal of Contextual Behavioral Science, 27, 34–44.

    Article  PubMed  Google Scholar 

  • Larson, R. W., Moneta, G., Richards, M. H., & Wilson, S. (2002). Continuity, stability, and change in daily emotional experience across adolescence. Child Development, 73, 1151–1165.

    Article  PubMed  Google Scholar 

  • Lee, J. (2020). Mental health effects of school closures during COVID-19. The Lancet Child & Adolescent Health, 4(6), 421.

    Article  Google Scholar 

  • Lee, J. A., Heberlein, E., Pyle, E., Caughlan, T., Rahaman, D., Sabin, M., & Kaar, J. L. (2021). Evaluation of a resiliency focused health coaching intervention for middle school students: building resilience for Healthy Kids Program. American Journal of Health Promotion, 0890117120959152. doi:

  • Lendrum, A., Humphrey, N., & Greenberg, M. (2016). Implementing for success in school-based mental health promotion: The role of quality in resolving the tension between fidelity and adaptation. Mental Health and Wellbeing through Schools (pp. 77–87). Routledge.

  • Liu, J. J. W., Ein, N., Gervasio, J., Battaion, M., & Fung, K. (2021). The pursuit of resilience: A meta-analysis and systematic review of resilience-promoting interventions. Journal of Happiness Studies, 1–21.

  • Lyons, K. E., & DeLange, J. (2016). Mindfulness matters in the classroom: The effects of mindfulness training on brain development and behavior in children and adolescents. Handbook of Mindfulness in Education, 271–283.

  • Matheson, E. L., Smith, H. G., Amaral, A. C. S., Meireles, J. F. F., Almeida, M. C., Linardon, J., Fuller-Tyszkiewicz, M., & Diedrichs, P. C. (2023). Using Chatbot Technology to improve brazilian adolescents’ body image and Mental Health at Scale: Randomized Controlled Trial. JMIR MHealth and UHealth, 11, e39934.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ma, Y., & Fang, S. (2019). Adolescents’ mindfulness and psychological distress: The mediating role of emotion regulation. Frontiers in Psychology, 10, 1358.

    Article  PubMed  PubMed Central  Google Scholar 

  • Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. J., & McDowell, H. (2012). Cochrane Review: Psychological and educational interventions for preventing depression in children and adolescents. Evidence‐Based Child Health: A Cochrane Review Journal, 7(5), 1409–1685.

    Article  Google Scholar 

  • Mira, A., Díaz-García, A., Castilla, D., Campos, D., Romero, S., Breton-Lopez, J., & Botella, C. (2019). Protocol for a randomized controlled dismantling study of an internet-based intervention for depressive symptoms: Exploring the contribution of behavioral activation and positive psychotherapy strategies. Bmc Psychiatry, 19(1), 1–13.

    Article  Google Scholar 

  • Moltrecht, B., Deighton, J., Patalay, P., & Edbrooke-Childs, J. (2021). Effectiveness of current psychological interventions to improve emotion regulation in youth: A meta-analysis. European Child & Adolescent Psychiatry, 30(6), 829–848.

    Article  Google Scholar 

  • Muris, P. (2001). A brief questionnaire for measuring self-efficacy in youths. Journal of Psychopathology and Behavioral Assessment, 23(3), 145–149.

    Article  Google Scholar 

  • Murray, D. W., Rosanbalm, K., Christopoulos, C., & Hamoudi, A. (2015). Self-regulation and toxic stress: Foundations for understanding self-regulation from an applied developmental perspective. OPRE Report, 21.

  • National Research Council. (2010). The Prevention and Treatment of Missing Data in clinical trials. Panel on handling Missing data in clinical trials. Committee on National Statistics, Division of behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

    Google Scholar 

  • Neumann, A., van Lier, P. A., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment, 17(1), 138–149.

    Article  PubMed  Google Scholar 

  • Olsen, J. M., & Nesbitt, B. J. (2010). Health coaching to improve healthy lifestyle behaviors: An integrative review. American Journal of Health Promotion, 25(1), e1–e12.

    Article  PubMed  Google Scholar 

  • Pajares, F. (2006). Self-efficacy during childhood and adolescence. Self-efficacy Beliefs of Adolescents, 5, 339–367.

    Google Scholar 

  • Papa, A., & Follette, W. C. (2014). Dismantling studies of psychotherapy. The Encyclopedia of Clinical Psychology, 1–6.

  • Park, J. H., Bang, Y. R., & Kim, C. K. (2014). Sex and age differences in psychiatric disorders among children and adolescents: High-risk students study. Psychiatry Investigation, 11(3), 251.

    Article  PubMed  PubMed Central  Google Scholar 

  • Passmore, J., & Lai, Y. L. (2020). Coaching psychology: Exploring definitions and research contribution to practice. Coaching Researched: A Coaching Psychology Reader, 3–22.

  • Peña, A., Olson, M. L., Hooker, E., Ayers, S. L., Castro, F. G., Patrick, D. L., Corral, L., Lish, E., Knowler, W. C., & Shaibi, G. Q. (2022). Effects of a diabetes Prevention Program on type 2 diabetes risk factors and quality of life among latino youths with Prediabetes: A Randomized Clinical Trial. JAMA Network Open, 5(9), e2231196.

  • Quartagno, M., Grund, S., & Carpenter, J. (2019). Jomo: A flexible package for two-level joint modelling multiple imputation. R Journal, 9(1).

  • R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.

  • Riediger, M., & Klipker, K. (2014). Emotion regulation in adolescence. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 187–202). The Guilford Press.

  • Sabin, C., Bowen, A. E., Heberlein, E., Pyle, E., Lund, L., Studts, C. R., & Kaar, J. L. (2021). The impact of a universal mental health intervention on youth with elevated negative affectivity: Building resilience for healthy kids. Contemporary School Psychology, 1–8.

  • Schneider, R. L., Arch, J. J., Landy, L. N., & Hankin, B. L. (2018). The longitudinal effect of emotion regulation strategies on anxiety levels in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 47(6), 978–991.

  • Schultz, P. P., & Ryan, R. M. (2015). The “why,”“what,” and “how” of healthy self-regulation: Mindfulness and well-being from a self-determination theory perspective. Handbook of mindfulness and self-regulation (pp. 81–94). New York, NY: Springer.

    Chapter  Google Scholar 

  • Shek, D. T. L., Sun, R. C. F., & Merrick, J. (Eds.). (2013). Positive youth development: Theory, research and application. Nova Science Publishers.

  • Sonesh, S. C., Coultas, C. W., Lacerenza, C. N., Marlow, S. L., Benishek, L. E., & Salas, E. (2015). The power of coaching: A meta-analytic investigation. Coaching: An International Journal of Theory Research and Practice, 8(2), 73–95.

    Google Scholar 

  • Spence, G. B., & Oades, L. G. (2011). Coaching with self-determination theory in mind: Using theory to advance evidence-based coaching practice. International Journal of Evidence-Based Coaching and Mentoring, 9(2), 37–35.

    Google Scholar 

  • Substance Abuse and Mental Health Services Administration (2019). Key substance use and mental health indicators. US Department of Health and Human Services. Retrieved from:

  • Suldo, S. M., & Shaffer, E. J. (2007). Evaluation of the self-efficacy questionnaire for children in two samples of american adolescents. Journal of Psychoeducational Assessment, 25(4), 341–355.

    Article  Google Scholar 

  • Van Buuren, S. (2018). Flexible Imputation of Missing Data. Second Edition. Boca Raton, FL: Chapman & Hall/CRC.

  • Victor, S. E., & Klonsky, E. D. (2016). Validation of a brief version of the difficulties in emotion regulation scale (DERS-18) in five samples. Journal of Psychopathology and Behavioral Assessment, 38, 582–589.

    Article  Google Scholar 

  • Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clinical Psychology Review, 51, 30–47.

    Article  PubMed  Google Scholar 

  • Zimmermann, P., & Iwanski, A. (2014). Emotion regulation from early adolescence to emerging adulthood and middle adulthood: Age differences, gender differences, and emotion-specific developmental variations. International Journal of Behavioral Development, 38(2), 182–194.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jill L. Kaar.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moran, M.J., Aichele, S., Shomaker, L.B. et al. Supporting Youth Mental Health Through a Health Coaching Intervention with a Mindfulness Component: A Pilot Randomized Controlled Trial During COVID-19. Child Youth Care Forum (2023).

Download citation

  • Accepted:

  • Published:

  • DOI: