Journal of Child and Family Studies

, Volume 19, Issue 2, pp 218–229 | Cite as

A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children

  • Randye J. Semple
  • Jennifer Lee
  • Dinelia Rosa
  • Lisa F. Miller
Original Paper

Abstract

Mindfulness-based cognitive therapy for children (MBCT-C) is a manualized group psychotherapy for children ages 9–13 years old, which was developed specifically to increase social-emotional resiliency through the enhancement of mindful attention. Program development is described along with results of the initial randomized controlled trial. We tested the hypotheses that children randomized to participate in MBCT-C would show greater reductions in (a) attention problems, (b) anxiety symptoms, and (c) behavior problems than wait-listed age and gender-matched controls. Participants were boys and girls aged 9–13 (N = 25), mostly from low-income, inner-city households. Twenty-one of 25 children were ethnic minorities. A randomized cross-lagged design provided a wait-listed control group, a second trial of MBCT-C, and a 3-month follow-up of children who completed the first trial. Measures included the Child Behavior Checklist, State-Trait Anxiety Inventory for Children, and Multidimensional Anxiety Scale for Children. Participants who completed the program showed fewer attention problems than wait-listed controls and those improvements were maintained at three months following the intervention [F (1, 1, 18) = 5.965, p = .025, Cohen’s d = .42]. A strong relationship was found between attention problems and behavior problems (r = .678, p < .01). Reductions in attention problems accounted for 46% of the variance of changes in behavior problems, although attention changes proved to be a non-significant mediator of behavior problems (p = .053). Significant reductions in anxiety symptoms and behavior problems were found for those children who reported clinically elevated levels of anxiety at pretest (n = 6). Results show that MBCT-C is a promising intervention for attention and behavior problems, and may reduce childhood anxiety symptoms.

Keywords

Mindfulness MBCT Children Emotion regulation Attention Anxiety 

References

  1. Achenbach, T. M. (1991). Manual for the child behavior checklist: Ages 4–18, and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  2. Anderson, N. D., Lau, M. A., Segal, Z. V., & Bishop, S. R. (2007). Mindfulness-based stress reduction and attentional control. Clinical Psychology & Psychotherapy, 14, 449–463.CrossRefGoogle Scholar
  3. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science & Practice, 10, 125–143.CrossRefGoogle Scholar
  4. Baldwin, S. A., Murray, D. M., & Shadish, W. R. (2005). Empirically supported treatments or type I errors? Problems with the analysis of data from group-administered treatments. Journal of Consulting & Clinical Psychology, 73, 924–935.CrossRefGoogle Scholar
  5. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality & Social Psychology, 51, 1173–1182.CrossRefGoogle Scholar
  6. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science & Practice, 11, 230–241.CrossRefGoogle Scholar
  7. Boals, G. F. (1978). Toward a cognitive reconceptualization of meditation. Journal of Transpersonal Psychology, 10, 143–182.Google Scholar
  8. Borkovec, T. D. (2002). Life in the future versus life in the present. Clinical Psychology: Science & Practice, 9, 76–80.CrossRefGoogle Scholar
  9. Boutron, I., Moher, D., Altman, D. G., Schulz, K. F., Ravaud, P. for the CONSORT Group. (2008). Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: Explanation and elaboration. Annals of Internal Medicine, 148, 295–309.Google Scholar
  10. Bush, G., Luu, P., & Posner, M. I. (2000). Cognitive and emotional influences in anterior cingulate cortex. Trends in Cognitive Sciences, 4, 215–222.CrossRefPubMedGoogle Scholar
  11. Davidson, R. J., Kabat-Zinn, J., & Schumacher, M. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–570.CrossRefPubMedGoogle Scholar
  12. Duncan, G. J., Dowsett, C. J., Claessens, A., Magnuson, K., Huston, A. C., Klebanov, P., et al. (2007). School readiness and later achievement. Developmental Psychology, 43, 1428–1446.CrossRefPubMedGoogle Scholar
  13. Ehrenreich, J. T., & Gross, A. M. (2002). Biased attentional behavior in childhood anxiety a review of theory and current empirical investigation. Clinical Psychology Review, 22, 991–1008.CrossRefPubMedGoogle Scholar
  14. Fan, J., McCandliss, B. D., Sommer, T., Raz, A., & Posner, M. I. (2002). Testing the efficiency and independence of attentional networks. Journal of Cognitive Neuroscience, 14, 340–347.CrossRefPubMedGoogle Scholar
  15. Fleischhaker, C., Bock, K., Hennighausen, K., Horwath, D., Kuhn-Hennighausen, C., Rauh, R., et al. (2008). Twenty-year follow-up investigation of the clinic for child and adolescent psychiatry “Haus Vogt”. Zeitschrift fur Kinder-und Jugendpsychiatrie und Psychotherapie, 36, 191–203.CrossRefPubMedGoogle Scholar
  16. Fontana, D., & Slack, I. (1997). Teaching meditation to children. Shaftesbury, UK: Element Books.Google Scholar
  17. Gaines, R. (1997). Key issues in the interpersonal treatment of children. The Review of Interpersonal Psychoanalysis, 2, 1–5.Google Scholar
  18. Goldin, P. R., Saltzman, A., & Gross, J. J. (2006). Mindfulness meditation based stress reduction for children and their parents. Paper presented at the Association for Behavioral and Cognitive Therapies 40th Annual Convention, Chicago, Il. (Nov 19, 2006).Google Scholar
  19. Goodman, T. A. (2005). Working with children: Beginners mind. In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 197–219). New York: Guilford.Google Scholar
  20. Gordon, D. A. (1977). Children’s beliefs in internal–external control and self-esteem as related to academic achievement. Journal of Personality Assessment, 41, 383–386.CrossRefPubMedGoogle Scholar
  21. Greco, L. A. (2006). ACT for teens with physical and emotional pain: Preliminary findings and directions for future research. Paper presented at the Association for Behavioral and Cognitive Therapies 40th Annual Convention, Chicago, IL. (Nov 19, 2006).Google Scholar
  22. Greco, L. A., & Hayes, S. C. (Eds.). (2008). Acceptance and mindfulness treatments for children and adolescents: A practitioner’s guide. Oakland, CA: New Context/New Harbinger Publications.Google Scholar
  23. Hannesdottir, D. K., & Ollendick, T. H. (2007). The role of emotion regulation in the treatment of child anxiety disorders. Journal of Clinical Child & Family Psychology, 10, 275–293.CrossRefGoogle Scholar
  24. Hayes, A. M., & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science & Practice, 11, 255–262.CrossRefGoogle Scholar
  25. Hoza, B., Gerdes, A. C., Mrug, S., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., et al. (2005). Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 34, 74–86.CrossRefGoogle Scholar
  26. Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective & Behavioral Neuroscience, 7, 109–119.CrossRefGoogle Scholar
  27. Joiner, T. E., Jr., Steer, R. A., Beck, A. T., Schmidt, N. B., Rudd, M. D., & Catanzaro, S. J. (1999). Physiological hyperarousal: Construct validity of a central aspect of the tripartite model of depression and anxiety. Journal of Abnormal Psychology, 108, 290–298.CrossRefPubMedGoogle Scholar
  28. Kabat-Zinn, J. (1990). Full catastrophe living. New York: Bantam Doubleday Dell.Google Scholar
  29. Kabat-Zinn, J. (1994). Mindfulness meditation for everyday life. New York: Hyperion.Google Scholar
  30. Kaslow, N. J., & Racusin, G. R. (1994). Family therapy for depression in young people. In W. M. Reynolds & H. F. Johnston (Eds.), Handbook of depression in children and adolescents: Issues in clinical child psychology (pp. 345–363). New York, NY: Plenum Press.Google Scholar
  31. Kumar, S. M. (2002). An introduction to Buddhism for the cognitive-behavioral therapist. Cognitive & Behavioral Practice, 9, 40–43.CrossRefGoogle Scholar
  32. Lee, J., Semple, R. J., Rosa, D., & Miller, L. (2008). Mindfulness-based cognitive therapy for children: Results of a pilot study. Journal of Cognitive Psychotherapy, 22, 15–28.CrossRefGoogle Scholar
  33. Linden, W. (1973). Practicing of meditation by school children and their levels of field dependence–independence, test anxiety, and reading achievement. Journal of Consulting & Clinical Psychology, 41, 139–143.CrossRefGoogle Scholar
  34. March, J. S. (1997). Multidimensional anxiety scale for children: Technical manual. Toronto, Ontario: Multi-Health Systems, Inc.Google Scholar
  35. March, J. S., & Parker, J. D. A. (1999). The multidimensional anxiety scale for children (MASC). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 299–322). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  36. Mineka, S., & Gilboa, E. (1998). Cognitive biases in anxiety and depression. In J. William, F. Flack, & J. D. Laird (Eds.), Emotions in psychopathology: Theory and research (pp. 216–228). New York: Oxford University Press.Google Scholar
  37. Moustafa, B. M. (1999). Multisensory approaches and learning styles theory in the elementary school (Descriptive Report).Google Scholar
  38. Piaget, J. (1962). The stages of the intellectual development of the child. Bulletin of the Menninger Clinic, 26, 120–128.PubMedGoogle Scholar
  39. Platzek, D. B. (1970). Anxiety in children. Unpublished study, Florida State University, Tallahassee, FL.Google Scholar
  40. Posner, M. I., & Petersen, S. E. (1990). The attention system of the human brain. Annual Review of Neuroscience, 13, 25–42.CrossRefPubMedGoogle Scholar
  41. Rani, N. J., & Rao, P. V. K. (1996). Meditation and attention regulation. Journal of Indian Psychology, 14, 26–30.Google Scholar
  42. Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. Northvale, NJ: Jason Aronson.Google Scholar
  43. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.Google Scholar
  44. Semple, R. J. (1999). Enhancing the quality of attention: A comparative assessment of concentrative meditation and progressive relaxation. Unpublished master’s thesis, University of Auckland, New Zealand.Google Scholar
  45. Semple, R. J. (2005). Mindfulness-based cognitive therapy for children: A randomized group psychotherapy trial developed to enhance attention and reduce anxiety. Unpublished doctoral dissertation, Columbia University, New York.Google Scholar
  46. Semple, R. J., & Lee, J. (2008). Treating anxiety with mindfulness: Mindfulness-based cognitive therapy for children. In L. A. Greco & S. C. Hayes (Eds.), Acceptance and mindfulness interventions for children, adolescents, and families (pp. 94–134). Oakland, CA: Context Press/New Harbinger Publications.Google Scholar
  47. Semple, R. J., Lee, J., & Miller, L. F. (2006). Mindfulness-based cognitive therapy for children. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications (pp. 143–166). Burlington, MA: Elsevier/Academic Press.CrossRefGoogle Scholar
  48. Siegler, R. S. (1991). Children’s thinking (2nd ed.). Upper Saddle River, NJ: Prentice-Hall.Google Scholar
  49. Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 37, 105–130.CrossRefGoogle Scholar
  50. Spielberger, C. D., Edwards, C. D., Lushene, R. E., Montuori, J., & Platzek, D. (1973). State-trait anxiety inventory for children: Professional manual. Redwood City, CA: Mind Garden, Inc.Google Scholar
  51. Stark, K. D., Rouse, L. W., & Kurowski, C. (1994). Psychological treatment approaches for depression in children. In W. M. Reynolds & H. F. Johnston (Eds.), Handbook of depression in children and adolescents: Issues in clinical child psychology (pp. 275–307). New York, NY: Plenum Press.Google Scholar
  52. Taghavi, M. R., Neshat-Doost, H. T., Moradi, A. R., Yule, W., & Dalgleish, T. (1999). Biases in visual attention in children and adolescents with clinical anxiety and mixed anxiety-depression. Journal of Abnormal Child Psychology, 27, 215–223.CrossRefPubMedGoogle Scholar
  53. Teasdale, J. D. (1999). Metacognition, mindfulness and the modification of mood disorders. Clinical Psychology & Psychotherapy, 6, 146–155.CrossRefGoogle Scholar
  54. Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research & Therapy, 33, 25–39.CrossRefGoogle Scholar
  55. Thornton, C. A. (1983). A multisensory approach to thinking strategies for remedial instruction in basic addition facts. Journal for Research in Mathematics Education, 14, 198–203.CrossRefGoogle Scholar
  56. Valentine, E. R., & Sweet, P. L. G. (1999). Meditation and attention: A comparison of the effects of concentrative and mindfulness meditation on sustained attention. Mental Health, Religion & Culture, 2, 59–70.CrossRefGoogle Scholar
  57. Walker, C. E., & Kaufman, K. (1984). State-trait anxiety for children. In D. J. Keyser & K. Kaufman (Eds.), Test critiques (1st ed., pp. 663–669). Kansas City, MO: Test Corporation of America.Google Scholar
  58. Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61, 671–689.CrossRefPubMedGoogle Scholar
  59. Williams, J. M. G., Russell, I., & Russell, D. (2008). Mindfulness-based cognitive therapy: Further issues in current evidence and future research. Journal of Consulting & Clinical Psychology, 76, 524–529.CrossRefGoogle Scholar
  60. Wislock, R. F. (1993). What are perceptual modalities and how do they contribute to learning? New Directions for Adult & Continuing Education, 59, 5–13.CrossRefGoogle Scholar
  61. Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. Journal of Attention Disorders, 11, 737–746.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Randye J. Semple
    • 1
  • Jennifer Lee
    • 2
  • Dinelia Rosa
    • 3
  • Lisa F. Miller
    • 3
  1. 1.Department of Psychiatry and the Behavioral Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Marist CollegePoughkeepsieUSA
  3. 3.Department of Counseling and Clinical Psychology, Teachers CollegeColumbia UniversityNew YorkUSA

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