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Up to 10% of bereaved people suffer from prolonged grief disorder, characterized by persistent yearning for lost loved ones and emotional pain that interferes with daily living. Grief-focused cognitive behavioral therapy (GF-CBT) has been shown to be more effective than either antidepressant medication or interpersonal psychotherapy in reducing grief symptoms.

However, many bereaved individuals have trouble tolerating GF-CBT’s emphasis on actively recalling their loved one’s death. Up to 25% of those offered GF-CBT decline it, while up to 50% fail to respond, and 22% find it excessively challenging. 

For this reason, the search continues for therapies for bereaved people who cannot tolerate or fail to respond to GF-CBT. Mindfulness-Based Cognitive Therapy (MBCT), proven somewhat effective in treating some forms of depression presents one such possibility.

Bryant et al. [JAMA Psychiatry] compared the effects of GF-CBT and MBCT in reducing prolonged grief symptoms in patients with prolonged grief disorder.

The researchers randomly assigned 100 Australian patients with prolonged grief disorder (average age=47 years; 87% female; 71% white) to either GF-CBT or MBCT. Both programs consisted of 90-minute, weekly individual sessions over an 11-week period. GF-CBT entailed didactic training, thought monitoring, and revisiting memories of the loved one’s death. Participants were instructed to reframe maladaptive grief-related thoughts, write letters to the deceased, and cultivate positive memories of them.

The standard MBCT protocol was modified to focus on problematic grief. MBCT participants were assigned 40 minutes of daily homework. 

Assessments were conducted at baseline, post-treatment, and 6-month follow-up using a primary outcome measure of prolonged grief symptoms. Secondary outcomes involved the assessment of mental health symptoms, grief-related cognition, and quality of life. The primary prolonged grief measure assessed symptoms such as loneliness, numbness, meaninglessness, emotional detachment, obsessive thoughts of loss, avoidance of loss reminders, and disengagement from life.

The results showed that at 6 months, the GF-CBT group had significantly greater reductions in prolonged grief symptoms (Cohen’s d=0.80), depressive symptoms (d=0.60), and grief related cognitions (d=0.70) compared to the MBCT group.

Both groups showed clinical improvements in prolonged grief, depression, and grief-related cognitions. For example, the GF-CBT group’s prolonged grief symptoms decreased from 43.6 points to 28.7 points while the MBCT group’s symptoms decreased from 40.6 to 32.8 points.

The superiority of GF-CBT was not apparent at post-treatment but emerged at the 6-month follow-up. Both groups had significant reductions in anxiety and improvements in quality of life, without significant differences between groups.

The study demonstrates that both MBCT and GF-CBT can reduce symptoms of prolonged grief immediately after treatment, but GF-CBT shows greater effectiveness at 6-month follow-up. The study is limited by its not including an analysis of home practice during and after treatment. Further, only 60% participants from each treatment group were retained at the 6-month follow-up.

Reference:

Bryant, R. A., Azevedo, S., Yadav, S., ... Dawson, K. S. (2024). Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 

Link to study

Central serous chorioretinopathy (CSCR) is an eye disease characterized by the accumulation of fluid between the choroid tissue layer and the retina, leading to retinal bulging and visual impairment. While this condition typically resolves within three months, it can sometimes persist chronically or recur.

Chronic CSCR treatment involves a variety of therapies including laser treatment, photodynamic therapy, and medication. Stress has been identified as a risk factor for CSCR, with elevated stress hormones like cortisol and epinephrine implicated in the buildup of sub-retinal fluid. 

Stress reduction techniques might promote healing and restore vision for CSCR. Özcan and Karapapak [International Ophthalmology] tested the effects of Mindfulness-Based Stress Reduction (MBSR) compared to a no-treatment control on visual acuity and macular thickness in patients with a recent onset of CSCR. 

The researchers randomly assigned 60 Turkish meditation-naïve adults (average age=40; 88% male) with a recent onset of CSCR to MBSR or a monitoring only control group. Recent onset of CSCR is usually not actively treated unless symptoms fail to resolve after three months. MBSR sessions consisted of daily one-hour sessions spanning three months, during which participants engaged in breath, body, and sensation-focused meditations. 

Participants’ best vision while wearing corrective lenses was assessed using a Snelling eye chart at 1, 3, and 6 months. The thickness of each participant’s retinal macula was measured by Spectral Domain Optical Coherence Tomography at each assessment point. The retinal macula thickens in CSCR due to excess fluid absorption, and a thinner macula is a sign of recovery.

Six of the initial MBSR participants were excluded from the analysis due to not completing MBSR training. Trial results showed that, at 1, 3, and 6 months, the MBSR group had significantly better visual acuity and lower macular thickness compared to controls. Controls also improved from baseline to follow-up, but their visual acuity recovery was slower, and both their visual acuity and macular thickness had less improvement compared to the MBSR group.

The findings underscore the potential of MBSR in ameliorating vision impairments and reducing macular thickness in CSCR patients. The researchers cautioned that maintaining patient engagement with MBSR was challenging.

Limitations of the study include the absence of an active control group, the lack of a stress measurement to elucidate stress as a key mechanism, and not including an intention-to-treat analysis of all individuals randomized. The description of MBSR provided was insufficient, hindering understanding of intervention components and implementation method.

Reference:

Özcan, D., & Karapapak, M. (2024). Effect of mindfulness-based stress reduction on acute central serous chorioretinopathy: A randomized control trial. International Ophthalmology, 44(1), 183. 

Link to study

Antiretroviral medications have enabled people living with HIV to live normal lifespans but about half of those with HIV meet diagnostic criteria for HIV-associated neurocognitive disorder (HAND). People diagnosed with HAND show deficits in attention, memory, verbal fluency, and visuospatial ability and are susceptible to depression, lower quality of life, and poorer medication compliance. Existing treatments for HAND include computerized cognitive training and interventions to increase levels of physical activity. 

Mindfulness training might also be a promising intervention because of its established beneficial effects on depression and quality of life for patients with a variety of chronic illnesses, as well as its potential benefit for executive cognitive function. Moskowitz et al. [AIDS and Behavior] tested the ability of Mindfulness-Based Stress Reduction (MBSR) to alleviate distress and neurocognitive symptoms and improve quality of life in older patients diagnosed with HAND.

The researchers randomly assigned 180 patients (mean age=65 years; 80% male; 73% white; average HIV duration=30 years) aged 55 years and over who were currently on antiretroviral medication, had undetectable serum HIV levels, and were diagnosed with HAND to either MBSR or a waitlist control.

Recruitment efforts targeted participants from the San Francisco Bay Area using various methods, such as community outreach talks, recommendations from healthcare providers, advertising on buses and in newspapers, and direct outreach facilitated by the UCSF Electronic Health Record Recruitment Service. The MBSR intervention followed the standard 8-week group-based protocol. 

Participants were assessed at baseline, post-intervention, and one-month follow-up using self-report measures of anxiety, depression, quality of life, and activities of daily living. The activities of daily living measures assessed participants’ basic abilities to shop, cook, do laundry, bathe, clean house, and take their medications, They were also assessed at all three time points on neurocognitive measures of information processing speed (a symbol-digit test), working memory (a letter number sequencing task), and vigilance (a continuous performance task). 

The trial results showed that the MBSR group had a significant decrease in depressive symptoms at post-intervention compared to the control group, but this difference was no longer significant at one month follow-up. The MBSR group  showed a significant improvement in quality of life compared to the control group at one month follow-up.

No significant group differences were observed in terms of anxiety, neurocognitive scores, or activities of daily living at either immediate post-intervention or one-month follow-up assessment.

The trial findings suggest that MBSR can reduce depressive symptoms and improve quality of life for older patients with HIV-associated neurocognitive disorder in the shorter term but does not improve anxiety, neurocognitive symptoms, or activities of daily living. The study is limited by reliance on a waitlist control and lack of long-term follow-up.

Reference:

Moskowitz, J. T., Sharma, B., Javandel, S., Moran, P., Paul, R., De Gruttola, V., Tomov, D., Azmy, H., Sandoval, R., Hillis, M., Chen, K. P., Tsuei, T., Addington, E. L., Cummings, P. D., Hellmuth, J., Allen, I. E., Ances, B. M., Valcour, V., & Milanini, B. (2024). Mindfulness-Based Stress Reduction for Symptom Management in Older Individuals with HIV-Associated Neurocognitive Disorder. AIDS and Behavior.

Link to study

Rates of adolescent and young adult depression and anxiety have risen since 2010 in many industrialized societies, especially for young women. Some experts attribute this increase to heightened exposure to social media. Research shows that such exposure can diminish women’s body satisfaction and self-esteem, likely stemming from the portrayal of idealized thinness and fitness standards in images and messages. Researchers are interested in developing practical strategies to mitigate the adverse impacts of social media on body image.

Mindfulness meditation, with its emphasis on acceptance, non-reactivity, non-judgment, and non-rumination, could serve to mitigate the negative impacts of social media. Hooper et al. [Body Image] investigated the effects of brief mindfulness meditation on women’s body appreciation, mood, and self-esteem after viewing idealized thinness and fitness images obtained from social media posts.

In this online study, researchers randomly assigned 162 English-speaking women (mean age = 26 years; 62% white) who typically spent an average of 2 to 3 hours daily on Instagram to either a brief mindfulness meditation or an audio control group.

All participants were exposed to 12 Instagram photos, each viewed for at least 20 seconds, featuring idealized images of female thinness or fitness. Following exposure to the images, participants listened to either a 10-minute guided mindfulness meditation or a 10-minute podcast providing general information about Brazilian jujitsu. The guided meditation emphasized attention to breathing and cultivation of concentration and calmness. 

Participants completed self-report measures at baseline, immediately after viewing the images, and immediately after listening to the meditation or podcast session. These measures assessed mood, self-esteem, and body appreciation, with the body appreciation measure including statements such as “At this moment I feel good about my body.”

The results revealed that viewing the idealized thinness and fitness images led to immediate and significant decreases in self-esteem (partial η2=0.69), body appreciation (η2=0.71) and positive mood  (η2=0.63) and increases in negative mood (η2 =0.58) for the total sample.

However, the mindfulness meditation group significantly increased self-esteem (η2=0.69), body appreciation (η2=0.66) and positive mood (η2=0.54) and reduced negative mood (η2=0.57) compared to the podcast control immediately following the audio exposure. Additionally, all of these self-report measures were significantly better after meditation than they were at baseline.

The study demonstrates that visual exposure to idealized thinness and fitness images obtained from Instagram posts worsens women’s mood, self-esteem, and body appreciation. These adverse effects can be mitigated, at least in the very short term, through brief mindfulness meditation as compared to listening to general information on a podcast not involving meditation.

The study's limitations include the use of a mundane control audio as opposed to a comparator like deep breathing or breath counting. The inclusion of such comparators could potentially alter reports of self-esteem, body appreciation, and mood following the image task.

Reference:

Hooper, R., Guest, E., Ramsey-Wade, C., & Slater, A. (2024). A brief mindfulness meditation can ameliorate the effects of exposure to idealised social media images on self-esteem, mood, and body appreciation in young women: An online randomised controlled experiment. Body Image. 

Link to study

Stimulant medications are often the first-line treatment for childhood attention deficit/hyperactivity disorder. Medication has shown to be more effective than behavioral treatment for ADHD, and it is still unclear whether behavioral treatments provide any  additional value when used in conjunction with medication.

While medication can significantly reduce inattention, impulsivity, and hyperactivity for most children with ADHD, about 20-35% of children do not appear to benefit from it. Additionally, medication side effects such as insomnia, loss of appetite, and anxiety are common. About 50% of children opt to eventually discontinue its use. As a result, there remains a need for effective non-pharmacological treatments. 

Mindfulness-based treatments, with their demonstrated effects on attention and emotional regulation, are worth exploring in this regard. Meppelink et al. [Mindfulness] tested the effectiveness of conjoint child-and-family mindfulness-based intervention against methylphenidate medication in children with ADHD.

The researchers randomly assigned 91 Dutch children with ADHD (average age = 11 years; 71% male), along with 91 of their mothers and 81 of their fathers, to either mindfulness-based or medication treatment groups. Children in the medication group received methylphenidate, titrated until reaching an optimal response. The mindfulness intervention included 8 weekly 1.5-hour group sessions for the children and 8 weekly 1.5-hours group sessions for their parent(s), focusing on mindful parenting.

After the initial training, families attended a 1.5-hour booster session. They were required to follow their assigned protocol for 4 months but could switch treatment afterwards. 

About 50% of the families in the mindfulness group kept their protocol, while the other half switched to medication. About 75% of the families in the medication group stayed with medication, while a quarter discontinued it.  Many families sought additional help from outside providers during the study. Thirty-five percent of the medication group sought out mindfulness-based treatments, and 23% of the medication group and 35% of the mindfulness group sought out other behavioral treatments.  

Children were assessed at baseline and 2, 4, and 10 months on self-, parent-, and teacher-report behavioral measures. They were also assessed on neuropsychological measures of attention at baseline and 2 months. 

The results showed that while both groups significantly improved on child-, parent-, and teacher-rated symptoms at 2 and 4 months (d = -0.20 to -0.57), improvements were significantly greater for the medication group (d = -0.28 to -0.76) . At two months, both groups fared significantly better on neuropsychological measures (d = 0.38 to 1.11) , but there were no significant between-group differences. At 10 months, maternal behavioral ratings no longer differed between the groups, although fathers still rated medication as more effective. 

The treatment effects remained consistent for both mindfulness and medication participants who stayed the course with their initial treatment assignment. Mindfulness participants who switched to medication deteriorated at 4 months (before switching) but showed improvements at 10 months. Medication participants who stopped medication either deteriorated at 4 months (before switching) or at 10 months. 

A second cohort of 29 children with ADHD and their families refused randomization and were assigned to their preferred treatment. Once again, while children in both treatment groups showed reduced symptoms, medication demonstrated superiority.

The findings suggest that both mindfulness and medication improve behavioral and neuropsychological measures in children with ADHD. In the short-term, medication showed superiority to mindfulness on behavioral measures, but no difference on neuropsychological measures. However, the superiority of medication declined over 10 months in maternal ratings, but not paternal ratings.

The study is limited by the many families who opted to switch protocols after four months or received adjunctive treatments outside the protocol complicating the interpretation of longer-term effects.

Reference:

Meppelink, R., de Bruin, E. I., Zoller, B. K., Oort, F. J., & Bögels, S. M. (2024). Child and Parent Mindfulness-Based Training Versus Medication for Childhood ADHD: A Randomised Clinical Trial. Mindfulness.

Link to study

Acute stressful events can trigger the release of cortisol and testosterone into the human bloodstream. While cortisol prepares us to fight or flee in the context of threat, testosterone may amplify male dominance and competitive behavior in socially stressful situations. Chronic or frequent exposure to stressors, however, can alter hormonal levels and potentially lead to the development of physical and psychiatric disease.

While significant knowledge has been gained regarding the cortisol stress response, less is known about complex feedback between these hormones and how they are mutually affected by stress reduction techniques. 

Fan et al. [Stress] tested the effects of mindfulness meditation and muscle relaxation on male college students’ salivary cortisol and testosterone levels before and after exposure to a stressor and after practicing a stress reduction technique.

The researchers randomly assigned 32 meditation-naïve Chinese college men (average age = 21 years) to either Integrative Body Mind Training (IBMT) or a muscle relaxation control group. Both treatments were delivered in 20-minute group training sessions conducted over the course of 7 consecutive days. IBMT included mindful stretching poses followed by open-monitoring sitting meditation emphasizing acceptance of experience.

The muscle relaxation control involved sequentially focusing attention on different muscle groups and relaxing them through focusing on sensations of warmth and heaviness.

After training, both groups participated in an experimental session consisting of 5 minutes of rest followed by a 3-minute stressor task. During the task, participants were instructed to subtract 47 from a 4-digit number sequentially. If participants failed to respond with a correct subtraction answer within 5 seconds, the computer emitted a harsh sound, and the participant had to restart the task.

The task was followed by a 20-minute relaxation period, during which the participants followed the IBMT or relaxation protocol they had trained on. Salivary cortisol and testosterone samples were drawn immediately after the rest, stressor, and relaxation periods.  

The results showed both groups significantly increased their cortisol and testosterone levels in response to the stressor task. After the relaxation period, muscle relaxation participants’ cortisol levels continued to rise (d=0.76), whereas IBMT participants’ did not. IBMT participants’ cortisol levels were significantly lower than muscle relaxation participants’ after the relaxation period (d=0.34).

Testosterone levels rose in response to the task and continued to rise for both groups during the relaxation period. However, this rise was significantly steeper for the IBMT group (d=1.07). Changes in cortisol and testosterone levels were uncorrelated.

The findings suggests that IBMT could potentially reduce the acute cortisol stress response while increasing testosterone levels in young adult males encountering an acute stressor. In contrast, progressive muscle relaxation was found to be less effective in reducing cortisol response and resulted in a weaker increase in testosterone levels. However, the study has limitations in determining whether these cortisol and testosterone responses are adaptive. 

Reference:

Fan, Y., Cui, Y., Tang, R., Sarkar, A., Mehta, P., & Tang, Y.-Y. (2024). Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males. Stress. 

Link to study

People with schizophrenic spectrum disorders (SSDs) often exhibit both positive (hallucinations, delusions) and negative (apathy, social withdrawal, lack of affect) symptoms. Negative symptoms respond poorly to current medications, and there is a need for novel treatments that can help minimize them. 

Oxytocin is a naturally occurring hormone associated with higher levels of emotional bonding and pro-social behavior in social contexts. It’s possible that administering oxytocin within a positive social context such as a group mindfulness-based intervention might improve empathy and lessen negative symptoms.

Zierhut et al. [Journal of Psychiatric Research] conducted pilot a study to test the effects of administering oxytocin vs. placebo in patients with SSDs participating in Mindfulness-Based Group Therapy.

The researchers randomly assigned 41 German adults diagnosed with an SSD (average age = 42 years; 68% male) to oxytocin + MBGT or a placebo + MBGT. Oxytocin (and placebo) were intranasally administered 45 minutes prior to group therapy sessions.

MBGT is a mindfulness-based intervention designed for adults with SSDs. It was delivered in two 50-minute small group sessions over the course of a single week. The first session included an introduction to mindfulness, a 15-minute breath awareness exercise, and the group sharing of experiences and goals. The second session focused on engaging all the senses and included a nature walk. 

Participants were assessed before and after the week-long intervention on measures of empathy, negative symptoms, stress, affect, and mindfulness (using the Southampton Mindfulness Questionnaire). Blood oxytocin levels were also assessed at multiple time points.

The results showed the combined sample reported significant increases in self-rated empathy (d=0.56) and perspective taking (d=0.69) from pre- to post-intervention, without significant between group differences. There was no improvement in either group, however, on a measure of empathy involving inferring the mental state of people depicted in pictures on a computer screen.

The oxytocin group showed significantly greater self-rated improvements in diminished emotional range (ηp2= 0.11) and lack of motivation (ηp2= 0.11) compared to the placebo controls. Self-reported negative affect decreased (d = -0.86 and  -0.57) and positive affect increased significantly (d=0.44 and 0.69) for both group. Both groups also reported significant decreases in perceived stress.

The study shows Mindfulness-Based Group Therapy can potentially improve self-reported empathy. Adding oxytocin leads to greater improvement in self-reported negative symptoms of diminished emotional range and lack of motivation. The study is a pilot study that needs replication with a larger sample size, longer treatment duration, the inclusion of a no-treatment control, and long-term follow-up.

Reference:

Zierhut, M., Bergmann, N., Hahne, I., Wohlthan, J., Kraft, J., Braun, A., Tam Ta, T. M., Hellmann-Regen, J., Ripke, S., Bajbouj, M., Hahn, E., & Böge, K. (2024). The combination of oxytocin and mindfulness-based group therapy for empathy and negative symptoms in schizophrenia spectrum disorders – A double-blinded, randomized, placebo-controlled pilot study. Journal of Psychiatric Research. 

Link to study

Over 40% of U.S. military personnel report post-deployment chronic pain, and up to a third of military veterans are prescribed opioids for long-term pain management. Over a quarter of these veterans go on to engage in some form of opioid misuse, either taking more than their prescribed doses, using opioids to manage negative emotions, or taking non-prescribed drugs.

Therapists are always looking for ways to manage pain more safely and effectively, and mindfulness training may have a role to play in reducing chronic pain and opioid misuse. 

Garland et al. [American Journal of Psychiatry] compared the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) and supportive psychotherapy in reducing self-reported pain and opioid misuse in past and present U.S. military personnel prescribed long-term opioids for chronic pain.

The researchers randomly assigned 230 past and present U.S. military personnel (average age = 58 years; average length of chronic pain = 19 years; 91% veterans; 83% male; 86% white) prescribed long-term opioid treatment for chronic pain to either MORE or supportive psychotherapy. Both treatments were delivered by the same licensed psychologists in 8 weekly two-hour group formats. While 63% of the participants received treatment in person, the onset of the COVID pandemic caused 39% to receive treatment on-line. 

The MORE curriculum combines elements of mindfulness training, cognitive reappraisal, and savoring of positive experiences, and psychoeducation on chronic pain and opioid misuse. The mindfulness component included breath- and body-focused meditations. In addition to 15 minutes of daily guided home mindfulness, reappraisal and savoring practice, participants were to engage in 3 minutes of mindful awareness prior to taking doses of their medication.

The supportive therapy control used a non-directive client-centered approach that included discussion of thoughts and emotions around pain, opioid use, and emotional distress, but did not include skills training. 

Participants were assessed at baseline, post-treatment, and 4-and 6-month follow-up on measures of pain, opioid use and misuse, and a variety of psychological variables. Participants also rated their opioid cravings three times daily throughout the six months of the study.

The results showed that the MORE group reduced average chronic pain severity, pain-related interference with daily activities, and daily opioid cravings to a significantly greater degree than controls. They also reduced their average daily opioid dosage (by 21%) significantly more than controls (by 4%). Both groups significantly reduced opioid misuse from baseline but did not differ from each other in that regard.

This trial suggests MORE for patients with chronic pain who are prescribed long-term opioid treatment attenuates self-reported pain outcomes. The study population of predominantly white, middle-aged males may restrict the degree to which these results may generalize to other populations. It is also not clear how switching from an in-person to on-line therapy format midway through the study might have affected the outcomes. 

People with schizophrenic spectrum disorders (SSDs) often exhibit both positive (hallucinations, delusions) and negative (apathy, social withdrawal, lack of affect) symptoms. Negative symptoms respond poorly to current medications, and there is a need for novel treatments that can help minimize them. 

Reference:

Garland, E. L., Nakamura, Y., Bryan, C. J., Hanley, A. W., Parisi, A., Froeliger, B., Marchand, W. R., & Donaldson, G. W. (2024). Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial. American Journal of Psychiatry.

Link to study

Children diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) typically display symptoms of inattention, hyperactivity, and impulsivity as well as difficulties in family, social, and academic life. While medication is often the first-line treatment, there is evidence that children with ADHD may also benefit from cognitive behavioral and mindfulness-based interventions (MBIs). However, studies evaluating the efficacy of MBIs for this demographic often suffer from the limitations of small sample sizes, absence of evidence-based comparators, and insufficient long-term follow-up. 

Wong et al. [Psychotherapy and Psychosomatics] compared the efficacy of mindfulness-based and cognitive behavioral interventions designed for children with ADHD and their parents in improving children’s attention and well-being while reducing parental stress.

The researchers randomly assigned 138 Cantonese-speaking parent-child pairs, with children aged between 8 and 12 years (average age = 9 years; 72% male) diagnosed with ADHD, to either a MBI or cognitive behavioral intervention. The MBI comprised 8 weekly 90-minute group sessions modeled after Mindfulness-Based Stress Reduction but tailored for school age children. Children and parents met in separate concurrently running groups. 

The control intervention involved 8-week cognitive-behavioral groups for the children and psychoeducational groups for the parents. The cognitive behavioral intervention focused on handling problems, improving self-control, understanding emotions, perspective taking, conversational skills, and managing social problems. The parental psychoeducational group reinforced concepts covered in the cognitive behavioral sessions and included discussion and role playing as well as self-care and relaxation skills.

Due to COVID-related lockdowns in Hong Kong, about 6% of the child-parent pairs received most of their training remotely via Zoom.

The primary outcome was children’s selective attention, assessed at baseline, 8 weeks, and 3 and 6 months using the Sky Search subtest of the Test of Everyday Attention. The subtest requires children to circle target spaceships on a sheet filled with distractor items. Secondary outcomes included various aspects of attention, executive function, parent-rated ADHD symptoms and behavioral problems, mindfulness, and well-being, as well as parental stress, rumination, and their own ADHD and well-being.

Results showed that the MBI group had significantly improved selective memory over baseline at six months (d=0.32), while the cognitive behavioral group had significantly improved selective memory over baseline at post-intervention (d=0.27), 3 months (d=0.45), and 6 months (d=0.27). There were no significant differences in selective memory between the two study groups, however. While there were several significant small-to-moderate within-group improvements on other measures of children’s attention, executive function, and behavioral and ADHD symptoms, there were no significant differences between group on any of these variables.

There were no within- or between-group improvements for parental well-being, perhaps reflecting the stress of COVID lockdown periods in China.

The study shows a mindfulness-based and a cognitive-behavioral intervention show the same small-to-moderate improvements in selective attention and behavior in children with ADHD on six-month follow-up, and shows no effect for relative changes in parents of children with ADHD.

The study is limited by the absence of an inactive control comparator that could rule out regression to the mean, repeat testing, or the passage of time. 

Reference:

Wong, S. Y. S., Chan, S. K. C., Yip, B. H. K.,... Bögels, S. M. (2023). The Effects of Mindfulness for Youth (MYmind) versus Group Cognitive Behavioral Therapy in Improving Attention and Reducing Behavioral Problems among Children with Attention-Deficit Hyperactivity Disorder and Their Parents: A Randomized Controlled Trial. Psychotherapy and Psychosomatics. 

Link to study

There is a growing body of evidence suggesting that mindfulness-based interventions not only improve school-aged children’s executive functioning and emotional regulation, but also their academic performance. Voltmer et al. [Scientific Reports] tested the effects of teacher-led meditation breaks on primary school children’s performance on a standardized arithmetic test.

The researchers randomly assigned nine 3rd and 4th grade classrooms containing a total of 140 students (51% male) in six German elementary schools to either a meditation or active control group. Teachers in the mindfulness group received 15 hours of instruction in mindfulness. They then led up to three 3- to 5-minute Breathing Break Intervention (BBI) sessions for their students per school day. These BBIs were selected from a set of 15 exercises designed to teach breath and body awareness, relaxation and self-calming, present-moment attention, and letting go. Control group students engaged in up to three 3- to 5-minute periods of coloring a mandala with crayons each school day. 

Students completed standardized arithmetic tests at baseline assessment , 9 weeks into the intervention, and 5 month follow-up. Arithmetic test scores were reported as age-normed T-scores with a mean of 50 and standard deviation of 10.

Teachers also rated student arithmetic ability on a five-point scale at all three assessments. Parental educational level and children’s working memory (measured using a test of repeating digit span backwards) were used as covariates in predicting intervention effects on arithmetic performance.

The research was conducted during the second year of the COVID pandemic. The previous school year had been interrupted by COVID-related shutdowns, and school administrators, anxious about student performance, had the 3rd graders take the 2nd grade test and 4th graders take the 3rd grade test at baseline. At week 9 and follow up assessments, however, students took the test appropriate for their grade level. The week 9 and follow up assessment interval was disrupted by further COVID shutdowns, and by shortened school weeks. Teachers during this interval stopped performing the interventions on any regular basis.

About 40% of the BBI group students continued sporadically taking breathing breaks on their own while engaging in distance learning from home, but rarely more than once a week.

The results showed the BBI group had considerably higher arithmetic T-scores than controls prior to intervention (50 vs. 42). After nine weeks of intervention, both study groups’ performances dropped, but the BBI group had a steeper drop so that their T-scores were now only marginally higher than controls (41 vs. 39).

At 5 months, the BBI group showed a steeper increase in scores so that their T-scores were again substantially higher than controls (49 vs. 41). Teacher-rated arithmetic ability did not differ between groups.

Breathing Break Interventions are an age-appropriate way to introduce mindfulness to grade schoolers. The researchers attributed the BBI group’s steeper improvement in arithmetic scores from baseline to 9 weeks to the intervention, but this interpretation does not account for the BBI group’s initially higher pre-intervention scores. At five months both groups essentially returned to their pre-intervention baselines.

Given the shifting use of grade-appropriate tests and COVID-related complications, the results are difficult to interpret and may reflect a null effect between groups.

Reference:

Voltmer, K., Hondrich, F., & von Salisch, M. (2023). Daily breath-based mindfulness exercises in a randomized controlled trial improve primary school children’s performance in arithmetic. Scientific Reports.

Link to study