New UK data adds to a mixed picture for mindfulness and mental health
Large-scale trials are a vital source of information on effective approaches to early intervention. Miriam Sorgenfrei looks at one such study focused on testing the impact of mindfulness on school pupils' mental health and wellbeing.
Last month, the MYRIAD study generated headlines by providing valuable new data on the limited effectiveness of school-based mindfulness training for early teens in England. We highlighted the importance of this trial in our major 2021 review of the evidence on supporting adolescent mental health, and with the enduring popularity of mindfulness approaches, it is worth looking at this data and its implications.
Mindfulness-based interventions encourage participants to focus their awareness on the present moment. They call for an inward focus that calms the mind and body: some describe being mindful as feeling like an antidote to the constant pressure of keeping up with the world and dealing with constant distractions that demand attention. Originally derived from Eastern traditions and Buddhist psychology, mindfulness has become increasingly popular across the globe, including in the UK, as a low-cost, universally accessible approach to building positive mental health.
What do we know about the effectiveness of secondary school-based mindfulness training?
Existing evidence suggests that mindfulness-based programmes may work in some contexts and help some students. For example, in an Australian trial, the practitioner-facilitated ‘Mindfulness Training for Teens’ programme reduced depression and anxiety among Year 10 but not Year 8 students.
The recent MYRIAD trial evaluated a universal, teacher-delivered mindfulness training called ‘.b’ (‘dot-be’) involving more than 8,300 participants in over 80 English schools. Each week, students were guided through a series of short mindfulness practices such as breath counting and being mindful of routine daily activities. The key finding is stark: compared to teaching as usual, the mindfulness training had no significant positive impact on the wellbeing of the 11–14-year-old participants post-intervention or at a one-year follow-up. Indeed, on some measures, those receiving the programme saw poorer outcomes, such as higher self-reported hyperactivity/inattention both post-intervention and at follow-up.
This adds to a mixed picture on the .b programme. An evaluation in Australia found no impact on students’ depression, anxiety or wellbeing, whereas an evaluation conducted in Finland found improvements in students’ resilience (although not their social-emotional functioning).
This is in line with our 2021 systematic review on the effectiveness of school-based mental health interventions: while some mindfulness-based interventions improved some students’ outcomes, there was substantial variation in which outcomes were improved and for whom.
Mindfulness practice is sometimes integrated with other elements, such as social and emotional learning or positive psychology, and there is some evidence these combinations can work. However, various interventions that are either based on or incorporate mindfulness have shown no or limited effects. For example, some evaluations only demonstrated effects on (less reliable) subscales of relevant measurement tools, or only for certain subgroups.
Why is the evidence so inconsistent?
There are various factors that can reduce effectiveness. One recent systematic review of mindfulness-based school interventions with early adolescents found that factors that facilitate effectiveness include teachers’ ability to embody mindfulness, collaboration among teachers, support from administrators and parents, a relaxing physical environment, and students’ willingness to learn.
Factors that hinder successful implementation include time pressure, a crowded curriculum, and students’ disengagement. Indeed, in the MYRIAD trial around 80% of participants did not complete the home practice, suggesting considerable levels of disengagement. As Oxford University’s and MYRIAD co-investigator Prof Mark Williams said about the findings: ‘[It]’s like going to the gym once and hoping you’ll get fit,’ he said. ‘But why didn’t they practise? Many of them found it boring. Those students who did engage, did improve.’
Where next in school-based mental health support?
Universal mental health support in schools is a vital part of the puzzle, because it reaches a huge number of young people regardless of their personal characteristics, family background or wider circumstances.
When it comes to choosing which is the right form of universal mental health support, the MYRIAD trial provides valuable new insight, on top of earlier evidence. Mindfulness-based approaches may not be the ‘best bet’ for improving all young people’s mental health and wellbeing.
By contrast, the evidence base is much stronger and more consistent for universal programmes that focus on improving students’ social and emotional learning, such as the whole-school programme Learning Together. Our evidence review found that these interventions not only have good evidence of enhancing young people’s social and emotional skills but also of reducing symptoms of depression and anxiety, albeit in the short term. And many SEL interventions can be successfully delivered by teachers.
For students at risk of developing serious mental health difficulties, our review found that the evidence is most consistent for approaches based on cognitive behavioural therapy (CBT). These were consistently shown to be effective, including in reducing anxiety symptoms in the short term and in reducing symptoms of depression in both the short and medium term. Here, interventions delivered by external professionals tended to be more effective than interventions facilitated by teachers.
So, while it might be appropriate to offer mindfulness to students who have an affinity for the approach, schools should carefully weigh the benefits of offering opt-in mindfulness training against other universal wellbeing promotion strategies, such as those based on positive psychology and those promoting social and emotional skills, combined with targeted approaches such as CBT, which have more consistent evidence of improving students’ mental health.