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Mindfulness: July Workshop 2013

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Siobhan Hugh-Jones

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Transcript of Mindfulness: July Workshop 2013

Workshop overview
2.Well-being of young people:
what the evidence shows
Positive Mental Health
Mindfulness in schools
4.Mindfulness
with young people
Promoting Well-being
5. University of Leeds study
http://forums.dpreview.com/forums/post/28879231
a taster of its potential
Dr Siobhan Hugh-Jones
Professor Harald Walach
Dr Sahaja Davis
Ms Abby Roberts
Apprentice Research Team

ESRC & University of Leeds funded project

1. well-being of young people: what have you noticed
2. well-being of young people: what the evidence shows
3. mindfulness: what it is, what we know about it and
how do you practice it?
4. mindfulness and young people: what the evidence shows
5. our project: is there a place for mindfulness in Leeds secondary schools
1. Well-being of young people:
what have you noticed?


What characterises young people who appear to be 'functioning' well in school?

And what characterises those who appear to be 'functioning' less well?



WHO (2012):
poor mental health is a state of being whereby one is predominantly unable to: enjoy and cope with day to day life, work productively and fruitfully, engage in meaningful social relationships and enjoy a sense of purpose and well-being.

?% of boys and ?% of girls 11-16 year olds in the UK have a mental health disorder (Green, 2004).

Depression, anxiety and conduct disorders in teenagers have increased by ??% in the past 25 yrs (MHF & ONS, 2004).

Nearly ?? children and young people suffer from severe depression (Green et al., 2005).

1 in 15 children and young people self-harm (MHF, 2006).

UK children’s well-being (life satisfaction) ranked ?? of 29 developed countries (UNICEF Report Card 11, 2013).
NCDS 50% of the sampled 26 year olds had received their diagnosis between the years of 11-15; 75% between the years 11 and 18.

More than half of all adults with mental health problems were diagnosed in childhood and adolescence (Kim-Cohen et al., 2003)

ONS (2004) problems experienced by YP with mental health disorders ripple out and affect social, educational and physical well-being.
impact
Keyes (2006) study with 3000 American adolescents: depressed youth are more likely to smoke, abuse substances, exhibit conduct disorder, experience academic problems, and drop out of school.

NCDS study found strong negative correlations between childhood conduct disorder and: qualifications and employment; relationships and family formation; health and disability by age 33.

BCS: higher risk of poverty at age 30 and lower chance of employment for children and adolescents who had mental health and/or behavioural development difficulties.
Poor mental health is prevalent in adolescence, is associated with multiple risk factors, and if untreated tends to persist into adulthood.

Genetic vulnerability and personal make-up; parents, schools and communities; adverse life events; deprivation (National CAMHS Review, 2008; ONS & MHF, 2004).

Why are some individuals more resilient that others despite same context?
Individual levels factors - range of causal pathways being researched.

Emotion regulation strategies:
not the event itself but how people respond to it that matters. Is mental health (for some people) determined by their routine response to stressful or adverse events?
Charles et al. (2013) levels of negative emotion on both stressful and non-stressful days predicted general affective distress and symptom-based diagnosis of affective disorder 10 years later.
General negative emotion and (over)reactions to seemingly minor emotional experiences (and not just major life events) play a significant role in later mental-health outcomes.
Without appropriate reactivity, there is an erosion of resources (wear and tear / ‘accumulation of small hits’ : WHO,2009).

But is not just about emotion.

factors influencing mental health
Yes, although positive mental health is not just the absence of poor mental health.


hedonic
positive feelings or emotion, subjective well-being, life satisfaction, happiness

eudemonic
positive functioning, engagement, fulfillment, sense of meaning, social well-being

When both are present = flourishing (rather than languishing). Keyes (2006) flourishing youth had the fewest depressive symptoms and conduct problems and highest psychosocial functioning (global self-concept, self-determination, closeness to others and school integration).

Emotional well-being (EWB) can include self-awareness, emotional self-management, problem-solving skills and resilience to distressing events. EWB is one component of positive mental health and possibly a precursor to it (WHO Europe, 2005).

Why is EWB so central?
'Broaden and Build' model (Fredrickson & Joiner, 2002): Positive emotions do more than simply help us to feel good in the present. Unlike negative emotional states, which narrow people’s thought-action repertoires (e.g. fight or flight), positive emotion broaden's thought-action repertoires, encouraging novel lines of thought or action. Positive emotional states trigger 'upward spirals' by broadening attention and cognition building coping capacity.




EWB promotion has been a dominant theme in public health research worldwide (Patton et al., 2000; Payton et al., 2000; Ravens-Sieberer et al., 2002; WHO Europe, 2005).

NICHE (2009) states that, as a building block of mental health, EWB is a valid focus for interventions with non-clinical populations of young people.

WHO (2009) a key rationale for promoting EWB is the hypothesis that by doing so we can modify certain outcomes even if other risk factors remain.



Promoting Emotional Well-being
Finding the right words
Emotional Intelligence Emotional Literacy
Social and Emotional Competence Emotional and Social Well-being
Shifting attention to the person and the context
as well as a notion of a 'cluster of competencies'

Emotional intelligence (EI)
captures individual differences in the way one experiences, identifies, understands, regulates and utilises self-related and other-related emotions (Petrides & Furnham, 2001).

Steiner's Model of Emotional Literacy

* Knowing your feelings *Having a sense of empathy * Learning to manage our emotions * Repairing emotional damage
* Emotional interactivity (Steiner & Perry, 1997)

Weare’s (2003)
the ability to understand, express and manage our own emotions, and respond to the emotions of others, in ways that are helpful to ourselves and others.

SEAL
derived from Goleman’s Emotional Intelligence
* Self-awareness *Managing feelings * Motivation *Empathy *Social skills

Our term: Emotional and Social Well-being

Evidence on ESWB


Robust evidence supporting links between EI and mental health in general (Martins, Ramalho, & Morin, 2010). Many causal pathways (eg EI might
buffer stress
by promoting positive ways of coping which, in turn, lead to successful adaptation, Keefer et al., 2009).
UK study with 500 adolescents: EI can make significant, incremental contributions to adolescent mental health distinct from the known contributions of personality (Davis & Humphrey, 2012)

Robust evidence for links between promoting ESWB in school and:
Improvements in behaviour and greater inclusion
(eg Wells et al., 2003; Epstein & Elias, 1996)
Learning & attainment
correlational and longitudinal studies document connections between social-emotional variables and
academic
performance (e.g., Caprara, et al.,2000; Wang et al., 1997). Active ingredient may be in change in attitude to school.
emotional and social competencies more influential than cognitive ability in personal, career and scholastic success (Goleman, 1996).
EL programs may affect central
executive cognitive functions
(inhibitory control and planning) that are the result of greater affect regulation in prefrontal areas of the cortex (Greenberg, 2006).
active ingredient: learning to manage emotions which block learning and promote those which facilitate learning.


factors influencing mental health
Role of thoughts
(eg Flouri & Pangouria, 2012) dysfunctional attitudes and negative automatic thoughts create stress response (internally generated threats). Interface between cognition and emotion: ‘emotional personality’.

Preservative Cognition Hypothesis (PCH):

worry or repetitive thinking prolongs stress-related physiological activation by amplifying short-term responses, delaying recovery or reactivating responses after a stressor has been experienced (Brosschot, Gerin and Thayer, 2006)

Emotional (over) reactivity and rumination about daily occurrences are risk factors for poor mental health.

Do the opposites of these confer positive mental health and well-being?

positive mental health / well-being
Yes, but positive mental health is not just the absence of poor mental health.
hedonic
positive feelings or emotion, subjective well-being, life satisfaction,
happiness
eudemonic
positive functioning, engagement, fulfillment, sense of meaning, social well-being
High on both =
flourishing
(rather than languishing): confers range of additional positive benefits to the absence of mental ill health.
Teenagers who scored as flourishing had high psychosocial functioning (global self-concept, self-determination, closeness to others and school integration) and no depressive symptoms and few conduct problems (Keyes, 2006).

Our interest:
hedonic
as
EWB is a strong precursor to overall well-being
(WHO 2005; 2009)
Broaden and Build model
(Fredrickson & Joiner, 2002): unlike negative emotional states, which narrow people’s thought-action repertoires (e.g., fight or flight), positive emotional states broaden people’s thought-action repertoires, encouraging them to discover novel lines of thought or action.
Positive emotions do more than simply help us feel good in the present - they also trigger upward spirals by broadening attention and cognition and building coping capacity.
Promotion of EWB
Dominant theme in public health research worldwide.

NIHCE (2009)
as a building block of mental health, EWB is a valid focus for interventions with non-clinical populations of young people.

WHO (2009)
by promoting EWB we can modify certain outcomes even if other risk factors remain.

Governments and schools have long traditions of trying to support EWB, although the evidence base drawn upon has tended to be thin (hence TaMHS) and tended to be linked to behaviour management rather than psychological health, in itself indicating that difficulties in emotional regulation work against learning.

So, focus has been on management of the (emotional) self.

Has given rise to diverse discourse around emotional well-being.


extent of the problem
Whole school approaches: the evidence
Wells, Barlow & Stewart-Brown (2003): systematic review of 17 studies found:

it is possible to have a
positive impact
on children’s mental health through school-based programmes.
most successful were whole school approaches, implemented continuously for more than a year, and aimed at promotion of mental health rather than prevention of mental illness (also WHO, 2006).
programmes which measured self-concept, emotional awareness and positive interpersonal behaviours (rather than conduct problems and anti-social behaviour) were more likely to show moderately positive or positive results.
programmes that aimed to improve children’s behaviour, and which were limited to the classroom, were less likely to be effective.
The case for a public mental health approach to the emotional needs of children and young people is as compelling as the case for universal immunisation.

Weare et al (2003) : holistic approaches more effective than targeted alone, and more likely to generate long term changes.
Vostanis et al. (2012) : review of school mental health provision in England: increasing move towards universal prevention.


Well-being in education : policy
NIHCE
(2009 – reviewed Jan 2013) Promoting young people’s social and emotional well-being in secondary education.
"The panel noted that
Mindfulness
is one of a group of interventions aimed at developing social and emotional well-being and, potentially, supporting other schooling outcomes. It agreed that no changes to the guidance were necessary yet in respect to this particular intervention."

Department for Education (10 July 2013): new national curriculum.
2.1 Every state-funded
school
must offer a curriculum which is balanced and broadly based and which:
promotes the spiritual, moral, cultural,
mental
and physical development of pupils at the school and of society, and
prepares pupils at the school for the opportunities, responsibilities and experiences of later life.
2.2
All schools should make provision for personal, social, health and economic education (PSHE),
drawing on good practice. Schools are also free to include other subjects or topics of their choice in planning and designing their own programme of education.
Oftsed (2013)
PSHE 'not good enough yet'
- although relatively little reference to psychological health vs safeguarding.

your experience
In your descriptions of young people who function optimally vs. poorly in school, where is social and emotional well-being?

What needs to happen for schools to take universal approaches to social and emotional well-being seriously?

Mindfulness


Good evidence for the effectiveness of mindfulness with clinical adolescent groups. Research now emerging on non-clinical groups.
Proliferation of mindfulness based approaches (MBA) for children and young people suitable for a range of settings (community, school, clubs, youth offender institutions) as well as for teachers and parents.
programmes differ in their format, intensity, duration and delivery
most require training to deliver and most cost.
universal availability vs. integrity
diversity can make research difficult, as can small numbers, opt in mechanisms and lack of control groups.

Mindfulness with young people: about 12 published papers in educational settings.
Burke (2010) reviewed all studies with 5-18's (clinical and non- clinical). All indicated feasibility and acceptability with no adverse effects. Effect sizes d = 0.2-1.4 (but methodological issues)
typical outcomes measures include well-being, attention, anxiety, depression, resilience, emotional regulations, social skills, attainment.


Evidence: Mindfulness in school
Evidence: Mindfulness in School
Schonert-Reichl & Lawlor (2010)

247, 4th - 7th grade pupils (mean 17.4 yrs).
intervention: delivered by teachers, 10 x 45 minute lessons, and three times daily x 3 min mindfulness practice.
self-report: significant increase measures of optimism and a trend toward an increase in positive emotions. No change in self-reported negative affect.
teacher report: improvement in social and emotional competence. Decrease in aggression and oppositional behaviour (but lack of independent ratings is problematic).

Joyce et al (2010)
Australian study 175, 10-13 year olds
intervention: 10 week x 45 minutes lessons delivered by teachers, 7 min personal daily practice.
self report: significant reduction in behavioral problems and depression scores. Gains were mainly limited to students showing clinically significant scores and low pro-social score pre- intervention.

McLaughlin (2011)
(unpublished dissertation) 91 children, grades 5-7
dispositional mindfulness associated with emotion regulation. Attention components help children perceive and respond to emotions.

Semple et al (2010)
RCT of 25 participants aged 9-13, low income.
Following MBCT – C, fewer attention problems than wait-list controls and improvements maintained at 3 months follow up.
Strong relationship between attention problems and behavior problems. Significant reduction in anxiety for those who were clinically elevated pre-trial.

Kukyen et al (2013)
522 young people 12–16 in 12 UK secondary schools (included control group)
.b program high acceptability. Fewer depressive symptoms, lower stress and greater well-being (small effects) . Improvements linked to level of practice.

challenges
Evidence indicates feasibility, acceptability and efficacy. Now need robust RCT evidence. But delivering MBA in schools is not without its challenges

buy in from senior staff
time and place (educational and geographical)
delivering to groups is cost effective but can be disrupted and disruptive
practice is essential but difficult to maintain (need to build in behavior change mechanisms)
who delivers? has cost and time implications
what should the primary outcome measures be?
should they be opt in programs?
they may increase referrals for student support
how can pupils with special needs be supported?
how can parents get involved?
how can MBA be made developmental?
.........etc.
but doing nothing is not an option.


Knowledge Exchange
Strand 1:
develop and Apprentice Research Team of 15 young people from Leeds.
Strand 2:
Researchers’ and professionals’ workshop: what do we know about mindfulness for schools?
Strand 3:
Create online knowledge bank showcasing evidence and potential of mindfulness for schools.
Strand 4:
Impact working group to identify routes to impact of research.
Strand 5:
Placements in schools and local services that will deepen understanding of broad context in which mindfulness in schools might be situated.
Strand 6:
Art Exhibition & Competition to which all Leeds secondary schools are invited to represent teenage stress or well-being.
Strand 7:
Perspectives event with head teachers, teachers, young people, practitioners, services to promote multi-way dialogue about the potential or mindfulness in schools.
Strand 8:
Podcasts of young people’s experience of using mindfulness.
Strand 9:
Final conference for researchers, young peoples, teachers, services, practitioners.

to work with a range of stakeholders to gather information on the appetite for, and ability to test
(in a RCT) the effectiveness of mindfulness based approaches in promoting teenage well-being in school
how can you get involved
join our contact list and get updates
invite us to meet with you to learn more about your experience and context
involve your young people
attend our upcoming events
invite us to give a talk in your school
declare an interest in being part of the RCT
Lifetime Impact Report: Evidence does not necessarily drive policy; campaigning and advocacy will also be required.


Barnes et al (2004)
effects of a school-based MM program on blood pressure and heart rate
38 African American and 35 white middle school students with normal blood pressure.
Intervention group: MM x 10-minute sessions at school and at home each day and to participate in one 20-minute instruction time per week for three months.
Control group: daily 20-minute walks and weekly 20-minute educational sessions about changing diet, increasing physical activity, and losing weight.
MM group showed significant decreases in resting systolic blood pressure and decreases in daytime and after-school ambulatory systolic and diastolic blood pressure, and they also showed decreases in heart rate.

Beauchemin et al (2008)
assessed 5 week MM programme for 34 volunteer 13-18 year olds with learning disabilities.
2 x teachers no training other than 3 hrs session with MM instructor
5-10 minutes daily mindfulness practice.
programme completers showed improved social skills, decreased anxiety and improved academic performance (but no control group).

Wisner (2008)
: eight-week MM for all students (1 biracial, 35 white) in alternative high school. staff and students 4-10 min MM x 4 days per week
Teacher ratings : improved in behavioral and emotional strengths
Students: increases interpersonal and intrapersonal strengths (family involvement, school functioning, and emotional regulation). Found MM helpful for 'calming themselves, relieving stress, increasing relaxation, and improving emotional coping. Reported knowing themselves and increased abilities to pay attention and to control thinking.




our questions
Questions
Which well-being (or other outcomes) matter to key stakeholders?
What influences the acceptability and implementation of mindfulness in Leeds secondary schools?
How do organisational climates and national policies and frameworks influence the uptake, application and impact of mindfulness in secondary schools?
What impact of mindfulness matters to different potential beneficiaries?
How might stakeholders envisage a workable RCT of mindfulness for schools in Leeds?
How we can best understand the potential economic impact of mindfulness in schools?
How we can generate impact based on the research evidence about mindfulness for young people, and how we can measure this?

6. Mindfulness for young people in Leeds
Is there a place for mindfulness based programmes in Leeds/ UK secondary school?

what should the primary purpose / outcome be?

what opportunities are available?

how can challenges be overcome?
Aims of the workshop
• To explain mindfulness and offer tasters of mindfulness practice.

• To offer research bites on the effectiveness of mindfulness for young people.

• To explore the potential of mindfulness in schools, inviting views on the opportunities and challenges with young people.


Evidence on ESWB

Wells et al (2003) and also Durlak et al. (2011) meta-analysis of 213 school-based, universal social and emotional learning (SEL) programs involving 270,034 kindergarten through high school students.

Compared to controls, SEL participants demonstrated significantly improved
social and emotional skills, attitudes, behavior, and academic performance
that reflected an 11-percentile-point gain in achievement.

Effects statistically significant for a minimum of 6 months after many interventions.
Full transcript