Mindfulness‐based interventions for improving cognition, academic achievement, behavior, and socioemotional functioning of primary and secondary school students

This Campbell systematic review examines the effectiveness of school‐based Mindfulness‐based interventions (MBIs) on cognition, behavior, socio‐emotional outcomes and academic achievement. The review summarizes 61 studies and synthesizes 35 studies, with a total of 6,207 student participants. MBIs have a small, statistically significant positive effect on cognitive and socio‐emotional outcomes. But there is not a significant effect on behavioral and academic outcomes. There was little heterogeneity for all outcomes, besides behavioral outcomes, suggesting that the interventions produced similar results across studies on cognitive, socio‐emotional and academic outcomes despite the interventions being quite diverse. Plain language summary Mindfulness‐based interventions in schools have positive effects on cognitive and socio‐emotional processes but do not improve behavior and academic achievement MBIs have a small, positive effect on cognitive and socio‐emotional outcomes, but not a significant effect on behavioral and academic outcomes. The review in brief The use of mindfulness‐based interventions (MBIs) in schools has been on the rise. Schools are using MBI's to reduce student stress and anxiety and improve socio‐emotional competencies, student behavior and academic achievement. MBIs have small, positive effects on cognitive and socio‐emotional processes but these effects were not seen for behavioral or academic outcomes. The studies are mostly of moderate to low quality. Therefore, further evidence from independent evaluators is needed to be able to evaluate the effectiveness of this type of intervention. What did this review study? With the diverse application and findings of positive effects of mindfulness practices with adults, as well as the growing popularity with the public, MBIs are increasingly being used with youth. Over the past several years, MBIs have received growing interest for use in schools to support socio‐emotional development and improve behavior and academic achievement. This review examines the effects of school‐based MBIs on cognitive, behavioral, socio‐emotional and academic achievement outcomes with youth in a primary or secondary school setting. MBIs are interventions that use a mindfulness component, broadly defined as “paying attention in a particularly way: on purpose, in the present moment, non‐judgmentally”, often with other components, such as yoga, cognitive‐behavioral strategies, or relaxation skills training. What studies are included? Included studies used a randomized controlled trial, quasi‐experimental, single group pre‐post test or single subject design and reported at least one of these outcomes: cognition, academic performance, behavior, socio‐emotional, and physiological. Study populations include preschool, primary and secondary school students. A total of 61 studies are included in the review, but only the 35 randomized or quasi‐experimental studies are used in the meta‐analysis. Most of the studies were carried out in North America, and others in Asia, Europe and Canada. All interventions were conducted in a group format. Interventions ranged in duration (4‐28 weeks) and number of sessions (6‐125 sessions) and frequency of meetings (once every two weeks to five times a week). What is the aim of this review? This Campbell systematic review examines the effectiveness of school‐based MBIs on cognition, behavior, socio‐emotional outcomes and academic achievement. The review summarizes 61 studies and synthesizes 35 studies, with a total of 6,207 student participants. What are the main results in this review? MBIs have a small, statistically significant positive effect on cognitive and socio‐emotional outcomes. But there is not a significant effect on behavioral and academic outcomes. There was little heterogeneity for all outcomes, besides behavioral outcomes, suggesting that the interventions produced similar results across studies on cognitive, socio‐emotional and academic outcomes despite the interventions being quite diverse. What do the findings in this review mean? Findings from this review indicate mixed effects of MBIs in schools. There is some indication that MBIs can improve cognitive and socio‐emotional outcomes, but no support for improvement in behavior or academic achievement. Despite the growing support of MBIs for adults, youth may not benefit in the same ways or to the same extent as adults. While not well studied, anecdotal evidence indicates costs and adverse effects of these types of interventions that should be better studied and weighed against the small to no effects on different types of outcomes when considering adoption of MBIs in schools. These findings should be read with caution given the weakness of the evidence produced by the studies. The high risk of bias present in the studies means that further evidence is needed to evaluate the effectiveness of this type of intervention. The evidence from this review urges caution in the widespread adoption of MBIs and encourages rigorous evaluation of the practice should schools choose to implement it. How up‐to‐date is this review? The review authors searched for studies published until May 2015. This Campbell systematic review was published in March 2017. Executive summary BACKGROUND Due to educational policy initiatives over the last two decades, school districts across the United States have placed more emphasis on improving academic standards and accountability. Indeed, children are spending between 20 to 25 hours per year on meeting federal, state and local school‐district testing requirements (Hart et al., 2015). This increased emphasis on academic standards and high stakes testing has, at least in part, been blamed for the increasing levels of stress and anxiety children are experiencing (APA, 2009; Merkangas et al., 2010; Pope, 2010). In addition to changes in education policy requiring an increased emphasis on academic standards and accountability, schools are increasingly expected to attend to the social, emotional, and behavioral needs and problems of students. Given that as many as 13% to 20% children in the U.S. are experiencing one or more mental disorders (Center for Disease Control and Prevention, 2013), schools are increasingly challenged to respond to the growing emotional and behavioral needs of their students. Moreover, socioemotional development and competencies have been linked to learning and academic achievement, and have thus become a target for school‐based interventions as a means of improving learning and academic achievement (Durlak, Weisberg, Dymnicki, Taylor, & Schhellinger, 2011; Eisenberg, Spinrade, & Eggum, 2010; Zins & Elias, 2006). One approach to supporting improvements in socioemotional development and competencies that has received growing interest for use in schools is mindfulness‐based interventions (MBIs). Mindfulness is defined as “paying attention in a particular way: on purpose, in the present moment, nonjudgementally” (Zabat‐Zinn, 1994, p. 4). Research suggests positive effects of MBIs for adults with chronic conditions, mental health diagnoses, psychiatric disorders, and stress (Chiesa, Calati, & Serretti, 2011; deVibe et al., 2012; Cramer, Haller, Lauche, & Dobos, 2012; Vollestad, B. Nielsen, & H. Nielsen, 2012. Moreover, studies suggest that mindfulness based practices may improve performance on a variety of socioemotional outcomes, including self‐regulation, stress, and mood disturbance (Cheisa & Serretti, 2009; Regehr, Glancy, & Pitts, 2013). There has been increasing interest in MBIs with children and adolescents, and schools are often seen as a convenient setting to implement MBIs with children and youth. Some of the more popular MBIs used in schools are Mindfulness Based Stress Reduction (MBSR; Kabat‐Zinn, 1979; Bootzin & Stevens, 2005), Mindfulness Based Cognitive Therapy for Children (MBCT‐C; Segal, Williams, & Teasdale, 2002; Semple, Reid, & Miller, 2005), Meditation of the Soles of the Feet (SoF; Singh et al., 2007), and Learning to Breath (LTB; Broderick & Metz, 2009). Despite the dramatic increase in the use of MBIs in schools to affect socioemotional and academic outcomes, little effort has been invested to systematically examine the body of evidence using rigorous methods, particularly for behavioral and academic outcomes of MBIs implemented in school settings. This review contributes to the literature by including the most recent research on MBIs in school settings, including outcomes that have not been examined in prior reviews of school‐based mindfulness interventions, including behavioral and academic outcomes, and employing stringent criteria for search, selection, coding, and analysis as specified in the Campbell Collaboration policies and guidelines to inform educational policy and practice and identify gaps in the current evidence base to guide future research in this growing area of practice and research. OBJECTIVES The purpose of this review is to examine and synthesize evidence of mindfulness‐based interventions implemented in school settings with primary and secondary school students on achievement, behavior and socioemotional outcomes to inform education practice and policy. Specifically, the primary aim of this review is designed to answer the following research question: 1. What are the effects of mindfulness‐based interventions on cognition, academic achievement, behavior and socioemotional outcomes? Moreover, within the context of this review, we aim to describe: ▪ The types of mindfulness‐based interventions being evaluated in school settings. ▪ The state and quality of evidence of intervention outcomes studies of mindfulness‐based interventions in school settings? SEARCH METHODS We attempted to identify and retrieve both published and unpublished studies through a comprehensive search that included multiple electronic databases, research registers, grey literature sources, and reference lists of reviews and relevant studies. We searched 13 electronic databases, research registers, relevant clearinghouse, government and research center websites, conference abstracts/proceedings, reference lists of prior reviews and included studies, and contact with experts and researchers in the area of school‐based mindfulness interventions. SELECTION CRITERIA Studies were included in this review if they met the following criteria: Types of studies: Randomized controlled trial (RCT), quasi‐experimental design (QED), single‐group pre‐post test design (SGPP) or single subject design (SSD). We only included RCT and QED studies in the meta‐analyses. Participants: Pre‐school, primary and secondary school students Interventions: Interventions of interest include those that are a) conducted in a school setting (during the school day or in a school‐based after school program) and b) use a mindfulness component/strategy. Mindfulness is broadly defined as “self‐regulation of attention to the conscious awareness of one's immediate experiences while adopting an attitude of curiosity, openness, and acceptance” (Bishop et al., 2004, p. 174). Outcomes: Studies must have reported at least one of the following outcomes: 1. Cognition (e.g., executive function, memory, cognition, attention) 2. Academic performance (e.g., standardized achievement tests, measures of content mastery, reading, grades) 3. Behavior (e.g., disciplinary referrals, aggression and other externalizing behaviors, time on task, compliance, attendance) 4. Socioemotional (e.g., anxiety, stress, engagement, social skills, self‐esteem, emotion regulation, grit, internalizing behaviors) 5. Physiological (e.g., cortisol, heart rate, brain activity) Other criteria: Studies must have reported post‐test data, interventions must have been conducted in a primary or secondary school setting, and must have been conducted or published between 1990 and 2015. The search was not restricted by geography, language, publication status or other study characteristics. DATA COLLECTION AND ANALYSIS Titles and abstracts of the studies found through the search procedures were screened for relevance by two reviewers for most electronic databases, with the exception of the Australian Education Index, the British Education Index, and CBCA Education which were reviewed by one author. Documents that were not obviously ineligible or irrelevant based on the title and abstract review were retrieved in full text for final eligibility screening. Two reviewers independently reviewed each full text report using a screening form to determine final inclusion. Any discrepancies between the reviewers were discussed and resolved through consensus. For all studies that passed the eligibility screening process described above, two reviewers independently coded each eligible study using a structured data extraction form. Following independent coding of studies, coders then compared coding and identified and discussed discrepancies, which were resolved through consensus. If consensus could not be reached between the two coders, a third member of the review team was consulted to resolve the discrepancy. We conducted descriptive analyses on variables of interest from all included studies to provide information regarding participant, setting, intervention characteristics for all studies that met eligibility criteria. For those that met criteria for inclusion in the meta‐analysis, we estimated effect sizes for each included RCT and QED study when enough data was reported in the study or provided by study authors. For RCT and QED studies, we calculated the magnitude of effect using the standardized mean difference effect size with Hedges’ g correction for continuous outcomes and odds ratios for outcomes presented as dichotomous variables. Following the estimation of individual study level effects, we conducted separate meta‐analyses using Comprehensive Meta‐Analysis, version 3.0 (CMA; Borenstein, Hedges, Higgins, & Rothstein, 2014) for the following outcome domains of interest: cognitive, academic, behavioral and socioemotional outcomes. To synthesize effects across studies, a weighted mean effect was calculated by weighting each study level effect size by the inverse of its variance. Random effects statistical models were used throughout. RCT and QED studies were pooled to allow for greater statistical power in all meta‐analyses (heterogeneity between RCT and QED studies was not statistically significant in any of the meta‐analyses). Following the estimation of summary effects, we conducted a test of homogeneity (Q‐test) to compare the observed variance to what would be expected from sampling error. The I2 statistic was used to describe the percentage of total variation across studies due to the heterogeneity rather than chance. We also constructed a forest plot displaying study‐level mean effect sizes and 95% confidence intervals for the included studies to provide opportunity for visual analysis of the precision of the estimated effect sizes, detection of studies with extreme effects, and information regarding heterogeneity of studies. Publication bias was assessed using funnel plots. When there was significant heterogeneity across studies, we conducted moderator analyses to examine the following variables: study type (RCT, QED), provider (classroom teacher, trained instructor), researcher involvement (yes/no), homework (yes/no), manualized program (yes/no), and number of weeks (# of weeks of the intervention). RESULTS Of the 61 studies that met criteria for inclusion in this review, 25 were RCT studies, 19 were QED studies, 9 were SGPP studies and 8 were SSD studies. Of the 44 RCT and QED studies, 35 provided enough data to calculate an effect size and were included in one or more of the meta‐analyses, depending on which outcomes of interest were reported in the studies. Of the 44 RCT and QED studies, seven were unpublished reports, with the remaining being published studies in peer‐reviewed journals. The interventions represent a wide range of mindfulness intervention types, but most interventions were at least partially manualized and of shorter duration. The interventions were delivered by primarily a classroom teacher (31%) or by a mindfulness‐trained interventionist (60%) external to the school system. Meta‐analytic findings indicate small, yet statistically significant effects on cognitive outcomes (k = 10; g = 0.25 (95% CI [0.06, 0.43], p = .01) and socioemotional outcomes (k = 28; g = 0.22 (95% CI [0.14, 0.30], p