Mindfulness-based Intervention in Elementary School Students With Anxiety and Depression: A Series of n-of-1 Trials on Effects and Feasibility

Catherine Malboeuf-Hurtubise, Eric Lacourse, Catherine Herba, Geneviève Taylor, Leila Ben Amor, Catherine Malboeuf-Hurtubise, Eric Lacourse, Catherine Herba, Geneviève Taylor, Leila Ben Amor

Abstract

Mindfulness-based interventions constitute a promising option to address anxiety and depression in elementary school students. This study evaluated the effect of a mindfulness-based intervention on anxiety and depression in elementary school students with a diagnosis of anxiety or depression disorder. A single-subject experimental A-B-A design was used. Participants were three elementary school students from grades three and four, along with their teacher. Anxiety and depression were measured on 10 occasions at baseline, during the intervention, and at follow-up. Primary hypotheses were tested using a univariate single case multilevel modeling strategy and visual analysis. Following intervention, 2 participants reported improvements on anxiety and depression, while their teachers reported deteriorating scores on these variables. Results from this n-of-1 trial design is consistent with other work suggesting caution with regard to the overall impact and efficacy of mindfulness-based interventions as a universal treatment option for youth. Future research is warranted.

Keywords: abnormal child psychology; anxiety; clinical psychology; cognitive-behavioral therapy; depression; mindfulness-based meditation.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Graphical display of baseline level and changes in level between consecutive phases in anxiety.
Figure 2.
Figure 2.
Graphical display of baseline level and changes in level between consecutive phases in depression.
Figure 3.
Figure 3.
Graphical display of baseline level and changes in level between consecutive phases in mindfulness.

References

    1. Canadian Mental Health Association. Fast facts about mental illness. 2015. . Accessed July 13, 2015.
    1. Oberle E, Schonert-Reichl K, eds. Mindfulness in Adolescence: New Directions for Youth Development, Number 142. Hoboken, NJ: Wiley; 2014.
    1. Mental Health Commission of Canada. Making the case for investing in mental health in Canada. 2013. . Accessed July 13, 2015.
    1. Mental Health Commission of Canada. School-based mental health in Canada: a final report. 2013. . Accessed July 13, 2015.
    1. Kabat-Zinn J. Mindfulness-based interventions in context—past, present, and future. Clin Psychol Sci Pract. 2003;10:144–156.
    1. Kabat-Zinn J. Wherever You Go There You Are: Minfulness Meditation in Everyday Life. New York, NY: Hyperion; 1994.
    1. Borkovec TD. Life in the future versus life in the present. Clin Psychol Sci Pract. 2002;9:76–80.
    1. Salmon P, Sephton S, Weissbecker I, Hoover K, Ulmer C, Studts JL. Mindfulness-based meditation in clinical practice. Cogn Behav Pract. 2004;11:434–446.
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78:169–183.
    1. Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000;68:615–623.
    1. Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol. 2004;72:31–40.
    1. Zoogman S, Goldberg SB, Hoyt WT, Miller L. Mindfulness interventions with youth: a meta-analysis. Mindfulness. 2015;6:290–302.
    1. Carboni JA, Roach AT, Fredrick LD. Impact of mindfulness training on the behavior of elementary students with attention-deficit/hyperactive disorder. Res Hum Dev. 2013;10:234–251.
    1. Mendelson T, Greenberg MT, Dariotis JK, Gould LF, Rhoades BL, Leaf PJ. Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. J Abnorm Child Psychol. 2010;38:985–994.
    1. Schonert-Reichl KA, Oberle E, Lawlor MS, et al. Enhancing cognitive and social–emotional development through a simple-to-administer mindfulness-based school program for elementary school children: a randomized controlled trial. Dev Psychol. 2015;51:52–66.
    1. Biegel GM, Brown KW, Shapiro SL, Schubert CM. Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: a randomized clinical trial. J Consult Clin Psychol. 2009;77:855–866.
    1. Haydicky J, Wiener J, Badali P, Milligan K, Ducharme JM. Evaluation of a mindfulness-based intervention for adolescents with learning disabilities and co-occurring ADHD and anxiety. Mindfulness. 2012;3:151–164.
    1. Zenner C, Herrnleben-Kurz S, Walach H. Mindfulness-based interventions in schools—a systematic review and meta-analysis. Front Psychol. 2014;5:603.
    1. Felver JC, Celis-de Hoyos CE, Tezanos K, Singh NN. A systematic review of mindfulness-based interventions for youth in school settings. Mindfulness. 2016;7:34–45.
    1. Moses EB, Barlow DH. A new unified treatment approach for emotional disorders based on emotion science. Curr Dir Psychol Sci. 2006;15:146–150.
    1. Hill CL, Updegraff JA. Mindfulness and its relationship to emotional regulation. Emotion. 2012;12:81–90.
    1. Chambers R, Gullone E, Allen NB. Mindful emotion regulation: an integrative review. Clini Psychol Review. 2009;29:560–572.
    1. Cicchetti D, Ackerman BP, Izard CE. Emotions and emotion regulation in developmental psychopathology. Dev Psychopathol. 1995;7:1–10.
    1. Kumar S, Feldman G, Hayes A. Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression. Cogn Ther Res. 2008;32:734–744.
    1. Boswell JF, Anderson LM, Barlow DH. An idiographic analysis of change processes in the unified transdiagnostic treatment of depression. J Consult Clin Psychol. 2014;82:1060–1071.
    1. Norton PJ, Philipp LM. Transdiagnostic approaches to the treatment of anxiety disorders: a quantitative review. Psychotherapy (Chic). 2008;45:214–226.
    1. Molenaar PC, Campbell CG. The new person-specific paradigm in psychology. Curr Dir Psychol Sci. 2009;18:112–117.
    1. Wood P, Brown D. The study of intraindividual differences by means of dynamic factor models: rationale, implementation, and interpretation. Psychol Bull. 1994;116:166–186.
    1. Schork NJ. Personalized medicine: time for one-person trials. Nature. 2015;520:609–611.
    1. Barlow DH, Nock MK. Why can’t we be more idiographic in our research? Perspect Psychol Sci. 2009;4:19–21.
    1. Collins FS, Varmus H. A new initiative on precision medicine. N Engl J Med. 2015;372:793–795.
    1. Clancy C, Collins FS. Patient-Centered Outcomes Research Institute: the intersection of science and health care. Sci Transl Med. 2010;2(37):18–37.
    1. Kravitz R, Duan N. Design and Implementation of N-of-1 Trials: A User’s Guide. Rockville, MD: Agency for Healthcare Research and Quality, US Department of Health and Human Services; 2014.
    1. Duan N, Kravitz RL, Schmid CH. Single-patient (n-of-1) trials: a pragmatic clinical decision methodology for patient-centered comparative effectiveness research. J Clin Epidemiol. 2013;66(8 suppl):S21–S28.
    1. Malboeuf-Hurtubise C, Lacourse É, Joussemet M, Ben Amor L. A mindfulness-based intervention for elementary students with internalized disorders: a multiple single case-study design. Paper presented at: 7th Annual Conference of Quantitative Methods and Humanities; 2015; Montreal, Quebec, Canada.
    1. Gravetter F, Forzano L-A. Research Methods for the Behavioral Sciences. Boston, MA: Cengage Learning; 2011.
    1. Harris AD, McGregor JC, Perencevich EN, et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc. 2006;13:16–23.
    1. Vohra S, Shamseer L, Sampson M, et al. ; CENT Group. CONSORT extension for reporting N-of-1 trials (CENT) 2015 Statement. J Clin Epidemiol. 2016;76:9–17.
    1. Spector PE. Research Designs. Beverly Hills, CA: Sage; 1981.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed Arlington, VA: American Psychiatric Associaton; 2013.
    1. Malboeuf-Hurtubise C, Achille M, Sultan S, Vadnais M. Mindfulness-based intervention for teenagers with cancer: study protocol for a randomized controlled trial. Trials. 2013;14:135.
    1. Malboeuf-Hurtubise C, Joussemet M, Douaire J, Lacourse E. Impact of a mindfulness-based pilot study on elementary students with severe learning difficulties. Paper presented at: Annual Conference of the National Association of School Psychologists; February 17-20, 2015; Lake Buena Vista, FL.
    1. Deplus S. Les interventions psychologiques basées sur la pleine conscience pour l’enfant et l’adolescent. Paper presented at: Les interventions psychologiques basées sur la pleine conscience pour l’enfant et l’adolescent; 2012; Montreal, Quebec, Canada.
    1. Reynolds CC, Kamphaus RW, eds. The Behavior Assessment System for Children. 2nd ed Circle Pines, MN: AGS Publishing; 2004.
    1. Achenbach TM. Child Behavior Checklist for Ages 4-18. Burlington, VT: Thomas M. Achenbach; 1991.
    1. Conners CK. Conners’ Rating Scales–Revised. Toronto, Ontario, Canada: Multi-Health Systems; 2001.
    1. Baer RA, Smith GT, Lykins E, et al. Construct validity of the Five-Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment. 2008;15:329–342.
    1. Smith JD. Single-case experimental designs: a systematic review of published research and current standards. Psychol Methods. 2012;17:510–550.
    1. Kratochwill TR, Hitchcock JH, Horner RH, et al. Single-case intervention research design standards. Remedial Spec Educ. 2013;34:26–38.
    1. Shadish WR. Analysis and meta-analysis of single-case designs: an introduction. J Sch Psychol. 2014;52:109–122.
    1. Van den Noortgate W, Onghena P. A multilevel meta-analysis of single-subject experimental design studies. Evid Based Commun Assess Intervention. 2008;2:142–151.
    1. Shadish WR, Rindskopf DM, Hedges LV. The state of the science in the meta-analysis of single-case experimental designs. Evid Based Commun Assess Intervention. 2008;2:188–196.
    1. Smith JD, Eichler WC, Norman KR, Smith SR. The effectiveness of collaborative/therapeutic assessment for psychotherapy consultation: a pragmatic replicated single-case study. J Pers Assess. 2015;97:261–270.
    1. Ferron JM, Bell BA, Hess MR, Rendina-Gobioff G, Hibbard ST. Making treatment effect inferences from multiple-baseline data: the utility of multilevel modeling approaches. Behav Res Methods. 2009;41:372–384.
    1. Shadish WR, Kyse EN, Rindskopf DM. Analyzing data from single-case designs using multilevel models: new applications and some agenda items for future research. Psychol Methods. 2013;18:385–405.
    1. Moeyaert M, Ferron JM, Beretvas SN, Van den Noortgate W. From a single-level analysis to a multilevel analysis of single-case experimental designs. J Sch Psychol. 2014;52:191–211.
    1. Ferron JM, Moeyaert M, Van den Noortgate W, Beretvas SN. Estimating causal effects from multiple-baseline studies: implications for design and analysis. Psychol Methods. 2014;19:493–510.
    1. Barlow M, Nock M, Hersen M. Single Case Experimental Designs: Strategies for Studying Behavior for Change. Boston, MA: Pearson/Allyn & Bacon; 2009.
    1. Werner-Seidler A, Perry Y, Calear AL, Newby JM, Christensen H. School-based depression and anxiety prevention programs for young people: a systematic review and meta-analysis. Clin Psychol Rev. 2017;51:30–47.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed Text Revision. Arlington, VA: American Psychiatric Association; 2000.
    1. Wisner B. An exploratory study of mindfulness meditation for alternative school students: perceived benefits for improving school climate and student functioning. Mindfulness. 2014;5:626–638.
    1. Thabane L, Mbuagbaw L, Zhang S, et al. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol. 2013;13:92.
    1. Britton WB, Lepp NE, Niles HF, Rocha T, Fisher NE, Gold JS. A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. J Sch Psychol. 2014;52:263–278.
    1. Sibinga E, Perry-Parrish C, Thorpe K, Mika M, Ellen JM. A small mixed-method RCT of mindfulness instruction for urban youth. Explore. 2014;10:180–186.

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