The Mischief in Mindfulness

School mindfulness programs have promised to reduce stress, focus attention, promote social and emotional learning, and cultivate character traits such as kindness.

It is a worthy idea but a large comprehensive study on the area has been lacking until recently with the completion of The MYRIAD Trial and its conclusions on mindfulness programs are not entirely positive.

The modern mindfulness movement really took root in the late 1980s and early 1990s, via the publication of Jon Kabat-Zinn's Full Catastrophe Living and the inclusion of school-based mindfulness programs grew organically as part of the movement. 

In the United States, estimates suggest that by 2014, there were 37 programs being implemented in schools (Weare K. Mindfulness in Schools: Where Are We and Where Might We Go Next? In The Wiley Blackwell Handbook of Mindfulness, 2014, Edited by Amanda Ie, Christelle T. Ngnoumen, Ellen J. Langer, and Ellen J. Langer). One of the largest programs, MindUP, had by 2018, introduced mindfulness to 6 million children in 12 countries on five continents (Gunther Brown, C. Debating Yoga and Mindfulness in Public Schools, 2019). Another program, called Mindful Schools, was by 2018 serving 1.5 million students with 25,000 teachers from 50 states and 100 countries trained (ibid).

More than half of all Australian teachers currently use some form of mindfulness in the classroom. In Australian education, school-based mindfulness programs are largely implemented on a universal basis - delivered to whole classes, year-levels, or schools in a compulsory and standardised way.

The most popular mindfulness program in Australia offers training for school teachers themselves which is self-paced for a maximum six hours (unless teachers opt to be “mindful champions” and do a three-day training program). In contrast, the mindfulness program in The MYRIAD Trial (program used was ‘dot be’) is taught by teachers who undertake an eight-week mindfulness program themselves (minimum of 16 hours training plus regular home mindfulness practice) before completing a four-day training workshop.

At least one major review suggests that mindfulness programs delivered by outside facilitators may be more effective in educational settings in the short-term than those delivered by trained teachers or educations.

The effectiveness of mindfulness programs was investigated extensively in The MYRIAD Trial - the largest ever mindfulness study. It did not find evidence that adding a school-based mindfulness intervention to the curriculum would help the mental health of school students aged 11-14 years old. On the contrary, some students report having worse mental health outcomes. The results of this study contradicts the findings of other smaller studies positing the benefits of mindfulness training in schools. 

While MYRIAD is only one study, its findings are significantly more reliable than the average study. Take into consideration its scale and rigour - over 8,300 student participants in MYRIAD as compared to only 6,121 participants in total for 76 existing studies examined in a 2017 review.

“The benefits of mindfulness training are often reaped from having structured, multi-week training programs, totalling dozens of hours of training and learning. In comparison, mindfulness curriculum in schools tend to involve less intensive practice experience,” says Associate Professor Nicholas Van Dam University of Melbourne who researches mindfulness with colleagues Dr Chris McCaw, and Dr Julieta Galante.

He says, “When we look at the evidence, a recent comprehensive review established that mindfulness-based programs can be helpful for a wide variety of people in different settings. That said, no evidence currently states that mindfulness-based programs are more beneficial than other treatment approaches, such as relaxation training or cognitive behavioural psychotherapy.

“And when we look at digital adaptations of mindfulness programs, such as meditation apps, there is even less evidence around its effectiveness, though they seem to have some benefit on average. A bigger challenge of meditation apps is its ability to keep people engaged - one estimate suggests that lesser than 10% of users would continue engaging with the apps just one week after downloading it."

For The MYRIAD Trial, it was a requirement for the students to participate in the mindfulness training, much like any other activity in the curriculum. The compulsory nature of the participation might in some ways explain the lower rates of engagement of students during mindfulness practice.

“In The MYRIAD Trial, some students got worse after undertaking mindfulness intervention. However, it is important to note that the students feeling worse tended to have existing, underlying mental health difficulties. And if you consider how mindfulness works, you can see why. Mindfulness practice involves people paying attention to bodily sensations, breath or thoughts. For those with existing mental health issues, or a history of trauma, sustained attention like this would bring unwelcome thoughts, feelings and sensations more clearly into awareness,” he says.

In short, mindfulness is unlikely to cause trauma, but it could result in the reliving of traumatic memories for some meditators. And these traumatic memories may be even harder to manage for adolescents, whose emotional regulation skills are still in development.

Recent research has found that negative or adverse events during meditation are surprisingly common, even when people are undertaking mindfulness practice at relatively low intensity. Some of these experiences include anxiety, agitation, insomnia or impairments in social functioning. However, we are seeing a growing understanding of how to teach and practise mindfulness in ways that reduce the likelihood of negative events when they do occur. For schools, many of the approaches and findings about adverse events are rarely taught in the training provided for teachers. Without such support, teachers would not be able to identify and manage adverse events when they occur for students.

While there are certifications by BeYou, and various tiers of funding support, much remains to be seen on the effectiveness of Australian programs. Rigorous evaluations are required to help answer many of the unknowns.

“The results from The MYRIAD Trial have cast the effectiveness of mindfulness programs in Australia in doubt. Besides, it highlighted that universal and mandatory mindfulness training does not work. And having low engagement rates and acceptability to the programs would determine the benefits of the programs.

“For engagement and acceptability to improve in schools, there needs to be greater consultation and co-design with students and teachers in the programs. Participation in these programs should be on an opt-in basis for students. For teachers, we need to put in place impactful, rigorous training, as well as ongoing support and supervision. Once the programs are established, their effectiveness and safety should be assessed by independent research teams using rigorous, randomised controlled trials,” says Assoc Prof Van Dam.

Melbourne University’s newly-opened Contemplative Studies Centre (CSC) aims to cut through confusion about mental health to help members of the public who are interested in health and wellbeing.

“Contemplative Studies Centre aims to clarify confusion around mindfulness, meditation, and other contemplative practices in a number of ways. Our mission is achieved through our engagement, education, and practice programs and our foundation of research.

“We regularly host events aimed at a wide variety of topics and a wide range of audiences to help clarify what meditation is and is not and what it can and cannot do. We are developing resources to help the public understand how to start and progress a meditation practice, as well as how to deal with difficulties that may arise along the way. We offer regular, free to access, guided meditation sessions from a number of traditions and teachers. We are developing educational offerings for university students and the wider public. We consult with organisations and companies to help them clarify how mindfulness and meditation might best work within a given context. We are undertaking research to examine a number of questions around mindfulness and meditation,” he says.