Open a magazine or turn on the radio and you are likely to hear someone extolling the benefits of mindfulness for any number of purposes, conditions, or age groups. Businesses, schools, and health care organizations are incorporating mindfulness techniques to boost employee, student, and patient well-being and engagement, as well as to help employers, teachers, and providers to thrive. In this two-part series, part 1 will attempt to distill some of the fundamentals with regard to the following questions: 1. What is mindfulness? 2. What is the evidence for mindfulness, particularly in youth? and 3. How would you apply mindfulness techniques in your office setting?
Mindfulness was largely brought into the mainstream health care world by Jon Kabat-Zinn, PhD, of the University of Massachusetts Medical Center, Worcester. Drawing on Buddhist traditions, he created a secularized version of meditative and movement techniques used for thousands of years to promote healthy living. A growing evidence base showed that these practices, combined in a formal curriculum dubbed mindfulness-based stress reduction (MBSR), could alleviate symptoms and distress in conditions as diverse as chronic pain, psoriasis, and anxiety. This has spawned numerous research programs and spin-offs, and remains a foundational approach to utilizing mindfulness in medical care. Dr. Kabat-Zinn’s definition of the term is thus worth noting – mindfulness is “the awareness that arises by paying attention on purpose, in the present moment, and nonjudgmentally.”1 Put simply, mindfulness means having your mind and your body in the same place at the same time. If your mind is wandering to what happened yesterday or planning for what might happen later today, then your mind and body are not in the same time. If your mind is thinking about what is going on at home while you are at work, or what your friends are doing, your mind and body are not in the same place.
The evidence that moving through life in a state of mindfulness, or awareness, is beneficial has developed at multiple levels in the adult literature. Mindfulness is consistently associated with greater self-esteem, competence, life satisfaction, and positive emotions. In addition, greater mindful awareness correlates with reductions in anxiety, depression, doctors’ visits, physical complaints, hostility, and self-consciousness.2 These findings hold across many populations, including medical students and community samples, as well as those with physical and stress-related disorders.3-5 Neuroscience findings supporting the benefits of mindfulness also are multiplying. For experienced meditators, mindfulness appears to prevent cortical thinning in important areas of the brain related to executive functions (prefrontal cortex) and mind-body connection (insula).6 Even for novices, Dr. Kabat-Zinn’s 8-week MBSR program shows declines in life stress that move alongside decreases in amygdala gray matter, essentially shrinking the brain’s fight-or-flight worry center.7 This training also increases neuronal growth in the hippocampus, an area implicated in learning, memory, and emotion regulation.8,9 The hippocampus typically is diminished by depression and PTSD, but, as with MBSR, neurogenesis occurs here with exercise or SSRI antidepressant medications.
The evidence base for mindfulness in children and adolescents is more nascent, but is also broadening. A study of a modified version of Dr. Kabat-Zinn’s MBSR in middle schoolers in an inner city environment compared 12 weeks of mindfulness training versus a typical health curriculum discussing adolescence, stress, and puberty. In this inner city environment, students randomized to mindfulness training reported less depression, less hostility, fewer ruminations, and fewer PTSD symptoms as well as fewer physical complaints.10 Regarding clinical populations, mindfulness training in adolescents has shown promise for ADHD, with improvement in both core symptoms and functionality.11 This especially seems pronounced when caregivers are supported in learning mindful parenting techniques alongside their teens’ mindfulness training.12
In a general psychiatry clinic, an 8-week adolescent MBSR program was added to supplement treatment as usual – psychotherapy and medication management. Those randomized to mindfulness showed improvements in sleep and self-esteem, as well as a decline in depressive and anxiety symptoms, perceived stress, and interpersonal problems.13 Perhaps most impressively, half of the MBSR group dropped at least one diagnosis after the 8-week program, whereas none of those in the wait list group, receiving psychiatric specialty care as usual, decreased their diagnosis count.
While the sum of such research in adults and children builds a strong case for the value of mindfulness at both the universal (well-child check) and problem-focused levels, there are limitations to our knowledge base. The number of studies and total number of children and adolescents enrolled in mindfulness research is far fewer than in studies with adults. A variety of mindfulness practices have been incorporated into study interventions such that results are not always comparable and distinguishing the mechanism of action is difficult. Additionally, double-blind and placebo-controlled studies are harder to accomplish with such active interventions, although headway is being made.14
Despite what remains to be discovered, bringing mindfulness into the lives of children and adolescents seems increasingly sensible, given the growing body of scientific support for the benefits of mindfulness practices at the behavioral and functional neuroanatomic levels. As is the case with recommending healthy diets, exercise, and other universal health-promoting behaviors, the knowledge that mindfulness practices are beneficial may not be enough to get patients and their families engaged in these methods. The second article in this series will address some nuts and bolts of prescribing mindfulness in a pediatric health care setting.
Dr. Rosenfeld is an assistant professor in the departments of psychiatry and pediatrics at the University of Vermont Medical Center, Robert Larner College of Medicine, Burlington. He said he has no relevant disclosures.
References
1. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness (New York: Bantam Books, Penguin Random House, 2013).
2. J Pers Soc Psychol. 2003 Apr;84(4):822-48.
3. Gen Hosp Psychiatry. 1982 Apr;4(1):33-47.
4. Am J Psychiatry. 1992 Jul;149(7):936-43.
5. Clin Psychol Rev. 2011 Aug;31(6):1041-56.
6. Neuroreport. 2005 Nov 28;16(17):1893-7.
7. Soc Cogn Affect Neurosci. 2010 Mar;5(1):11-7.
8. Neuroimage. 2009 Apr 15;45(3):672-8.
9. Psychiatry Res. 2011 Jan 30;191(1):36-43.
10. Pediatrics. 2016 Jan;137(1):e20152532.
11. J Atten Disord. 2008 May;11(6):737-46.
12. J Child Fam Stud. 2012 Oct;21(5):775-87.
