A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children

Abstract

Mindfulness-based cognitive therapy for children (MBCT-C) is a manualized group psychotherapy for children ages 9–13 years old, which was developed specifically to increase social-emotional resiliency through the enhancement of mindful attention. Program development is described along with results of the initial randomized controlled trial. We tested the hypotheses that children randomized to participate in MBCT-C would show greater reductions in (a) attention problems, (b) anxiety symptoms, and (c) behavior problems than wait-listed age and gender-matched controls. Participants were boys and girls aged 9–13 (N = 25), mostly from low-income, inner-city households. Twenty-one of 25 children were ethnic minorities. A randomized cross-lagged design provided a wait-listed control group, a second trial of MBCT-C, and a 3-month follow-up of children who completed the first trial. Measures included the Child Behavior Checklist, State-Trait Anxiety Inventory for Children, and Multidimensional Anxiety Scale for Children. Participants who completed the program showed fewer attention problems than wait-listed controls and those improvements were maintained at three months following the intervention [F (1, 1, 18) = 5.965, p = .025, Cohen’s d = .42]. A strong relationship was found between attention problems and behavior problems (r = .678, p p = .053). Significant reductions in anxiety symptoms and behavior problems were found for those children who reported clinically elevated levels of anxiety at pretest (n = 6). Results show that MBCT-C is a promising intervention for attention and behavior problems, and may reduce childhood anxiety symptoms.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. Achenbach, T. M. (1991). Manual for the child behavior checklist: Ages 4–18, and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.

    Google Scholar 

  2. Anderson, N. D., Lau, M. A., Segal, Z. V., & Bishop, S. R. (2007). Mindfulness-based stress reduction and attentional control. Clinical Psychology & Psychotherapy, 14, 449–463.

    Article  Google Scholar 

  3. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science & Practice, 10, 125–143.

    Article  Google Scholar 

  4. Baldwin, S. A., Murray, D. M., & Shadish, W. R. (2005). Empirically supported treatments or type I errors? Problems with the analysis of data from group-administered treatments. Journal of Consulting & Clinical Psychology, 73, 924–935.

    Article  Google Scholar 

  5. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality & Social Psychology, 51, 1173–1182.

    Article  Google Scholar 

  6. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science & Practice, 11, 230–241.

    Article  Google Scholar 

  7. Boals, G. F. (1978). Toward a cognitive reconceptualization of meditation. Journal of Transpersonal Psychology, 10, 143–182.

    Google Scholar 

  8. Borkovec, T. D. (2002). Life in the future versus life in the present. Clinical Psychology: Science & Practice, 9, 76–80.

    Article  Google Scholar 

  9. Boutron, I., Moher, D., Altman, D. G., Schulz, K. F., Ravaud, P. for the CONSORT Group. (2008). Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: Explanation and elaboration. Annals of Internal Medicine, 148, 295–309.

    Google Scholar 

  10. Bush, G., Luu, P., & Posner, M. I. (2000). Cognitive and emotional influences in anterior cingulate cortex. Trends in Cognitive Sciences, 4, 215–222.

    Article  PubMed  Google Scholar 

  11. Davidson, R. J., Kabat-Zinn, J., & Schumacher, M. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–570.

    Article  PubMed  Google Scholar 

  12. Duncan, G. J., Dowsett, C. J., Claessens, A., Magnuson, K., Huston, A. C., Klebanov, P., et al. (2007). School readiness and later achievement. Developmental Psychology, 43, 1428–1446.

    Article  PubMed  Google Scholar 

  13. Ehrenreich, J. T., & Gross, A. M. (2002). Biased attentional behavior in childhood anxiety a review of theory and current empirical investigation. Clinical Psychology Review, 22, 991–1008.

    Article  PubMed  Google Scholar 

  14. Fan, J., McCandliss, B. D., Sommer, T., Raz, A., & Posner, M. I. (2002). Testing the efficiency and independence of attentional networks. Journal of Cognitive Neuroscience, 14, 340–347.

    Article  PubMed  Google Scholar 

  15. Fleischhaker, C., Bock, K., Hennighausen, K., Horwath, D., Kuhn-Hennighausen, C., Rauh, R., et al. (2008). Twenty-year follow-up investigation of the clinic for child and adolescent psychiatry “Haus Vogt”. Zeitschrift fur Kinder-und Jugendpsychiatrie und Psychotherapie, 36, 191–203.

    Article  PubMed  Google Scholar 

  16. Fontana, D., & Slack, I. (1997). Teaching meditation to children. Shaftesbury, UK: Element Books.

    Google Scholar 

  17. Gaines, R. (1997). Key issues in the interpersonal treatment of children. The Review of Interpersonal Psychoanalysis, 2, 1–5.

    Google Scholar 

  18. Goldin, P. R., Saltzman, A., & Gross, J. J. (2006). Mindfulness meditation based stress reduction for children and their parents. Paper presented at the Association for Behavioral and Cognitive Therapies 40th Annual Convention, Chicago, Il. (Nov 19, 2006).

  19. Goodman, T. A. (2005). Working with children: Beginners mind. In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 197–219). New York: Guilford.

    Google Scholar 

  20. Gordon, D. A. (1977). Children’s beliefs in internal–external control and self-esteem as related to academic achievement. Journal of Personality Assessment, 41, 383–386.

    Article  PubMed  Google Scholar 

  21. Greco, L. A. (2006). ACT for teens with physical and emotional pain: Preliminary findings and directions for future research. Paper presented at the Association for Behavioral and Cognitive Therapies 40th Annual Convention, Chicago, IL. (Nov 19, 2006).

  22. Greco, L. A., & Hayes, S. C. (Eds.). (2008). Acceptance and mindfulness treatments for children and adolescents: A practitioner’s guide. Oakland, CA: New Context/New Harbinger Publications.

    Google Scholar 

  23. Hannesdottir, D. K., & Ollendick, T. H. (2007). The role of emotion regulation in the treatment of child anxiety disorders. Journal of Clinical Child & Family Psychology, 10, 275–293.

    Article  Google Scholar 

  24. Hayes, A. M., & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science & Practice, 11, 255–262.

    Article  Google Scholar 

  25. Hoza, B., Gerdes, A. C., Mrug, S., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., et al. (2005). Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 34, 74–86.

    Article  Google Scholar 

  26. Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective & Behavioral Neuroscience, 7, 109–119.

    Article  Google Scholar 

  27. Joiner, T. E., Jr., Steer, R. A., Beck, A. T., Schmidt, N. B., Rudd, M. D., & Catanzaro, S. J. (1999). Physiological hyperarousal: Construct validity of a central aspect of the tripartite model of depression and anxiety. Journal of Abnormal Psychology, 108, 290–298.

    Article  PubMed  Google Scholar 

  28. Kabat-Zinn, J. (1990). Full catastrophe living. New York: Bantam Doubleday Dell.

    Google Scholar 

  29. Kabat-Zinn, J. (1994). Mindfulness meditation for everyday life. New York: Hyperion.

    Google Scholar 

  30. Kaslow, N. J., & Racusin, G. R. (1994). Family therapy for depression in young people. In W. M. Reynolds & H. F. Johnston (Eds.), Handbook of depression in children and adolescents: Issues in clinical child psychology (pp. 345–363). New York, NY: Plenum Press.

    Google Scholar 

  31. Kumar, S. M. (2002). An introduction to Buddhism for the cognitive-behavioral therapist. Cognitive & Behavioral Practice, 9, 40–43.

    Article  Google Scholar 

  32. Lee, J., Semple, R. J., Rosa, D., & Miller, L. (2008). Mindfulness-based cognitive therapy for children: Results of a pilot study. Journal of Cognitive Psychotherapy, 22, 15–28.

    Article  Google Scholar 

  33. Linden, W. (1973). Practicing of meditation by school children and their levels of field dependence–independence, test anxiety, and reading achievement. Journal of Consulting & Clinical Psychology, 41, 139–143.

    Article  Google Scholar 

  34. March, J. S. (1997). Multidimensional anxiety scale for children: Technical manual. Toronto, Ontario: Multi-Health Systems, Inc.

    Google Scholar 

  35. March, J. S., & Parker, J. D. A. (1999). The multidimensional anxiety scale for children (MASC). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 299–322). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

    Google Scholar 

  36. Mineka, S., & Gilboa, E. (1998). Cognitive biases in anxiety and depression. In J. William, F. Flack, & J. D. Laird (Eds.), Emotions in psychopathology: Theory and research (pp. 216–228). New York: Oxford University Press.

    Google Scholar 

  37. Moustafa, B. M. (1999). Multisensory approaches and learning styles theory in the elementary school (Descriptive Report).

  38. Piaget, J. (1962). The stages of the intellectual development of the child. Bulletin of the Menninger Clinic, 26, 120–128.

    PubMed  Google Scholar 

  39. Platzek, D. B. (1970). Anxiety in children. Unpublished study, Florida State University, Tallahassee, FL.

  40. Posner, M. I., & Petersen, S. E. (1990). The attention system of the human brain. Annual Review of Neuroscience, 13, 25–42.

    Article  PubMed  Google Scholar 

  41. Rani, N. J., & Rao, P. V. K. (1996). Meditation and attention regulation. Journal of Indian Psychology, 14, 26–30.

    Google Scholar 

  42. Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. Northvale, NJ: Jason Aronson.

    Google Scholar 

  43. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.

    Google Scholar 

  44. Semple, R. J. (1999). Enhancing the quality of attention: A comparative assessment of concentrative meditation and progressive relaxation. Unpublished master’s thesis, University of Auckland, New Zealand.

  45. Semple, R. J. (2005). Mindfulness-based cognitive therapy for children: A randomized group psychotherapy trial developed to enhance attention and reduce anxiety. Unpublished doctoral dissertation, Columbia University, New York.

  46. Semple, R. J., & Lee, J. (2008). Treating anxiety with mindfulness: Mindfulness-based cognitive therapy for children. In L. A. Greco & S. C. Hayes (Eds.), Acceptance and mindfulness interventions for children, adolescents, and families (pp. 94–134). Oakland, CA: Context Press/New Harbinger Publications.

    Google Scholar 

  47. Semple, R. J., Lee, J., & Miller, L. F. (2006). Mindfulness-based cognitive therapy for children. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications (pp. 143–166). Burlington, MA: Elsevier/Academic Press.

    Google Scholar 

  48. Siegler, R. S. (1991). Children’s thinking (2nd ed.). Upper Saddle River, NJ: Prentice-Hall.

    Google Scholar 

  49. Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 37, 105–130.

    Article  Google Scholar 

  50. Spielberger, C. D., Edwards, C. D., Lushene, R. E., Montuori, J., & Platzek, D. (1973). State-trait anxiety inventory for children: Professional manual. Redwood City, CA: Mind Garden, Inc.

    Google Scholar 

  51. Stark, K. D., Rouse, L. W., & Kurowski, C. (1994). Psychological treatment approaches for depression in children. In W. M. Reynolds & H. F. Johnston (Eds.), Handbook of depression in children and adolescents: Issues in clinical child psychology (pp. 275–307). New York, NY: Plenum Press.

    Google Scholar 

  52. Taghavi, M. R., Neshat-Doost, H. T., Moradi, A. R., Yule, W., & Dalgleish, T. (1999). Biases in visual attention in children and adolescents with clinical anxiety and mixed anxiety-depression. Journal of Abnormal Child Psychology, 27, 215–223.

    Article  PubMed  Google Scholar 

  53. Teasdale, J. D. (1999). Metacognition, mindfulness and the modification of mood disorders. Clinical Psychology & Psychotherapy, 6, 146–155.

    Article  Google Scholar 

  54. Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research & Therapy, 33, 25–39.

    Article  Google Scholar 

  55. Thornton, C. A. (1983). A multisensory approach to thinking strategies for remedial instruction in basic addition facts. Journal for Research in Mathematics Education, 14, 198–203.

    Article  Google Scholar 

  56. Valentine, E. R., & Sweet, P. L. G. (1999). Meditation and attention: A comparison of the effects of concentrative and mindfulness meditation on sustained attention. Mental Health, Religion & Culture, 2, 59–70.

    Article  Google Scholar 

  57. Walker, C. E., & Kaufman, K. (1984). State-trait anxiety for children. In D. J. Keyser & K. Kaufman (Eds.), Test critiques (1st ed., pp. 663–669). Kansas City, MO: Test Corporation of America.

    Google Scholar 

  58. Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61, 671–689.

    Article  PubMed  Google Scholar 

  59. Williams, J. M. G., Russell, I., & Russell, D. (2008). Mindfulness-based cognitive therapy: Further issues in current evidence and future research. Journal of Consulting & Clinical Psychology, 76, 524–529.

    Article  Google Scholar 

  60. Wislock, R. F. (1993). What are perceptual modalities and how do they contribute to learning? New Directions for Adult & Continuing Education, 59, 5–13.

    Article  Google Scholar 

  61. Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. Journal of Attention Disorders, 11, 737–746.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding for this study was provided by a Columbia University, Teachers College Dean’s grant and a grant from the Center for Integrative Studies, Inc. We express our appreciation to Richard H. Lathrop, PhD and an anonymous reviewer for their valuable comments on an earlier version of this article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Randye J. Semple.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Semple, R.J., Lee, J., Rosa, D. et al. A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children. J Child Fam Stud 19, 218–229 (2010). https://doi.org/10.1007/s10826-009-9301-y

Download citation

Keywords

  • Mindfulness
  • MBCT
  • Children
  • Emotion regulation
  • Attention
  • Anxiety