Can mindfulness therapies help adolescents with mental illness?

Dora Gellen

I first encountered the concept of mindfulness when I was 16 years old. My college offered the opportunity to attend an 8-week mindfulness course and I quickly became intrigued by the impact that mindfulness had on my well-being.
What is mindfulness?

You may have heard about mindfulness before or even tried it out yourself. With its roots in ancient Buddhist philosophy, mindfulness has become more and more popular in both everyday and research contexts in our Western world.

So, what exactly constitutes mindfulness? In psychological research, it is particularly important to think about how we define and measure mindfulness because different definitions and measures can make it challenging to interpret and generalise findings.

Jon Kabat-Zinn defines mindfulness as:

“paying attention in a particular way: on purpose, in the present moment, and non-judgmentally”

Kabat-Zinn played a particularly important role in popularising mindfulness as a treatment in Western societies, highlighting two key components of mindfulness: 1) paying attention and 2) being present.

Common mindfulness activities include breathwork, mindful eating, meditation exercises, and body scans. If I had to pick a favourite, I would probably choose breathwork. Mindfulness exercises — like breathwork — may be particularly beneficial for those struggling with stress and anxiety, as they can help to calm the sympathetic nervous system, which is the body’s physiological system involved in stress.

Why mindfulness in adolescence?

Adolescence is a rapid and critical developmental stage in an individual’s life (Blakemore & Mills, 2014; Blakemore, 2019). One of the biggest reasons why researchers are trying to understand mental health in adolescence is because adolescence is a significant risk period for the onset of psychopathological disorders, nearly half of which begin to develop before the individual reaches the age of 14 years (Kessler et al., 2005). In addition to this, well-being is also argued to be particularly volatile during this stage (Steinberg, 2011; Harter, 2015).

As we know, mental health disorders in youth are associated with detrimental long-term life outcomes, including physical ill-health, suicidal tendencies, decreased likelihood of academic success, and higher unemployment rates to mention a few (Fergusson, Boden & Horwood, 2007). Having a history of depression and anxiety myself as an adolescent, I understand these struggles first-hand. What makes things even worse is the stigma associated with mental illness, which seems to be more prominent in minority groups.

It goes without saying that the need for effective adolescent mental health treatments as well as preventative strategies in youth is pressing. Mindfulness-based interventions (MBIs) may as well be one of the solutions.

Mindfulness-based interventions (MBIs) in adolescence

Mindfulness-based intervention — MBI — is an umbrella term pertaining to a variety of programmes that incorporate a mindfulness element. As mentioned earlier, the emergence of MBIs in the Western world is often traced back to Jon Kabat-Zinn, who founded Mindfulness-based Stress Reduction (MBSR) to reduce chronic pain problems.

Though MBIs were initially created for adults, they have since been adapted to adolescents and children. Hence, they are suggested to be developmentally appropriate for these age groups. It should be acknowledged, however, that research on MBIs in adolescents is not as extensive as research on MBIs in adults. Consequently, the findings in this field should be interpreted with caution.

MBIs may be used as treatments for a diverse range of disorders, including depression, anxiety, eating disorders, attention-deficit hyperactivity disorder (ADHD) as well as addiction. Common mindfulness interventions in teens include the aforementioned MBSR, Mindfulness-based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT). These treatments share similarities as well as differences in their format, length and the type of exercises employed. MBSR and MBCT tend to be group-based interventions (lasting for around 8 weeks), meanwhile, ACT and DBT can also be administered individually, and their durations vary vastly.

Mindfulness treatments may be delivered face-to-face or digitally, with the latter being referred to as digital MBIs (d-MBIs). Given technology’s omnipresence, d-MBIs could offer significant advantages for youth, including ease of treatment accessibility and flexibility in therapy completion times. Online MBIs may also be more suitable for teens than face-to-face sessions since many teenagers nowadays prefer communication via technology. As everyone is unique and preferences are likely to differ, it is great to have such diversity in MBI options.

MBIs and adolescent mental illness

When I was in therapy myself, we practised different types of mindfulness exercises. Most of these exercises focused on cultivating awareness and staying in the present moment. We focused on breathing, meditating and noticing our thoughts and emotions.

Considering the research on MBIs in adolescent mental illness, it is not surprising to see that a significant amount of studies have been conducted on depression. Depression is common in adolescence (Thapar et al., 2012) and MBIs may offer a helpful way of treating depressive symptoms in teens. For example, MBCT may be particularly beneficial for adolescents suffering from depression with residual symptoms (Ames et al., 2014), though such research is still in its infancy. Similar results have also been reported for anxiety; nevertheless, the data show somewhat higher levels of effectiveness for depression when compared to anxiety (Dunning et al., 2019).

Strengths of MBIs

One of the most significant advantages of mindfulness interventions for adolescent mental health problems is their feasibility since MBIs appear to be cost-effective treatments. Additionally, MBIs are non-invasive unlike treatments relying on drugs (e.g. antidepressants). Adolescents also seem to have a good level of acceptance of these treatments overall (Ames et al., 2014; Kostova et al., 2019), which suggests that MBIs are suitable for this group. It is a significant strength that MBIs can be formatted and delivered in ways that are appropriate for different age groups, cultural backgrounds, and mental health disorders, as this makes them more accessible to teens from diverse backgrounds.

Compared to traditional psychological therapies, such as Cognitive Behavioural Therapy (CBT), mindfulness programmes could also propose a more effective solution for preventing depression relapse rates in adolescents (Ames et al., 2014). We need to remember though that most evidence at this stage is preliminary and further findings are necessary to test this claim, but the results so far are promising. One of the processes by which MBIs could contribute to a decrease in relapse is by enabling individuals to become more aware of their rumination and thought patterns (Teasdale et al., 2000). However, the regularity of home practice is an important factor in this regard (Ricarte et al., 2015).

Challenges of MBIs

Although the benefits and feasibility of MBIs in adolescence are supported by certain scientific findings (e.g. Kostova et al.’s 2019 systematic review), they are also doubted by some others. For example, a meta-analysis by Odgers et al. (2020) demonstrates a non-significant effect of MBIs on teenage anxiety in Western countries. Moreover, researchers have suggested that MBIs can be effective for mental health disorders, such as depression, but only in the case of older and not younger adolescents (Gómez-Odriozola & Calvete, 2021). There is still a lot of work to be done before we can draw precise conclusions about the effectiveness of mindfulness as a treatment for adolescent mental illness.

One might claim that it is difficult for mindfulness interventions to grow alongside young individuals because these programmes require a great deal of effort, time and dedication to be effective. Nonetheless, the reality is that we could argue this for any psychotherapy. It could still be further maintained, however, that mindfulness techniques are more difficult to acquire for adolescents, which could potentially impact their effectiveness. This point somewhat resonates with me because when I first began to learn mindfulness as an adolescent, it was difficult to understand what mindfulness meant and what it was exactly that I needed to feel during mindfulness. Practice certainly helps to overcome these barriers to a certain extent, but it can be time-consuming. Particularly for an adolescent, who is studying for GCSEs and A-levels, the pressure is already big enough as it is, and practising mindfulness regularly is likely to be the last thing on the teenager’s mind.

It is also critical to note that the severity of mental illness could influence treatment outcomes. MBIs have been mostly investigated in young individuals with mild to moderate levels of mental health disorders, but little is known about what MBIs can offer for more severe adolescent mental health issues. Considering therapist competence is equally important since levels of experience and training are likely to influence how well adolescents learn mindfulness and thereby impact the outcome of clinical MBIs.

Finally, we cannot go without considering methodological shortcomings in research, such as small sample sizes (Semple & Burke, 2019), which make it challenging to predict the usefulness of MBIs for adolescent mental illness. Other methodological limitations, such as publication bias, also raise concerns about the reliability and validity of these mindfulness investigations (Reangsing, Punsuwun & Schneider, 2021).

Where next?

Research on mindfulness treatments for adolescent mental illness is still in its infancy. To gain a comprehensive understanding of mindfulness’ usefulness in the clinical context, further steps and testing are necessary. Overcoming methodological challenges in the field, such as small sample sizes and a lack of longitudinal data, is critical for ensuring that the findings and conclusions drawn about mindfulness treatments are valid and meaningful (Semple & Burke, 2019).

We also need more nuanced information about the ways in which culture may be implicated in mindfulness-based treatments. Some cross-cultural data on MBIs and anxiety in adolescents indicate more significant positive outcomes in non-Western cultures compared to Western cultures (Odgers et al., 2020). Whether these differences may be attributed to cultural norms and values, conceptualisations of mindfulness, or other scientific factors (such as those listed above), is unclear and calls for additional investigations.

Moreover, the gathering of information regarding adolescents’ opinions about mindfulness treatments must continue. This could be done via various techniques, such as qualitative research using focus groups and in-depth interviews. It is vital for researchers and clinicians to understand adolescent perspectives as these help to improve and shape treatment designs and their outcomes.

Overall, MBIs appear to be promising treatments for adolescent mental illness but the currently available evidence is inconsistent regarding their precise effectiveness. Many questions remain: which MBI is the most suitable for which mental illness and which adolescent group? Present issues in the research field need to be addressed and further research is required to understand the role of mindfulness in adolescent mental health treatments more holistically.

References

Ainsworth, B., Atkinson, M. J., AlBedah, E., Duncan, S., Groot, J., Jacobsen, P., … & Underhill, R. (2023). Current Tensions and Challenges in Mindfulness Research and Practice. Journal of Contemporary Psychotherapy, 1–6.

Blakemore, S.J. and Mills, K.L. (2014). Is adolescence a sensitive period for sociocultural processing?. Annual review of psychology, 65, pp.187–207.

Blakemore, S.J. (2019). Adolescence and mental health. The lancet, 393(10185), pp.2030–2031.

Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2007). Recurrence of major depression in adolescence and early adulthood, and later mental health, educational and economic outcomes. The British Journal of Psychiatry, 191(4), 335–342.

Gómez-Odriozola, J., & Calvete, E. (2021). Effects of a mindfulness-based intervention on adolescents’ depression and self-concept: the moderating role of age. Journal of Child and Family Studies, 30, 1501–1515.

Harter, S. (2015). The construction of the self: Developmental and sociocultural foundations. Guilford Publications

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593–602.

Kostova, Z., Levin, L., Lorberg, B., & Ziedonis, D. (2019). Mindfulness-based interventions for adolescents with mental health conditions: A systematic review of the research literature. Journal of Child and Family Studies, 28(10), 2633–2649.

Mrazek, A. J., Mrazek, M. D., Reese, J. V., Kirk, A. C., Gougis, L. J., Delegard, A. M., … & Schooler, J. W. (2019). Mindfulness-based attention training: Feasibility and preliminary outcomes of a digital course for high school students. Education Sciences, 9(3), 230.

National Health Service (NHS) Digital (2021). Mental Health of Children and Young People in England 2021. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2021-follow-up-to-the-2017-survey

Odgers, K., Dargue, N., Creswell, C., Jones, M.P., & Hudson, J.L. (2020). The limited effect of mindfulness-based interventions on anxiety in children and adolescents: A meta-analysis. Clinical Child and Family Psychology Review, 23, pp.407–426.

Reangsing, C., Punsuwun, S., & Schneider, J. K. (2021). Effects of mindfulness interventions on depressive symptoms in adolescents: A meta-analysis. International journal of nursing studies, 115, 103848.

Ricarte, J. J., Ros, L., Latorre, J. M., & Beltrán, M. T. (2015). Mindfulness-based intervention in a rural primary school: Effects on attention, concentration and mood. International Journal of Cognitive Therapy, 8(3), 258–270.

Semple, R. J., & Burke, C. (2019). State of the research: Physical and mental health benefits of mindfulness-based interventions for children and adolescents. OBM Integrative and Complementary Medicine, 4(1), 1–58.

Steinberg, L. (2011). Adolescence (9th Edition). New York: McGraw Hill.

Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of consulting and clinical psychology, 68(4), 615.

Thapar, A., Collishaw, S., Pine, D.S., & Thapar, A.K. (2012). Depression in adolescence. The lancet, 379(9820), pp.1056–1067.

Dora is a first-year PhD Researcher in Health Sciences. Her current research focuses on the impact of social media on the mental well-being of adolescents and their caregivers using a mixed-methods design. Having completed her BA in Psychological and Behavioural Sciences at the University of Cambridge, Dora’s passion is understanding mental health and mental well-being during adolescence and her research aims to make a contribution to interventions and policies in this field