An Online Mindfulness Program for Teachers: A Feasibility Study of the DeStress Monday at School Program.

Objectives: Stress has deleterious effects on teachers' well-being and interactions with students. While in-person mindfulness programs have demonstrated benefits for teachers' mental health, in-person classes are often not feasible due to teachers' busy schedules. This study assessed four components of feasibility (implementation, demand, acceptability, and limited-efficacy testing) for an online mindfulness intervention for teachers. Method: A volunteer sample of 50 primary school teachers was recruited across three urban public schools and was offered a 9-week online mindfulness program (DeStress Monday at School). The program provided weekly mindfulness practices for (1) self-care and (2) classroom use to promote teacher and student stress management. Surveys and focus group discussions assessed program feasibility. Paired t-tests were used to evaluate pre-post changes in teacher well-being. Results: Most participants had no technical problems, providing general support for implementation. Support for program demand was mixed; while 85% of participants used practices at least once, some never used practices, and over half used practices only 1-3 times. Those who used practices generally rated their acceptability favorably. Qualitative analyses showed significant pre-post improvements in work-related and overall stress, depressive and anxiety symptoms, and sleep; those who used practices reported more benefits than those who did not. Qualitative data corroborated these findings, with teachers describing improved stress- and emotion-management following program use. Conclusions: Our findings suggest mindfulness can be delivered online to teachers and may enhance mental health and wellness. Next steps include conducting more rigorous research with a control condition to better understand potential program impact. Preregistration: This study is not preregistered. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-023-02142-3.

Exploring the Influence of a Mindfulness Intervention on the Experiences of Mothers with Infants in Neonatal Intensive Care Units.

Objectives: Mothers with infants in the neonatal intensive care unit (NICU) are at increased risk of psychological distress, which can have lasting negative impacts on both mother and infant. However, few interventions are available to promote these mothers' mental health and wellbeing. In the context of a pilot randomized controlled trial testing a mindfulness intervention for mothers with infants in the NICU, we explore the experiences of the mothers participating in the mindfulness-based intervention, with mothers in the control group as comparison, and the ways they felt it influenced their time in the NICU. Method: Twenty-six participants (15 participants in the intervention arm and 11 participants in the control arm) recruited from two NICUs in an urban center in Eastern United States completed semi-structured interviews. Interviews explored the mothers' NICU experience as well as experience with the mindfulness and health education (control) programs. Data was analyzed using an iterative, thematic constant comparison process informed by grounded theory. Results: Mothers reported that participation in the mindfulness intervention helped them to calm the chaos through recentering and fostering connections, find comfort through non-judgmental acceptance, gain perspective on the situation, and facilitate self-care. These were experienced only among the mothers in the intervention arm. These themes did not vary based on demographics of the mothers in the mindfulness study arm or their pre-study awareness of mindfulness. Conclusions: Mindfulness interventions may foster new practices and perspectives for mothers with infants in the NICU, potentially leading to improved mental health wellbeing.

Confirming Profiles of Comorbid Psychological Symptoms in Urban Youth: Exploring Gender Differences and Trait Mindfulness.

Prior work has identified the need for replication of psychological research; however, validation efforts are rare. The purpose of the current study was to confirm latent profiles of comorbid psychological symptoms in an urban adolescent sample and examine differences in gender and trait mindfulness across these profiles. Cross-sectional data from 201 eighth grade students (63% female; Mage = 13.24; 86% Black) across nine Baltimore City public middle schools were analyzed. Confirmatory latent profile analyses showed that the previously-identified 3-profile solution with boundary constraints was the best fit for the data, and significant sex and trait mindfulness differences were identified. The current study supports the need for future replication studies using this methodology to improve theory and targeted interventions.

Changing the paradigm: Using strategic communications to promote recognition of child sexual abuse as a preventable public health problem.

Child sexual abuse (CSA) is common, severe, and substantively contributes to the global burden of disease through its impact on physical, mental, and behavioral health problems. While CSA is preventable through non-justice system response efforts, the vast majority of resources support criminal justice efforts to identify, prosecute, punish and monitor offenders after CSA has already occurred. Policy makers have not supported CSA prevention efforts in part because the public does not view CSA as a preventable public health problem. Here, we describe a program of research to be conducted to bridge the gaps between expert and public opinion about CSA as a preventable public health problem. We propose such research use a three-step approach to alter the way experts communicate about CSA to increase audiences' understanding of CSA as preventable. The three steps are: 1) identify consensus expert and public perspectives about CSA and the differences between these perspectives; 2) develop and test communication strategies to align public with expert perspectives; and 3) broadly disseminate validated communication strategies. Through this approach, we seek to develop and disseminate an informed communications strategy that effectively and accurately translates the science of CSA prevention to the public and the media.

Exploring the Psychosocial Impact of a Mindfulness Workforce Development Program on Instructors of Color: A Qualitative Descriptive Study.

A growing body of literature supports the use of mindfulness-based practices to increase resilience and reduce emotional and behavioral problems of low-income youth of color who are exposed to chronic trauma. The current study, the first of its kind, addresses existing gaps in the literature by examining the social and emotional effects of mindfulness on instructors of color, a largely understudied population. All trainees (n = 25) in a year-long, mindfulness-based workforce development program in Baltimore were invited to participate in this qualitative descriptive study that involved semistructured interviews regarding the personal emotional impact of participating in the program, as well as possible changes in the subjects' perceptions of yoga and the potential role of yoga in their communities. We applied a transcript-based analysis approach to the data from the individual interviews and derived themes using the constant comparative method. Twenty-one trainees (84%) participated in semistructured interviews. Participants were between the ages of 18 and 29 and were predominantly male (71.4%) and African-American (85.7%). We identified four key themes related to participating in the program: (1) changes in emotional functioning and self-perception, (2) changes in interactions with others, (3) changes in perception of yoga and mindfulness, and (4) perceived real-world application of yoga and mindfulness. The current study adds to the literature by exploring the public health implications of mindfulness, particularly in addressing effects of chronic trauma in low-income communities of color. The workforce development program also merits further evaluation as a potential model for enabling local and national nonprofit organizations to offer low-income youth and youth of color employment options that enhance resources in trauma-affected communities.

Mindfulness and Posttraumatic Stress Disorder Symptom Severity in Urban African-American High School Students.

OBJECTIVES: The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population. METHOD: Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness. RESULTS: Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03]. IMPLICATIONS: This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.

A randomized controlled trial of a trauma-informed school prevention program for urban youth: Rationale, design, and methods.

INTRODUCTION: Youth in disadvantaged urban areas are frequently exposed to chronic stress and trauma, including housing instability, neighborhood violence, and other poverty-related adversities. These exposures increase risk for emotional, behavioral, and academic problems and ultimately, school dropout. Schools are a promising setting in which to address these issues; however, there are few universal, trauma-informed school-based interventions for urban youth. METHODS/DESIGN: Project POWER (Promoting Options for Wellness and Emotion Regulation) is a randomized controlled trial testing the impact of RAP Club, a trauma-informed intervention for eighth graders that includes mindfulness as a core component. Students in 32 urban public schools (n = 800) are randomly assigned to either RAP Club or a health education active control group. We assess student emotional, behavioral, and academic outcomes using self-report surveys and teacher ratings at baseline, post-intervention, and 4-month follow up. Focus groups and interviews with students, teachers, and principals address program feasibility, acceptability, and fidelity, as well as perceived program impacts. Students complete an additional self-report survey in ninth grade. Schools provide students' academic and disciplinary data for their seventh, eighth, and ninth grade years. In addition, data on program costs are collected to conduct an economic analysis of the intervention and active control programs. DISCUSSION: Notable study features include program co-leadership by young adults from the community and building capacity of school personnel for continued program delivery. In addition to testing program impact, we will identify factors related to successful program implementation to inform future program use and dissemination.

Psychometric properties of the Child and Adolescent Mindfulness Measure (CAMM) in racial minority adolescents from low-income environments.

No study has yet assessed the psychometric properties of scores from any mindfulness measure in racial minority adolescents from low-income environments. The present study examined the reliability and validity of Child and Adolescent Mindfulness Measure (CAMM) scores in a nonclinical sample of late adolescents (N = 92) from low-income neighborhoods who predominantly identified as African American. Findings confirmed a one-factor structure for responses to the 10 CAMM items as well as adequate internal consistency (Cronbach's α = .88). In support of validity, CAMM scores demonstrated large significant negative correlations with scores from measures of constructs that should be negatively related to mindfulness, including depressive symptoms, worry, ruminative coping, and involuntary engagement responses to stress. Thus, CAMM scores appear to reliably and validly assess mindfulness in racial minority adolescents from low-income environments. Having a psychometrically sound mindfulness measure for this population will aid in understanding the mechanisms by which mindfulness-based interventions work, which could lead to improved interventions and outcomes for this population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A mindfulness intervention to reduce maternal distress in neonatal intensive care: a mixed methods pilot study.

Mothers with an infant in the neonatal intensive care unit (NICU) are at risk for depression, anxiety, and trauma symptoms, with negative implications for maternal-infant bonding, maternal well-being, and infant development. Few interventions to promote NICU mothers' mental health, however, have been developed or tested. This pre-post pilot study assessed feasibility, acceptability, and preliminary outcomes of a mindfulness intervention for NICU mothers. Twenty-seven mothers were recruited from a university NICU and offered a mindfulness intervention via introductory video and audio-recorded practices. Participants completed a baseline self-report survey. After 2 weeks of engaging with intervention materials, participants completed a second survey and in-depth interview. Quantitative data were analyzed using paired t tests; qualitative data were analyzed using thematic coding. Twenty-four women (89%) completed the study. Quantitative data indicated significant improvements in depressive, anxiety, and trauma symptoms, negative coping, NICU-related stress, and sleep (p < 0.05). Qualitative data identified themes of perceived improvements in psychological distress and stress symptoms, self-care, and relationships. Findings support the mindfulness intervention's feasibility, acceptability, and potential promise for reducing maternal distress and promoting well-being. Use of video and audio modalities may facilitate program sustainability and scale up. Further research on the program is merited.

A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers.

Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators - students and their classroom teachers - merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings.

NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis.

CONTEXT: Parents whose infants are being treated in the NICU are at high risk for depression and anxiety, with negative implications for parenting and infant development. OBJECTIVE: We conducted a systematic review and meta-analysis of NICU-based interventions to reduce maternal depressive or anxiety symptoms. DATA SOURCES: PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed. STUDY SELECTION: Inclusion criteria included randomized controlled design, a parent-focused intervention delivered in the NICU, valid maternal depressive or anxiety symptom measures at pre- and postintervention, and publication in a peer-reviewed journal in English. DATA EXTRACTION: Data extraction was conducted independently by 2 coders. RESULTS: Twelve studies met inclusion criteria for qualitative review; 2 were excluded from quantitative analyses for high risk of bias. Fixed- and random-effects models, with 7 eligible studies assessing depressive symptoms, indicated an effect of -0.16 (95% confidence interval [CI], -0.32 to -0.002; P < .05) and, with 8 studies assessing anxiety symptoms, indicated an effect of -0.12 (95% CI, -0.29 to 0.05; P = .17). The subset of interventions using cognitive behavioral therapy significantly reduced depressive symptoms (effect, -0.44; 95% CI, -0.77 to -0.11; P = .01). LIMITATIONS: The small number and methodological shortcomings of studies limit conclusions regarding intervention effects. CONCLUSIONS: Combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for the impact of cognitive behavioral therapy interventions on maternal depressive symptoms.

"The Program Affects Me 'Cause it Gives Away Stress": Urban Students' Qualitative Perspectives on Stress and a School-Based Mindful Yoga Intervention.

CONTEXT: School-based mindfulness and yoga studies generally measure stress-related outcomes using quantitative measures. OBJECTIVE: This study answers the following research questions: How do youth define stress and in what ways, if any, was a mindful yoga intervention helpful to youth during stress experiences? DESIGN AND SUBJECTS: To explore youths' own perspectives on stress, stressors in youths' lives, and perceived changes in responses to stress post-intervention, we conducted focus group discussions with 22 middle school students from low-income urban communities following a 16-week mindful yoga intervention. RESULTS: Using thematic analysis, the following three themes emerged: (1) youth conflated stress with negative emotions; (2) peer and family conflicts were common stressors; and (3) youth reported improved impulse control and emotional regulation following the intervention. Study findings have implications for refining intervention content (e.g., discussions of stress), as well as informing the selection and development of quantitative measures for future research on stress and stress responses in urban youth.

Assessing Fidelity of Implementation (FOI) for School-Based Mindfulness and Yoga Interventions: A Systematic Review.

As school-based mindfulness and yoga programs gain popularity, the systematic study of fidelity of program implementation (FOI) is critical to provide a more robust understanding of the core components of mindfulness and yoga interventions, their potential to improve specified teacher and student outcomes, and our ability to implement these programs consistently and effectively. This paper reviews the current state of the science with respect to inclusion and reporting of FOI in peer-reviewed studies examining the effects of school-based mindfulness and/or yoga programs targeting students and/or teachers implemented in grades kindergarten through twelve (K-12) in North America. Electronic searches in PsychInfo and Web of Science from their inception through May 2014, in addition to hand searches of relevant review articles, identified 312 publications, 48 of which met inclusion criteria. Findings indicated a relative paucity of rigorous FOI. Fewer than 10% of studies outlined potential core program components or referenced a formal theory of action, and fewer than 20% assessed any aspect of FOI beyond participant dosage. The emerging nature of the evidence base provides a critical window of opportunity to grapple with key issues relevant to FOI of mindfulness-based and yoga programs, including identifying essential elements of these programs that should be faithfully implemented and how we might develop rigorous measures to accurately capture them. Consideration of these questions and suggested next steps are intended to help advance the emerging field of school-based mindfulness and yoga interventions.

A Qualitative Evaluation of Student Learning and Skills Use in a School-Based Mindfulness and Yoga Program.

Previous studies on school-based mindfulness and yoga programs have focused primarily on quantitative measurement of program outcomes. This study used qualitative data to investigate program content and skills that students remembered and applied in their daily lives. Data were gathered following a 16-week mindfulness and yoga intervention delivered at three urban schools by a community non-profit organization. We conducted focus groups and interviews with nine classroom teachers who did not participate in the program and held six focus groups with 22 fifth and sixth grade program participants. This study addresses two primary research questions: (1) What skills did students learn, retain, and utilize outside the program? and (2) What changes did classroom teachers expect and observe among program recipients? Four major themes related to skill learning and application emerged as follows: (1) youths retained and utilized program skills involving breath work and poses; (2) knowledge about health benefits of these techniques promoted self-utilization and sharing of skills; (3) youths developed keener emotional appraisal that, coupled with new and improved emotional regulation skills, helped de-escalate negative emotions, promote calm, and reduce stress; and (4) youths and teachers reported realistic and optimistic expectations for future impact of acquired program skills. We discuss implications of these findings for guiding future research and practice.

Assessing fidelity of core components in a mindfulness and yoga intervention for urban youth: applying the CORE Process.

In the past years, the number of mindfulness-based intervention and prevention programs has increased steadily. In order to achieve the intended program outcomes, program implementers need to understand the essential and indispensable components that define a program's success. This chapter describes the complex process of identifying the core components of a mindfulness and yoga program for urban early adolescents through the systematic study of fidelity of implementation of the intervention. The authors illustrate the CORE Process [(C) Conceptualize Core Components; (O) Operationalize and measure; (R) Run analyses and Review implementation findings; and (E) Enhance and refine], based on data gained from a mindfulness and yoga intervention study conducted as a community-academic partnership in Baltimore city.

Physiological blunting during pregnancy extends to induced relaxation.

There is accumulating evidence that pregnancy is accompanied by hyporesponsivity to physical, cognitive, and psychological challenges. This study evaluates whether observed autonomic blunting extends to conditions designed to decrease arousal. Physiological and psychological responsivity to an 18-min guided imagery relaxation protocol in healthy pregnant women during the 32nd week of gestation (n=54) and non-pregnant women (n=28) was measured. Data collection included heart period (HP), respiratory sinus arrhythmia (RSA), tonic and phasic measures of skin conductance (SCL and NS-SCR), respiratory period (RP), and self-reported psychological relaxation. As expected, responses to the manipulation included increased HP, RSA, and RP and decreased SCL and NS-SCR, followed by post-manipulation recovery. However, responsivity was attenuated for all physiological measures except RP in pregnant women, despite no difference in self-reported psychological relaxation. Findings support non-specific blunting of physiological responsivity during pregnancy.

Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth.

Youth in underserved, urban communities are at risk for a range of negative outcomes related to stress, including social-emotional difficulties, behavior problems, and poor academic performance. Mindfulness-based approaches may improve adjustment among chronically stressed and disadvantaged youth by enhancing self-regulatory capacities. This paper reports findings from a pilot randomized controlled trial assessing the feasibility, acceptability, and preliminary outcomes of a school-based mindfulness and yoga intervention. Four urban public schools were randomized to an intervention or wait-list control condition (n=97 fourth and fifth graders, 60.8% female). It was hypothesized that the 12-week intervention would reduce involuntary stress responses and improve mental health outcomes and social adjustment. Stress responses, depressive symptoms, and peer relations were assessed at baseline and post-intervention. Findings suggest the intervention was attractive to students, teachers, and school administrators and that it had a positive impact on problematic responses to stress including rumination, intrusive thoughts, and emotional arousal.