The effect of universal school-based mindfulness on anhedonia and emotional distress and its underlying mechanisms: A cluster randomised controlled trial via experience sampling in secondary schools.

This cluster randomised controlled trial examined the effectiveness of universal school-based mindfulness training (MT; vs. passive control) to lower anhedonia and emotional distress among mid-adolescents (15-18 years). It further examined three potential mechanisms: dampening of positive emotions, non-acceptance/suppression of negative emotions, and perceived social pressure not to experience/express negative emotions. Adolescents (ncontrol = 136, nintervention = 95) participated in three assessment points (before, after and two/three months after the in-class MT), consisting of Experience Sampling (ES) assessments and self-report questionnaires (SRQs) to corroborate the ES assessments. Analyses were based on general linear modelling and multilevel modelling. Overall, no evidence was found for a significant beneficial and long-lasting impact of the MT on adolescents' mental health. Importantly, some barriers inherently linked to universal MT approaches (low engagement in and mixed attitudes towards the MT) may have tempered the effectiveness of the MT in the current trial. Further research should prioritise overcoming these barriers to optimise programme implementation. Additionally, given the potential complex interplay of moderators at micro- (home practice), meso- (school climate), and macro-level (broader context), research should simultaneously focus on alternative ways of delivering MT at schools to strengthen adolescents' mental health.