International Journal of Children’s Spirituality

Vol. 16, No. 4, November 2011, 315–330

Preliminary outcomes of a mindfulness-based programme for

Hong Kong adolescents in schools: well-being, stress and
depressive symptoms
Ngar-sze Lau and Ming-tak Hue

The Hong Kong Institute of Education, Hong Kong, China

(Received 12 October 2011; final version received 2 November 2011)

Mindfulness-based intervention with adults has been found to be highly

effective and as such it has been the subject of much research in the past few
decades. However, the study of mindfulness-based approaches with adolescents,
especially in the Asian context, is still under-explored. This paper reports find-
ings from a pilot controlled trial assessing preliminary outcomes of a mindful-
ness-based programme in schools in Hong Kong. Fourteen to 16-year-old
adolescents with low academic performance from two secondary schools were
invited to take part in intervention and control groups (n = 48). It was hypothe-
sised that a six-week mindfulness-based programme would increase well-being,
reduce stress and symptoms of depression. Well-being, stress and depressive
symptoms of both intervention and control groups were assessed at baseline and
post-intervention. The findings showed that there was a significant decrease in
symptoms of depression and a significant increase in one dimension of well-
being among both groups. Qualitative data reflected that the mindfulness
programme was beneficial and feasible to adolescents at schools. The results
support conducting a randomised controlled trial with a larger sample and a long
term follow-up.
Keywords: mindfulness; adolescents; well-being; stress; depressive symptoms;
schools

Introduction
Due to its rapidly changing social environment, adolescents in Hong Kong have
had to face increasingly difficult psychosocial conditions over recent years. Atten-
tion and well-being are considered to be essential factors for effective learning, but
a survey revealed that nearly 80% of youths found difficulty in paying attention to
their daily activities such as schoolwork, sports, leisure activities and social events.
Compared with other Asian cities, the attention levels of Hong Kong’s youths were
found to be among the lowest (Al-Sudairy 2007; Research International 2007).
Indeed, a recent survey found that 11% of Hong Kong adolescents reported that
they suffered from internet addiction (Hong Kong Playground Association 2011).
This suggests that there may be a threat to effective learning and the psychosocial
well-being of youths.

*Corresponding author. Email: enslau@ied.edu.hk; lauelsa@hotmail.com

ISSN 1364-436X print/ISSN 1469-8455 online

Ó 2011 Taylor & Francis
http://dx.doi.org/10.1080/1364436X.2011.639747
http://www.tandfonline.com
316 N. Lau and M. Hue

Furthermore, the increasing rate of suicide and suicide attempts amongst Hong
Kong students in the past decade has aroused considerable concern (Sun, Hui, and
Watkins 2006). Evidence has shown that suicide has become the leading cause of
death for the 15 to 24 age group (Yip et al. 2004). The suicide rate of early adoles-
cents has risen from 1.6% to 3.3% from 1999 to 2003 (Lee et al. 2007). From the
findings of a territory-wide study, 21% of high school students reported suicidal
ideation or attempts in the previous twelve months (Hong Kong Jockey Club Centre
for Suicide Research and Prevention 2004). Further study of this phenomenon and
exploration of solutions for improving the psychosocial conditions of adolescents
are therefore needed urgently.

Depressive symptoms
Studies have shown that significant risk factors related to suicide attempts by Hong
Kong adolescents include poor family cohesion, poor peer support, family conflicts
and depression. Depression has been found to be a strong mediator of suicidal idea-
tion (Sun, Hui, and Watkins 2006), and a high risk factor for engaging in suicidal
behaviour when a suicide attempt is exposed (Wong et al. 2005). Another study
suggested that depressive symptoms promote tobacco use in Hong Kong adoles-
cents (Lam et al. 2005). Thus, strategies for reducing depression are important not
only in improving mental and physical health, but also in reducing the major risk in
suicidal behaviour amongst those at-risk adolescents.

Stress
Adolescence is a stage when important developmental events affect stress levels
and influence the emotional states of adolescents. This period of transition during
adolescence, which is described as a time of stress and storm, includes the develop-
ment of autonomy, responsibility and a set of values (Irvin 1996), as well as iden-
tity formation (Erikson 1968). Previous research reported that adolescents who have
anger problems also tend to have high levels of stress and experience health prob-
lems such as high blood pressure and other cardiovascular issues (Hauber et al.
1998), hopelessness (Kashani et al. 1995), interpersonal difficulties (Muris et al.
2004) and suicidality (Goldston et al. 1996). Though stress may be inevitable dur-
ing adolescence, employing appropriate stress coping methods would be beneficial
to physical health, personal growth and overall well-being.

Well-being
It was recently found that Hong Kong adolescents who have higher levels of posi-
tive youth development are more satisfied with life and have fewer behavioural
problems (Sun and Shek 2011). Studies have confirmed that well-being is associ-
ated with not only life satisfaction (Trzcinski and Holst 2008), but also positive
emotions, health and survival (Huppert and Whittington 2003). Well-being is
defined as a ‘combination of feeling good and functioning effectively’ (Huppert
2009). Feeling good refers to positive experiences of happiness, emotions and affec-
tion, while functioning effectively relates to having a sense of purpose, value, and
autonomy (Huppert 2009; Huppert and Johnson 2010). The concept and approach
of enhancing well-being has recently transitioned from treating disorder in order to
 International Journal of Children’s Spirituality 317

preventing disorder in the field of mental health research and policy making
(Huppert 2009; WHO 2001) to encourage positive mental health and well-being.
Therefore, enhancing well-being is important to the personal growth of adolescents,
irrespective of the dimension of mental health or physical health.

Mindfulness-based programme
Previous research has revealed the key challenges facing Hong Kong’s adolescents,
such as depression and stress. In this study, we focus on exploring feasible coping
strategies or interventions pertinent to enhancing the well-being of adolescents.
In recent decades, mindfulness training has become a widely used method of
intervention in reducing stress and promoting well-being in both clinical and non-
clinical populations. The positive results of an eight-week mindfulness-based stress
reduction (MBSR) programme (Kabat-Zinn 1982, 1990) and the mindfulness-based
cognitive therapy (MBCT) programme (Segal, Williams, and Teasdale 2002) have
contributed to the increasing interest in mindfulness research. Evidence indicates
the effectiveness of mindfulness training in reducing stress and anxiety (Kabat-Zinn
et al. 1992), emotional disorders (Arch and Craske 2006), attention-deficit in adults
(Brown and Ryan 2003), prevention of depressive relapse (Segal, Williams, and
Teasdale, 2002; Teasdale et al. 2002; Williams 2008) and suicidal behaviour
(Hargus et al. 2010; Lau, Segal, and Williams 2004). It has also been considered
for the treatment of substance abuse disorders (Marlatt 1994). Additionally, mindful-
ness meditation has been proven to have significant effects on brain function regula-
tion and EEG patterns (Davidson et al. 2003). In the past few years, mindfulness
training has been incorporated into psychotherapies and healing strategies for
enhancing physical and mental well-being (Germer, Siegel, and Fulton 2005).
Mindfulness is a meditation skill which originated from Ancient India over
2500 years ago. It has been a core practice in both monastic and lay communities
in Theravada Buddhist traditions in parts of South Asia. With right mindfulness and
calmness, the mind is able to let go of attachment and release negative thoughts
and emotions. Unwholesome and harmful speech and actions can be stopped and
transformed by the right practice. In a positive way, mindfulness practice is able to
cultivate wholesome thoughts, speech and actions with compassion, joy and loving-
kindness (Palmo 2002).
In the recently developed secular mindfulness programme, mindfulness is
referred to as a level of consciousness with non-reactive awareness and openhearted
acceptance at the present moment (Kabat-Zinn 2003). Mindfulness training is a cul-
tivation of a mental state with moment-to-moment attention, awareness and accep-
tance of an object in mind and body, such as feelings, sensations and thoughts
(Bishop et al. 2004; Germer, Siegel, and Fulton 2005; Kabat-Zinn 1990). Mindful-
ness can be cultivated in daily life activities such as walking, standing, sitting, lying
down and eating.
Currently there is an increasing interest in exploring the effects of mindfulness-
based training with children and adolescents in the west. Positive effects of mind-
fulness training with non-clinical children and adolescents with attention-deficit dis-
order, ADHD, and aggressive behaviour patterns were found (Beauchemin,
Hutchins, and Patterson 2008; Hassed et al. 2009; Singh et al. 2007; Thompson and
Gauntlett-Gilbert 2008; Zylowska et al. 2008). However, concerns have been raised
that there is a lack of empirical evidence of the efficacy of these studies due to
318 N. Lau and M. Hue

factors such as small sample size and absence of a control group (Burke 2010). In
recent studies of school-based mindfulness programmes for adolescents, the results
were encouraging that mindfulness practice was significantly correlated with
improved well-being (Huppert and Johnson 2010) and mental health (Mendelson
et al. 2010). However, to our knowledge, there has been no study which has exam-
ined the effects of mindfulness on psychosocial conditions of adolescents in Hong
Kong. This pilot study which explores the effects of a six-week mindfulness pro-
gramme in Hong Kong schools may address the gap.

The study
There were two goals of conducting a pilot controlled trial of the mindfulness pro-
gramme: firstly, to evaluate the feasibility and acceptability of the programme, and
secondly, to evaluate its possible impacts for improving the psychosocial condition
of adolescents in school settings. In this study, psychosocial condition was mainly
conceptualised as promoting well-being, stress reduction and depression reduction.
Designed for Hong Kong adolescents, the programme was aimed at improving the
psychosocial effects of the young people by cultivating a state of mindful
awareness.
All Form Four students from two schools were invited to join either the six-
week mindfulness programme or the controlled group. Well-being, stress, depres-
sion and mindfulness were assessed at baseline and after the intervention. For the
first goal, we evaluated the feasibility and acceptability of the programme mainly
from the feedback from students. We expected that approximately 20 students per
school would enroll in the programme, and that approximately 80% of participants
would complete 80% of the sessions. For the second goal, we hypothesised that the
programme would result in an improvement in well-being, and indicate a reduction
in stress and depressive symptoms. Before we approached the schools, the study
had been approved by the Ethical Review Committee of the Hong Kong Institute of
Education.

Methods
Participants
Considering the feasibility and conditions of the study in recruiting adolescents
aged from 14- to 16-years-old, we collaborated with two public schools, both of
which were government-aided. One was located in Kowloon, the other in New Ter-
ritories. These two schools were selected because the teachers of religious studies
were enthusiastic and supportive of contemplative practice, which was very new in
the local school setting in Hong Kong. Two schools which were categorised as
Band 3 were the lowest banding schools in Hong Kong. Students in Band 3 schools
were categorised with lower learning ability and lower learning performance than
those in Band 1 and Band 2. All Form Four students in the two schools are of Can-
tonese ethnicity.
The mindfulness programme and the study were presented to all Form Four stu-
dents at the school assemblies. Invitation letters and parental consent forms were sent
to all the students. The programme was offered as an extracurricular activity after the
normal school schedule. After the presentation, about 50 students from two schools
expressed interest in joining the programme by signing written consent forms. An
 International Journal of Children’s Spirituality 319

equal number of students with matched backgrounds were invited to join the control
group by completing the pre and post-assessment without any intervention. It was
announced that students who participated in the study would be offered a book token.

Procedures
Students who enrolled in the mindfulness training group would attend a six-week
programme and a one day retreat. The six-week programme included a two-hour
session per week at each school. Due to limited resources, no more than 25 partici-
pants could be recruited at each school. The two classes were led by the same
instructor with the same programme, which was delivered in a multi-purpose room
with enough space for physical activity. After the fourth lesson, all participants from
the two schools attended the one day retreat at the Tai Po campus of the Hong
Kong Institute of Education. Pre- and post-intervention assessments of the interven-
tion and control group participants were arranged at the same location to reduce
inconsistency. Qualitative data from the participants was also collected. Evaluation
meetings were conducted to collect views from teachers after the programme.

Mindfulness programme
The six-week mindfulness programme, which was modified and adapted from the
mindfulness-based stress reduction program (MBSR) (Kabat-Zinn 1990), was pre-
sented to students as a short course to enhance concentration and reduce stress by
cultivating moment-to-moment awareness. This programme was delivered in a secu-
lar approach without any religious terminology. The instructor was an experienced
teacher with MBSR training. The programme included four major activities:
(1) gentle stretching exercise, which enhances the cultivation of mindfulness
through awareness of body movement and sensation; (2) practice with daily activi-
ties, including sitting, standing, walking , lying down and eating which involves the
awareness of body sensations, thoughts and emotions; (3) body scan, which consists
of a guided movement of attention throughout the body from the head to the toes
whilst sitting or lying down; (4) loving-kindness practice, which involves sending
well wishes and blessings to oneself and all other people in the world.
The practices in the first three activities were aimed at cultivating moment-
to-moment awareness. For example, in a 15-minute walking practice, the students
were invited to be aware of the sensation of touching the floor with their feet, and
the moving posture of each step. In the first few minutes of the walking practice,
most of the participants were distracted by some thoughts or emotions due to habit.
The instructor would remind them again to be aware of the sensations and move-
ment of their feet. However, most of the participants were able to enhance their
concentration after 10 to 15 minutes walking practice.
The aim of the loving-kindness practice was to boost positive mindsets by culti-
vating friendship towards oneself and others. With the guidance of the instructor,
participants would contemplate a few sentences in a sitting posture, i.e., ‘May I be
well and happy; may I be free from hatred; may I release my negative thoughts and
emotions; may all people be well and happy...’ This practice would increase an
acceptance of oneself including of past failures and inadequacies. A greater
acceptance of oneself would facilitate acceptance and forgiveness towards others
including enemies or those who caused pain.
320 N. Lau and M. Hue

Apart from the six two-hour-sessions (12 hours), all the participants were invited
to join a whole day retreat (seven hours). A tea meditation, a mindful lunch and out-
door mindful walking were additionally offered in the day retreat. Moreover, the stu-
dents were encouraged to do daily home practice on a voluntary basis (15 minutes).

Measures
Standard demographic characteristics including age, gender, meditation experience and
religious faith were obtained. Participants from both the intervention group and the
control group were invited to complete the following measures to assess the variables.

Mindfulness
As we could not find appropriate mindfulness measures for adolescents, we adapted
the measures which are commonly used on adults. In the current study, mindfulness
was measured by means of a combination of the Mindful Attention Awareness
Scale (MAAS) (Brown and Ryan 2003) and the Freiburg Mindfulness Inventory
(FMI) (Walach et al. 2006).
The MAAS was chosen as it assesses the extent to which an individual is atten-
tive to and aware of the present-moment experiences in everyday life. The scale
consists of a 15-item self-report questionnaire with a six-point Likert scale ranging
from ‘1’ (‘almost always’) to ‘6’ (‘almost never’). Sample items include ‘I find
myself doing things without paying attention’ and ‘I find it difficult to stay focused
on what’s happening in the present’. A higher mean score reflects higher level of
mindfulness of the respondent.
The FMI 14-item form is developed to assess non-judgmental present-moment
observation and openness to experiences of non-meditating samples. The scale which
consists of a four-point Likert scale from ‘1’ (‘rarely’) to ‘4’ (‘almost always’) was
used. It measures three domains of mindfulness in daily life: mindful presence, open-
ness to experience and non-judgmental acceptance. Sample items include ‘I see my
mistakes and difficulties without judging them’ and ‘I accept unpleasant experi-
ences’. Higher scores are related to increased self-awareness and self-knowledge.

Well-being
Well-being was assessed by Scales of Psychological Well-being (SPWB) (Ryff and
Keyes 1995). SPWB was chosen as it assesses psychological well-being with
regards to the existential challenges of life. The scale consists of a 46-item measure
with six domains including autonomy, environmental mastery, personal growth,
positive relations with others, purpose in life, and self-acceptance. A six-point Lik-
ert-type scale ranging from ‘1’ (‘strongly disagree’) to ‘6’ (‘strongly agree’) is used
for the assessment. Sample items include ‘Most people see me as loving and affec-
tionate’ and ‘In general, I feel I am in charge of the situation in which I live’.
Higher scores reflect greater levels of psychological well-being.

Depressive symptoms
Depressive symptoms were measured by the Depression Anxiety Stress Scales
(DASS) (Lovibond and Lovibond 1993, 1995). DASS is a 42-item instrument
 International Journal of Children’s Spirituality 321

measuring the three dimensions of negative emotional states which are depression,
anxiety and stress, with 14-item for each domain. A four-point Likert-type scale
ranging from ‘0’ (‘did not apply to me at all’) to ‘3’ (‘applied to me very much, or
most of the time’) is used for the assessment. Sample items include ‘I found it diffi-
cult to relax’, ‘I felt that life was worthwhile’ and ‘I felt I was close to panic’. A
higher score shows a greater level of depressive symptoms.

Perceived stress
Perceived stress was measured by the Perceived Stress Scale (PSS) (Cohen et al.
1983; Cohen and Williamson 1988). PSS is used to assess the degree of stress in
one’s life situation over the past month with 10 items. It is suggested that people
examine potential challenging issues in relation to their available coping resources.
A five-point Likert-type scale ranging from ‘0’ (‘never’) to ‘4’ (‘very often’) is
used. Sample items include ‘How often have you felt that you were on top of
things?’ and ‘How often have you felt nervous and “stressed”?’ A higher score
shows a greater degree of perceived stress.
All the measures were translated into a Chinese version by a parallel back-trans-
lation procedure with the approach to cross-cultural translation (Brislin 1986) except
DASS which had been translated and validated. The Cronbach’s a coefficients of
these scales at baseline and at post-intervention in the present study were 0.84 and
0.90 for the MAAS, 0.66 and 0.81 for FMI, 0.88 and 0.87 for SPWB, 0.96 and
0.96 for DASS, 0.68 and 0.65 for PSS respectively. All indicated acceptable inter-
nal consistencies. Alphas of FMI and PSS were lower than expected. This was pos-
sibly due to the difficulty of understanding the translated items, particularly the
negatively stated wordings. Self-recorded journals of students were collected as
qualitative data throughout the programme.

Results
Recruitment and attendance
The recruitment of participants for the programme was not as smooth as expected.
In one school, 21 students enrolled for the programme. Three students decided to
drop out after the first lesson. In another school, 24 students enrolled. Two students
decided to leave. With respect to the programme attendance for the remaining stu-
dents, over 61.5% students attended at least 80% of the programme classes. Most
absences were the result of the students who were absent on that school day. Con-
sidering the study of the impact of the programme, we finally included only those
who had 80% attendance in the programme in the sample. The mean age of the
intervention group (n = 24) was 15.83 years. There were 15 female students
(62.5%). Chi-square tests were conducted to verify that the intervention group and
the control group were not statistically different on gender, meditation practice
experience and religious faith (t (44) = 0.60, p = 0.73).
In the formal meeting with school teachers, their support of the mindfulness-
based training trial for adolescents in schools was made clear. Teachers expressed
that the students have a great need to receive the training for promoting emotional
regulation and reducing aggression. One teacher reported that she was surprised to
find that those students who were easily distracted had recently exhibited increased
levels of concentration. Teachers expressed that they would like to know more
322 N. Lau and M. Hue

about mindfulness training in order to implement more skills in formal school

curricula.

Feasibility to students
We collected qualitative data from the written responses of the participants in order
to evaluate the experiences and effectiveness of the programme and activities.
Responses indicated that students had a positive experience in the programme and
felt the skills could be helpful in their daily lives:

I think walking meditation was my favourite activity because it was a lot of fun. Addi-
tionally, from loving-kindness practice, I learnt how to forgive myself and others.
Now I understand that I can enjoy a tasty meal when I eat quietly without talking.
(Form 4 girl)

I could feel the happiness when I was practicing with many others. Now I understand
that relaxation is important in life. Moreover, I appreciate nature so much! (Form 4
boy)

When we were practicing loving-kindness meditation, I sent my best wishes to Ms

Law who has been ill recently. (Form 4 girl)

The lying down body scan was the most impressive activity in the programme. I feel
very happy that I can relax my mind and body. I reminded myself not to be too ner-
vous in daily life, and to be more patient. I have learnt how to relax. And I found that
people and things which are close to me should be appreciated. (Form 4 boy)

I think that the lying down body scan was my favourite activity as I could observe
the sleeping faces of others, though I would finally fall asleep. I realised that it is not
difficult to keep good relationships with others. It is about simply opening your heart
to understand others. I like a quiet place for meditation. (Form 4 girl)

Preliminary outcomes
Baseline comparisons
Table 1 presents the baseline data for the outcome variables by using chi-square
tests and independent sample t-tests. Our findings indicate that there were no signif-
icant differences at pre-intervention among the intervention and control groups
except in the measures of MAAS (p <0.05).

Effects of the mindfulness programme

Effects of the mindfulness programme were further assessed by using multivariate
repeated-measures (MANOVA) to compare groups over time, which was pre and
post-intervention. The factors in the analyses were group (intervention or control),
time (baseline and post-intervention), and dependent variables. There were no dif-
ferences in the variables among two groups in the pre-test. Results for multivariate
analyses and follow-up univariate analyses of separate dimensions are presented in
Table 2 and Table 3.
 International Journal of Children’s Spirituality 323

Table 1. Independent-samples t-tests on age and baseline data for all variables.
Intervention Control
Measure Mean SD Mean SD t P
MAAS 59.25 9.16 66.33 12.24 2.27 0.03⁄
FMI 35.50 4.96 35.00 5.07 0.35 0.73
SPWB 157.75 20.48 152.46 20.66 0.89 0.38
DASS 127.13 27.89 139.08 19.64 1.72 0.09
PSS 29.42 4.10 31.08 5.27 1.22 0.23
Notes: MAAS, Mindful Attention Awareness Scale; FMI, Freiburg Mindfulness Inventory; SPWB, Scales
of Psychological Well-being; DASS, Depression Anxiety Stress Scales; PSS, Perceived Stress Scale.
⁄
p < 0.05.

Mindfulness
As indicated in Table 2, Time x Group interaction for mindfulness with combining
MASS and FMI is insignificant, F (2, 45) = 1.25, p = 0.30. On the other hand,
since mindfulness is commonly defined as a multi-faceted construct (Bishop et al.
2004), dimensions of mindfulness measured by FMI were analysed individually
(Walach et al. 2006). However, a significant Time x Group interaction effect was
revealed in the dimension of mindful presence, F (1, 46) = 6.56, p = 0.01⁄⁄, as
shown in Table 3. Post-hoc t-tests found that only those who attended the mindful-
ness program had improved in the mindful presence dimension, t = -3.06,
p = 0.01⁄⁄, while the participants in the control group had no change, t = 0.64,
p = 0.53. The interaction effects of all other dimensions of mindfulness were
insignificant.

Well-being
Since the effect for well-being as a single construct appeared null in this case,
repeated-measures ANOVA were performed to explore the effects of the mindful-
ness program on the different dimensions of well-being as captured by SPWB. As
shown in Table 3, a significant interaction was found for the dimension of personal
growth, F (1, 46) = 9.54, p = 0.00⁄⁄⁄. Post-hoc paired-samples t-tests showed that
the experimental group had a higher level of personal growth after the mindfulness
training, t (23) = 2.24, p = 0.04⁄, whereas the control group had a lower level in
the post-test, t (23) = 2.13, p = 0.04⁄. There were no significant interactions found
in other dimensions of well-being.

Table 2. Multivariate Repeated-measures ANOVA on dependent variables.

Main effects Interaction
Group Time Group x Time
Variables F (2, 45) P F (2, 45) p F (2, 45) p
Mindfulness (MASS & FMI) 1.32 0.28 0.37 0.69 1.25 0.30
Well-being (SPWB) 2.55 0.09 2.48 0.10 1.56 0.22
Depression & stress (DASS & PSS) 0.15 0.87 0.61 0.55 5.80 0.01⁄⁄

Notes: p < 0.05⁄; p < 0.01⁄⁄.

324 N. Lau and M. Hue

Table 3. Univariate repeated-measures ANOVA on dependent variables.

Main effects Interaction
Group Time Group x Time
Measures F (1, 46) p F (1, 46) p F (1, 46) p
FMI mindful presence 0.61 0.44 2.66 0.11 6.56 0.01⁄
FMI openness to experience 0.50 0.49 0.25 0.62 0.99 0.32
FMI non-judgmental acceptance 0.48 0.49 0.09 0.76 0.14 0.71
SPWB personal growth 0.64 0.43 0.20 0.89 9.54 0.00⁄⁄⁄
SPWB autonomy 2.78 0.10 0.85 0.36 1.67 0.20
SPWB mastery 1.23 0.27 4.45 0.04 0.30 0.59
SPWB relations 2.03 0.16 0.07 0.80 0.32 0.58
SPWB self-acceptance 3.09 0.09 0.15 0.70 3.09 0.09
SPWB life purpose 0.01 0.93 0.02 0.88 0.01 0.93

Notes: ⁄p < 0.05; ⁄⁄

p < 0.01; ⁄⁄⁄
p < 0.001.

Depressive symptoms and perceived stress

Recoding was performed to reflect higher depressive levels and stress levels with
lower scores. A significant Time x Group interaction was found for combining
depressive symptoms and perceived stress, F (2, 45) = 5.80, p = 0.01⁄⁄. Post-hoc
t-tests found that the control group had higher depressive levels with significantly
lower score on DASS at the post-intervention (DASS: t (23) = 3.10, p = 0.01⁄⁄).
Meanwhile, the depressive level of the intervention group did not increase after the
intervention (DASS: t (23) = -1.57, p = 0.13). Thus, it showed that the mindfulness
programme was significantly related to the reduction of depressive levels of the
intervention group. But there were no significant interactions found for the dimen-
sions of perceived stress (PSS: t (23) = -2.02, p = 0.06).
Means and SD’s of variables at baseline and post-intervention for the interven-
tion and control groups are presented in Table 4. The differences of other variables
were not significant, however, the post-intervention means of both intervention and
control groups showed a consistent anticipated pattern in an expected direction for
well-being (168.00 in the intervention group versus 152.46 in the control group)
and perceived stress (31.25 in the intervention group and 29.21 in the control
group). There was significant difference at the baseline score of MASS between the
intervention group (59.25) and the control group (66.33). Nevertheless, after the
programme, the intervention group score was increased (62.88), while the control
group score was explicitly decreased (63.25). The variables in general were changed
in a direction which was coherent with the hypothesis.

Discussion
To our knowledge this was the first controlled trial of a school-based mindfulness
programme for adolescents in Hong Kong. Our aim was to examine the possible
impacts of a six-week mindfulness programme for improving the psychosocial
condition of adolescents, and its feasibility in the local school settings. Our preli-
minary findings of this pilot study provided some positive evidence that the mind-
fulness programme was related to the improvement of the psychosocial situation of
the adolescents. The study also suggests that a mindfulness-based programme is fea-
sible for adolescents in schools.
 International Journal of Children’s Spirituality 325

Table 4. Means and SD’s of variables at baseline and post-intervention for the intervention
and control groups.
Intervention Control
Pre Post Pre Post
Measures Mean SD Mean SD Mean SD Mean SD
MAAS 59.25 9.16 62.88 11.94 66.33 12.24 63.25 13.03
FMI 35.50 4.96 36.79 6.41 35.00 5.07 35.63 6.09
SPWB 157.75 20.48 168.00 24.62 152.46 20.66 152.46 12.62
DASS 127.13 27.89 133.88 21.25 139.08 19.64 126.21⁄ 24.60
PSS 29.41 4.10 31.25 3.48 31.08 5.27 29.21 4.72
FMI mindful presence 7.79 1.53 8.92⁄ 1.61 8.21 1.56 7.96 1.37
FMI openness to 10.79 1.69 10.58 2.55 10.04 1.97 10.67 2.43
experience
FMI non-judgmental 14.58 3.31 15.00 3.20 14.38 2.41 14.33 3.27
acceptance
SPWB personal growth 28.17 3.82 30.08⁄ 5.30 29.08 4.11 27.33 4.52
SPWB autonomy 26.38 3.37 26.67 4.61 25.63 5.02 23.88 5.12
SPWB mastery 25.79 4.39 27.71 4.79 24.83 6.27 25.96 3.86
SPWB relations 28.96 6.56 29.21 6.69 27.42 4.74 26.75 3.99
SPWB self-acceptance 26.04 4.45 27.88 5.23 25.33 5.28 24.17 3.94
SPWB life purpose 26.42 5.33 26.46 4.06 24.21 5.08 24.38 4.62

Notes: ⁄p < 0.05; ⁄⁄

p <0.01.

Analysis of the study results indicated that the mindfulness programme signifi-
cantly reduced the depressive symptoms among adolescents who joined the inter-
vention. It suggests that mindfulness-based practices were effective in enhancing
the capacities of adolescents in reducing depression. Our findings are consistent
with a previous study arguing that mindfulness training was a promising strategy
for depression reduction across clinical and nonclinical populations (Kumar,
Feldman, and Hayes 2008). Depression has been found as a strong mediator of sui-
cidal ideation among Hong Kong adolescents (Sun, Hui, and Watkins 2006), and a
high-risk factor for engaging in suicidal behaviour when a suicide attempt is exposed
(Wong et al. 2005). Another study suggested that depressive symptoms promote
tobacco use in Hong Kong’s adolescents (Lam et al. 2005). Therefore, reduction of
depressive symptoms by mindfulness intervention has important implications for
mental health, physical health and risk for engaging in suicidal behaviours.
There were no significant differences on measures of perceived stress, though
the pattern of scores was in the predicted direction. As mentioned before, the Cron-
bach’s a coefficients of PSS at baseline and post-intervention (0.68 and 0.65) were
much lower than expected. It may be possibly due to the difficulty of understanding
the translated items, especially the negatively translated items. Further exploration
with a larger sample and follow-up assessment of other scales with higher reliability
is desirable.
In this study, it was found that there was significant difference between pre-and
post- in improving personal growth, a well-being dimension, among the intervention
group. In general the scores pattern was in the predicted direction though there was
no significant evidence found in other dimensions of well-being. This suggests that
the mindfulness-based programme was positively associated with the enhancement
of personal growth among adolescents’ well-being.
326 N. Lau and M. Hue

One surprising outcome is that the intervention group and control group only
differed in mindful presence, a dimension of FMI. There were no significant differ-
ences on measures of MASS although the scores were changed in an expected
direction. The findings are not consistent with the previous studies, which support
the argument that there is a strong association between an increase in mindfulness
and decrease in depression and perceived stress after mindfulness training (Carmody
and Baer 2008; Kumar, Feldman, and Hayes 2008). In the current study, the Cron-
bach’s a coefficients for FMI at baseline and post-intervention (0.66 and 0.81) were
lower than expected. It raised questions about the reliability and validity of the two
scales in the assessment of mindfulness for adolescents in the context of Hong
Kong. Furthermore, from a past study (Leigh, Bowen, and Marlatt 2005), it was
found that increased alcohol and tobacco use were associated with higher FMI
scores. In another study, increases in psychological mindedness were associated
with higher MAAS scores (Beitel, Ferrer, and Cecero 2005). Further studies with
highly reliable and valid measurements of mindfulness for adolescents in the Hong
Kong context are desirable.
It should also be pointed out that prominent western research has found that
there was a significant increase in mindfulness and well-being after mindfulness
practice in an 8-week mindfulness programme (Shapiro et al. 2008). An increase in
mindfulness was found to be a mediator between formal mindfulness practice at
home and well-being (Carmody and Baer 2008). This may suggest that in the pres-
ent study there was insufficient mindfulness training and homework practice during
the six-week mindfulness-based programme, which was only 19 hours in duration.
A programme with a longer period of intervention might be considered in future.
From the qualitative findings of students, the response to the programme was
encouraging. The students learnt new approaches to reducing stress, understanding
the mind and body, caring for others, and appreciating nature and human relation-
ships. However, in this pilot study, the programme curriculum and content was
mostly adapted from the west. In future, we can consider developing a curriculum
for adolescents with modified means and local Chinese cultural elements.
Small sample size was one of the major limitations in the study. The recruitment
response to the mindfulness-based programme was not as enthusiastic as expected
and there was a natural drop-out rate. After excluding those participants without
80% attendance, the sample size was less than satisfactory. From discussions in the
evaluation meetings with the school teachers, it was found that some students who
had low learning motivation in the schools had low motivation in joining after-
school activities. Besides considering conducting a larger trial of randomised and
controlled study, an adaptable strategy including modifying the schedule and the
setting to prevent absence would be desirable. Compared with the normal duration
of 40 to 50 minutes for each lesson in the normal school schedule, a two-hour les-
son would be relatively long from the perspective of students. In the future, each
session of the programme can be shortened to less than one hour, and the whole
programme duration can be prolonged to 10 to 12 weeks to maintain the basic
quantity of mindfulness intervention.
Additionally, the instructor in this pilot study was a visitor of the school. It took
some time for her to build up rapport with the students during the programme. In
future, we would consider developing a classroom-based programme which is
offered by school teachers at classrooms within the school schedule. Considering
the tight schedule of schools in the Hong Kong context, a short session can be
 International Journal of Children’s Spirituality 327

offered by the class teachers in the morning as a whole school practice. This is sim-
ilar to the whole-school reading session which has been introduced in all local
schools in the past decade. Moreover, instead of offering mindfulness programmes
as an extra-curricular activity, mindfulness practice can also be incorporated into
normal curricula and major subjects such as mathematics, art and language. In
Hong Kong, mindfulness-intervention is still developing in both clinical and non-
clinical populations, especially in education. Most of the front-line teachers had not
heard about mindfulness and how it can be applied in schools. A teacher’s manual
and related training programme can be developed in promoting mindfulness skills
to be used in different curricula. In further study, the relationship between mindful-
ness and academic results can be explored. In short, we suggest conducting a ran-
domised controlled trial with a larger sample and long-term follow-up in future.
In conclusion, despite these limitations, this study has successfully served as the
first attempt to analyse the effects of a mindfulness programme for adolescents at
schools in the Hong Kong Chinese community. The preliminary results provide initial
and encouraging support for the potential effectiveness of mindfulness training in
enhancing the psychosocial condition of adolescents, with a significant decrease in
depressive symptoms and a significant increase in personal growth and well-being.
The qualitative findings reflected that a mindfulness-based programme may be feasible
at schools and beneficial to adolescents who have low academic performance. Enhanc-
ing the regulatory responses to depression among adolescents has the potential not
only to promote public and mental health by reducing tobacco use and suicidal idea-
tion, but also to reduce the risk for engaging in suicidal behaviour in Hong Kong.

Acknowledgements
This work was supported by the Internal Research Grant from the Hong Kong Institute of
Education. We warmly acknowledge Clive Erricker, Helen Ma and Mark J. Williams for
their invaluable and encouraging advices in the early stages of the project. We are grateful
to the critical and positive comments from the two anonymous reviewers. We thank Steve
Pickering, Ruth Wills, and W.K. Hou who proofread the manuscript. We thank Anita Wong
who offered the mindfulness classes, Aosi Mak and Queenie Lai who assisted in data
collection and administration work. We are grateful to PVHK and Ricky Woo for their
sponsorship of the book tokens for students. Finally, we want to extend our deepest
gratitude to the two schools, especially all the student participants, and the teachers Ms N.L.
Lee and Ms Dionne Lo who supported the study.

Notes on contributors
Ngar-sze Lau is teaching fellow of the Centre for Religious and Spirituality Education and
Department of Social Science (Affliated) at the Hong Kong Institute of Education. She is
currently conducting research on mindfulness and education in Hong Kong.

Ming-tak Hue is associate professor of the Department of Special Education and

Counselling at the Hong Kong Institute of Education. He has been conducting research on
guidance and counseling, pastoral care and Chinese culture, and school discipline in Hong
Kong schools.

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