Journal of Child and Adolescent Counseling

ISSN: 2372-7810 (Print) 2372-7829 (Online) Journal homepage: https://www.tandfonline.com/loi/ucac20

The Impact of a Schoolwide Mindfulness Program

on Adolescent Well-Being, Stress, and Emotion
Regulation: A Nonrandomized Controlled Study in
a Naturalistic Setting

Andrew J. Campbell, Richard P. Lanthier, Brandi A. Weiss & Megan D. Shaine

To cite this article: Andrew J. Campbell, Richard P. Lanthier, Brandi A. Weiss & Megan D. Shaine
(2019): The Impact of a Schoolwide Mindfulness Program on Adolescent Well-Being, Stress, and
Emotion Regulation: A Nonrandomized Controlled Study in a Naturalistic Setting, Journal of Child
and Adolescent Counseling, DOI: 10.1080/23727810.2018.1556989

To link to this article: https://doi.org/10.1080/23727810.2018.1556989

Published online: 04 Feb 2019.

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Journal of Child and Adolescent Counseling
Copyright © Association for Child and Adolescent Counseling
ISSN: 2372-7810 print / 2372-7829 online
DOI: https://doi.org/10.1080/23727810.2018.1556989

The Impact of a Schoolwide Mindfulness Program on

Adolescent Well-Being, Stress, and Emotion Regulation:
A Nonrandomized Controlled Study in a Naturalistic
Setting
Andrew J. Campbell
Department of Psychology and Counseling, Hood College, Frederick, Maryland, USA

Richard P. Lanthier and Brandi A. Weiss

Graduate School of Education and Human Development, George Washington University,
Washington, District of Columbia, USA

Megan D. Shaine
Department of Psychology and Counseling, Hood College, Frederick, Maryland, USA

Few studies have explored large, school-wide mindfulness programs targeted at adolescents in natur-
alistic settings, while still including key design elements like control groups. The authors explored the
impact of a six-week large-scale mindfulness program in a high school setting on adolescent partici-
pants’ subjective wellbeing, perceived stress, and emotion regulation. Participants were divided into
control and treatment groups and completed pre- and post-tests on the various outcomes. Participation
in the program was associated with a significant decline in perceived stress, although the effect size was
small, potentially because of limitations associated with the naturalistic setting. Suggestions for future
research linking mindfulness programs to adolescent mental health are discussed.
Keywords: mindfulness, secondary school, adolescent, stress

In mindfulness meditation (MM), practitioners intentionally adopt and maintain a perspective in

which they observe and accept any stimuli that enter their field of awareness (Shapiro, Carlson,
Astin, & Freedman, 2006). Researchers have recently begun exploring the possible therapeutic
effects of MM (Baer & Krietemeyer, 2006), with mindfulness programs generally showing efficacy
in treating a range of normative distress and mental health concerns (Khoury et al., 2013). However,
mindfulness research with adolescents is limited (Burke, 2010). Adolescence is a period of great

Correspondence should be sent to Andrew J. Campbell, Hood College, 401 Rosemont Ave., Frederick, MD, 21701.
E-mail: campbell@hood.edu
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ucac.
*
This article was accepted under the previous editor, Dr. Ryan Holliman.
2 CAMPBELL ET AL.

transition, during which hormonal and developmental shifts lead to increased independence,
decreased need for parents, and heightened reliance on peers, all of which create disruptions to
the adolescent sense of self, in turn creating the potential for high levels of distress. Data from the
National Comorbidity Survey Adolescent Supplement (NCS-A) reveals a national crisis in adoles-
cent mental health, with researchers estimating the 12-month prevalence of diagnosable mental
health concerns to be 40.3%, and the 12-month prevalence of serious mental concerns to be 8.0%
(Kessler, Chiu, Demler, & Walters, 2005). For example, recent data show that the 12-month
prevalence of severe depression in youth increased from 5.7% in 2010 to 9.0% in 2016
(Substance Abuse and Mental Health Services Administration [SAMHSA], 2017) and, more
concerning, research suggests that only around 20% of youth in need actually receive necessary
mental health support (Kaffenberger & Seligman, 2007).
In recent years, practitioners have used MM programs to support adolescent mental health in
a variety of contexts. Research has supported their use to mitigate a range of mental health–
related concerns, including those associated with stress and anxiety (Khoury et al., 2013).
However, very limited research has effectively explored their use with nonclinical populations
(Burke, 2010) or in schools, and research on large-scale schoolwide programs is even more
limited. We endeavor to describe such a schoolwide program and to examine its impact on
adolescent perceived stress, subjective well-being (SWB), and emotion regulation (ER).

THE MODEL OF MINDFULNESS

Shapiro, Carlson, Astin and Freedman’s (2006) model of mindfulness explains the theory
underlying mindfulness and how MM may lead to improved psychological outcomes. They
argue that mindfulness relies on three axioms to bring about change. First, mindfulness
necessitates intention, specifically the bringing to mind of what is hoped for and expected to
be accomplished. Second, mindfulness requires attention, specifically the adoption of a present-
moment observation of arising stimuli, both internal, like thoughts and emotions, and external,
like sounds or images. Finally, mindfulness needs individuals to adopt an attitude, specifically
one of openness, affection, and kindness to oneself and whatever stimuli may be encountered,
no matter how seemingly unpleasant (Shapiro et al., 2006).
When practiced consistently, the three axioms can bring about a subtle shift in individuals,
labeled reperceiving. Reperceiving is a modification in perspective, whereby individuals are
able to move away from reacting to stimuli, positive and negative, internal and external, to
recognizing that stimuli previously viewed as “subject” can instead be viewed as “object.” With
this shift, stimuli become less offensive and distressing. For example, if a mindful adolescent
notices she feels angry, her previous reaction might have been to lash out, because the anger
was a distressing part of her very being. Through reperceiving, she now recognizes that the
anger is merely an object of her awareness and not part of her, and she no longer needs to react
emotionally. The anger is merely noticed, allowed its time, and then permitted to
dissipate. MM, often incorporated into more complex mindfulness-based interventions
(MBIs), includes substantial practice to help encourage reperceiving.
 SCHOOL MINDFULNESS AND ADOLESCENT WELL-BEING 3

MINDFULNESS-BASED INTERVENTIONS WITH ADOLESCENTS

Research on the use of MBIs with adolescents has increased dramatically in the past decade, although
the vast majority has taken place either with clinical populations or with small samples (Burke, 2010).
Participation in various MBIs has been related to improved interpersonal relationships (Sibinga et al.,
2011), improved sleep quality (Bootzin & Stevens, 2005; Britton et al., 2010), increased self-esteem
(Biegel, Brown, Shapiro, & Schubert, 2009; Zylowska et al., 2008), dispositional mindfulness (i.e.,
the characterological capacity to rest in a mindful state in everyday life; Tan & Martin, 2012), and
attention, compassion, and emotional reactivity (Saltzman & Goldin, 2008). Participation in MBIs
may also contribute to decreases in psychological inflexibility (Tan & Martin, 2012), hostility
(Sibinga et al., 2011), behavioral issues in adolescents with attention-deficit/hyperactivity disorder
(ADHD) (Zylowska et al., 2008), emotional reactivity (Saltzman & Goldin, 2008), emotional
disturbance, hopelessness, anxiety (Sinha & Kumar, 2010), impulsivity, externalizing symptoms
(Bögels, Hoogstad, van Dun, De Shutter, & Restifo, 2008), conduct disorder (Beauchemin,
Hutchins, & Patterson, 2008), and substance use (Bootzin & Stevens, 2005; Britton et al., 2010).

SCHOOL MINDFULNESS INTERVENTIONS AND RELEVANT OUTCOMES

Mindfulness programs may be particularly cost-effective for supporting youth in schools

(Wisner, 2013), where they already spend much of their time: up to seven hours per day,
around 180 days per year (U.S. Department of Education, 2003). Large-scale schoolwide
programs can have a widespread effect on a school’s adolescent populace, but such programs
require substantial buy-in from administrators, faculty, and students to be effective. In addition,
interested practitioners or researchers must navigate a wide range of logistics and interests to
find success.
While much of the previously described research was conducted within community centers
or with clinical populations, educators and researchers have more recently attempted to bring
MBIs to schools (e.g., Huppert & Johnson, 2010), often through curricula like Mindful Schools
(Biegel & Brown, 2010), Learning to BREATHE (Broderick & Metz, 2009), InnerKids (Flook
et al., 2010), and .b (pronounced “dot b”; Kuyken et al., 2013), the curriculum used in the
current study. The majority of such programs have been implemented with elementary age
children (Semple, Droutman, & Reid, 2017), and research with secondary school participants is
relatively uncommon. In addition, as a result of the complexities of implementing such
programs in a naturalistic secondary school setting, such as navigating unique student schedules
with multiple teachers, most of the research conducted in secondary schools is preliminary and
hampered by small single-classroom samples. Fortunately, studies with control classrooms that
consider key adolescent mental health outcomes, like perceived stress, are emerging.

Perceived Stress

Perceived stress is defined as an uncomfortable emotional experience that occurs in response to

an individual’s perception of an internal stressful event, such as test anxiety, or external
stressful event, such as the death of a loved one (Cohen, Kamarck, & Mermelstein, 1983).
Research on the impact of secondary school MBIs with perceived stress has been mixed.
4 CAMPBELL ET AL.

Edwards, Adams, Waldo, Hadfield, and Biegel (2014) found that a middle school MBI was
associated with decreases in perceived stress, although the program lacked randomization or
a comparison group. In a small (n = 48) controlled study, Lau and Hue (2011) found no
significant relationship between their program and stress. In contrast, a large controlled study
by Kuyken et al. (2013) found a significant relationship between their .b program and perceived
stress, but only at three-month follow-up. With a small noncontrolled sample, Eva and Thayer
(2017) found that adolescent participants experienced a statistically significant decline in
perceived stress after experiencing the Learning to BREATHE program. Despite the somewhat
inconsistent literature, we nonetheless hypothesized that the .b program in the current work
would have a positive effect on perceived stress. The mechanism of mindfulness theoretically
supports the notion that participation in the .b program should lead to declines in stress, through
the process of reperceiving, which would hypothetically lead to lower levels of distress from
formerly anxiety-provoking feelings (Shapiro et al., 2006). We also felt that the strengths of the
.b program in the current work—its large scale and the inclusion of a control group—might
ameliorate some of the issues found in the previously described research.

Subjective Well-Being

As with the effect on perceived stress, the limited research that has explored SWB in
a secondary school MBI has likewise been inconsistent, although generally positive. SWB
includes three core elements: life satisfaction, positive affect (PA), and negative affect (NA)
(Andrews & Withey, 1976). A range of studies has found that, in comparison with a control,
participation in an MBI program was associated with declines in negative affect, a key
component of well-being also studied in the current work (Andrews & Withey, 1976;
Broderick & Metz, 2009; Sibinga, Webb, Ghazarian, & Ellen, 2016). Sanger, Thierry, and
Dorjee (2018) found that in a small sample, participants experienced a significant improvement
in well-being, although the change was only marginally significant in comparison with control.
Kuyken et al. (2013) also found an improvement in well-being but only at the three-month
follow-up. Clearly, more research needs to be conducted on the possible effect of MBIs on the
SWB of adolescents, an issue we sought to address in the current work.

Emotion Regulation

ER refers to how individuals influence and respond to their emotions, often through such
particular strategies as expression and suppression (Gross, 1998). Although the effect of
secondary school MBI programs on perceived stress and SWB has been somewhat unpredict-
able, studies have consistently shown that such programs are related to improvements in ER.
Broderick and Metz (2009) found overall declines in problematic ER as well as specific
improvements in emotional awareness and clarity in adolescents who participated in school
MBIs when compared to those in a control group. Shahidi, Akbari, and Zargar (2017) also
found overall improvements in ER, with declines in rumination, catastrophizing, and blaming
of others, as well as increases in positive refocusing, positive reappraisal acceptance, planning,
and perspective taking. Sibinga et al. (2016) likewise found that participation in a mindfulness-
based stress reduction (MBSR) program was associated with decreases in rumination, negative
coping, somatization, and self-hostility. Researchers have also found that school MBIs have led
 SCHOOL MINDFULNESS AND ADOLESCENT WELL-BEING 5

to improvements in teacher-reported student ER, social emotional competence (Schonert-Reichl

& Lawlor, 2010), and personal growth (Lau & Hue, 2011). Gould, Dariotis, Mendelson, and
Greenberg (2012) found that urban youth describing low baseline depressive symptoms experi-
enced reductions in various problematic ER components, including involuntary engagement
and impulsive action, after an MBI program, relative to those in a control group, although those
high in baseline depressive symptoms did not. In a small sample, Fung, Guo, Jin, Bear, and Lau
(2016) likewise found that young adolescents who experienced a school MBI were significantly
less likely to use expressive suppression, a negative ER strategy, as a means to block their
emotions. Van der Gucht, Takano, Raes, and Kuppens (2018) found that participation in
a mindfulness program based on MBSR was associated with declines in cognitive reactivity,
a type of maladaptive emotional reaction, compared with those in a control group, at both
posttest and at follow-up (specific duration not stated). Qualitative research has also supported
that such programs may lead to improvements in self-awareness and self-regulation (Wisner &
Starzec, 2016), as well as improved emotional appraisals of self and others (Dariotis et al.,
2016) and improvements in self-regulation (Eva & Thayer, 2017).
Secondary school MBIs have also been shown to impact a range of other outcomes,
including a reduction of clinical symptoms of posttraumatic stress (Gordon, Staples, Blyta,
& Bytyqi, 2004; Sibinga et al., 2016), depression (Kuyken et al., 2013; Raes, Griffith, Van
der Gucht, & Williams, 2013; Van der Gucht et al., 2018), anxiety (Potek, 2011; Sibinga
et al., 2013; Van der Gucht et al., 2018), both internalizing and externalizing problems
(Fung et al., 2016), test anxiety (Shahidi et al., 2017), eating disorder symptoms, and
weight and shape concerns (Atkinson & Wade, 2015). Secondary school MBIs have also
been associated with increased levels of healthy physical activity (Salmoirago-Blotcher
et al., 2018), dispositional mindfulness (Edwards et al., 2014; Lau & Hue, 2011), improved
sleep quality (Bei et al., 2013), optimism, attention, and concentration, as compared with
control, as rated by teachers (although within pre- and early adolescents, a slightly younger
population; Schonert-Reichl & Lawlor, 2010). It is important to note, again, that many
studies of secondary school MBIs are often limited by small samples sizes (e.g., Bei et al.,
2013; Lau & Hue, 2011; Potek, 2011; Wisner, 2008), small control groups that make
comparisons difficult (Broderick & Metz, 2009), or lack of control groups (Gordon et al.,
2004) altogether. Thus, school-based MBI research tends to suffer from problems of
methodological rigor that temper claims and conclusions.

THE CURRENT STUDY

We sought to extend the available literature on school MBIs by studying a large-scale school-
wide MBI with treatment and control groups that would improve external validity, as well as
describe such a program as a case example for practitioners interested in running a secondary
school MBI in the future. Specifically, we collected data from a large sample and used a no-
treatment control group, although random assignment was not possible. We hypothesized that
participation in the secondary school MBI would lead to improvements in all psychological
outcomes, in comparison with the control group, including a decline in perceived stress and
improvements in SWB and ER.
6 CAMPBELL ET AL.

METHODS

Participants

We analyzed data collected by an organization that had a preexisting relationship with

a suburban Northeastern public high school. The organization worked with the school’s
administration and teachers to select full classes and their associated students to be part of
either the treatment group or control group. Students in the treatment group also had the option
of opting out of the program. A total of 1,007 participants completed pre- and posttest surveys
for all dependent variables, with 423 in the control group and 584 in the intervention group,
although missing data led to slightly varied sample sizes for each outcome. The sample was
49.5% male (n = 498) and 49.3% female (n = 496); two students (0.2%) identified as
transgender.1 In all, 69.9% of participants identified as White/Caucasian (n = 704), 10.4% as
Asian/Asian American (n = 105), 7.3% as multiple races (n = 74), 6.9% as Hispanic (n = 69),
2.5% as Black/African American (n = 25), and 2.1% as other (n = 21). Student ages ranged
from 13 to 19 (M = 15.96, SD = 1.17).

Measures

Perceived stress

We measured perceived stress with the Perceived Stress Scale (PSS; Cohen et al., 1983),
a 10-item self-report scale that assesses the level of stress individuals have experienced in
a timeframe set by the researchers. In the current study, participants selected how well each
item described their experience of stress from 0 (Never) to 4 (Very often) in the past month.
Total scores were created by summing the items, with higher scores indicating greater
perceived stress: scores of 0 to 13 are considered low, 14 to 26 moderate, and 27 to 40 high
in perceived stress (Cohen et al., 1983). Test-retest reliability has been high in the short term,
with r ranging from .85 to .91 (Cohen et al., 2002, 1983), and scale scores have shown good
reliability and validity with adolescent samples (Black, Milam, Sussman, & Johnson, 2012;
Glasscock, Anderson, Labriola, Rasmussen, & Hansen, 2013). Pretest internal consistency was
α = 0.87, while posttest was α = 0.88.

Subjective well-being

As noted, SWB includes three core elements: life satisfaction, PA, and NA (Andrews &
Withey, 1976). In the current study, we used PA and NA as indices of SWB, because research
has shown life satisfaction to be a highly stable concept unlikely to shift due to short-term
interventions. We assessed PA and NA with the International Positive and Negative Affect
Schedule—Short Form (I-PANAS-SF; Thompson, 2007), a 10-item self-report scale based on
the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988). The
I-PANAS-SF includes five items for PA and five for NA, each of which is an individual feeling
adjective (e.g., upset, determined). Individuals state how much they “normally” feel the
emotion, from 1 (Never) to 5 (Always), with PA and NA total scores ranging from 5 to 25
each, and higher scores indicating higher levels of PA and NA. Initial validation research
 SCHOOL MINDFULNESS AND ADOLESCENT WELL-BEING 7

showed Cronbach’s α = .78 for PA and α = .76 for NA. Thompson (2007) reported convergent
validity with Diener’s (1984) measure of SWB and Lyubomirsky and Lepper’s (1999) happi-
ness scale, as well as acceptable criterion-related validity (with gender) and cross-cultural
validity (Thompson, 2007). The scale has been validated with young adults but not yet
specifically with adolescents, but we deemed it appropriate for use due to its length and the
relative simplicity for adolescents to comprehend feelings adjectives, rather than have to
respond to more complex questions about SWB. We computed internal consistency and
found all Cronbach’s alphas to be acceptable for research purposes, with pretest and posttest
PA at α = 0.70 and 0.75, and NA at α = 0.72 and 0.72, respectively.

Emotion regulation

Given the complexity of the construct, there are a variety of means by which researchers
assess individual ER abilities. For the current work, we measured ER using three subscales
from the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). The DERS
is a 36-item questionnaire that uses a 5-point Likert-type scale ranging from 1 (Almost never
applies to me) to 5 (Almost always applies to me). The DERS is composed of six subscales,
discovered through factor analysis: limited access to ER strategies (eight items); lack of
emotional clarity (five items); nonacceptance of emotional responses (six items); impulse
control difficulties (six items); lack of emotional awareness (six items); and difficulties enga-
ging in goal-directed behavior (five items). Prior reliability data with adolescents were positive,
with intercorrelations ranging from r = .04 to r = .68, and each subscale showing adequate
internal consistency (α > .76; Weinberg & Klonsky, 2009). DERS scores have also demon-
strated acceptable convergent validity, with high correlations with similar scales, specifically
the Negative Mood Regulation (NMR) Scale (Catanzaro & Mearns, 1990). We used the last
three subscales due to their specific relevance to the adolescent population. We obtained pretest
Cronbach’s alphas of 0.88 and 0.87, 0.82 and posttest of 0.85, and 0.88 and 0.90, respectively.

Procedure

The local organization and the partnering school administration received parental consent for
students to participate in school programs and relevant research, including the mindfulness
program. Students provided verbal assent to participate in both the mindfulness program and
research, and they had the option to opt out of receiving the program. This third party then
conducted the program, and we analyzed the collected data to determine the effect of the
program on students in classes in the treatment group versus those in the control group.
The mindfulness program became a “rallying cry” and major point of pride for the school,
serving as a pilot for possible future initiatives. The program began with a full-school assembly
that included students and their families, as well as administrators, teachers, and staff. Speakers
highlighted the school’s intention of shifting the school to a “mindful” culture, which increased
buy-in from all parties. In establishing the program, the organization’s staff worked with the
school’s administration and teachers and selected English classes from grades nine through 12
for the control and treatment groups. Classes were conducted at the end of the year, and
teachers tailored their curricula to allow for this weekly gap in course content. The treatment
group received a six-week mindfulness program using the .b curriculum, a nonsectarian
8 CAMPBELL ET AL.

approach based on Jon Kabat-Zinn’s (1990) MBSR, while the control group received their
English curricula as usual. The .b curriculum consists of 10 program books and includes topics
such as “an introduction to sitting MM practice”; “mindful eating,” in which participants train
in increasing awareness of the various sensations of eating chocolate; “navigating the unsettled
mind”; “mindful body scans,” in which participants note the experiences of their various body
parts in a prone state; mind–body activities related to tai chi and yoga; mindfulness in the
context of feelings; and mindfulness training exercises for specific situations (The Mindfulness
in Schools Project, 2013). The overall goal is to encourage students to decrease reactivity to
negative emotions and thoughts. The program uses several pedagogical tools, including images,
film clips, and other multimedia to maintain the interest and engagement of its adolescent
participants. As of 2016, more than 4,100 teachers had been trained in the program (Kuyken
et al., 2013).
Trained volunteers and organization staff taught the program to the classes. Each volunteer had
led at least one MBSR program in the past and received a short weekend workshop on adapting
content for the adolescent audience with the new .b curriculum. Trainers were instructed to adhere
to the weekly program, but they were also allowed some flexibility by the organization in the
specific implementation of the program. For example, some trainers used longer meditations on
feelings, while others focused on body scans. Partner organization staff and volunteers coordi-
nated the data collection and collected the data using paper survey instruments in person during
classes the weeks before and after the six-week program was implemented.

Statistical Analysis

We used a set of analyses of covariance (ANCOVAs) to determine if there was a statistically

significant difference between the pre- and posttest score means for the two groups of
participants, control and treatment. All ANCOVAs included race/ethnicity, gender, and age as
covariates to remove the possible effects of these demographic variables.

RESULTS

Preliminary Analysis

We screened the data to ensure that the sample included only surveys completed seriously, and
eight surveys were removed due to the participants selecting the same answer for every item.
Table 1 contains means and standard deviations for pre- and posttests. For the main analyses,
we included all completed outcome subscales regardless of whether the student had missing
data in other subscales, which led to slightly different sample sizes for each subscale.
We tested a range of assumptions before undertaking the data analysis. When comparing
groups at baseline, there were no statistically significant differences for ER, SWB, or perceived
stress. We examined scatterplots to demonstrate normal distribution of the dependent variables,
and Levene’s test was not statistically significant for any outcome, showing homogeneity of
variance. Finally, we measured skew and kurtosis for all outcome measures, both pre- and
posttest. All measures had skew between −0.432 and 1.069, acceptably between Kim’s (2013)
 SCHOOL MINDFULNESS AND ADOLESCENT WELL-BEING 9

TABLE 1
Means and Standard Deviations for Pre- and Posttest Outcomes for Treatment and Control Groups

Treatment Control
Pretest Posttest Pretest Posttest

Scale M SD M SD M SD M SD

Perceived stress 18.57 6.81 17.25 6.94 17.84 7.14 17.44 7.29
Negative affect 12.20 3.15 11.75 2.98 11.92 3.29 11.69 3.24
Positive affect 17.81 3.01 17.82 3.17 18.01 3.19 17.93 3.25
Lack of emotional awareness 15.28 5.00 15.10 5.19 15.73 5.07 15.38 5.26
Difficulties engaging in goal-directed behaviors 15.44 4.98 11.64 4.85 14.95 5.14 11.32 4.95
Impulse control difficulties 11.74 4.97 15.61 5.15 11.60 5.04 15.17 5.48

TABLE 2
Interaction From 2 × 2 Analyses of Covariance (ANCOVAs)

Scale n F df2 p η2

Perceived stress 902 12.304 891 <.001* .014

Negative affect 961 2.582 950 .116 .003
Positive affect 959 1.858 948 .173 .002
Lack of emotional awareness 954 0.482 943 .488 .000
Difficulties engaging in goal-directed behaviors 959 0.023 948 .881 .000
Impulse control difficulties 955 0.039 944 .884 .000

*Significant at the 0.001 level (one-tailed).

benchmarks of −2 and 2, and kurtosis between −0.829 and 0.700, acceptable according to the
benchmarks of between −7 and 7 (Kim, 2013).

Effects of School MBI on Outcomes

We hypothesized that participation in the school MBI would lead to statistically significant
improvements in perceived stress, SWB, and ER in comparison with control. Table 2 shows
a summary of the results of the ANCOVAs run for the full sample. For perceived stress only,
the time by group was statistically significant, with F (1, 891) = 12.304, p < .001, η2 = .01. See
Figure 1 for a graph of the statistically significant effect on perceived stress means for each
group. For program participants, mean PSS scores dropped significantly, from 18.57 to 17.25,
while those in the control group stayed relatively level, from 17.84 to 17.44. Though statisti-
cally significant, these changes may represent only limited clinical or practical significance,
which we discuss further in the next section. The program’s effects were not significant for any
other outcome variables.
10 CAMPBELL ET AL.

19

18.5
PSS Mean Score

18
Treatment

17.5 Control

17

16.5
Pre-Test Post-Test
Data Collection Time

FIGURE 1. Change in pre- to posttest mean scores in perceived stress

for treatment and control.

DISCUSSION

Acknowledging the limitations associated with the naturalistic setting, the results of this study
provide support for the positive impact of secondary school MBIs on adolescent perceived
stress, and the study itself serves as a case for the use of large-scale programs implemented
within environs that adolescents frequent. We discuss how the current research provides
suggestions for future directions for improving our understanding of the mindfulness process.
The results showed a positive impact of the program on perceived stress, a noteworthy result
for such a large, schoolwide program. A decline in perceived stress seems a natural outcome of
experiencing an MM program, per Shapiro et al.’s (2006) mechanism of mindfulness. If the
practice of mindfulness leads to reperceiving, as hypothesized, stimuli previously deemed
stressful would now be perceived as less offensive and distressing. As a result, it seems natural
that PSS scores, which relate to how individuals cope with or become upset by outside
circumstances and irritations, would also decline after the completion of an MM program.
The .b modules on mindfulness of emotions and body scans would both specifically help
students learn to be less reactive to stimuli that previously created stress in the body and mind.
Though the results do represent a statistically significant decline in comparison with control,
the 1.32 point reduction in PSS scores (from 18.57 to 17.25) may represent only a limited
clinically significant change, with participants maintaining “moderate” levels of stress after
experiencing the program (Cohen et al., 1983). Similarly, the small effect, η2 = .01, is also
small enough that it demonstrates only minimal practical significance. Therefore, while the
statistically significant impact on perceived stress is noteworthy, we acknowledge the need for
caution in overestimating the clinical meaning of the results. In fact, this may continue the
pattern of relative inconsistency in understanding the relationship between school MM pro-
grams and adolescent stress (e.g., Lau & Hue, 2011). We hypothesize that the program’s limited
 SCHOOL MINDFULNESS AND ADOLESCENT WELL-BEING 11

practical and clinical effect on adolescent perceived stress was due to the multitude of variables
associated with the naturalistic school setting, including the training of the MM facilitators and
the fidelity of the program implementation, discussed further in the next section.
Regarding the other outcome variables, we were surprised that declines in participant NA
did not reach statistical significance, given that previous research supported this hypothesis
(Broderick & Metz, 2009; Sibinga et al., 2016). This lack of significant change in NA is
potentially reflective of mindfulness theory. It seems appropriate that an increased understand-
ing of mindfulness might lead to an increased awareness of all emotions, including negative
ones (Shapiro et al., 2006). It is possible that certain participants experienced the calming
effects of meditation, which led to a decrease in NA, while others experienced an increase in
emotional awareness, leading to an increase in the perception of NA. Combined, these
responses might lead to a net nonsignificant effect.
Finally, results showed that the program had no significant impact on ER. This result also
diverges from available research and is likewise unexpected, given a practical consideration of
how and why mindfulness programs work (Broderick & Metz, 2009; Schonert-Reichl &
Lawlor, 2010). We selected the DERS subscales based on their relevance to the adolescent
group, but they ultimately may not have described the particular strategies that were most
associated with mindfulness in adolescents. It is also plausible that the impact of MM on ER
strategies might take more time, either in terms of intensity of treatment (i.e., number of hours
of mindfulness practice), a hypothesis supported by past research (Carmody & Baer, 2008), or
simple passage of time. Shapiro et al. (2006) description of reperceiving, the larger modifica-
tion to perception that takes place with persistent mindfulness practice, highlights how this shift
may occur over extended mindfulness practice time. Perhaps while mindfulness practice can
lead to a relatively rapid shift in stress, shifts in ER might come about over months or years of
practice.

Limitations

The current study had a number of limitations, the majority of which were connected to the
practical difficulties associated with implementing the MM program in a school setting.
A primary concern was the use of various staff and volunteer trainers to teach the classes;
therefore, each trainer may have conveyed the material in a slightly different way. This issue
brings the fidelity of program implementation into question. It would have been much more
ideal if the organization had been able to establish a consistent protocol by which it was to
ensure that trainers had the same level of training in MM programs, and future research should
include fidelity of program implementation as a factor to consider in research design.
Despite our efforts to help respond to some of the perceived methodological issues in past
school MBIs, the school setting itself still led to a range of methodological challenges that need
to be addressed as we attempt to gain a better understanding of school MBI effectiveness with
adolescents. As mentioned previously, it was not possible to randomly assign the participants to
treatment and control groups, which would have been preferable, and would have allowed for
a full experimental design. In addition, the organization was not able to collect long-term
follow-up data because of the restrictions of the school schedule. Students in the control group
were also aware of the program being conducted in their school; therefore, this awareness may
have impacted their survey responses in some way. Similarly, practicalities of the naturalistic
12 CAMPBELL ET AL.

setting meant that some students were not available for the pretest, posttest, or both, all of
which would negatively impact the data (de Leeuw, Hox, & Dillman, 2008). These “unique”
elements led to a large portion of respondents having missing data: 36.3% of those involved in
the study and over 25% for most outcome measures. While the large sample meant that the
study’s power was still sufficient, analyses of the missing data showed that there were
differences in the demographics of participants with missing data and those without. For
example, the missing data included a larger percent of African American students than the
nonmissing data, perhaps because of systemic and structural issues associated with the experi-
ences of students of color and their history of marginalization that have hindered attendance
and limited education achievement (for example, experiencing longer commutes to school,
which would lead to increased absences due to weather). These results indicate that certain
groups were less likely to have completed pre- and posttesting, were not part of the analyses,
and therefore were less represented in the overall results.

Implications

The current study showed that a schoolwide MBI can have a positive impact on adolescent
perceived stress, and it also reveals a number of directions for future studies. Most simply,
future work should continue to explore the effectiveness of schoolwide programs in naturalistic
settings, while attempting to improve the research design through improved fidelity and
training of the mindfulness trainers. Future .b programs should continue to work to decrease
student stress, which could lead to larger positive effects on adolescent well-being. Various
research has demonstrated the link between adolescent stress and a range of negative academic
outcomes, including increased absences (Teasley, 2004), lower academic achievement, and
even dropout rates (Eicher, Staerklé, & Clémence, 2014), especially in male students (Hjorth
et al., 2016). Lower stress is also associated with improved school climate, and schoolwide
programs such as the one described in the current study could help create a sense of positive
school connection and also decrease stress, both of which support student achievement. Future
researchers and clinicians should explore the relationships between such programs, perceived
stress, and measures of student well-being and academic achievement.
There are other implications related to better understanding the relationship between mind-
fulness and ER. Given the lack of significant effects found on the various measures of ER, it is
plausible that ER plays a different role in the relationship between mindfulness and psycholo-
gical well-being than previously believed (Broderick & Metz, 2009) and should not necessarily
be viewed as an outcome. Perhaps emotional awareness, one of the employed DERS subscales,
might be better viewed as a component of mindfulness, or as a possible mediator, an idea
supported by Grabovac, Lau, and Willett (2011)’s Buddhist psychological model. Future
researchers could consider studying the impact of schoolwide programs on ER using the full
DERS or other scales that measure ER, such as the Emotion Regulation Questionnaire (Gross
& John, 2003). This would allow for measurement of other types of ER, like cognitive
reappraisal, that are potentially highly associated with the mechanisms of mindfulness.
Myriad other options also exist for future studies, particularly given the possibility of
including trait variables, like dispositional mindfulness (Brown & Ryan, 2003), in the context
of how MM or MBSR programs impact individuals. For example, are school MBIs more
effective for individuals who are high or low on dispositional mindfulness? While the survey
 SCHOOL MINDFULNESS AND ADOLESCENT WELL-BEING 13

used by the organization in the current study did not use an instrument to measure dispositional
mindfulness, the results of research using such a tool could help researchers understand how
participation in a school MBI interacts with participant dispositional mindfulness. This would
then allow for a fuller understanding of its relationship to various psychological outcomes, in
turn helping to more fully explain the mechanisms that underlie mindfulness.
The current study supports the growing body of research on the impact of mindfulness on
adolescent well-being and was unique in that it was a controlled study of a large-scale program.
The results showed that students who participated in the program experienced a statistically
significant decline in perceived stress as compared to those in the control group. The limited
practical or clinical significance may be associated with issues of fidelity in the implementation
of the program due to limitations of the naturalistic study. Future work should seek to address
these issues through randomization of students or classes into treatment and control groups and
improved consistency in training of the program’s facilitators.

DISCLOSURE STATEMENT

No potential conflicts of interest were reported by the authors.

Note
1. Totals are inconsistent because small numbers of participants chose not to provide certain demo-
graphic information.

ORCID

Andrew J. Campbell http://orcid.org/0000-0001-9805-8363

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