School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial?, 2022, Montero-Marin et al

John Mac

John Mac

Senior Member (Voting Rights)
Abstract here
Links to related MYRIAD papers here


Giving teenagers mindfulness lessons at school to boost wellbeing is largely a waste of time, a major UK study has found.

The technique, which encourages people to meditate and live in the moment, was no better than what schools were already doing for mental health.

Many pupils were not that interested in using the method, calling it "boring".

Hundreds of teachers and thousands of pupils at 85 different secondary schools took part in the experiment.

Researchers say the results, which are published in a journal called Evidence Based Mental Health, are disappointing, but useful.

It suggests that even though mindfulness may still help some pupils, offering it universally at schools is doomed to fail.

Other interventions that might help, like tackling deprivation and giving more targeted mental health support, should be explored, they recommend.

What is mindfulness?
It's an approach that aims to help people focus on what is actually happening, rather than worry about what has happened or what might happen.

Advocates say it can help people enjoy life more and understand themselves better, rather than getting caught up in harmful, negative thoughts.

The school pupils were given a course of mindfulness lessons during a school term. They were also asked to continue the technique at home - but very few did.

Co-researcher Prof Mark Williams, from Oxford University, said that, on average, pupils only practised mindfulness once over the 10-week course.

"That's like going to the gym once and hoping you'll get fit," he said. "But why didn't they practise? Many of them found it boring."

Many of the teachers, meanwhile, said they had found the mindfulness training useful for their own wellbeing.

Dr Dan O'Hare from the British Psychological Society said: "It is important not to view mindfulness sessions as a panacea, and as an 'off the shelf' product that can just help teenagers and their teachers to become 'more resilient', without appreciating all the other influential factors, such as the school environment.

"We also cannot ignore the fact that teenagers and teachers have gone through an incredibly difficult two years, and given the circumstances in which we are living, and the stressors this brings, it perhaps isn't completely surprising that the cohort in the studies didn't see a huge uplift in their wellbeing."

Dr Julieta Galante, from Cambridge University, said the research showed the importance of gathering evidence to find out if an intervention really works: "The mindfulness-based programme tested in this study had been thought to be effective based on a few small studies, and had already begun to be implemented in some schools. But we need to be very sure of benefit before rolling out any universal health intervention."

Prof Stella Chan, an expert at the University of Reading, said: "The findings do not completely rule out the potential of mindfulness-based therapy for young people; as in any therapy, it works for some people but not all. The important questions are who can benefit from it, when and how."
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https://www.bbc.co.uk/news/health-62126567
 
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"Other interventions that might help, like tackling deprivation and giving more targeted mental health support, should be explored, they recommend."

So, trying to resolve the negative situations that pupils might be in, rather than trying to get them to think positively about them, might be more useful? Unfortunately that will cost more, so probably won't happen.
 
MSEsperanza said:
Science Media Centre:

https://www.sciencemediacentre.org/...s-are-seeking-experimental-treatments-abroad/

Speaker of the briefing:

https://www.sciencemediacentre.org/...young-people-results-from-the-myriad-project/

(I'm curious but not managed to read yet)
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I think @MSEsperanza you might have mixed up the links in your post. The first is to an unrelated study, and I assume you intended to include instead the link to the actual comments, see https://www.sciencemediacentre.org/...ulness-training-in-adolescents-aged-11-to-14/
 
A most telling quote: "This is disappointing as there had been some hope for an easy solution" * I think that quote is revealing of the enthusiasm for this kind of intervention at the political level. Easy = cheap, and that is a defining attitude to children and young people in the UK.

*Professor Dame Til Wykes
 
What's amazing about all of this is that psychology and psychiatry went through a decades-long phase working with militaries and other awful agencies to brainwash people for nefarious ends, like trying to train people to be super soldiers incapable of remorse (although that alarmed wise people in militaries who understand that a remorseless killer doesn't make for a good soldier). And found out that it's not possible, doesn't work.

And since then they turned into the idea of doing the same for positive ends. And it's working just as well. Why would any of this nonsense work in the first place? There is literally no basis other than a generic "it would be interesting/awesome/terrifying if we could do this".

This childish nonsense can't come to a sudden a brutal end soon enough. It will take at least a full generation to repair the reputational harm done to medicine with this, but until then we'll go through an even stupider phase where this stuff is prescribed just because, along with power poses and museum visits and a bunch of other dumb things.

There's a solid chance that almost all behavioral sciences are a bunch of nonsense all the way through. They are stuck at magical thinking, that never goes well, never produces anything useful.
 
What is mindfulness?
It's an approach that aims to help people focus on what is actually happening, rather than worry about what has happened or what might happen.
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'worry'

And that is how you spin normal, healthy, ongoing and necessary integration of the past, present, and future, into simplistic pathology.

The past matters, the present matters, the future matters, concurrently, all the time.
 
I thought Dr Galante's quote was worth posting in full, from the SMC material linked by MSEspe. I liked the recognition of the importance of follow-up outcomes.
Dr Julieta Galante, NIHR Postdoctoral Fellow and Senior Research Associate, University of Cambridge, said:

“This work shows the importance of large well-designed randomised trials to assess health interventions before any large-scale universal roll out. The mindfulness-based programme tested in this study had been thought to be effective based on a few small studies, and had already begun to be implemented in some schools. But we need to be very sure of benefit before rolling out any universal health intervention because the opportunity cost of implementing ineffective interventions can be high. For example, instead of investing their time in the .b programme, teachers and children can in the future invest that time in more effective programmes. New programmes need to be developed and tested using best practice, and mindfulness training may or may not be part of them. Large, well-designed trials also save taxpayers’ money in the long-term and avoid potential large-scale harm.”
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“The study also shows the importance of measuring follow-up outcomes, say after a year, rather than just measuring them right after the intervention ends – when more biases can be at play and fleeting benefit could be confused with long-term benefit.”
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Professor Dame Wykes, (she of the ' easy solution' comment) said:
Professor Dame Til Wykes, Head of the School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London (IoPPN), said:
...
“The one optimistic aspect of the study was its positive effects on teachers. One might speculate that this is because the techniques were beneficial personally for the teachers or that they were pleased to have some intervention to offer their students.”
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Techniques beneficial personally for the teachers - well I guess the course of mindfulness techniques provided during school time meant that the teachers had a break from teaching, and could go have a cup of tea in the staff room or go home early. So, not surprising that the teachers liked it.

rvallee said:
This childish nonsense can't come to a sudden a brutal end soon enough. It will take at least a full generation to repair the reputational harm done to medicine with this, but until then we'll go through an even stupider phase where this stuff is prescribed just because, along with power poses and museum visits and a bunch of other dumb things.
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'Childish' doesn't seem the right adjective, because the 11 to 14 year olds seem to have had no problem identifying this course as a waste of time and letting people know that's what they thought. The nonsense is a near opposite of childish - maybe 'patronising', 'manipulative' ....

I rather liked museum visits.
 
Here is the actual study.

School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial?, 2022,Montero-Marin et al

Abstract

Background Preventing mental health problems in early adolescence is a priority. School-based mindfulness training (SBMT) is an approach with mixed evidence.

Objectives To explore for whom SBMT does/does not work and what influences outcomes.

Methods The My Resilience in Adolescence was a parallel-group, cluster randomised controlled trial (K=84 secondary schools; n=8376 students, age: 11–13) recruiting schools that provided standard social–emotional learning. Schools were randomised 1:1 to continue this provision (control/teaching as usual (TAU)), and/or to offer SBMT (‘.b’ (intervention)). Risk of depression, social–emotional–behavioural functioning and well-being were measured at baseline, preintervention, post intervention and 1 year follow-up. Hypothesised moderators, implementation factors and mediators were analysed using mixed effects linear regressions, instrumental variable methods and path analysis.

Findings SBMT versus TAU resulted in worse scores on risk of depression and well-being in students at risk of mental health problems both at post intervention and 1-year follow-up, but differences were small and not clinically relevant. Higher dose and reach were associated with worse social–emotional–behavioural functioning at postintervention. No implementation factors were associated with outcomes at 1-year follow-up. Pregains−postgains in mindfulness skills and executive function predicted better outcomes at 1-year follow-up, but the SBMT was unsuccessful to teach these skills with clinical relevance.

SBMT as delivered in this trial is not indicated as a universal intervention. Moreover, it may be contraindicated for students with existing/emerging mental health symptoms.

Clinical implications Universal SBMT is not recommended in this format in early adolescence. Future research should explore social−emotional learning programmes adapted to the unique needs of young people.

https://ebmh.bmj.com/content/early/2022/07/07/ebmental-2022-300439
 
So not only was it unsuccessful in reducing mental health problems, it actually made things worse for those with existing mental health problems. That's pretty damning. I suspect mindfulness training can also make situations worse for adults with mental health problems.
 
Andy said:
Here is the actual study.

School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial?, 2022,Montero-Marin et al
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From the SMC's covering:


A series of 7 papers, including 2 perspective pieces are being published as a special edition of Evidence-Based Mental Health:

‘Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial’ by Willem Kukyen et al.
DOI: 10.1136/ebmental-2021-300396

‘Effectiveness of universal school-based mindfulness training compared with normal school provision on teacher mental health and school climate: results of the MYRIAD cluster randomised controlled trial’ by Willem Kukyen et al.
DOI: 10.1136/ebmental-2022-300424

‘School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial?’ by Jesus Montero-Marin et al.
DOI: 10.1136/ebmental-2022-300439

‘The impact of mindfulness training in early adolescence on affective executive control, and on later mental health during the COVID-19 pandemic: a randomised controlled trial’ by Daren Dunning et al.
DOI: 10.1136/ebmental-2022-300460

‘Do mindfulness-based programmes improve the cognitive skills, behaviour and mental health of children and adolescents? An updated meta-analysis of randomised controlled trials’ by Daren Dunning et al.
DOI: 10.1136/ebmental-2022-300464

(Perspective) ‘Universal prevention of depression at schools: dead end or challenging crossroad?’ By Pim Cuijpers
DOI: 10.1136/ebmental-2022-300469

‘How can we optimise learning from trials in child and adolescent mental health?’
(Perspective) by Nick Axford et al.
DOI: 10.1136/ebmental-2022-300500

Edit: See also https://myriadproject.org/publications/ for clickable URLs (directing to PDFs)
 
Trish said:
So not only was it unsuccessful in reducing mental health problems, it actually made things worse for those with existing mental health problems. That's pretty damning. I suspect mindfulness training can also make situations worse for adults with mental health problems.
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This is interesting, people cherry pick from eastern religions, with yoga, meditation and mindfulness being prime examples but ignore much of the original context including things like contraindications.

Though mindfulness is primarily lifted from Buddhism, it is not unconnected to meditation techniques that developed as part of classical yoga, where mental health issues were seen as a clear contra indicator for meditation. I am aware of a number of anecdotes of mental breakdowns triggered by mindfulness meditation techniques and I believe it should only be taught by someone who understands what can go wrong and how to deal with such outcomes. However in the commoditising of mindfulness it is seen something that can be taught by a technician and something that is a go to for people with mental health issues without any real understanding of how the two may interact.
 
Honestly the most surprising thing about this is that they accepted the results. Not that those results are reliable, there is no reliable way to assess mental health or the impact of such an intervention, either way, but they're deviating from the script here, although the "benefits the teachers by giving them free time off" is kind of the same as pointing at secondary measures that can be spun as positive.

I wonder why they accept failure here. They usually simply pretend that whatever benefit they want is still there. Probably over budgets, someone actually wanted to know whether it's worth the expenses before committing them. Those budgets would come out of educational budgets, not healthcare, and they aren't as reckless over this stuff.

But it says a lot, that an accepted definition of mental health is basically: don't worry, be happy. As if it's normal for people to be gullible idiots always chasing a high somewhere, walking across the street without ever stressing over whether there are cars on the way. That's actually awful and basically goes against human nature.
 
Trish said:
So not only was it unsuccessful in reducing mental health problems, it actually made things worse for those with existing mental health problems. That's pretty damning. I suspect mindfulness training can also make situations worse for adults with mental health problems.
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For many with anxiety and other mental health issues distraction is a coping mechanism.
Focusing on the moment , or on something in particular can make things worse.( Similar to if you are in pain )

some types of yoga are not recommended for those with some forms of depression.
Some with autism can find these therapies harmful too.

CBT can also be disastrous for some mental health conditions.

Harms are rarely acknowledged - it's good to see it reported here.
 
Professor Dame Til Wykes, Head of the School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London (IoPPN), said:
...
“The one optimistic aspect of the study was its positive effects on teachers. One might speculate that this is because the techniques were beneficial personally for the teachers or that they were pleased to have some intervention to offer their students.”
Click to expand...
:facepalm:
 
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