About this paper symposium

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Panel information
Panel 16. Prevention and Interventions

Paper #1
Mindfulness Stress Buffering in Adolescence: A Meta-analysis and Theoretical Integration of Existing Research
Author information	Role
Jill T. Krause, Colorado State University, United States	Presenting author
Rachel G. Lucas-Thompson, Colorado State University, United States	Non-presenting author
Megan J. Moran, Colorado State University, United States	Non-presenting author
Abstract
Background: Mindfulness is theorized to improve health and wellbeing through supporting more adaptive responses to stress and thereby buffering the negative effects of stress on health (Creswell & Lindsay, 2014). In adults, this mindfulness stress buffering hypothesis is well-supported by empirical evidence (Adams et al, 2015; Bergin & Pakenham, 2016; Tomlinson et al., 2018). However, evidence is much more mixed in adolescents, for whom meta-cognitive capacities that support mindfulness are still developing (Goodman et al., 2017). The goal of this project was to perform the first systematic investigation of existing evidence for the tenants of the mindfulness stress buffering hypothesis in adolescents (10-25 years, Steinberg, 2014). Methods: This preregistered systematic review and meta-analysis quantified the effects of both trait mindfulness (i.e., untrained) and mindfulness-based intervention on psychological, behavioral, and physiological indicators of stress in adolescents. In total, 695 effect sizes across 167 studies (N=58,109) were included. Results: Three-level meta-analysis models were conducted, and revealed significant negative associations of mindfulness with perceived stress, emotion reactivity, and stress appraisals, and a significant positive association with distress tolerance. Effect sizes were medium for perceived stress (r=-.29), and small for emotion reactivity (r=-.14), stress appraisals (r=-.14), and distress tolerance (r=.10). Mindfulness was not significantly related to physiological indicators of baseline/diurnal stress, stress reactivity, or stress recovery. However, results also showed that mindfulness was a significant moderator of stress on mental, physical, and behavioral health outcomes, and the effect was trivial-to-small (r=-.08). Moderation analyses showed mixed patterns of findings depending on study and sample characteristics. Moderators of intervention characteristics suggested important ways to modify interventions to promote efficacy in future work. Conclusions: Findings from this meta-analysis provide a valuable overarching view of the state of the evidence on the association between mindfulness and stress in an age group that is particularly vulnerable to stress and its adverse health effects. Main effects underscore the potential of mindfulness for mitigating stress directly, as well as buffering its deleterious health consequences. Moderation results highlight key considerations for the field of mindfulness research in adolescents related to measurement and study design, as well as gaps in terms of relatively understudied subgroups.

Paper #2
Associations of Momentary Mindfulness and Emotion Regulation and Moderating Effects of Mental Health among Adolescents
Author information	Role
Reagan L. Miller, Colorado State University, United States	Presenting author
Mark Prince, University of Southern California, United States	Non-presenting author
Shelley Haddock, Colorado State University, United States	Non-presenting author
Toni Zimmerman, Colorado State University, United States	Non-presenting author
Abstract
Introduction: Greater mindfulness is thought to give rise to more positive psychological health among adolescents through the promotion of adaptive emotion regulation. While there is extensive evidence linking higher average levels of mindfulness to higher average levels of emotion regulation, and research suggests that both mindfulness and emotion regulation are dynamic processes that evolve over time, less is known about the moment-to-moment patterns occurring within individuals. Additionally, it is unclear if the mindfulness-emotion regulation relationship changes as a function of adolescents’ mental health status. The current study sought to fill these gaps in the literature by investigating the between- and within-person concurrent (same moment) and prospective (next moment) effects of mindfulness on emotion regulation among adolescents exposed to chronic stressors. This study also explored the moderating effects of mental health symptoms. Hypotheses: We expect that between- and within-person mindfulness will be inversely associated with concurrent and prospective reports of emotion regulation difficulties. In addition, we hypothesize that individuals with greater mental health challenges will experience a diminished effect between mindfulness and emotion regulation concurrently and prospectively. Method/Population: Eighty-one participants who were 10-18 years old (M=14.33; SD=2.20; 56% male; 57% Non-Hispanic White) completed ecological momentary assessments (EMA) three times a day for seven days and contributed a total of 1,186 EMA reports. Results: Multi-level structural equation modeling revealed that between- and within-person mindfulness was inversely associated with concurrent and prospective emotion regulation difficulties. Mental health symptoms, namely post-traumatic stress disorder (PTSD) and internalizing symptoms, also moderated concurrent within-person associations. Individuals with higher PTSD and internalizing symptoms experienced the greatest benefit to emotion regulation difficulties during moments of greater than average mindfulness. However, from one moment to the next, greater than average mindfulness in one moment (T1) was associated with greater than average emotion regulation difficulties in the next moment (T2) for individuals with high PTSD. In other words, while mindfulness had immediate momentary benefits for emotion regulation, these benefits did not extend prospectively for individuals with significant mental health challenges. Discussions: Results of this study carry meaningful implications for just-in-time interventions as they highlight that greater momentary mindfulness may be most beneficial for emotion regulation within the same moment for adolescents with significant mental health difficulties. Additional implications and future directions will be discussed.

Paper #3
Barriers and Facilitators to Adolescent Engagement in a Mindfulness-based Intervention
Author information	Role
Megan Moran, Colorado State University, United States	Presenting author
Rachel G. Lucas-Thompson, Colorado State University, United States	Non-presenting author
Talia Thompson, University of Colorado Anschutz Medical Campus, United States	Non-presenting author
Addie Rzonca, Colorado State University, United States	Non-presenting author
Lauren B. Shomaker, Colorado State University, United States	Non-presenting author
Abstract
Background: Mindfulness-based intervention (MBI) has been associated with positive health outcomes in adolescents; however, effects tend to be small, and findings have been inconsistent. Engagement, or the cognitive-behavioral and emotional processes that indicate productive involvement with an activity, is likely important for MBI efficacy. Importantly, research suggests that requiring adolescents to participate in MBI when they do not engage offers no benefit and may exacerbate existing mental health concerns. This exploratory qualitative interview study identifies barriers and facilitators to adolescent engagement in MBI. Methods: Interviewers conducted semi-structured interviews with N=25 adolescents who participated in a 6-week group MBI. Interview schedules were developed to capture adolescents’ subjective, qualitative experience of engaging in MBI. Using reflexive thematic analysis, data were reduced through coding, categorization, and development of themes. Results: One set of themes related to emotional engagement (i.e., the extent of positive affective response): “Feelings of calm, interest, and relaxation support and sustain participation,” “Tiredness and boredom impede engagement,” and “Deeper interpersonal connection between participants may increase engagement.” Another set of themes related to cognitive-behavioral engagement (i.e., effortful participation): “Stress reduction motivates adolescents to engage,” “Busy teens struggle to sustain full participation,” and “Home practice reminders and tools are welcome and necessary.” Results include direct quotes to highlight voices of adolescents with a range of MBI engagement experiences. Conclusions: Findings identify key barriers and facilitators to adolescent engagement in a group MBI program. They also reveal potential opportunities for optimizing adolescent MBI to increase engagement, including considerations related to content, facilitation, and providing support outside of group sessions.

Paper #4
A Mindfulness-Based Intervention integrating In-Person and Mobile App Programming for Adolescents with Conduct Problems
Author information	Role
Timothy F. Piehler, University of Minnesota, United States	Presenting author
Rachel G. Lucas-Thompson, Colorado State University, United States	Non-presenting author
Nicole Morrell, University of Minnesota, United States	Non-presenting author
Abstract
Introduction: Existing interventions for adolescent conduct problems, such as aggression, defiance, and violence, are resource intensive and have limited effectiveness for many youth (Bakker et al., 2016). Mindfulness-based interventions (MBIs) have been demonstrated to improve underdeveloped self-control, a key risk factor underlying adolescent conduct problems (Chambers et al., 2008). However, MBIs have not been previously investigated for their effectiveness for adolescents with conduct problems. Many youth who participate in MBIs struggle to apply new mindfulness skills in their daily lives, particularly during times of stress, limiting program effectiveness (Lucas-Thompson et al., 2019). The integration of mobile apps with in-person interventions has been proposed as a promising synergistic strategy, with in-person programming supporting engagement and motivation to develop new skills and apps facilitating integration and practice of skills in daily life (Satre et al., 2021). We sought to investigate the feasibility and acceptability of delivering an existing evidence-based, face-to-face MBI, Learning to BREATHE (L2B) augmented with a newly developed, integrated mobile app (L2B+App) to adolescents with conduct problems. Methods: We first completed a multiphase, stakeholder-engaged effort to develop a mobile app designed to augment the 6-session face-to-face L2B intervention. This process involved a series of co-design workshops with adolescents who recently completed standard L2B (n = 10) in which they generated designs for an app to support L2B. Next, using a preliminary version of the app, we piloted the combined in-person L2B and app intervention (L2B+App) with a small group of young adults (n = 5) in order to generate feedback and refine app functioning. Finally, we recently launched a high school-based pilot trial of the L2B+App intervention with adolescents (n = 10) displaying mild to moderate conduct problems. Weekly surveys and focus groups will evaluate participant and facilitator impressions of the feasibility and acceptability of L2B+App. Results: Our app development process yielded an app that was responsive to stakeholder feedback and carefully integrated with the L2B program. Key features of the app include 1) a searchable library of mindfulness practice guides in text, audio or video; 2) daily messages supporting motivation and self-efficacy in completing mindfulness practices aligned with weekly L2B themes; 3) daily stress assessments that trigger suggested mindfulness activities for elevated stress. The preliminary pilot with young adults yielded strong feasibility and acceptability results, with all participants describing the app as easy to use, a good fit with face-to-face L2B programming, and helpful in supporting their mindfulness practice in daily life. The school-based pilot of L2B+App with adolescents with conduct problems is currently ongoing with results expected in late fall of 2024. Conclusions: Our iterative, stakeholder-engaged design process yielded a promising mobile app that will augment delivery of in-person L2B. Our pilot study will produce important feasibility and acceptability data for the use of an MBI augmented with a mobile app in a novel population of adolescents with conduct problems. This approach has the potential to innovate our delivery of MBIs with adolescents and accelerate the development of novel intervention approaches for adolescent conduct problems.

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