Effect of a Nurse-Led Mindfulness Intervention with At-Risk Adolescents: A Randomized Control Trial

Purpose:

At-risk behaviors are related to poor outcomes among adolescents. Increasing evidence supports adolescence as a vital time to introduce stress reduction techniques to reduce risk and improve mental health.  The purpose of the current study was to  implement and evaluate a mindfulness based intervention for at-risk adolescents in a randomized control pre-test, post-test design with an attentional comparison group.

Methods:

Participants were sixth grade female students from a public boarding school for at risk youth in Maryland. After informed consent by parents and signing assent, students (N=23) were randomized by dormitory to participate in the mindfulness (MC) group (n=12) or the attentional comparison group (n = 11) once per week for 6 weeks. MC sessions were led by an investigator trained in mindfulness techniques and curriculum. A nurse led the attention only group.  Baseline evaluation consisted of demographics plus outcome variable tools administered before and after the program:  coping (Response to Stress Questionnaire, RSQ), positive affect (10 item Positive and Negative Affect Scale for Children, PANAS-C) and mindfulness (Mindfulness Attention Awareness Scale, MAAS). Statistical analysis was performed using SPSS version 20. Qualitative methods were used to analyze participatefeedbak and evaluation of the program.

Results:

There were no statistically significant differences between the two intervention groups at baseline. Twenty-two of 23 (95.7%) enrolled participants completed the interventions. Participants completed 86.4% of study measures. In separate repeated measures analyses of variance for each outcome, there were no significant interactions between group and time for primary coping [F(1,17)=0.48,p=0.498], positive affect [F(1,17)=1.285,p=0.273],  or mindfulness [F(1,17)=0.492,p=0.493].  Positive affect increased significantly [F(1,17)=10.675,p<=0.005], mindfulness scores increased [F(1,17)=3.117,p=0.095], and primary coping [F(1,17)=0.15,p=0.903] did not change over time. 

Conclusion:

The study demonstrated excellent feasibility for MC in this at risk population.  The most important limitations are the size of the sample, potential for intervention cross contamination,  homogeneity of the sample, and timing at the end of the school year all limiting the generalizability of the findings.  Group interventions were effective at improving mindfulness and positive affect.  Implications for nursing practice suggest mindfulness can be a part of reducing risks and improving mental health. Diverse and larger samples with longitudinal measures may guide best practices in using mindfulness with at risk adolescents going forward.