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Dr Lucy Foulkes

@lfoulkesy

Jul 13

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This is important: A carefully-designed, well-powered trial has found that teaching mindfulness in schools does not reduce depressive symptoms (CES-D), social-emotional-behavioural functioning (SDQ) or wellbeing (WEMWBS) in 11-13 year olds (N=8376) ebmh.bmj.com/content/early/…

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...

ebmh.bmj.com/content/early/…

School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD...

In fact, school mindfulness lessons resulted in *worse* depressive symptoms and wellbeing scores for those adolescents who had elevated depressive symptoms at baseline – although these decreases were small and not considered clinically meaningful

I was a postdoc on this trial 2015-2017. A huge amount of work went into doing this properly – this has been years in the making and involved many people across multiple institutions. There was a lot of hope that mindfulness skills might help, which is why this is so important

This doesn’t necessarily mean mindfulness is a bad idea/waste of time for adolescents. But it does suggest teaching mindfulness en masse in schools is the wrong approach, and might even cause harm for some (in 11-13 year olds at least, age may be the issue here)

Importantly, this trial adds to a small but growing body of research that indicates universal school MH interventions can lead to an *increase* in internalising symptoms. (universal = teach MH skills all students; targeted = teach smaller group considered to be in need)

eg pubmed.ncbi.nlm.nih.gov/35474211/

Antibullying interventions have a small impact on reducing internalizing symptoms. Ongoing development of antibullying interventions should address how best to maximize their impact on internalizing...

pubmed.ncbi.nlm.nih.gov/35474211/

Research Review: Do antibullying interventions reduce internalizing symptoms? A systematic review,...

Antibullying interventions have a small impact on reducing internalizing symptoms. Ongoing development of antibullying interventions should address how best to maximize their impact on internalizing...

I say this cautiously, but I am increasingly sceptical about whether universal school interventions are the right way to deal with adolescent MH problems. Universal makes a lot sense on paper – it’s fair, ‘everyone has mental health’ etc…

..but the data so far show that when universal interventions work, the effect sizes are really small (eg below), and they often don’t work at all. Or sometimes they even increase problems pubmed.ncbi.nlm.nih.gov/34571372/

Even if universal interventions ‘only’ don’t work, that’s a problem because it’s an opportunity cost—time that adolescents spend doing the intervention is time they are not doing something else that might help more

There is obviously a major problem with adolescents who need more MH support, and schools are the obvious place to offer it. It’s great to see this work carefully examining (one) universal approach

Next steps IMO = we either need to improve the content of the universal interventions, or change approach entirely (just work on targeted interventions)

Dr Lucy Foulkes

@lfoulkesy

Psychologist @UCLPALS (soon @OxExpPsy) exploring how we talk about mental health and illness

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