Co-Principal Investigators: Patricia Broderick and Jennifer Frank

Purpose: The demands and risks of adolescence often lead youth to make poor decisions that negatively affect their mental health and academic engagement and achievement. The sheer number of challenges adolescents face in navigating this developmental stage may overwhelm their available cognitive and emotional resources, especially for those who have experienced less than optimal conditions in infancy and childhood. At the same time, attention and emotion regulation skills are developing during adolescence, with accompanying changes in brain regions that support executive functioning. Teaching adolescents mindfulness practices may strengthen their attention, executive function, and emotion regulation skills that in turn should improve their academic and social functioning. The purpose of this study is to a integrate mindfulness practices and teachings into the regular high school health curriculum by completing the development of the Learning to BREATHE (L2B) program, a curriculum intended to facilitate the development of attention and emotion regulation skills within the context of public high school health classes. In addition, a training program for teachers and school counselors to deliver the program will be developed along with materials to support the program’s implementation.

Project Activities: The research is divided into three phases. In the first phase, a complete measurement protocol for evaluating intervention fidelity, quality, and efficacy will be developed and teachers will be trained to be mindfulness facilitators. The second phase will involve implementation, evaluation, and refinement of L2B and pilot testing of the measurement protocol over the course of three high school semesters. After each presentation (four classes per semester), the program will be revised in response to ongoing evaluation to support its integration into the school’s health curriculum. In the final phase, students in two high schools will be randomly assigned to health classes that include L2B or offer the typical health curriculum. Student assessments will include measures of emotion regulation, executive function, and academic performance.

Products: The products of this project include a mindfulness curriculum to be delivered in high school health classes called the Learning to BREATHE (L2B) program, a training manual for teachers and school counselors to deliver the intervention, and a participant workbook. Products also include measures of program fidelity and quality and evidence of the L2B program’s promise for enhancing emotion regulation, executive functioning, and academic performance in high school students. Peer reviewed publications will also be produced.

Structured Abstract

Setting: This project will take place in suburban Pennsylvania.

Sample: Approximately 320 11th grade students and their health class teachers and school counselors from two high schools.

Intervention: The Learning to BREATHE (L2B) program tailors mindful awareness practices to the developmental needs of adolescents. Program goals include helping students understand their thoughts and feelings, learning mindfulness tools for managing distressing or painful emotions, and providing opportunities to practice these skills in a group setting. Six themes are built around the BREATHE acronym: (B for Body) body awareness, (R for Reflections) understanding and working with thoughts, (E for Emotions) understanding and working with feelings, (A for Attention) integrating awareness of thoughts, feelings and bodily sensations, (T for “Take it as it is”) reducing harmful self-judgments, and (H for Healthy Habits of Mind) cultivating positive emotions and integrating mindfulness into daily life. The overall goal of the program is to cultivate emotional balance and inner empowerment (E) through the practice of mindfulness. The L2B intervention utilizes a common structure to introduce the six themes over 12 class sessions: introduction and discussion of the session theme; group activity that supports comprehension and personal understanding of the theme; and a period of mindfulness practice that relates to the theme. In addition, a homework assignment is provided for each session to reinforce understanding and practice. A student workbook allows students to record their experience with meditation practice and contains helpful tips for bringing mindfulness into daily life.

Research Design and Methods: During the initial phase of this project, the research team will develop a complete measurement protocol for evaluating intervention fidelity, quality, and efficacy. Concurrently, teachers will be trained to be mindfulness facilitators. As the team moves into the second phase of the research project, L2B will be integrated into health classes over three semesters. Each implementation of the intervention will be carefully documented and the timing and duration of each component will be recorded and analyzed. The researchers will supervise the lead teacher who will present L2B in these classes and facilitators-in-training (other teachers and/or the school counselor) will co-teach and/or observe and record their observations of the program using the first draft of the fidelity measure. Post-intervention program evaluations involving questionnaires, student interviews, teacher focus groups, and assessments of students’ emotion regulation and executive function will be conducted to assess feasibility, program quality and fidelity, attractiveness, students’ and teachers’ impressions of effectiveness, and changes in emotion regulation and executive function. After each implementation, evaluation data will drive intervention and measurement protocol modifications. In the final year of the study, 11th grade students will be randomly assigned to health classes that integrate L2B into the standard health curriculum or that conduct health class instruction as usual in order to determine the promise of the intervention for improving student outcomes.

Control Condition: Students in the control group will experience the typical high school health curriculum in the district.

Key Measures: Students will complete self-report measures of emotion regulation including the Ruminative Response Scale, the Positive and Negative Affect Schedule (PANAS), the Somatization Index of the Child Behavior Checklist, the Difficulties in Emotion Regulation Scale, the Regulation of Emotions Questionnaire, and the Risky Behavior Survey. Students’ will also complete the Attention Network Test (ANT) and The Stroop Task to measure executive functioning. The researchers will also collect students’ grades, attendance, and standardized test scores from school records.

Data Analytic Strategy: Interview and focus group data will be transcribed and analyzed iteratively throughout data collection using the constant comparative method. Researchers will use selective coding based on expected outcomes. Using these criteria, researchers will compare students’ pre- and post-program responses as well as teacher focus group responses. If warranted by the data, researchers will conduct a negative case analysis to explore data that do not conform to the theoretical relationships present in other data. Inter-rater reliability will be calculated using a percent agreement process for computing consensus. To compare treatment and control conditions in the final study of promise, the researchers will use analysis of covariance procedures controlling for baseline characteristics and other covariates indicated by group differences in pre-test variables. Student gender and age will be examined as potential moderators of L2B impact.

Products and Publications

Journal article, monograph, or newsletter

Broderick, P.C., Frank, J.L., Berrena, E., Schussler, D.L., Kohler, K., Mitra, J., ... and Greenberg, M.T. (2018). Evaluating the Quality of Mindfulness Instruction Delivered in School Settings: Development and Validation of a Teacher Quality Observational Rating Scale. Mindfulness, 1–10.