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CampbellCollaboration 

Education Coordinating Group 


Mindfulness-based interventions for improving cognition, 
academic achievement, behavior, and socioemotional 
functioning of primary and secondary school students 


Brandy R. Maynard, Michael R. Solis, Veronica L. Miller, and Kristen E. Brendel 



A Campbell Systematic Review 
2017:5 


Published: March 2017 
Search executed: May 2015 




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Title 

Mindfulness-based interventions for improving cognition, academic 

Institution 

achievement, behavior, and socioemotional functioning of primary and 
secondary school students 

The Campbell Collaboration 

Authors 

Maynard, B. R. 

Solis, M. R. 

Miller, V. L. 

Brendel, K. E. 

DOI 

io.4073/csr.20i7.5 

No. of pages 

144 

Last updated 

10 March 2017 

Citation 

Maynard BR, Solis MR, Miller VL, Brendel KE. Mindfulness-based 
interventions for improving cognition, academic achievement, behavior, and 
socioemotional functioning of primary and secondary school students. 
Campbell Systematic Reviews 2017:5 

DOI: io.4073/csr20i7.5 

ISSN 

1891-1803 

Copyright 

© Maynard et al. 

This is an open-access article distributed under the terms of the Creative 
Commons Attribution License, which permits unrestricted use, distribution, 
and reproduction in any medium, provided the original author and source are 
credited. 

Roles and 
responsibilities 

See page 68 

Editors for 

this review 

Editor: Sandra Jo Wilson 

Managing editor: Carlton J. Fong 

Sources of support 

The Campbell Collaboration Education Coordinating Group provided 
financial support. 

Declarations of 

interest 

The authors have no vested interest in the outcomes of this review, nor any 
incentive to represent findings in a biased manner. 

Corresponding 

author 

Brandy R. Maynard 

School of Social Work 

Tegeler Hall, 3550 Lindell Blvd 

Saint Louis University 

St. Louis, MO 63103 

USA 

E-mail: bmaynari@slu.edu 


Full list of author information is available at the end of the article. 


Campbell Systematic Reviews 


Editor-in-Chief 

Julia Littell, Bryn Mawr College, USA 

Editors 


Crime and Justice 

David B. Wilson, George Mason University, USA 

Charlotte Gill, George Mason University, USA 

Education 

Sandra Jo Wilson, Vanderbilt University, USA 

International 

Development 

Birte Snilstveit, 3ie, UK 

Hugh Waddington, 3ie, UK 

Social Welfare 

Brandy Maynard, Saint Louis University, USA 

Knowledge Translation 
and Implementation 

Aron Shlonsky, University of Melbourne, Australia 

Methods 

Therese Pigott, Loyola University, USA 

Ryan Williams, AIR, USA 

Managing Editor 

Chui Hsia Yong, The Campbell Collaboration 

Co -Chairs 


Crime and Justice 

David B. Wilson, George Mason University, USA 

Peter Neyroud, Cambridge University, UK 

Education 

Sarah Miller, Queen's University, UK 

Gary W. Ritter, University of Arkansas, USA 

Social Welfare 

Mairead Furlong, National University of Ireland 

Brandy Maynard, Saint Louis University, USA 

Knowledge Translation 
and Implementation 

Robyn Mildon, CEI, Australia 

Cindy Cai, AIR, USA 

International 

Development 

Peter Tugwell, University of Ottawa, Canada 

Hugh Waddington, 3ie, UK 

Methods 

Ariel Aloe, University of Iowa, USA 

The Campbell Collaboration was founded on the principle that systematic reviews on the 
effects of interventions will inform and help improve policy and services. Campbell offers 
editorial and methodological support to review authors throughout the process of 
producing a systematic review. A number of Campbell’s editors, librarians, 
methodologists and external peer reviewers contribute. 

The Campbell Collaboration 

P.O. Box 4404 Nydalen 

0403 Oslo, Norway 
www.camnbellcollaboration.or2 


Table of contents 


PLAIN LANGUAGE SUMMARY 5 

EXECUTIVE SUMMARY 7 

Background 7 

Objectives 8 

Search methods 8 

Selection criteria 8 

Data collection and analysis 9 

Results 10 

Authors’ conclusions 11 

1 BACKGROUND 13 

1.1 The problem, condition or issue 13 

1.2 The intervention and how it might work 16 

1.3 Prior reviews 20 

1.4 Why it is Important to do the review 21 

2 OBJECTIVES 23 

3 METHODS 24 

3.1 Criteria for considering studies for this review 24 

3.2 Search methods for identification of studies 27 

3.3 Data collection and analysis 29 

3.4 Deviations from the protocol 32 

4 RESULTS 33 

4.1 Results of search 33 

4.2 Description of included RCT & QED studies 35 

4.3 Risk of bias in included RCT & QED studies 36 

4.4 Synthesis of results 39 

4.5 Publication bias 43 

5 DISCUSSION 44 

5.1 Summary of main results 44 

5.2 Quality of the evidence 45 

5.3 Limitations and potential biases in the review process 46 

5.4 Agreements and disagreements with other studies or reviews 46 


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6 AUTHORS’ CONCLUSIONS 48 

6.1 Implications for practice and policy 48 

6.2 Implications for research 49 

6.3 References to included studies 51 

6.4 References to excluded studies 56 

6.5 Additional references 59 

7 INFORMATION ABOUT THIS REVIEW 67 

7.1 Review authors 67 

7.2 Roles and responsibilities 68 

7.3 Sources of support 69 

7.4 Declarations of interest 69 

7.5 Plans for updating the review 69 

7.6 Author declaration 70 

8 APPENDIX 71 

8.1 Documentation of search strategies in electronic databases 71 

8.2 Data extraction form 75 

8.3 Characteristics of included studies: RCT and QED studies 84 

8.4 Characteristics of single group pre-post test studies 108 

8.5 Characteristics of single subject design studies 110 

8.6 Excluded studies 114 

8.7 Risk of bias table 116 

8.8 Cognitive outcomes by study included in meta-analysis 134 

8.9 Academic outcomes by study included in meta-analysis 135 

8.10 Behavioral outcomes by study included in meta-analysis 136 

8.11 Socioemotional outcomes by study included in meta-analysis 137 

8.12 Risk of bias by study 142 

8.13 Funnel plots 143 


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Plain language summary 


Mindfulness-based interventions in schools have positive effects on cognitive and 
socio-emotional processes but do not improve behavior and academic achievement 


MBIs have a small, positive effect on cognitive and socio-emotional outcomes, but not a significant 
effect on behavioral and academic outcomes. 


The review in brief 


The use of mindfulness-based interventions (MBIs) in schools has been on the rise. Schools are 
using MBI’s to reduce student stress and anxiety and improve socio-emotional competencies, 
student behavior and academic achievement. 

MBIs have small, positive effects on cognitive and socio-emotional processes but these effects were 
not seen for behavioral or academic outcomes. The studies are mostly of moderate to low quality. 
Therefore, further evidence from independent evaluators is needed to be able to evaluate the 
effectiveness of this type of intervention. 


What did this review study? 


With the diverse application and findings of positive effects of mindfulness practices with adults, as 
well as the growing popularity with the public, MBIs are increasingly being used with youth. Over 
the past several years, MBIs have received growing interest for use in schools to support socio- 
emotional development and improve behavior and academic achievement. 

This review examines the effects of school-based MBIs on cognitive, behavioral, socio-emotional 
and academic achievement outcomes with youth in a primary or secondary school setting. MBIs 
are interventions that use a mindfulness component, broadly defined as “paying attention in a 
particularly way: on purpose, in the present moment, non-judgmentally”, often with other 
components, such as yoga, cognitive-behavioral strategies, or relaxation skills training. 


What studies are included? 


Included studies used a randomized controlled trial, quasi-experimental, single group pre-post test 
or single subject design and reported at least one of these outcomes: cognition, academic 
performance, behavior, socio-emotional, and physiological. Study populations include preschool, 
primary and secondary school students. 


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A total of 61 studies are included in the review, but only the 35 randomized or quasi-experimental 
studies are used in the meta-analysis. Most of the studies were carried out in North America, and 
others in Asia, Europe and Canada. All interventions were conducted in a group format. 
Interventions ranged in duration (4-28 weeks) and number of sessions (6-125 sessions) and 
frequency of meetings (once every two weeks to five times a week). 


What is the aim of this review? 

This Campbell systematic review examines the effectiveness of school-based MBIs on 
cognition, behavior, socio-emotional outcomes and academic achievement. The review 
summarizes 61 studies and synthesizes 35 studies, with a total of 6,207 student participants. 


What are the main results in this review? 


MBIs have a small, statistically significant positive effect on cognitive and socio-emotional 
outcomes. But there is not a significant effect on behavioral and academic outcomes. 

There was little heterogeneity for all outcomes, besides behavioral outcomes, suggesting that the 
interventions produced similar results across studies on cognitive, socio-emotional and academic 
outcomes despite the interventions being quite diverse. 


What do the findings in this review mean? 


Findings from this review indicate mixed effects of MBIs in schools. There is some indication that 
MBIs can improve cognitive and socio-emotional outcomes, but no support for improvement in 
behavior or academic achievement. Despite the growing support of MBIs for adults, youth may not 
benefit in the same ways or to the same extent as adults. 

While not well studied, anecdotal evidence indicates costs and adverse effects of these types of 
interventions that should be better studied and weighed against the small to no effects on different 
types of outcomes when considering adoption of MBIs in schools. 

These findings should be read with caution given the weakness of the evidence produced by the 
studies. The high risk of bias present in the studies means that further evidence is needed to 
evaluate the effectiveness of this type of intervention. The evidence from this review urges caution 
in the widespread adoption of MBIs and encourages rigorous evaluation of the practice should 
schools choose to implement it. 


How up-to-date is this review? 


The review authors searched for studies published until May 2015. This Campbell systematic 
review was published in March 2017. 


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Executive summary 


BACKGROUND 


Due to educational policy initiatives over the last two decades, school districts across the United 
States have placed more emphasis on improving academic standards and accountability. Indeed, 
children are spending between 20 to 25 hours per year on meeting federal, state and local school- 
district testing requirements (Hart et al., 2015). This increased emphasis on academic standards 
and high stakes testing has, at least in part, been blamed for the increasing levels of stress and 
anxiety children are experiencing (APA, 2009; Merkangas et al., 2010; Pope, 2010). In addition to 
changes in education policy requiring an increased emphasis on academic standards and 
accountability, schools are increasingly expected to attend to the social, emotional, and behavioral 
needs and problems of students. Given that as many as 13% to 20% children in the U.S. are 
experiencing one or more mental disorders (Center for Disease Control and Prevention, 2013), 
schools are increasingly challenged to respond to the growing emotional and behavioral needs of 
their students. Moreover, socioemotional development and competencies have been linked to 
learning and academic achievement, and have thus become a target for school-based interventions 
as a means of improving learning and academic achievement (Durlak, Weisberg, Dymnicki, Taylor, 
& Schhellinger, 2011; Eisenberg, Spinrade, & Eggum, 2010; Zins & Elias, 2006). 

One approach to supporting improvements in socioemotional development and competencies that 
has received growing interest for use in schools is mindfulness-based interventions (MBIs). 
Mindfulness is defined as “paying attention in a particular way: on purpose, in the present 
moment, nonjudgementally” (Zabat-Zinn, 1994, p. 4). Research suggests positive effects of MBIs 
for adults with chronic conditions, mental health diagnoses, psychiatric disorders, and stress 
(Chiesa, Calati, & Serretti, 2011; deVibe et al., 2012; Cramer, Haller, Lauche, & Dobos, 2012; 
Vollestad, B. Nielsen, & H. Nielsen, 2012. Moreover, studies suggest that mindfulness based 
practices may improve performance on a variety of socioemotional outcomes, including self- 
regulation, stress, and mood disturbance (Cheisa & Serretti, 2009; Regehr, Glancy, & Pitts, 2013). 
There has been increasing interest in MBIs with children and adolescents, and schools are often 
seen as a convenient setting to implement MBIs with children and youth. Some of the more 
popular MBIs used in schools are Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1979; 
Bootzin & Stevens, 2005), Mindfulness Based Cognitive Therapy for Children (MBCT-C; Segal, 
Williams, & Teasdale, 2002; Semple, Reid, & Miller, 2005), Meditation of the Soles of the Feet 
(SoF; Singh et al., 2007), and Learning to Breath (LTB; Broderick & Metz, 2009). Despite the 
dramatic increase in the use of MBIs in schools to affect socioemotional and academic outcomes, 


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little effort has been invested to systematically examine the body of evidence using rigorous 
methods, particularly for behavioral and academic outcomes of MBIs implemented in school 
settings. 

This review contributes to the literature by including the most recent research on MBIs in school 
settings, including outcomes that have not been examined in prior reviews of school-based 
mindfulness interventions, including behavioral and academic outcomes, and employing stringent 
criteria for search, selection, coding, and analysis as specified in the Campbell Collaboration 
policies and guidelines to inform educational policy and practice and identity gaps in the current 
evidence base to guide future research in this growing area of practice and research. 


OBJECTIVES 


The purpose of this review is to examine and synthesize evidence of mindfulness-based 
interventions implemented in school settings with primary and secondary school students on 
achievement, behavior and socioemotional outcomes to inform education practice and policy. 
Specifically, the primary aim of this review is designed to answer the following research question: 

l. What are the effects of mindfulness-based interventions on cognition, academic 
achievement, behavior and socioemotional outcomes? 

Moreover, within the context of this review, we aim to describe: 

■ The types of mindfulness-based interventions being evaluated in school settings. 

■ The state and quality of evidence of intervention outcomes studies of mindfulness-based 
interventions in school settings? 


SEARCH METHODS 


We attempted to identity and retrieve both published and unpublished studies through a 
comprehensive search that included multiple electronic databases, research registers, grey 
literature sources, and reference lists of reviews and relevant studies. We searched 13 electronic 
databases, research registers, relevant clearinghouse, government and research center websites, 
conference abstracts/proceedings, reference lists of prior reviews and included studies, and contact 
with experts and researchers in the area of school-based mindfulness interventions. 


SELECTION CRITERIA 


Studies were included in this review if they met the following criteria: 

Types of studies: Randomized controlled trial (RCT), quasi-experimental design (QED), single- 
group pre-post test design (SGPP) or single subject design (SSD). We only included RCT and QED 
studies in the meta-analyses. 


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Participants: Pre-school, primary and secondary school students 

Interventions: Interventions of interest include those that are a) conducted in a school setting 
(during the school day or in a school-based after school program) and b) use a mindfulness 
component/strategy. Mindfulness is broadly defined as “self-regulation of attention to the 
conscious awareness of one's immediate experiences while adopting an attitude of curiosity, 
openness, and acceptance” (Bishop et al., 2004, p. 174). 

Outcomes: Studies must have reported at least one of the following outcomes: 

1. Cognition (e.g., executive function, memory, cognition, attention) 

2. Academic performance (e.g., standardized achievement tests, measures of content 
mastery, reading, grades) 

3. Behavior (e.g., disciplinary referrals, aggression and other externalizing behaviors, time 
on task, compliance, attendance) 

4. Socioemotional (e.g., anxiety, stress, engagement, social skills, self-esteem, emotion 
regulation, grit, internalizing behaviors) 

5. Physiological (e.g., cortisol, heart rate, brain activity) 

Other criteria: Studies must have reported post-test data, interventions must have been 
conducted in a primary or secondary school setting, and must have been conducted or published 
between 1990 and 2015. The search was not restricted by geography, language, publication status 
or other study characteristics. 


DATA COLLECTION AND ANALYSIS 


Titles and abstracts of the studies found through the search procedures were screened for relevance 
by two reviewers for most electronic databases, with the exception of the Australian Education 
Index, the British Education Index, and CBCA Education which were reviewed by one author. 
Documents that were not obviously ineligible or irrelevant based on the title and abstract review 
were retrieved in full text for final eligibility screening. Two reviewers independently reviewed each 
full text report using a screening form to determine final inclusion. Any discrepancies between the 
reviewers were discussed and resolved through consensus. For all studies that passed the eligibility 
screening process described above, two reviewers independently coded each eligible study using a 
structured data extraction form. Following independent coding of studies, coders then compared 
coding and identified and discussed discrepancies, which were resolved through consensus. If 
consensus could not be reached between the two coders, a third member of the review team was 
consulted to resolve the discrepancy. 

We conducted descriptive analyses on variables of interest from all included studies to provide 
information regarding participant, setting, intervention characteristics for all studies that met 
eligibility criteria. For those that met criteria for inclusion in the meta-analysis, we estimated effect 


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sizes for each included RCT and QED study when enough data was reported in the study or 
provided by study authors. For RCT and QED studies, we calculated the magnitude of effect using 
the standardized mean difference effect size with Hedges’ g correction for continuous outcomes 
and odds ratios for outcomes presented as dichotomous variables. 

Following the estimation of individual study level effects, we conducted separate meta-analyses 
using Comprehensive Meta-Analysis, version 3.0 (CMA; Borenstein, Hedges, Higgins, & Rothstein, 
2014) for the following outcome domains of interest: cognitive, academic, behavioral and 
socioemotional outcomes. To synthesize effects across studies, a weighted mean effect was 
calculated by weighting each study level effect size by the inverse of its variance. Random effects 
statistical models were used throughout. RCT and QED studies were pooled to allow for greater 
statistical power in all meta-analyses (heterogeneity between RCT and QED studies was not 
statistically significant in any of the meta-analyses). Following the estimation of summary effects, 
we conducted a test of homogeneity (Q-test) to compare the observed variance to what would be 
expected from sampling error. The I 2 statistic was used to describe the percentage of total variation 
across studies due to the heterogeneity rather than chance. We also constructed a forest plot 
displaying study-level mean effect sizes and 95% confidence intervals for the included studies to 
provide opportunity for visual analysis of the precision of the estimated effect sizes, detection of 
studies with extreme effects, and information regarding heterogeneity of studies. Publication bias 
was assessed using funnel plots. When there was significant heterogeneity across studies, we 
conducted moderator analyses to examine the following variables: study type (RCT, QED), 
provider (classroom teacher, trained instructor), researcher involvement (yes/no), homework 
(yes/no), manualized program (yes/no), and number of weeks (# of weeks of the intervention). 


RESULTS 


Of the 61 studies that met criteria for inclusion in this review, 25 were RCT studies, 19 were QED 
studies, 9 were SGPP studies and 8 were SSD studies. Of the 44 RCT and QED studies, 35 provided 
enough data to calculate an effect size and were included in one or more of the meta-analyses, 
depending on which outcomes of interest were reported in the studies. Of the 44 RCT and QED 
studies, seven were unpublished reports, with the remaining being published studies in peer- 
reviewed journals. The interventions represent a wide range of mindfulness intervention types, but 
most interventions were at least partially manualized and of shorter duration. The interventions 
were delivered by primarily a classroom teacher (31%) or by a mindfulness-trained interventionist 
(60%) external to the school system. 

Meta-analytic findings indicate small, yet statistically significant effects on cognitive outcomes (k = 
10; g = 0.25 (95% Cl [0.06, 0.43], p = .01) and socioemotional outcomes (k = 28; g = 0.22 (95% Cl 
[0.14, 0.30], p < .001), and small and non-significant effects on academic outcomes (k = 5; g = 0.27 
(95% Cl [-0.04, 0.57], p = .08.) and behavioral outcomes (k = 13; g = 0.14 (95% Cl [-0.02, 0.30], p 
= .08). Heterogeneity was small and not statistically significant in all meta-analyses with the 
exception of behavioral outcomes ( 7 2 = 48%; T 2 = .034; Q = 22.96, p = .03). Six studies measured 
physiological factors, with three of those studies from the same author team. Due to the nature of 
these measures, the time dependency of some of these measures (cannot compare AM cortisol to 


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PM cortisol for example), and that so few studies measured these outcomes, quantitatively 
synthesizing these outcomes across these studies was not warranted. 

Overall, there was a moderate to high risk of bias across the 35 studies included in the meta- 
analyses, with variation in high risk areas across studies. Twenty-one studies (60%) were rated low 
risk and 14 studies (40%) were rated high risk of bias for random sequence generation. Only one 
study reported that participants and study and school staff were blinded to program allocation 
(Sibinga et al., 2013), although they did not specify how they blinded study and school staff to 
condition. The remaining studies were rated as high risk (86%) or unclear risk (11%). Most of the 
studies in this review were rated as low risk of attrition bias (74%). For the studies included in the 
meta-analyses, most studies were assessed as unclear risk for reporting bias as we could not find 
any protocols of studies with which to compare planned to actual reported outcomes. It must be 
noted, however, that several studies reported to use, and then only reported data for, subscales of 
measures rather than reporting the full measure score or all subscale scores. Thus, it is unclear 
whether the a priori intentions of these authors were to only use certain subscales or if the 
participants did complete the full measure and the study authors only described the use of and 
reported data for the subscale only. We also coded for additional factors related to potential bias in 
this corpus of studies: researcher allegiance bias, funding source bias, and confounding factors. Of 
the 35 studies included in the meta-analysis, we were able to clearly identify an author role in the 
development and/or delivery of the intervention in 18 (51%) of the studies. The funding source was 
often not reported, or the studies were not funded. In four of the studies (11%), the authors 
identified a funding source that was also an entity involved in the development or the delivery of 
the intervention. We also examined whether there were confounding factors with either the 
treatment or comparison groups. Thirteen studies (37%) were assessed as having a confound at the 
level of the instructor (n = 7; only one instructor in treatment, control or both conditions) or at the 
school/classroom level (n = 6; one classroom or school in the treatment, control or both 
conditions). A larger mean effect was observed for studies in which a confound was present, thus 
likely upwardly biasing results; however, we conducted sensitivity analysis and found that the 
difference in magnitude of effect between studies with and without confounds was not statistically 
significant. 


AUTHORS’ CONCLUSIONS 


Results indicate mixed results of school-based mindfulness interventions across the outcomes of 
interest in this review, with finding favorable impacts of mindfulness interventions on those 
processes that are likely more directly targeted by mindfulness interventions, namely cognitive and 
socioemotional outcomes. We found a lack of support at posttest to indicate that those positive 
effects on cognitive and socioemotional outcomes then translate into favorable outcomes for 
academic and behavioral outcomes as is hypothesized. The lack of heterogeneity for all outcomes 
with the exception of the behavioral outcomes indicate that the interventions in this review, 
although quite diverse in their characteristics, produced similar results across studies on cognitive, 
socioemotional and academic outcomes. These findings provide some support for the use of 
school-based mindfulness interventions for some outcomes, but do not provide overwhelming 
support of MBIs as being the panacea as some have advocated. The quality of the evidence varied, 


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with some important risks of bias present across a large proportion of studies which threatens the 
internal validity of the included studies and is cause for caution in interpreting the results of this 
review. 

Overall, the evidence from this review urges caution in the enthusiasm for, and widespread 
adoption of, school-based mindfulness interventions for children and youth. While the evidence 
points to positive effects on socioemotional and cognitive outcomes, there is a lack of evidence of 
effects on academic and behavioral outcomes. Despite the empirical support of mindfulness-based 
interventions for adults, children and adolescents may not benefit from mindfulness-based 
interventions similarly to adults. Children and adolescents may not be developmentally ready for 
the complex cognitive tasks, focus and level of awareness that mindfulness-based interventions 
require. Moreover, we know little about the costs and adverse effects of school-based mindfulness 
interventions— the costs of implementing these programs may not be justified, and there are some 
indications that mindfulness-based interventions may have some adverse effects on children and 
youth; however, these have not been adequately examined. If schools do want to implement 
mindfulness-based interventions, we urge schools to evaluate the practice in a rigorous way and 
monitor outcomes and costs. 


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l Background 


l.i THE PROBLEM, CONDITION OR ISSUE 


Evidence suggests that students today are experiencing high levels of stress as well as other 
emotional and developmental challenges that may impede their ability to learn and succeed in 
school (APA, 2009; Merikangas et al., 2010; Pope, 2010). Approximately i3%-20% of children in 
the U.S. experience at least one mental disorder, and these rates have been on the rise since 2005 
(Centers for Disease Control and Prevention, 2013). The increased prevalence of stress and anxiety, 
and at earlier ages than prior generations, has been at least partially attributed to school-related 
stress— particularly, high stakes testing, increased academic pressure, and the overscheduling of 
students in multiple extracurricular activities (APA, 2009; Gregor, 2005; Pope, 2010; Suldo et al., 
2009). Indeed, students report school-related stress as being their greatest source of stress (APA, 
2009) and teachers rate behaviors associated with anxiety as some of the most common problems 
of children and adolescence (Harrison, Vannest, Davis & Reynolds, 2012). The prevalence and 
levels of student stress and anxiety has become a concern for schools as emerging evidence 
suggests strong links between stress and anxiety with academic performance as well as with 
emotion regulation, behavioral functioning, and brain and cognitive development, which are also 
strongly linked to academic performance (Andersen, 2003; Andersen & Teicher, 2009; Sandler et 
al., 2000; Shonkoff et al., 2009; Suldo et al., 2009; Teicher et al., 2002; Wolchik et al., 2006). 

Social-emotional development and competencies have also been linked to learning and academic 
achievement and increasingly viewed as a target for school-based interventions (Zins & Elias, 

2006; Eisenberg, Spinrad, & Eggum, 2010; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 
2011). A growing body of evidence has found numerous social and emotional factors, including 
emotion regulation, effortful control, social and self-awareness, self-management, relationships 
skills and decision-making, to be directly and indirectly related to academic performance, school 
engagement, and externalizing and internalizing behaviors (Brackett & Rivers, 2014; Denham & 
Brown, 2010; National Center for Educational Statistics, 2002; Wang et al., 1997). Social- 
emotional competencies are positively related to academic success, greater impulse control, better 
concentration and attention in school, whereas a lack of social-emotional skills is linked to 
academic, social and behavioral problems (See Eisenberg et al., 2010 and Denham & Brown, 2010). 
For example, an inverse relationship between emotion regulation and effortful control has been 
found with externalizing behavior problems in pre-school age children through adolescence (Eiden 
et al., 2007, Eisenberg et al., 2004; Gardner et al., 2008). Conversely, students who exhibit greater 
ability to self-regulate are more likely to demonstrate better ability to concentrate and pay 
attention in school and exhibit better impulse control and fewer externalizing behaviors, leading to 


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improved functioning and success in school (Eigsti et al, 2006; Eisenberg et al., 2010; McClelland 
et al., 2007; Mischel et al., 1989). 

The increased prevalence of stress, anxiety, mental health problems and other social, emotional, 
and behavioral risk factors, along with the increase in knowledge of the impact of these factors on 
learning and achievement, has prompted schools and policy-makers to begin to more explicitly 
attend to students’ social and emotional functioning through both curricula and ancillary programs 
(Zins & Elias, 2006). Indeed, for students to succeed in school, it seems ever more apparent that 
schools need to provide strong social and emotional components and support students’ well-being 
in addition to providing strong academic curriculum and instruction (Zins, Weissberg, Wang, & 
Walberg, 2004). 

As schools have struggled to find ways to support students’ overall well-being, one approach 
receiving growing interest is the use of mindfulness practices. Mindfulness, commonly defined as 
“paying attention in a particular way: on purpose, in the present moment, nonjudgmentally” 
(Kabat-Zinn, 1994, p. 4), has become mainstream and practiced by high profile stars and athletes 
as a means of improving health, well-being and athletic performance. Indeed, mindfulness was 
featured on 60 Minutes, free lessons in mindfulness are given as perks at companies like Google 
(Walton, 2014), and meditation is an integral part of the Seattle Seahawks training regimen 
(Roenigk, 2013). Google “mindfulness” and millions of news articles, video and audio files, images, 
books, practice guides and links to various centers for mindfulness will be listed in the results. 

From a simple Google search, it appears that mindfulness is a common topic in the public sphere. 

While mindfulness seems to be a popular trend being adopted by individuals, it is also beginning to 
be considered in various areas of public policy, including education policy. Over the past decade, 
interest in mindfulness has been growing and mindfulness-based approaches to improving health 
and well-being, particularly with adults, has spread across fields, including psychology, healthcare, 
neuroscience, and business. This burgeoning interest in mindfulness is due, at least in part, to a 
significant and growing body of evidence pointing to positive effects of mindfulness training on 
cognitive processes. Evidence suggests that mindfulness practice improves performance on a 
variety of measures of self-regulation (Lo & Allen, 2008; Heeren, Van Broek, & Philippot, 2009) 
and emotion regulation (e.g., Speca et al., 2000; Fincune & Mercer, 2006), as well as enhancing 
cognitive functions such as attention, working memory and some executive functions (Chiesa, 
Calati, & Serretti, 2011), all of which are important to success in school. Indeed, Mindfulness 
interventions have been found to alter brain structure and function, including increased blood flow 
to and thickening of the cerebral cortex (Davidson, 2008) and increased gray matter concentration 
in areas of the brain involved with emotion regulation, learning and memory (Holzel et al., 2011). A 
meta-analysis of 21 neuroimaging studies found consistent differences between meditators and 
non-meditators in eight regions of the brain key to meta-awareness, body awareness, memory and 
self and emotion regulation (Fox et al., 2014). 

Moreover, mindfulness has been found to be effective in the treatment of a myriad of health, social 
and psychological problems. Numerous studies and meta-analyses have investigated the use of 
mindfulness-based interventions (MBIs) in medicine, with mindfulness training and practice being 


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found to help patients with chronic conditions manage pain (e.g., Cramer, Haller, Lauche, & 

Dobos, 2012; Veehof, Oskam, Schreurs, & Bohlmeijer, 2011), fibromyalgia symptoms (i.e., Lauche, 
Holger, Dobos, Langhorst, & Schmidt, 2013), and reduce stress in breast cancer patients (i.e., 
Zainal, Booth, & Huppert, 2013). Additionally, syntheses and meta-analyses have found positive 
effects of MBIs in treating individuals with mental health diagnoses, such as anxiety (deVibe et al., 
2012; Vollestad, B. Nielsen, & H. Nielsen, 2012), psychiatric disorders (i.e., Chiesa, Calati, & 
Serretti, 2011), psychosis (Khoury, Lecomte, Gaudiano, & Paquin, 2013), personal development 
and quality of life (deVibe et al., 2012) as well as stress in healthy people (i.e., Cheisa & Serretti, 
2009) including university students (Regehr, Glancy, & Pitts, 2013). Indeed, the use of mindfulness 
has greatly expanded into various fields to aid in the treatment of a vast array of conditions as well 
as to more generally enhance health and wellbeing. 

While the vast majority of research on mindfulness has historically been focused on adults, the 
increase in promising research based on the diverse application of MBIs with adults and the 
growing popularity of mindfulness with the general public has naturally led to the extension of 
mindfulness to the application with children and youth (Zenner et al., 2014). It has been argued 
that children could benefit from mindfulness in ways similar to adults (Davis, 2012; Hooker & 
Fodor, 2008), and initial reviews suggest that MBIs are feasible with children and adolescents with 
adaptations (Burke, 2009; Zelazo & Lyons, 2012). Mindfulness-based interventions (MBIs) have 
been adapted from adult interventions or developed specifically for youth for a range of clinical 
conditions as well as more generally to enhance health and well-being, and applications for use in 
schools are also gaining attention. 

The use of MBIs is on the rise in schools across the United States and United Kingdom as more and 
more schools have begun implementing various mindfulness-based programs and integrating 
mindfulness into the curricula (e.g., MindUP, The Inner Resilience Program, South Burlington 
Wellness and Resilience Program, Mindful Schools, Learning to Breathe, Mindfulness in Schools 
Project, Still Quiet Place, Stressed Teens, and Wellness Works in Schools). Moreover, efforts to 
promote mindfulness practices are being included in public policy initiatives. In the United 
Kingdom, for example, members of parliament have received training in mindfulness and have 
heard testimony of the evidence and benefits of mindfulness, including testimony from thousands 
of school children who have experienced mindfulness training in school. Also, an all-party 
parliamentary group was launched in the United Kingdom to conduct a nine-month inquiry into 
the potential role of mindfulness in areas of public policy, including education (Booth, 2014). The 
third session of the all-party parliamentary group focused on “mindfulness in health and 
education”, and members considered possible applications of mindfulness, with discussion of 
challenges for scaling up mindfulness programs to be included in teacher training as well as other 
potential policy actions (http : / / parliamentarywellbeinggroup .org.uk) . 

Although the use of MBIs appears to be on the rise in schools, and policy makers are calling for 
more mindfulness in education policy, it is unclear whether mindfulness-based approaches do 
indeed positively impact academic, emotional, and behavioral outcomes in students. While there is 
a growing body of studies of MBIs on a range of cognitive, social, and psychological outcomes 
including working memory, attention, academic skills, social skills, and emotional regulation 


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(Meiklejohn et al., 2012), few studies have synthesized this literature using systematic and 
quantitative methods and few have focused specifically on school-based interventions. As schools 
develop practices and policies to try to more effectively and efficiently improve student outcomes, 
it is important that researchers, practitioners, policy makers, and other key stakeholders have 
access to evidence of effects of MBIs to make informed decisions rather than rely on anecdotal 
evidence and follow current popular trends. This information is critical as schools must make 
important academic, curricular and budgetary decisions. If a particular psychosocial intervention 
has large positive effects, then the use of academic time and limited school resources may be 
warranted to implement such a program during the school day; however, if the effects are minimal 
or adverse, then the use of academic time and limited school resources may not be worth those costs. 


1.2 THE INTERVENTION AND HOW IT MIGHT WORK 


Mindfulness was defined by Kabat-Zinn (1994) as “paying attention in a particularly way: on 
purpose, in the present moment, and non-judgmentally” (p. 4). Mindfulness is a type of practice 
derived from the Buddhist contemplative practices and traditions of Vipassana and Zen/Chan 
(Chiesa, Calati, & Serretti, 2011; Eberth & Sedlmeier, 2012), which is characterized by awareness of 
the current state of the mind and body without judgment, elaboration, or attachment (Burke, 2010; 
Eberth & Sedlmeier, 2012). Many scholars have embraced a two component model of mindfulness 
which includes self-regulation of attention and attending to the present moment. Self-regulation of 
attention refers to bringing awareness to a point of full attention to one’s thoughts, feelings, and 
sensations. This includes maintaining sustained attention, keeping attention flexible, focusing on 
direct/current experience and inhibiting elaborate processing. The second component, orientation 
to the present moment, refers to the attitude or approach one takes in attending to the present 
moment and is exemplified by curiosity, openness, and acceptance (Bishop et al., 2004). Shapiro 
and colleagues (2006) conceptualized mindfulness as being comprised of three core components: 
intention, attention and attitude. The second and third components are similar to the two- 
component model described above. It’s in the first component, intention, that their model differs. 
Intention involves the ability to regulate attention in a conscious and purposeful way. Shapiro and 
colleagues assert that one’s intention for undertaking mindfulness practice (e.g., self-regulation, self- 
exploration, self-liberation) has been largely overlooked, but is important and may evolve over time. 

While several models have been put forth to describe components of mindfulness and explain 
processes by which MBI’s may work (e.g., Grabovac et al., 2011; Howell & Buro, 2011; Jankowski & 
Holas, 2013; Melbourne Academic Mindfulness Interest Group, 2006; Shapiro et al., 2006; 

Shapiro et al., 2011; Zelazo & Lyons, 2012), the specific mechanisms of mindfulness have not been 
fully explicated. Most models propose on one or more possible mechanisms, including cognitive, 
psychological and neurobiological mechanisms. We will focus on mechanisms that are most 
relevant to school-related outcomes of interest to this review (see Figure 1). 


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Figure l: Logic model for MBIs with school students 


Mediating 

Intervention Mechanisms and Outcomes 

Proximal Outcomes 


Mindfulness 

Training 

Awareness 

• Thoughts 

• Emotions/Feelings 

• Body sensations 
Attention 

• Purposeful 

• Present moment 

Acceptance 

• Self-reflective 
stance 

• Non-judgmental 
attitude 


Cognitive Processes 

• Attentional 
focus/capacity 

• Self-regulation 

• Executive function 

• Working memory 

• Meta-cognitive 
awareness 

• Emotion regulation 

• Cognitive interference 

• Physiological responses 
(muscle tension, 
breathing, heart rate) 


Academic, Behavioral, 

and Socioemotional 
Outcomes 

• Improved academic 
task completion 

• Improved academic 
performance 

• Reduction in 
externalizing 
behavior/increase in 
prosocial behavior 

• Decreased anxiety 

• Improved social skills 

• Improved self-esteem 

• Increased 
persistence/grit 


Evidence suggests that mindfulness invokes cognitive processes and functions that are important 
to academic achievement, socioemotional functioning and behavior, namely attention, self- 
regulation, working memory, executive function, and metacognitive awareness (Grabovec et al., 
2011; Melbourne-Based Mindfulness Interest Group, 2006; Zelazo et al., 2012; Shapiro et al., 
2006). Some of these constructs are fairly broad, have overlapping components or are described or 
classified in the literature differently, thus making discussing the mechanisms involved in 
mindfulness interventions somewhat challenging. For example, self-regulation is conceptualized in 
terms of encompassing attention in some literature, but maintained as distinct constructs in 
others. Despite the variation across the literature in the ways in which cognitive processes are 
defined and measured, it is well recognized that cognitive processes are targeted and affected by 
MBI’s and are important to academic achievement and socioemotional and behavioral outcomes. 


As noted above, “paying attention” is a key component of mindfulness practice, requiring one to 
focus and direct attention in specific ways. Evidence suggests that mindfulness can enhance 
various aspects of attention or affect brain structure in areas related to attention (Carmody, 2009; 
Chiesa et al., 2011; Napoli et al., 2005). Given that a student’s ability to sustain attention in class 
and on the right things is critical, and that performance and behavior are positively associated with 
attention (Hart, 2004; Rudasill, Gallagher, & White, 2010), MBI’s could improve school 
achievement and behavior by helping students focus and sustain attention in school. 


Self-regulation is another mechanism by which mindfulness may positively affect school-related 
outcomes. Self-regulation generally refers to monitoring and controlling our thoughts, actions and 
emotions (Zelazo & Lyons, 2012). It is often divided into cognitive self-regulation (including 
executive function, attention, planning) and emotional self-regulation (behavior and mental 


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health; Duncan & Magnuson, 2009) and studied under the umbrella of executive function, which 
may also include working memory, cognitive flexibility, and inhibitory control (Zelazo & Lyons, 
2012). The ability to monitor and control one’s thoughts, behaviors and emotions plays an 
important role across all life domains, including school related outcomes. Self-regulation has been 
found to be related to, or a predictor for, a number of outcomes important to student success in 
school, such as externalizing and internalizing problems, classroom behaviors and disciplinary 
incidents, and math and reading (Berking & Wupperman, 2012; Ponitz et al., 2009; Quinn & 
Fromme, 2010; Richardson et al., 2012; Setken et al., 2010; Wyman et al., 2010). Evidence 
suggests that mindfulness positively effects self-regulation, as operationalized and measured in a 
variety of ways, and has been associated with changes in brain regions underlying self-regulation 
(Holzel et al., 2011). MBIs target self-regulation in that mindfulness practice requires one to attend 
to one’s thoughts in the present moment and accept those thoughts without trying to change the 
thoughts or engage in action, promoting sustained attention and cognitive flexibility while also 
reducing emotional reactivity (Zelazo & Lyons, 2012). The emphasis on attending with acceptance 
and with a nonjudgmental attitude enables students to engage in more socially appropriate 
behavior and promote well-being by viewing situations through a different perspective and 
engaging in a type of detachment, which allows one to consider other potential responses and 
disrupt typical patterns of thinking and acting (Hart, 2004; Zelazo & Lyons, 2012). Thus, through 
cognitive and emotional self-regulation, MBIs may improve academic and behavioral outcomes, 
reduce mental health symptoms, and improve socioemotional well-being. 

While mindfulness has been associated with a number of positive outcomes and may invoke a 
variety of potential mechanisms, mindfulness is a broad construct and interventions using 
mindfulness vary. This review will focus on MBIs with preschool, primary and secondary students 
in school settings. A number of MBI’s being used in schools are being adapted from MBIs used 
with adults and others are being developed specifically for use with youth. For example, 
Mindfulness Based Stress Reduction (MBSR; Kabat-Zinn, 1979) and Mindfulness-Based Cognitive 
Therapy for Children (MBCT-C; Semple, Reid, & Miller, 2005), are MBIs that were originally 
developed for adults and have been adapted for youth. MBSR, a group intervention aimed at 
reducing stress, is composed of eight weekly 2.5-hour sessions with a daily 45-minute homework 
assignment (Grossman, Niemann, Schmidt, & Walach, 2004). Participants receive instruction in 
various aspects of mindfulness, including mindful awareness during meditation, yoga, and are 
taught to engage in continuous awareness of physical, mental, and emotional states without 
judgment or evaluation. Mindfulness based cognitive therapy (MBCT) was originally developed by 
Segal, Williams, and Teasdale (2002) as a treatment to reduce relapse of recurrent major 
depressive episodes in adults and was later adapted for use with children (MBCT-C; Semple, Reid 
& Miller, 2005; Semple, Lee, Rosa & L. Miller, 2010) to address anxiety. Researchers have adapted 
and implemented MBSR with children in clinical settings (Bootzin & Stevens, 2005), community 
settings (Saltzman & Goldin, 2008) and school settings (Bakosh, 2013; Bakosh, 2015; Sibinga, 
2013; Sibinga, 2015). Both MBCT (for adults) and MBCT-C combine mindfulness-based practices 
such as attention on the breath and awareness of the present moment with cognitive interventions 
to achieve “affective self-regulation” (p. 222), but the children’s version has been reduced from 12 
weeks to 8 weeks in duration, there is less amount of time of each seated period and group size is 
smaller (Semple et al., 2010). Another distinction between the adult and child programs is that 


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MBCT-C encourages parental involvement in the form of information sessions, brief mindfulness 
training exercises, and home practice of meditation with children. Since its development, several 
studies of MBCT-C in school settings have been conducted (i.e., Semple et al., 2005), as well as in 
other settings (e.g., Lee, Semple, Rosa, & L. Miller, 2008; Bogels, Hoogstad, van Dun, DeShutter, & 
Restifo, 2008). 

Learning to BREATHE (L2B; Broderick & Metz, 2009) is an example of an MBI that was designed 
specifically for the classroom setting. The curriculum “tailors mindfulness-based approaches to the 
developmental needs of adolescents” (p. 38) by helping students be mindful of their present 
situation through lessons on body, thought, and emotion awareness, reducing self-judgment, and 
being mindful in everyday life (Broderick & Metz, 2009). L2B is a brief, six, twelve, or sixteen week 
curriculum conducted in a group setting that has been integrated into school curriculum in health 
class (Broderick & Metz, 2009) or choir class (Metz, Frank, Reibel, Cantrell, Sanders, & Broderick, 
2013). Each lesson includes a short overview of the mindfulness principle being studied, group 
discussion, time to practice mindfulness by applying the principle, and home meditation practice 
assignments with supporting materials provided (Broderick and Metz, 2009; Metz et al., 2013). 

In the descriptions of these approaches, one can discern that there are more similarities between 
MBI approaches than differences. For example, all of the approaches incorporate a training period 
of guided meditation techniques focusing on mindful attention and awareness of breath, body, or 
mind and followed by independent practice. The interventions differ in their intended purposes, 
such as treatment of anxiety and stress, managing aggressive behaviors, emotional regulation, and 
overall health promotion and how they are implemented in school settings. MBIs have been 
implemented in “core” content classes (reading and Language Arts, math, science, or social 
studies), in “elective periods” such as physical education classes (Napoli et al., 2008), choir classes 
(Metz et al., 2013), enrichment or intervention periods, or in time outside the regular school day 
(e.g., after-school tutoring or summer school). The type of setting is often determined by the 
purposes or outcomes measured, as well as the practical and systemic constraints and 
requirements in the school. For example, Broderick & Metz (2009) examined outcomes related to 
mental health by conducting the intervention in students’ health classes. 

While many of the MBIs discussed to this point intervene directly with the youth, there are MBIs 
that also involve parents or teachers, either as a supplement to student training or as the primary 
target of the intervention. For example, Semple and colleagues (2010) conducted parent-training 
sessions in mindfulness, which provided an overview of the program their children would be 
receiving at school, as well as some opportunities for the parents to engage in mindfulness practice. 
Parents were also encouraged to participate in their child’s home practice sessions; however, no 
data were collected or analyzed as a result of these parent-training sessions. It is yet unclear 
whether parent or teacher participation in the intervention provides any added benefit or enhances 
student outcomes. Other MBIs have been conducted with teachers or parents as the primary or 
only recipient of the intervention. In these interventions, the intent of providing teacher or parent 
training is to affect parent or teacher outcomes, with some hypothesizing indirect outcomes on 
students through changes in parent or teacher behavior from mindfulness practice. For example, 
Jennings and colleagues (2011) examined the effects of Cultivating Awareness and Resilience in 


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Education (CARE), a mindfulness-based professional development program designed for teachers 
to reduce stress, improve teachers’ performance, and prevent “burnout.” Instruction in CARE 
provides teachers with training in a series of mindfulness activities, with periods of silent reflection 
and opportunities to extend the practices into daily classroom routines. Teachers reported high 
satisfaction with the CARE training, but there were no measures of student performance. Because 
MBIs that target teachers or parents as the primary recipient of the MBI focus on different 
outcomes (teacher and parent outcomes versus student outcomes, with perhaps some secondary 
student outcomes), we believe it is most appropriate to separate interventions targeting students 
from studies targeting teachers or parents as the primary recipient of the intervention. Therefore, 
we will focus this review on interventions in which students are the primary recipients of the MBI. 


1.3 PRIOR REVIEWS 


While several reviews have been conducted on mindfulness-based interventions with adults for a 
myriad of problems and outcomes, less attention has been given to reviewing the literature on 
outcomes of mindfulness-based approaches for children and youth, particularly outcomes relevant 
to education. To date, we have located nine reviews of mindfulness-based interventions that 
include studies with children or youth. One of the reviews focused on health-related effects of 
sitting-meditative practices (Black, Milam, & Sussman, 2009) and two reviews were not specifically 
focused on children or education, but did include some studies of mindfulness-based approaches 
with children and/or youth with intellectual disabilities (Chapman, 2013) and developmental 
disabilities (Hwang & Kearney, 2013). The remaining five reviews examined effects of MBIs with 
children and youth and are more relevant to the proposed review, thus will be discussed in more depth. 

Meiklejohn and colleagues (2012), Greenberg and Harris (2012), and Thompson and Gauntlett- 
Gilbert (2006) published traditional narrative reviews describing mindfulness interventions with 
children and youth. Meikeljohn and colleagues focused on literature related to integrating 
mindfulness training in primary and secondary education, whereas Greenberg and Harris and 
Thompson and Guantlett-Gilbert reviewed mindfulness practices in clinical settings or prevention 
or health promotion contexts. All three reviews described a variety of mindfulness-based 
approaches and two summarized findings of intervention studies. These reviews concluded that 
mindfulness-based approaches are feasible and promising, but cautioned that additional and more 
rigorous research was needed. While these reviews provide an overview of MBIs with children and 
youth, the authors did not describe their search, selection, or coding procedures and did not 
quantitatively synthesize effects of the interventions, thus limiting the conclusions that can be 
drawn regarding the effects of MBIs with children and youth. 

In addition to several narrative reviews, three reviews were identified that used systematic review 
methods (Burke, 2010; Zenner, Hernleben-Kurz, & Walach, 2014; Zoogman, Goldberg, Hoyt, & 
Miller, 2014), two of which also quantitatively synthesized effects using meta-analytic methods 
(Zenner et al., 2014; Zoogman et al., 2014). Burke (2010) conducted a systematic review of 
mindfulness-based approaches with children and adolescents. Burke identified 15 studies (6 used a 
between-group design) that met review criteria that included articles written in English and studies 
that used secular contemplative mindfulness mediation techniques. The author conducted a search 


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for studies in 12 research databases and, although the author did not limit the review to published 
studies, a comprehensive search for grey literature was not conducted and dissertations or 
conference papers were not accessed. This review included studies of mindfulness with clinical and 
non-clinical samples, but not all included studies were relevant to education (e.g., outpatient 
gastroesophageal reflux, body weight) and only four were conducted in school settings. Eight of the 
studies included in the Burke review were also included in the Meildejohn review. Burke concluded 
that the studies provided evidence of the feasibility and acceptability of mindfulness-based 
approaches for children and adolescents, but the research base is limited by a lack of rigorous 
efficacy studies, which was attributed, in part, to the early stage of research in this area. 

Two meta-analyses of MBIs with children and youth have been published. Zoogman et al., (2014) 
reports the first published meta-analysis of mindfulness meditation with youth. The search was 
conducted in 2011 and was limited to peer-reviewed journal articles published in English. Twenty 
studies (13 RCTs, 1 QED, and 6 within group pre-post test studies) reporting effects of mindfulness 
interventions with clinical and non-clinical samples were included in the meta-analysis. The mean 
effect of the included interventions was 0.227 [Cl 0.148, 0.305] and heterogeneity was not 
significant. Of the 12 moderators tested, only one moderator was significant— studies using clinical 
samples reported significantly larger effect sizes than studies using non-clinical samples. 
Additional analyses performed found significantly greater effects for psychological symptoms than 
measures of other outcomes. Zenner and colleagues (2014) conducted a systematic review and 
meta-analysis of MBis in schools with a focus on psychological outcomes (cognitive performance, 
emotional problems, stress and coping, and resilience). The authors conducted a comprehensive 
search in 2012 for published and unpublished reports yielding 24 studies (10 RCTs, 8 QEDs, 1 two- 
armed cohort study, and 5 non-controlled trials). The mean effect of the 19 studies using a 
comparison group design was g = 0.40 [0.21, 0.58]. The authors found significant effects on 
cognitive performance, resilience, and stress measures and non-significant effects on emotional 
problems. The authors found significant heterogeneity between studies. The included studies were 
often underpowered and small, and a wide variety of programs were evaluated, with many 
researchers implementing their own programs. The authors concluded that mindfulness-based 
approaches in schools are promising and the available evidence justifies allocating resources to 
mindfulness intervention implementation and evaluation. They recommended that larger studies 
employing more robust and well-validated measures be used in future research. 


1.4 WHY IT IS IMPORTANT TO DO THE REVIEW 


The aforementioned reviews contribute to our understanding of mindfulness-based approaches 
with children and youth; however prior reviews are limited in several ways. First, most prior 
reviews used non-systematic search methods and narrative synthesis methods, are not directly 
relevant to education settings, or were limited by including only published studies, thus limiting 
their applicability to informing practice and policy in education. This systematic review expands 
and improves upon prior work in several ways. First, this review focused on a range of outcomes 
relevant to educational settings and included academic performance outcomes. As academic 
performance outcomes have not been included in prior reviews, the present review provides timely 
information that can be used in school policy and practice decisions. Second, this review employed 


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a systematic and transparent process for searching, retrieving, and coding studies, and included 
searches for unpublished studies. Using a systematic method to conduct the review of outcome 
research limits bias and reduces chance effects, leading to more reliable results (Cooper, 1998). 
Further, explicitly and transparently describing the review process allows for others to replicate 
and expand the review to include new studies or criteria. 

In short, this review contributes to the literature by including the most recent research on MBIs in 
school settings, including outcomes that have not been included in prior reviews of school-based 
MBIs, and employing stringent criteria for search, selection, coding, and analysis as specified in the 
Campbell Collaboration policies and guidelines. Thus, this review provides the most up-to-date and 
rigorous review of MBIs to inform educational policy and practice and identify gaps in the current 
evidence base to guide future research. 


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2 Objectives 


The purpose of this review is to examine and synthesize evidence of mindfulness-based 
interventions implemented in school settings with primary and secondary school students on 
achievement, behavior, socioemotional and physiological outcomes to inform education practice 
and policy. Specifically, the primary aim of this review is designed to answer the following research 
question: 

What are the effects of mindfulness-based interventions on cognition, academic achievement, 
behavior, socioemotional and physiological outcomes? 

Moreover, within the context of this review, we also aim to describe: 

• the types of MBIs being evaluated in school settings. 

• the state and quality of evidence of intervention outcomes studies of MBIs in school settings. 


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3 Methods 


The study protocol that guided this review (Maynard et al., 2013) can be accessed at 
https: / / campbellcollaboration.org/library/ mindfulness-based-interventions-primary-and- 

secondarv-school-students.html . 


3.1 CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW 


3.1.1 Types of studies 

To be included in this review, studies must have used one of the following research designs: 
randomized controlled trial (RCT), quasi-experimental design (QED; studies using a comparison 
group design, but assigned groups to condition non-randomly), single-group pre-post test design 
(SGPP) or single subject design (SSD). For RCT and QED studies, wait list control, no treatment, 
treatment-as-usual and alternative treatment groups were considered acceptable comparison 
groups. The type of comparison group used in each study was coded and examined as a moderator. 
We did not require that studies provide pre-test data or make statistical adjustments; however, we 
coded such data for use in analysis. To be eligible for inclusion, SSD studies must have employed 
one of the following designs: alternating treatments, multiple baseline, or withdrawal. Although it 
is not typical for single-group or single subject designs to be included in Campbell reviews, this is a 
relatively nascent area of research and we believe it is important to provide a comprehensive 
picture of the state of evidence related to mindfulness-based interventions in school settings. These 
studies were included in this review to provide a description of MBIs being used in schools and the 
means and extent to which interventions are being assessed. We quantitatively synthesized effects 
separately by study design. Limitations and biases related to study designs that are inherently 
weaker were explicitly recognized and discussed. 

3.1.2 Types of participants 

Participants were children in pre-school, primary and secondary school grades in regular 
education, special education or alternative education settings from any country. As we anticipated, 
and as prior reviews have suggested, effects of MBIs may differ based on whether the sample is 
comprised of students that are high risk or come from a clinical population or from the general 
population of students. Therefore, we included MBIs that were implemented with any sample of 
students (e.g., general population, ADHD, special education) and coded the studies accordingly. 
Because we were interested in informing education policy, studies that included participants in 
inpatient hospital or residential settings were excluded from this review. Studies in which parents 


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or teachers were the primary recipients of the intervention were excluded, although studies that 
included a parent or teacher component of an MBI intervention with students were included. 

3.1.3 Types of interventions 

Interventions of interest included those that were a) conducted in a school setting (during the 
school day or in a school-based after school program) and b) used a mindfulness 
component/strategy. Mindfulness was broadly defined as “self-regulation of attention to the 
conscious awareness of one's immediate experiences while adopting an attitude of curiosity, 
openness, and acceptance” (Bishop et al., 2004, p. 174). While definitions and mindfulness 
practices vary across studies, “most involve focusing non-judgmental attention on moment-to- 
moment private experiences, such as breath, thoughts, physical sensations, or other external 
aspects of the environment” (Thompson & Gauntlett-Gilbert, 2008, p. 398). For the purposes of 
this review, mindfulness-based interventions included methods for teaching mindfulness 
awareness where participants are encouraged to focus their attention either on a covert activity 
(e.g., thoughts, feelings, urges) or overt activity (e.g., lights, sounds, smells). Mindfulness 
interventions could include present moment work, meditation, relaxation skills training, breathing 
techniques and awareness of moment techniques delivered in vivo, via formal meditation practices 
or informal mindfulness exercises. Some specific interventions eligible included, but were not 
limited to, Mindfulness Based Stress Reduction (MBSR), Mindfulness Based Cognitive Therapy 
(MCBT), Learning to BREATHE, Inner Kids Program, and Acceptance and Commitment Therapy 
(ACT). 

We included studies that used multi-component interventions as long as one of the components 
was a mindfulness strategy. We coded for the various components used in addition to mindfulness 
and reported this information in the description of the interventions. 

We excluded Transcendental Meditation (TM) interventions. TM is another meditation-based 
intervention that has been implemented in schools (e.g., Quiet Time Program by David Lynch 
Foundation; Barnes et al., 2013) and examined for the reduction of stress in adolescents (e.g., 
Barnes, Trieber, & Davis, 2001). While MBIs and TM share a component of meditation, TM based 
interventions were not considered for this review for several reasons. While TM is a concentrative 
technique in which the meditator focuses the mind using a mantra, a picture, or a physical 
experience (Sedlmeier et al., 2012), there is concern about the religious aspect of TM, which is not 
usually present in MBIs. In fact, in one area, school administrators cancelled plans to implement 
TM due to concerns by parents that it would be promoting a religion (The Associated Press, 2006). 
Further, a United States federal appeals court (1979) called TM a form of religious teaching and 
ruled that the practice could not be taught as an elective in public high schools in the state of New 
Jersey, United States ( Malnak v. Yogi, 1979). While some MBIs may also have a religious 
component, MBIs are generally recognized and taught as a secular intervention, whereas religious 
aspects are consistently present with TM. Moreover, MBIs typically contain a practice of 
generalizing the skill of mindfulness into day-to-day activities such as academic tasks or the 
regulation of attention, whereas TM is primarily viewed a period of meditation in order to “take a 
break” from day-to-day activities. Due to the differences in nature and intent between MBIs and 
TM, interventions utilizing TM were excluded from this review. 


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3 - 1-4 Types of outcome measures 

Studies must have reported at least one of the following outcomes: 

1. Cognition (e.g., executive function, memory, cognition, attention) 

2. Academic performance (e.g., standardized achievement tests, measures of content 
mastery, reading, grades) 

3. Behavior (e.g., disciplinary referrals, aggression and other externalizing behaviors, time 
on task, compliance, attendance) 

4. Socioemotional (e.g., anxiety, stress, engagement, social skills, self-esteem, emotion 
regulation, grit, internalizing behaviors) 

5. Physiological (e.g., cortisol, heart rate, brain activity) 

Measurement of above outcomes could have been conducted using standardized or unstandardized 
instruments and self-, parent-, or teacher reported or researcher administered measures were 
eligible. To be included in the meta-analysis, primary study authors must have reported enough 
information to calculate an effect size. If sufficient information to calculate an effect size was not 
provided, every effort was made to contact primary study authors to request the necessary 
information. 

For studies in which the author reported both the total scale score and individual subscale scores 
for a measure, we did the following. For measures in which the total scale and all subscales were 
coded as the same outcome construct (as defined above), we used only the total scale score for 
analysis. For measures in which the subscales were measuring different outcome constructs (as 
defined above), we kept only the subscales scores for analysis. 

3.1.5 Duration of follow-up 

It was anticipated that most studies would report outcomes at post-test and thus post-test 
outcomes were the primary focus of this review; however, we noted studies that reported follow-up 
data or a subsequent report was published with outcomes examined at a follow-up time point. 

3.1.6 Types of settings 

The review included interventions conducted in a school setting. 

3.1.7 Other criteria 

Studies were included if they were conducted or published between 1990 and present. We selected 
1990 as the cut off as MBIs implemented in school settings is a newer phenomenon and we wanted 
the literature to be relevant to current practices. No additional criteria were applied. The search 
was not restricted by geography, language, publication status or other study characteristics. 


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3-2 SEARCH METHODS FOR IDENTIFICATION OF STUDIES 


3.2.1 Electronic searches 

We included all studies that met the inclusion criteria outlined above. We attempted to identity and 
retrieve both published and unpublished studies through a comprehensive search that included 
multiple electronic databases, research registers, grey literature sources, and reference lists of 
reviews and relevant studies. 

1 ) Electronic Databases 

a. Academic Search Complete 

b. Australian Education Index 

c. British Education Index 

d. CBCA Education 

e. Education Complete 

f. ERIC 

g. MEDLINE 

h. ProQuest Dissertations and Theses 

i. PsycINFO 

j. Social Science Citation Index 

k. Social Service Abstracts 

l . Sociological Abstracts 

m. SPORTDiscus 

2) Research Registers and Websites 

a. Cochrane Collaboration Library 

b. Database of Abstracts of Reviews of Effectiveness 

c. National Technical Information Service 

d. System for Information on Grey Literature 

e. Evidence for Policy Practice Information and Coordinating Centre (EPPI-Centre) 

f. Association for Mindfulness in Education (mindfuleducation.org) 

g. Mindfulness in Schools Project (mindfulnessinschools.org) 

Search terms and keywords: We used combinations of terms related to the intervention, 
population, study design, and setting to search the electronic databases. Database-specific 
strategies were explored for each database, including the use of truncation and database-specific 
limiters and thesauri were consulted to employ more precise search strategies within each 
database. Below are examples of the types of terms we used: 


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1) Intervention: mindful* OR meditat* OR yoga OR “breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR “Mindfulness-based cognitive therapy” OR MBCT 
OR “learning to breathe” OR MindUP OR “Meditation on the Soles of the Feet” OR “non- 
judgmental awareness” OR “present-moment” ) 

AND 

2) Report type: evaluation OR intervention OR treatment OR outcome OR program OR trial 
OR experiment OR “control group” OR “controlled trial” OR “quasi-experiment*” OR 
random* 

AND 

3) Targeted population: “elementary school” OR “primary school” OR “high school” OR 
“secondary school” OR “middle school” OR kindergarten OR pre-kindergarten 

The full search strategy for each database is reported in Appendix 8.1. 

3.2.2 Searching other resources 

1 ) Grey literature sources 

a. Social Science Research Network 

b. Authors of prior studies were contacted in an attempt to obtain unpublished studies, 
studies in process and published studies missed in the database search. 

c. Conference abstracts and proceedings were reviewed to identity potentially relevant 
studies. Conference searches included: 

i. The Society for Research on Educational Effectiveness 

fhttps : / / www. sree.org / pages / conferences / index. php) . and the 

ii. American Educational Research Association Repository 
fhttp://www.aera.net/EventsMeetings/tabid/ioo63/Default.aspx. 

iii. Society for Research on Child Development (SCRD) 

iv. Society for Research on Adolescence (SRA) 

d. Clearinghouses, research centers and government websites were reviewed to identify 
potential sources of relevant data: 

i. The US Department of Education’s web site contains reports of funded programs 
and initiatives: 

http : / / www2 . ed. gov/ about /offices /list /opepd /ppss / reports .html 

ii. The Institution of Education Sciences, What Works Clearinghouse contains 
reports of intervention investigations: 
http://ies.ed.gov/funding/grantsearch/index.asp 


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iii. Mindfulness Experience: http://www.mindfulexperience.org/mrg-user- 

reviews.php 

iv. Garrison Institute’s Contemplative Education Database: 
www.garrisoninstitute.org 

2) The reference lists from prior reviews and included studies were reviewed for potential 
studies. We also conducted forward citation searching using Google Scholar to search for 
studies citing our included studies. 


3.3 DATA COLLECTION AND ANALYSIS 


3.3.1 Selection of studies 

Titles and abstracts of the studies found through the search procedures were screened for relevance 
by two reviewers for most electronic databases, with the exception of the Australian Education 
Index, the British Education Index, and CBCA Education. The three databases noted above were 
searched by a search specialist contracted to conduct searches in those databases, as the review 
authors did not have access. For the search results in those three databases, one reviewer screened 
titles and abstracts for relevance. Titles and abstracts that were obviously ineligible or irrelevant 
were screened out at the title/abstract stage. For example, studies that were deemed inappropriate 
at the title/abstract review stage were those that did not involve the target population (e.g., they 
involved college students or adults), did not involve an intervention, or were theoretical in nature. 

If there was any question as to the appropriateness of the study at this stage by either of the 
abstract screeners, the full text document was obtained. Documents that were not obviously 
ineligible or irrelevant based on the title and abstract review were retrieved in full text for final 
eligibility screening. Two reviewers independently reviewed each full text report using a screening 
form to determine final inclusion. Any discrepancies between the reviewers were discussed and 
resolved through consensus. 

3.3.2 Data extraction and management 

For all studies that passed the eligibility screening process described above, two reviewers 
independently coded each eligible study using a structured data extraction form (Appendix 8.2; see 
also Maynard et al., 2015). The data extraction form, which was pilot tested by the coders, included 
items related to bibliographic information and source descriptors; methods and procedures; 
context, nature, and implementation of the intervention; sample characteristics; and outcome data 
needed to calculate effect sizes. Due to the large number of studies, four trained coders on the 
review team contributed to coding primary studies: Brandy Maynard, Michael Solis, Veronica 
Miller, and Kristen Brendel. Following independent coding of studies, coders then compared 
coding and identified and discussed discrepancies, which were resolved through consensus. If 
consensus could not be reached between the two coders, a third member of the review team was 
consulted to resolve the discrepancy. 


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3.3*3 Assessment of risk of bias in included studies 


Two review authors independently assessed risk of bias in RCT and QED studies using the 
Cochrane Collaboration’s risk of bias tool (Higgins et al., 2011). We assessed risk of bias for each of 
the six following domains: sequence generation, allocation, blinding, complete outcome data, and 
selective reporting. We also coded for additional factors related to potential bias in this corpus of 
studies: researcher allegiance bias, funding source bias, and confounding factors. In terms of 
allegiance bias and funding source bias, we assessed whether the study authors were directly 
involved in either the development or delivery of the intervention or were funded by an entity that 
had some stake in the intervention. Because studies are more likely to be biased in favor of the 
treatment intervention when study authors have a direct role in the development or the 
implementation of the study (Luborsky et al., 1999; Munder et al., 2013), or when funded by a 
source that has a stake in the intervention (Lundh et al., 2012), we believe it was important to 
assess for these biases in this review. We also examined whether there were confounding factors 
with either the treatment or comparison groups. Specifically, we examined whether there was one 
unit (e.g., teacher, classroom, school) in one or both conditions. When the treatment or 
comparison condition is confounded in this way, it is impossible to distinguish between the effect 
of that unit and the effect of the intervention and thus unobserved factors may be contributing to 
the outcome. 

Each study was coded as “low”, “high”, or “unclear” risk of bias on each of the domains. Following 
independent coding by two authors, coders met to identify any discrepancies and all discrepancies 
were resolved through consensus. If consensus could not be reached between the two reviewers, a 
third member of the review team was consulted. Risk of bias in each domain was reported within 
and across studies in the results section using narrative and graphs. We anticipated that most 
studies included in this review would be at high risk of bias, thus we did not plan to restrict 
analyses based on risk of bias. 

3 . 3.4 Synthesis procedures and statistical analysis 

We conducted descriptive analyses on variables of interest from all included studies to provide 
information regarding: 

• Study participants (e.g., risk level/subgroups, gender, race, income level, grade, age), 

• Settings where studies are situated (e.g., school type, classroom type, geographical 
location/country, community characteristics), 

• Relevant intervention characteristics (e.g., mindfulness strategies used, involvement of 
parents/teachers, duration of intervention, modality of intervention, implem enter 
training). 

• Risk of bias across RCT and QED studies included in the meta-analyses on each domain 

Following descriptive analysis, we estimated effect sizes for each included RCT and QED study 
when enough data was reported in the study or provided by study authors. For RCT and QED 
studies, we calculated the magnitude of effect using the standardized mean difference effect size 


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with Hedges’ g correction for continuous outcomes and odds ratios for outcomes presented as 
dichotomous variables. For studies in which the unit of assignment (e.g., classroom, school) did not 
match the unit of analysis (e.g., student) and the primary study authors did not account for 
clustering in their analysis (or the data extracted from the studies used for calculating effect sizes 
was not adjusted), we followed recommendations in the Cochrane Handbook (cite, 2011, 16.3.4) to 
derive approximately correct analysis by reducing the size of each trial to its ‘effective sample size’ 
(Rao, 1992) by dividing the sample size for each group by the ‘design effect’ (1 + (M-i)ICC). We 
applied this correction only to findings that were statistically significant as nonsignificant findings 
will remain nonsignificant without the correction (WWC manual). With the exception of Kuyken et 
al. (2013) and Metz et al. (2013), ICCs were not reported by study authors. In cases where study 
authors reported ICCs, we used the ICCs reported by the authors. For studies in which ICCs were 
not reported, we used an ICC of .20 for achievement outcomes and .10 for behavioral and 
socioemotional outcomes (cite WWC procedures manual). The direction of effect sizes were 
transformed to a positive effect to indicate the treatment group performed more favorably than the 
control group and a negative effect to indicate the control group performed more favorably than 
the treatment group. 

Following the estimation of individual study level effects, we conducted separate meta-analyses 
using Comprehensive Meta-Analysis, version 3.0 (CMA; Borenstein, Hedges, Higgins, & Rothstein, 
2014) for the following outcome domains of interest: cognitive, academic, behavioral and 
socioemotional outcomes. Within each of these domains, several included studies used multiple 
measures and/or multiple reports (e.g., parent, teacher) of the same measure. These circumstances 
created statistical dependencies that violate assumptions of standard meta-analytic methods. In 
order to ensure independence of study-level effect sizes, the mean of the measures was taken to 
estimate a study-level average across the measures within each outcome domain so that only one 
effect size estimate from each independent sample on each outcome domain was used in the meta- 
analyses. We followed standard procedures in CMA version 3.0 to use the mean of the selected 
outcomes for studies with multiple measures of the same outcome construct. In cases where 
multiple points of follow-up were provided, we coded follow-up points to conduct a separate 
analysis for effect sizes comparing studies with similar points of follow-up; however, there were not 
a sufficient number of studies measuring points beyond post-test, thus we only post-test effects 
were synthesized. One study provided data on two treatment groups— one group of general 
population students and another group of homeless students (Viafora et al., 2015). In this case, we 
used the data from the general population group for analysis (there was no comparison group for 
the homeless student group). 

To synthesize effects across studies, a weighted mean effect was calculated by weighting each study 
level effect size by the inverse of its variance. Random effects statistical models were used 
throughout. The random effects variance component was estimated using the methods of moments 
method. RCT and QED studies were pooled to allow for greater statistical power in all meta- 
analyses (heterogeneity between RCT and QED studies was not statistically significant in any of the 
meta-analyses). 


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Following the estimation of summary effects, we conducted a test of homogeneity (Q-test) to 
compare the observed variance to what would be expected from sampling error. The I 2 statistic was 
used to describe the percentage of total variation across studies due to the heterogeneity rather 
than chance. We also constructed a forest plot displaying study-level mean effect sizes and 95% 
confidence intervals for the included studies to provide opportunity for visual analysis of the 
precision of the estimated effect sizes, detection of studies with extreme effects, and information 
regarding heterogeneity of studies. Publication bias was assessed using funnel plots and the Egger’s 
test, both conducted in CMA version 3.0. 

When there was significant heterogeneity across studies, as determined by a statistically significant 
Q, we conducted moderator analyses using a random effects ANOVA for categorical variables. We 
did not assume a common among-study variance component across subgroups; tau-squared was 
computed within groups and not pooled across groups. The categorical variables examined per our 
protocol included: study type (RCT, QED), provider (classroom teacher, trained instructor), 
researcher involvement (yes/no), homework (yes/no), and manualized program (yes/no). For the 
one continuous variable we examined (number of weeks of the intervention), we used random 
effects meta-regression. All moderator analyses were conducted in CMA version 3.0. 


3.4 DEVIATIONS FROM THE PROTOCOL 


We experienced circumstances that required us to deviate from the protocol at times. During the 
literature search, the CINHAL and FRANCIS databases were undergoing technical difficulties and 
we were not able to access those databases, thus we did not search those databases as planned. We 
found six studies that measured physiological outcomes. While six studies measured physiological 
outcomes, not all studies measured the same, or enough of the same conceptually similar outcomes 
to warrant meta-analysis. Thus, we did not quantitatively synthesize effects of physiological 
outcomes, but rather provided a descriptive analysis of these studies. Also of note is that we did not 
originally plan to document adverse outcomes, but decided post-hoc to review studies for reporting 
of adverse outcomes. 


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4 Results 


4.1 RESULTS OF SEARCH 


Electronic searches of bibliographic databases and searches of other sources identified a total of 
1353 citations. Titles and abstracts were screened for relevance and 1260 were excluded as 
duplicates or deemed inappropriate. The full text of the remaining 93 potential studies was 
reviewed and screened for eligibility by two independent coders. Sixty-one studies passed full-text 
screening and were included in the review. See Figure 4.1 for the flow chart of the study selection 
process. 


Figure 4.1: Flow chart of study selection process 


Identification 


Screening 


Included 


> 


Reviewed 1353 titles and 
abstracts from databases +• 
websites and references from 
reviews and retrieved studies 


1 


f 

r v 

Screened 93 full-text articles 
for eligibility 

j 




61 studies m 
inclusion 

^ , 

et criteria for 
in review 

„ • 


Excluded 1260 studies deemed 
inappropriate upon review of 
the title and abstract 


Excluded 28 studies that did 
not meet inclusion criteria 
Study design (n = 1 1 ) 
Intervention (n = 15) 
Participant (n = I) 
Outcomes (n = 1) 

Not avail in full text ( n = 1) 
duplicate secondary reports 
(n=3) 


r 

9 SGPP studies 

v / 


Included in meta- 
analysis 



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4.1.1 Included studies 


Of the 61 studies that met criteria for inclusion in this review, 25 were RCT studies, 19 were QED 
studies, 9 were SGPP studies and 8 were SSD studies. Of the 44 RCT and QED studies, 35 provided 
enough data to calculate an effect size and were included in one or more of the meta-analyses, 
depending on which outcomes of interest were reported in the studies. Characteristics of included 
RCT and QED studies is reported in Appendix 8.3, SGPP studies are reported in Appendix 8.4 and 
SSD studies are reported in Appendix 8.5. 

4.1.2 Excluded studies 

Twenty-eight reports were excluded and three others were identified as secondary reports of 
included studies during the full-text screening stage. The majority of studies were excluded due to 
not meeting criteria for study design (e.g., the article did not report results of an intervention, used 
a mindfulness comparison group; n = 11). The remaining studies were excluded due to not meeting 
criteria related to intervention characteristics (i.e., not a school-based intervention; n = 15), 
participant characteristics (e.g., teachers; n=i), outcomes (n = 1) or were not available in full text 
(n=i). A list of excluded studies and reasons for exclusion is presented in Appendix 8.6. 


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4.2 DESCRIPTION OF INCLUDED RCT & QED STUDIES 


Of the 44 RCT and QED studies, seven were unpublished reports, with the remaining being 
published studies in peer-reviewed journals. Most of the studies were conducted in North America 
(74%), with others conducted in Asia (5%), Europe (16%) and Canada (5%). All studies were 
written in English, with the exception of Justo et al. (2011) written in Spanish. Sample sizes ranged 
from 23 to 557, with a mean sample size of 141. The studies measured one or more of the outcomes 
of interest: 10 studies measured cognitive outcomes, 5 measured academic outcomes, 13 measured 
behavioral outcomes, 28 measured socioemotional outcomes and 6 measured physiological 
outcomes. No studies reported adverse outcomes. See Table 4.1 for a summary of characteristics 
across the included 44 studies as well as the subgroup of the 35 studies included in at least one 
meta-analysis. 

Table 4.1: Characteristics of included RCT and QED studies 


Characteristic 

All studies 

N (%) 

Studies in MA 

N (%) 

Characteristic 

All studies 

N (%) 

Studies in MA 

N (%) 

Publication Year 



Geographic Region 



1990-2004 

1(2) 

0(0) 

Asia 

2 (5) 

2 (5) 

2005-2008 

3(7) 

1(2) 

Australia 

0 (0) 

0 (0) 

2009-2012 

16 (36) 

13 (37) 

Europe 

7 (16) 

5(14) 

2013-2016 

24 (55) 

21 (60) 

Canada 

2 (5) 

2 (5) 




United States 

33 (75) 

26 (74) 

Study Design 



Manualized Program 



RCT 

25 (59) 

21 (60) 

Fully manualized 

18 (41) 

17 (49) 

QED 

19 (43) 

14 (40) 

Partially manualized 

20 (45) 

16 (46) 

Publication Type 



Unable to determine 

6 (14) 

2 (5) 

Journal 

36 (82) 

27 (77) 

Grade levels 



Dissertation 

7(16) 

7(20) 

Preschool 

2 (5) 

2 (5) 

Other report 

1(2) 

1(2) 

Elementary 

13 (30) 

10 (29) 

Sample Size 



Middle School 

7 (16) 

6 (17) 

1-50 

10 (23) 

9(26) 

High school 

16 (36) 

12 (34) 

51-100 

13 (30) 

10 (29) 

Mixed grades 

6 (14) 

5 (14) 

101-200 

12 (27) 

7(20) 

Intervention Components 



201-300 

4(9) 

4(11) 

Present moment work 

38 (86) 

30 (86) 

>300 

5(11) 

5(14) 

Meditation 

37 (84) 

30 (86) 

Primary Provider 



Relaxation skills training 

27 (61) 

21 (60) 

Classroom 

teacher 

18 (41) 

11 (31) 

Breathing techniques/ 
breath awareness 

41 (93) 

33 (73) 

Trained Instructor 

23 (52) 

21 (60) 

Mindfulness in daily activities 

18 (41) 

15 (43) 

Other 

3(7) 

3(9) 

Body scan 

20 (45) 

16 (46) 




Yoga 

21 (48) 

18 (51) 


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4-2.1 Participant characteristics 


A total of 6,207 students were participants in the studies included in the meta-analyses. The mean 
age of participants across studies that reported age (n = 32) was 12.64 years. Approximately one 
third of the studies were conducted with elementary students and one third with high school 
students. Two studies were conducted with pre-school students, seven with middle school students, 
and six with students across grade levels. Most studies that reported the gender of the sample (n = 
41) included a balanced mix of male and female students, although two studies included only male 
students and three included only female students. The majority of studies (84%) included students 
from the general population of regular education schools. The seven studies that included a special 
population included students who were at risk of dropout, African American students at risk of 
cardiovascular disease, urban boys with financial need and academic potential, at-risk high school 
girls, students with autism spectrum disorders, Special education needs (including emotional, 
behavioral, and learning difficulties) and at risk for being excluded from school, and students at 
risk students attending a disciplinary alternative education program. 

4.2.2 Intervention characteristics 

The included studies examined a range of MBIs. Of the 44 RCT and QED studies included in this 
review, almost half of the interventions were based on MBCT or MSBR (n = 20) and/or 
incorporated yoga (n = 21). Most of the interventions were either fully manualized or partially 
manualized interventions (n = 38). All of the interventions were delivered in a group format, with 
most programs delivered during the school day (n = 40) and the remaining programs delivered 
after school (n = 4). Interventions ranged in duration and frequency. For studies reporting 
adequate information, interventions ranged from 4 to 28 weeks (N = 42, M= 10.5, SD = 5.5) and 
were provided in 6 to 125 sessions (N = 42, M = 26, SD = 25). Interventions also varied in terms of 
how frequently students met to receive the intervention from one time every other week to 5 times 
a week, for an average of 13 hours of mindfulness instruction (SD = 11). Most interventions 
incorporated breathing techniques/breath awareness, present moment work (86%), and 
meditation (84%). Relaxation skills training was reported in 61% of the interventions and body 
scan in 45% of the interventions. At home practice was assigned or encouraged in about half (45%) 
of the studies. Some interventions included other components in addition to mindfulness, such as 
cognitive and/or behavioral strategies (n = 8), yoga (n = 11) or other strategies, such as 
talk/ discussion, touch therapy, psychoeducation, aromatherapy, and/or literature (n = 11). Most 
studies (77%) did not measure fidelity of the intervention. 


4.3 RISK OF BIAS IN INCLUDED RCT & QED STUDIES 


Overall, there was a moderate to high risk of bias across the 35 studies included in the meta- 
analyses, with variation in high risk areas across studies. (See Figure 4.3 for a summary of risk 
across studies, Appendix 8.7 for a Table reporting each domain of risk for each study and Appendix 
8.xx for a for Risk of bias within studies. 


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4 - 3 *i Selection bias 


Selection bias is composed of random sequence generation and allocation concealment. We rated a 
study as being low risk on random sequence generation if they reported that they used 
randomization to assign participants to treatment and control groups. Twenty-one studies (60%) 
were rated low risk and 14 studies (40%) were rated high risk of bias for random sequence 
generation. In education and social science research, very rarely do studies report enough 
information to rate the level of risk on allocation concealment; therefore, we rated studies as 
unclear risk if they were randomized trials and high risk if they were non-randomized trials, unless 
study authors provided information about concealment procedures. Only four studies (11%) 
provided sufficient information to rate studies as low risk of bias on allocation concealment (Bluth 
et al., 2015; Flook et al., 2015; Haden et al., 2014; Noggle et al., 2012). 

4.3.2 Performance and detection bias 

For the types of interventions in this study, it is not typical, nor often practical, to blind study 
participants or personnel. Therefore, as we expected, most of the studies in this review were rated 
high risk for performance bias. Only one study reported that participants and study and school 
staff were blinded to program allocation (Sibinga et al., 2013), the remaining studies were rated as 
high risk (86%) or unclear risk (11%). For detection bias, expecting assessors to be blinded to 
condition is possible and a reasonable expectation for these study designs. We rated studies as low 
risk of bias if they reported blinding of outcome assessors or used only self-report measures. 
Overall, 60% of the included studies were rated as low risk of detection bias either because 
outcome assessors were blinded (n = 2) or studies used solely self-report questionnaires (n = 19). 

4.3.3 Attrition bias 

Most of the studies in this review were rated as low risk of attrition bias (74%). Four were rates as 
unclear risk, primarily because it was unclear what the analytic sample size was for the analyses or 
they were not clear on the initial sample size and thus we could not adequately calculate attrition. 
Five studies were rated at high risk of bias because their overall attrition rate was greater than 20% 
or there was high differential attrition between groups and the authors did not use any analytic 
approaches to impute missing data. 

4.3.4 Reporting bias 

We were not able to locate a study protocol for any of the included studies; therefore, we judged 
most of the included studies to be at unclear risk of selective reporting bias. Because we don’t have 
study protocols for the studies included in this review to compare what they had planned to 
measure to what they actually reported, it is uncertain whether these studies reported results for all 
outcomes they actually measured. One study mentioned the use of a study protocol (Schonert- 
Reichl et al., 2015), but no other information regarding the publishing of the protocol was provided 
and it could not be located. It must also be noted that several studies reported data for subscales of 
measures rather than reporting data for the full measure or all of the other subscale scores. Thus, it 
is unclear whether the a priori intentions of these authors were to only use certain subscales or if 
the participants did complete the full measure and the study authors only reported data for the 
subscale only. 


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Because some studies were not included in the meta-analysis due to not reporting sufficient data to 
calculate an effect size, several studies that would have been rated as high risk due to not providing 
sufficient data to calculate an effect size were not included in the meta-analysis. 

4*3*5 Other biases 

We coded for additional factors related to potential bias in this corpus of studies: researcher 
allegiance bias, funding source bias, and confounding factors. Coding for allegiance bias and 
funding source bias was challenging, as study authors were often not explicit about their role or 
relationship in the study development or implementation and rarely acknowledged conflicts of 
interest. Of the 35 studies included in the meta-analysis, we were able to clearly identify an author 
role in the development, adaptation, and/or delivery of the intervention in 19 (54%) of the studies, 
one study in which an author had some affiliation with the organization delivering the intervention 
and another study in which one author was employed at the school where the intervention was 
delivered. In all other studies, it was unclear whether the author was independent or just did not 
report their involvement. We conducted sensitivity analyses to examine researcher involvement on 
magnitude of effect size. Larger effects were found in studies with researcher involvement 
compared to those with no researcher involvement on behavioral outcomes but smaller effects 
were found in studies with researcher involvement on socioemotional, academic, and cognitive 
outcomes, although the differences between groups were not statistically significant for any 
outcome. 

In terms of the funding source, most authors either did not report the funding source or the studies 
were not funded. In four of the studies (11%), the authors identified a funding source that was also 
an entity involved in the development or the delivery of the intervention. 

We also examined whether there were confounding factors with either the treatment or 
comparison groups. Specifically, we examined whether there was one unit (e.g., teacher, classroom, 
school) in one or both conditions. When the treatment or comparison condition is confounded in 
this way, it is impossible to distinguish between the effect of that unit and the effect of the 
intervention and thus unobserved factors maybe contributing to the outcome. Fourteen studies 
(40%) were assessed as having a confound at the level of the instructor (n = 7; only one instructor 
in treatment, control or both conditions) or at the school/ classroom level (n = 7; one classroom or 
school at the treatment, control or both conditions). A larger mean effect was observed on all 
outcomes for studies in which a confound was present compared to those without confounds, thus 
likely upwardly biasing results; however, the differences in magnitude of effect between studies 
with and without confounds was not statistically significant. 


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Figure 4.3: Risk of bias across studies 


Random sequence generation (selection bias) 
Allocation concealment (selection bias) 
Blinding of participants and personnel (performance bias) 
Blinding of outcome assessment (detection bias) 
Incomplete outcome data (attrition bias) 
Selective reporting (reporting bias) 
Other bias 




-+- 


0 % 


25 % 


50 % 


75 % 100 % 


Low risk of bias 


]] Unclear risk of bias 


High risk of bias 


4.4 SYNTHESIS OF RESULTS 


4.4.1 Mean effects on cognitive outcomes 

Twenty effect sizes from 10 studies were synthesized to examine effects on cognitive outcomes. 
Results indicate that the overall mean effect (Hedges’ g) at post-test on cognitive measures was 
0.25 (95% Cl [0.06, 0.43 ],p = .01). Heterogeneity analysis indicated a low amount of heterogeneity 
( 7 2 = 25%) that was not statistically significant (Q = 12.10, p = .21). The mean effect size and 
confidence intervals for each study are shown in the forest plot in Figure 4.4 below. See Appendix 
8.8 for a full list of all measures of cognitive outcomes included in this meta-analysis by study. 

Figure 4.4: Forest plot of mean effects on cognitive outcomes 

Lower Upper Hedges’ g and 95 % Confidence Interval 
Study Name a limit limit 


Flook (2015) 

-•17 

-.78 

•43 

Britton (2014) 

-.11 

-.50 

•23 

Powell (2008) 

-.05 

-.42 

•33 

Quach (2014) 

.38 

-.01 

.76 

Flook (2010) 

•41 

-.08 

•90 

Schonert (2015) 

•41 

-•33 

1-15 

Chukwu (2015) 

.42 

-.22 

1.05 

Bergen-Cico (2015) 

•43 

-.10 

•97 

Parker (2014) 

•52 

.12 

•91 

Razza (2015) 

.76 

-•30 

1.82 

Grand Mean 

•25 

.06 

•43 


-2M 



Favors Control Favors Treatment 


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4.4-2 Mean effects on academic outcomes 

Fifteen effect sizes from five studies were synthesized to examine effects on academic outcomes. 
Results indicate that the overall mean effect (Hedges’ g) at post-test on academic outcomes was 
0.27 (95% Cl [-0.04, 0.57 ],p = .08.). Heterogeneity was not significant (I 2 = 0%; Tau 2 = .00 Q = 
0.52, p = .97). The mean effect size and confidence intervals for each study are shown in the forest 
plot in Figure 4.5 below. See Appendix 8.9 for a full list of all measures included in this meta- 
analysis by study. 

Figure 4.5: Forest plot of mean effects on adademic outcomes 


Lower Upper 


Studv Name 

0 

limit 

limit 

Bakosh (2015) 

.09 

-.56 

•74 

Smith (2014) 

.26 

-.18 

•70 

Schonert (2015) 

•36 

-.56 

1.27 

Flook (2015) 

•39 

-.41 

1.19 

Wick (2013) 

48 

-•75 

1.70 

Grand Mean 

.27 

-.04 

•58 


Hedges’ g and 95 % Confidence Interval 



-2.00 -1.00 0.00 1.00 2.00 


Favors Control Favors Treatment 


4.4.3 Mean effects on behavioral outcomes 

Twenty-eight effect sizes from 13 studies were synthesized to examine effects on behavioral 
outcomes. Results indicate that the overall mean effect (Hedges’ g) at post-test on behavioral 
outcomes was 0.14 (95% Cl [-0.02, 0.30], p = .08). It is important to note that there was a 
moderate amount of heterogeneity (J 2 = 48%; T 2 = .034; Q = 22.96, p = .03). The mean effect size 
and confidence intervals for each study are shown in the forest plot in Figure 4.6 below. See 
Appendix 8.10 for a full list of all measures included in this meta-analysis by study. 

4. 4.3.1 Moderator analysis for behavioral outcomes 

We conducted moderator analyses to examine whether study or intervention characteristics could 
explain the variation observed across studies. None of the moderators examined were statistically 
significant: study type (Qb = 3.51; p = .06), provider ( Qb = 0.71; p = .40), homework (Qb = 0.28; p = 
.60), manualized program (Qb = 7.27; p = .06), number of weeks (Q = .003; p = .97). 


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Figure 4.6: Forest plot of mean effects on behavioral outcomes 


Lower Upper 


Studv name 

0 

limit 

limit 

Haden (2014) 

-.98 

-1.83 

-•13 

Chukwu (2015) 

-.60 

-1.24 

.04 

Schonert (2015) 

-•13 

-•52 

.26 

Britton (2014) 

.02 

-•37 

•41 

Smith (2014) 

.10 

-•34 

•41 

Khalsa (2012) 

.12 

-•45 

.69 

Ricard (2013) 

.18 

-•05 

•41 

Wick (2013) 

•19 

-•59 

.96 

Sibinga (2015) 

.20 

-•03 

•43 

Parker (2014) 

•33 

-•05 

.72 

Schonert (2010) 

•38 

•13 

•63 

Flook 2015 

•50 

-•17 

1.17 

Koenig (2012) 

•65 

.10 

1.19 

Grand Mean 

•14 

-.02 

•30 


Hedges’ g and 95 % Confidence Interval 



Favors Control Favors Treatment 


4.4.4 Mean effects on socioemotional outcomes 

One hundred sixty-eight effect sizes from 28 studies were synthesized to examine effects on 
socioemotional outcomes. Results indicate that the overall mean effect (Hedges’ g) at post-test on 
socioemotional outcomes was 0.22 (95% Cl [0.14, 0.30], p < .001). There was a small amount of 
heterogeneity (J 2 = 14%; Q = 31.20, p = .263; Tau 2 = .01). The mean effect size and confidence 
intervals for each study are shown in the forest plot in Figure 4.7 below. See Appendix 8.11 for a full 
list of all measures included in this meta-analysis by study. 


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Figure 4.7: Forest plot of mean effects on socio emotional outcomes 


Lower Upper 

Study Name a limit limit 


Bluth (2015) 

-0.01 

-0.83 

0.81 

Lau (2011) 

0.01 

-0.62 

0.64 

Campbell (2015) 

0.01 

6 

M 

00 

0 

.20 

White (2012) 

0.05 

-0.27 

O.36 

Haden (2014) 

0.06 

-0.76 

O.87 

Ricard (2013) 

0.06 

6 

M 

O 

.29 

Quach (2014) 

0.08 

- 0.32 

O.48 

Sibinga (2013) 

0.10 

-0.510 

■71 

Britton (2014) 

0.11 

-0.28 

0-50 

Parker (2014) 

0.14 

6 

bs 

M 

O 

•89 

Sibinga (2015) 

0.17 

-0.06 

O.4O 

Theraldson (2012) 

0.18 

- 0-35 

0.70 

Powell (2008) 

0.20 

-0.l8 

0-57 

Kuyken (2013) 

0.20 

-0.03 

0-43 

Razza (2015) 

0.21 

- 0.52 

0-93 

Mendelson (2010) 

0.25 

- 0.36 

O.85 

Khalsa (2012) 

0.25 

- 0.31 

0.8l 

Schonert (2015) 

0.26 

- 0-34 

0.86 

Noggle (2012) 

0.30 

- 0-370 

.96 

Schonert (2010) 

0-34 

0.09 

0-59 

Deuskar (2007) 

0-35 

- 0.56 

1.26 

Ramadoss (2010) 

0.40 

-0.06 

0.87 

Metz (2013) 

0.41 

0.14 

0.69 

Raes (2014) 

0-44 

- 0.15 

1.02 

Flook (2015) 

0.56 

-0.101. 

22 

Potek (2012) 

0.64 

-0.08 

1.36 

Viafora (2013) 

0.66 

-0.24 

1-55 

Justo (2011) 

1.10 

0.64 

1.56 

Grand Mean 

0.22 

0.140 

■30 



Favors Control 


Favors Treatment 


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4-4-5 Physiological outcomes 


Six studies measured physiological factor in their study; three of those studies were conducted by 
the same author team (Barnes et al., 2004; Barnes et al., 2008; Gregoski et al., 2011). Two studies 
measured cortisol; one study measured cortisol at three time points during the day (AM, pre-lunch, 
and afternoon; Shonert-Reichl, 2015) while the other study measured total cortisol output (Sibinga 
et al., 2013). One study measured sleep (Sibinga et al., 2013), two studies measured sodium 
excretion rates (Barnes et al., 2008; Gregoski et al., 2011) and three studies measured systolic and 
diastolic blood pressure and heart rate (Barnes et al., 2004; Barnes et al., 2008; Gregoski et al., 
2011). Due to the nature of these measures, the time dependency of some of these measures 
(cannot compare AM cortisol to PM cortisol for example), and that so few studies measured these 
outcomes, quantitatively synthesizing these outcomes across these studies was not warranted. 


4.5 PUBLICATION BIAS 


There was a sufficient number of studies to examine publication bias for cognitive, behavioral and 
socioemotional outcomes using funnel plots (see Figure 8.12 in Appendix) and for socioemotional 
outcomes using Egger’s linear regression approach (a minimum of 17 studies is recommended; 
Card, 2012). In examining the funnel plot for behavioral outcomes, the funnel plot appears 
relatively symmetrical, but the funnel plot for cognitive and socioemotional outcomes appears to be 
somewhat asymmeterical, with a larger number of studies clustering on the right side of the funnel. 
Results of Egger’s regression for socioemotional outcomes was not significant (f = 1.76, p = .09 ), 
indicating an absence of publication bias in the studies contributing effect sizes for socioemotional 
outcomes. The funnel plot for cognitive outcomes, however, is less symmetrical, and few small 
sample studies with small effects were observed, indicating the possibility of publication bias. 


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5 Discussion 


5.1 SUMMARY OF MAIN RESULTS 


The present review identified a total of 61 studies that met review criteria, including 44 randomized 
or quasi-experimental studies and an additional 17 studies that used a single-group pre-posttest 
design or single subject study design to examine effects of a school-based mindfulness intervention 
on a cognitive, academic, behavioral, socioemotional or physiological outcome. It is interesting to 
note that we observed an increase in the number of MBI studies over time, as a higher proportion 
of the included studies were published more recently. Of the included studies, 35 provided 
adequate effect size data to be included in a meta-analysis for at least one of the outcomes of 
interest for this review. Results indicate mixed results of school-based mindfulness interventions 
across the outcomes of interest in this review, with small positive effects observed on cognitive and 
socioemotional outcomes and positive, yet non- significant effects on academic and behavioral 
outcomes. The lack of heterogeneity for all outcomes with the exception of the behavioral outcomes 
indicate that the interventions in this review, although quite diverse in their characteristics, 
produced similar results across studies on cognitive, socioemotional and academic outcomes. 

These findings provide some support for the use of school-based mindfulness interventions for 
some outcomes, but do not provide overwhelming support of mindfulness interventions as being 
the panacea as some have advocated. Given the quality and high risk of bias across studies in 
several areas, caution must be used in the interpretation of the study results. 

First, the results of this review largely correspond to what we would expect given the mechanisms 
by which mindfulness interventions are hypothesized to work. The proximal processes targeted by 
mindfulness interventions are cognitive processes, which are then hypothesized to impact more 
distal outcomes— academic, behavioral, and socioemotional outcomes. Our results provide support 
for favorable impacts of mindfulness interventions on those processes that are likely more directly 
targeted by mindfulness interventions, namely cognitive outcomes. Socioemotional outcomes may 
be a more proximal target as well as many of the measures were linked to emotional regulation 
processes that are invoked in mindfulness training. There is no direct support, at least not at 
posttest, to indicate that more distal outcomes, such as behavior and academic achievement, which 
are hypothesized to be impacted through improved cognitive and socioemotional outcomes, are 
affected by MBIs. It could also be that the effects found for cognitive and socioemotional outcomes 
may be due to the type of self-report measures typically used to measure these types of outcomes 
versus the administrative measures used to measure academic outcomes and observational 
measures to measure behavioral outcomes. 


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The mixed effects found in this review could be due to several possible explanations. First, as 
alluded to above, mindfulness interventions are most directly targeting cognitive and 
psychological/socioemotional processes. Thus, we expected that we would be more likely to find 
positive effects on those outcomes than behavioral or academic outcomes, which are arguably more 
distal outcomes. Mindfulness interventions may not be powerful enough to affect cognitive and 
socioemotional process sufficiently to mediate academic or behavioral outcomes as hypothesized 
by proponents of MBIs. Alternatively, since the vast majority of participants were not clinical or 
special needs populations, and were likely functioning within normal ranges across these measures 
(and thus have less opportunity to improve greatly), there may have been less opportunity for 
substantial improvement in the populations being studied, and thus small effects observed. Using 
mindfulness based interventions as a universal intervention with those already in normal ranges on 
cognitive, socioemotional and behavioral measures may be unnecessary, or perhaps measures need 
to be more sensitive to smaller changes to find effects when testing MBIs as a universal prevention 
strategy. It could also be that MBIs may have greater impact with students who are experiencing 
clinical, or high levels of, distress, anxiety or stress and could then have a greater impact on 
behavioral and academic outcomes. These issues require further exploration- examining 
differential impacts of MBIs with clinical versus non-clinical populations could provide some 
needed nuance to the MBI effectiveness literature. 

The MBIs in this review were also shorter-term interventions. It is possible that MBIs may have a 
greater impact with greater dosage over longer durations. A number of authors and proponents of 
MBIs often cite the short duration as a limitation in observing effects of mindfulness on various 
outcomes (Carmody, & Baer, 2008; Carson, Carson, Gil, & Baucom, 2004; Chiesa, Calati, & 

Serretti, 2011; Jha, Stanley, Kiyonaga, Wong, & Gelfand, 2010), and some studies indicate that a 
longer duration would have greater effects (Mathew, Whitford, Kenny, & Denson, 2010; Miller, 
Fletcher, & Kabat-Zinn, 1995). Also, we examined effects of interventions at posttest, thus we are 
unsure what the longer-term effects of MBIs on proximal and distal outcomes. Academic outcomes 
are often more difficult to change immediately, and given that the studies in this review measured 
grades, it may take a longer measurement period to see meaningful change in grades, as well as the 
other outcomes of interest. 


5.2 QUALITY OF THE EVIDENCE 


The quality of the evidence varied, with some important risks of bias present across a large 
proportion of studies which threatens the internal validity of the included studies and is cause for 
caution in interpreting the results of this review. Overall, a large proportion of included studies 
presented with a high risk of bias related to allocation concealment and performance bias. In most 
studies, reporting bias was rated as unclear risk of bias, which is problematic as reporting bias is a 
potential threat and we could not adequately assess it in this body of literature. Publication bias 
may also be present in this literature, as some funnel plots were asymmetrical, thus indicating 
potential for publication bias on at least some of the outcomes. A large proportion of the studies 
included in this review were conducted by researchers who were likely invested in the programs 
(involved in development or implementation) and had tacit knowledge of the interventions, and 
participants and personnel were not blinded in the majority of the studies- thus we are concerned 


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that this body of evidence is biased in favor of the MBIs due to allegiance and experimenter 
expectancy effects. In examining the results of the meta-analyses, the confidence intervals were 
fairly wide, with the exception of socioemotional outcomes, which were much narrower. This is 
reasonable in that we had a much larger number of studies and low heterogeneity across studies 
included in the meta-analysis for socioemotional outcomes. Thus, we can be more confident in the 
estimate of the average effect for socioemotional outcomes and less so in the average effect 
observed for cognitive, academic and behavioral outcomes. Also, a number of studies were 
confounded and, while the differences in mean effects were not significantly different for those 
studies that had a confound and those that did not, the magnitude of effects were larger in those 
that had a confound, and thus could be upwardly biasing the mean effect. Overall, there is room for 
improvement in the current evidence of effects of school-based mindfulness interventions. 


5.3 LIMITATIONS AND POTENTIAL BIASES IN THE REVIEW 
PROCESS 


We made every attempt to search for published studies; however, the majority of the studies 
included in this review were published journal articles, with approximately 20% being unpublished 
dissertations. Three of the databases were reviewed by only one of the authors, thus there may be a 
greater chance of errors in identifying potential studies from these three databases. The review 
authors did not use a formal method to assess the quality of the body of evidence; the authors did 
however assess risk of bias and reported on study characteristics that are indicators of study 
quality. There is some indication of publication bias present, which could be upwardly biasing the 
mean effect for all or some outcomes examined in this review. 


5.4 AGREEMENTS AND DISAGREEMENTS WITH OTHER STUDIES OR 
REVIEWS 


The findings of the present review largely correspond with other systematic reviews and meta- 
analyses of MBIs with children and youth. Narrative reviews, including those by Meiklejohn and 
colleagues (2012), Greenberg and Harris (2012), and Thompson and Gauntlett-Gilbert (2006) 
concluded that mindfulness-based approaches were feasible and promising, but cautioned that 
additional and more rigorous research was needed. Findings from a systematic review of 15 studies 
(6 between-group designs) of mindfulness-based approaches with children and adolescents (Burke, 
2010) concluded that the studies provided evidence of the feasibility and acceptability of 
mindfulness-based approaches for children and adolescents, but the research base was limited by a 
lack of rigorous efficacy studies. Finally, two meta-analyses of MBIs with children and youth found 
positive and significant effects of MBIs on primarily psychological outcomes. Zoogman et al., 

(2014) reported a synthesis of studies examining mindfulness meditation with youth across 
outcomes, including psychological and non-psychological symptoms (specific outcomes are not 
reported). The search was conducted in 2011 and was limited to peer-reviewed journal articles 
published in English. Twenty studies (13 RCTs, 1 QED, and 6 within group pre-post test studies) 
were included in the review, yielding an overall mean effect of 0.227 [Cl 0.148, 0.305], with lager 
mean effects found across studies using clinical samples compared to studies using non-clinical 
samples. Zenner and colleagues (2014) conducted a systematic review and meta-analysis of 


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mindfulness-based interventions in schools with a focus on psychological outcomes. The authors 
conducted a search in 2012 for published and unpublished reports yielding 24 studies (10 RCTs, 8 
QEDs, 1 two-armed cohort study, and 5 non-controlled trials). The mean effect across all outcomes 
of the 16 studies using a comparison group design was g = 0.40 [0.21, 0.58], with significant 
heterogeneity between studies. In the current meta-analysis of socioemotional outcomes (the 
outcome category that most closely aligns with the Zoogman et al. and Zenner et al. reviews), the 
mean effect of 0.21 is similar to the mean effect of 0.227 estimated by Zoogman et al. and smaller 
than the mean effect estimated by Zenner et al. The differences in mean effects between the present 
review and Zoogman et al. could be due to the inclusion of different outcomes, studies and effect 
size estimation procedures. The present review provides the first synthesis of effects specifically on 
cognitive, academic and behavioral outcomes in addition to the socioemotional outcomes reported 
in prior reviews. 


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6 Authors’ conclusions 


6.1 IMPLICATIONS FOR PRACTICE AND POLICY 


The number and types of MBIs being implemented in schools is expanding significantly, and 
intervention research is beginning to shed more light onto the effects and mechanisms of 
mindfulness interventions on a range of outcomes. Up to this point, much of the arguments and 
enthusiasm for the broad implementation of mindfulness-based approaches with children, as well 
as those in schools, have been predicated on generalizing the positive evidence from mindfulness 
research with adults and from expert opinion, or the use of cherry-picking studies in favor of MBIs 
to promote mindfulness interventions with children. This review adds to the body of evidence 
examining MBIs for children, and for the use of MBIs in school settings specifically. While the 
results of this review found positive effects favoring mindfulness interventions on cognitive and 
socioemotional outcomes, we urge caution in the use of these findings to support further 
implementation of MBIs in schools. 

Schools often justify the implementation of socioemotional programs, including mindfulness-based 
training, on the premise that those programs will, in turn, promote positive behavior and improve 
academic achievement. The evidence to support MBIs to improve behavioral and academic 
outcomes, at least in the short-term, is not yet supported by the evidence. There is also seemingly 
widespread belief that MBIs, given the positive effects with adults, have great potential for direct 
and indirect benefits for students. Moreover, those who argue for an expansion of MBIs with 
children do not adequately, if at all, consider the costs or potential negative effects. Although rarely 
discussed and more rarely studied, adverse effects of mindfulness and meditation are gaining more 
attention, as Willoughby Britton, a mindfulness researcher at Brown, has begun to map and 
analyze accounts of harmful effects of contemplative practices, which include mindfulness and 
meditation (Rocha, 2014; Britton & Lindahl, 2015), through interviews with meditation teachers 
and practitioners from across a range of contemplative practice traditions. Some of her preliminary 
findings indicate that meditation can result in difficult or challenging experiences and cause or 
worsen symptoms. None of the studies included in this review measured potentially adverse 
outcomes, and if they didn’t find positive effects, authors were more likely to provide justifications 
for why their intervention did not work rather than to consider that their intervention was not 
effective. There were exceptions to this, however. For example, Tharaldsen (2002) found that 
participants in their study experienced deterioration in life satisfaction and no improvement in 
psychological symptoms. They considered the possibility that their results “may be a result of an 
increased focus on troublesome emotions due to awareness training and a maladaptive use of 
distraction skills that lead to avoidance” and that “certain aspects of mindfulness can be more 


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confusing than beneficial to adolescents” (Tharaldsen, 2012, p. 120). Indeed, children and 
adolescents may not benefit from mindfulness-based interventions similarly to adults, and there 
may be some adverse effects, because children and adolescents may not be developmentally ready 
for the complex cognitive tasks, focus and level of awareness that mindfulness-based interventions 
require (Melbourne Academic Mindfulness Interest Group, 2006; Shapiro, 1992). 

There are also direct and indirect costs in implementing these interventions, and the cost-benefit of 
mindfulness-based intervention is largely ignored. The direct costs of implementing mindfulness- 
based interventions are those that are obvious to the implementation of any intervention in 
schools, namely the cost of materials and personnel needed to implement the intervention. The 
included studies did not provide sufficient information to calculate the total cost of the 
interventions that schools would be responsible for if they were to adopt these interventions. 
Indirect costs, but nonetheless important, are opportunity costs, specifically the cost of lost 
instructional time or not implementing something else that could be more effective (Melbourne 
Academic Mindfulness Interest Group, 2006). Some of these interventions were very short in 
duration, in that they only took up a few minutes of the school day on a daily basis and thus 
resulted in little lost instructional time. However, other interventions used more class time, or even 
an entire class period. It is unclear if the small effects gained from these interventions on cognitive 
and socioemotional outcomes are worth the lost instructional time. If the primary focus of schools 
is to enhance academic outcomes, then using instructional time to provide a universal MBI may 
not be a good use of time, considering that we found a lack of evidence for significant effects on 
academic outcomes. However, there remains yet much we do not know about the effects of MBIs, 
specifically whether students near or in the clinical range of anxiety or other emotional disorders 
may benefit more than students in the general population of the school. Prior reviews found some 
evidence for greater effects with children and adolescents from clinical populations (Zoogman et 
al., 2014), and thus there may be some students for which MBIs may be worth the cost and time. 

Overall, the evidence from this review urges caution in the enthusiasm for, and widespread 
adoption of, MBIs for children and youth— specifically for use in schools. While the evidence points 
to positive effects on socioemotional and cognitive outcomes, there is a lack of evidence of effects 
on academic and behavioral outcomes. Moreover, we know little about the costs and adverse effects 
of school-based mindfulness interventions. The costs of implementing these programs may not be 
justified, and there are some indications that MBIs may have some adverse effects on children and 
youth that have not received adequate attention. If schools do want to implement MBIs, we urge 
schools to evaluate the practice in a rigorous way and monitor outcomes and costs. 


6.2 IMPLICATIONS FOR RESEARCH 


The number of studies examining effects of MBIs have expanded considerably, particularly over 
just the past few years. Clearly, there is much interest in examining the effects of school-based 
mindfulness interventions. However, a large proportion of studies in this review were conducted by 
authors who clearly had some involvement in the development, adaptation, or delivery of the 
intervention and thus were not independent evaluators. Moreover, several of the studies were 
funded by bodies that had an interest in the success of the MBIs being evaluated. Overall, authors 
engaged in the evaluation of school-based mindfulness interventions appear to be largely biased in 


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favor of mindfulness interventions. This is problematic in that studies in which authors have some 
allegiance to the intervention or are otherwise involved in the development or implementation of 
the intervention are more likely to find positive effects than studies that are not conducted by 
authors with a vested interest in the outcomes of the interventions. The large proportion of studies 
in which authors had some role in the development and delivery of the interventions under 
investigation in this review may have biased the mean effect in favor of mindfulness interventions 
and overestimated the effects of these interventions. Moreover, the tacit knowledge that 
researchers who develop or implement the interventions they are testing may positively skew the 
outcomes in such a way that would not be replicable if someone with less knowledge or investment 
were implementing the intervention. It is recommended that future evaluations of MBIs be 
conducted by an independent third party investigator, and when possible, that personnel and 
assessors be blinded to group assignment. 

Also, a significant number of studies in this review had major and troublesome confounds that 
clearly limits the extent to which we can draw causal inferences from this body of research. For 
each outcome examined in this review, all studies with confounds were biased in favor of the 
treatment group, thus resulting in an upward bias of the mean effect across studies. Future studies 
should avoid confounds in their study designs. 

Other important areas in which to further develop school-based mindfulness intervention research 
is to move beyond mean effects of interventions and begin to explicitly examine the mechanisms of 
change (e.g., what are the pathways and mediators), which components of mindfulness 
interventions are effective and/or necessary (e.g., is home practice necessary and how much? Does 
yoga/movement enhance mindfulness practice), what works for whom and under what 
circumstances, and examine adverse effects of these interventions. 


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6.3 REFERENCES TO INCLUDED STUDIES 


References to studies that have supplemental reports are identified by coordinating superscript 

numbers. Primary articles are indicated by an A; secondary with a B. 

Bakosh, L., S. (2013). Investigating the effects of a daily audio-guided mindfulness intervention 
for elementary school students and teachers. Sofia University: Palo Alto, California. 
Retrieved from ProQuest Dissertations & Theses Full Text. (3618722) 

Bakosh, L. S., Snow, R. M., Tobias, J. M., Houlihan, J. L., & Barbosa-Leiker, C. (2015). Maximizing 
Mindful Learning: Mindful Awareness Intervention Improves Elementary School Students’ 
Quarterly Grades. Advance online publication, Mindfulness, doi 10.1007/S12671-015-0387-6. 

Barnes, V. A., Davis, H. C., Murzynowski, J. B. &Trieber, F. A. (2004). Impact of meditation on 
resting and ambulatory blood pressure and heart rate in youth. Psychosomatic Medicine, 
66 ( 6 ), 909 - 914 - 

Barnes, V. A., Pendergrast, R. A., Harshfield, G., A., & Treiber, F. A. (2008). Impact of breathing 
awareness meditation on ambulatory blood pressure and sodium handling in prehypertensive 
African American adolescents. Ethnicity & Disease, 18(1), 1-5. 

Beauchemin, J., Hutchins, T. L., & Patterson, F. (2008). Mindfulness meditation may lessen 

anxiety, promote social skills, and improve academic performance among adolescents with 
learning disabilities. Complementary Health Practice Review, 13(1), 34-45. 
http://d0i.0rg/10.1177/1533210107311624 

Bei, B., Byrne, M. L., Ivens, C., Waloszek, J., Woods, M. J., Dudgeon, P., ... Allen, N. B. (2013). Pilot 
study of a mindfulness-based, multi-component, in-school group sleep intervention in 
adolescent girls. Early Intervention in Psychiatry, 7(2), 213-220. Retrieved from 
http://ezproxy.lib.utexas.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true 
&db=a9h&AN=87293383&site=ehost-live 

Bergen-Cico, D., Razza, R., & Timmins, A. (2015). Fostering self-regulation through curriculum 

infusion of mindful aoga: A pilot study of efficacy and feasibility. Journal of Child and Family 
Studies, 1-14. 

Berking, M., & Wupperman, P. (2012). Emotion regulation and mental health: recent findings, 
current challenges, and future directions. Current Opinion in Psychiatry, 25(2), 128-134. 

Bluth, K., Campo, R. A., Pruteami-Malinici, S., Reams, A., Mullarkey, M., & Broderick, P. C. (2015). 
A school-based mindfulness pilot study for ethnically diverse at-risk adolescents. 
Mindfulness. Advance online publication, http://d0i.0rg/10.1007/s12671-014-0376-1 

Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized 
controlled pilot trial of classroom-based mindfulness meditation compared to an active 
control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278. 
http://d0i.0rg/10.1016/j.jsp.2014.03.002 

Broderick, P. C., & Metz, S. (2009). Learning to BREATHE: A pilot trial of a mindfulness 

curriculum for adolescents. Advances in School Mental Health Promotion, 2(1), 35-46. 
http://d0i.0rg/10.1080/1754730X.2009.9715696 


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Campbell, A. J. (2015). The impact of a school mindfulness program on adolescent stress, 
wellbeing, and emotion regulation, with attachment as a moderator. Unpublished 
dissertation. The George Washington University, Ann Arbor. Retrieved from ProQuest 
Dissertations & Theses Full Text. (1654442923) 

Carboni, J. A., Roach, A. T., & Fredrick, L. D. (2013). Impact of mindfulness training on the 

behavior of elementary students with Attention-Deficit/Hyperactive Disorder. Research in 
Human Development, 10(3), 234-251. http://d0i.0rg/10.1080/15427609.2013.818487 
Carmona, S. (2014). An exploration of mindfulness as a stress reduction prevention for 
adolescents (Ed.D.). California State University, Fullerton, Ann Arbor. Retrieved from 
ProQuest Dissertations & Theses Full Text. (1657424257) 

Chukwu, O. C.-B. (2015). Analysis of teacher ratings on the Behavior Rating Inventory of 
Executive Functions (BRIEF) at the level for urban middle school students included in a 
study of the effectiveness of a Mindfulness Awareness Program (Ed.D.). The George 
Washington University, Ann Arbor. Retrieved from ProQuest Dissertations & Theses Full 
Text. (1656484311) 

Deuskar, M. (2007). The effectiveness of Yogic relaxation technique in the reduction of 

examination anxiety among high school students. Journal of Psychosocial Research, 3 (1), 
119-129. 

Edwards, M., Adams, E. M., Waldo, M., Hadfield, O. D., & Biegel, G. M. (2014). Effects of a 
mindfulness group on Latino adolescent students: Examining levels of perceived stress, 
mindfulness, self-compassion, and psychological symptoms. The Journal for Specialists in 
Group Work, 39(2), 145-163. http://d0i.0rg/10.1080/01933922.2014.891683 
Felver, J. C., Frank, J. L., & McEachern, A. D. (n.d.). Effectiveness, acceptability, and feasibility of 
the Soles of the Feet mindfulness-based intervention with elementary school students. 
Mindfulness, 5, 589 - 597 - 

Flook, L., Goldberg, S. B., Pinger, L., & Davidson, R. J. (2015). Promoting prosocial behavior and 
self-regulatory skills in preschool children through a mindfulness-based kindness curriculum. 
Developmental Psychology, 51(1), 44-51. Retrieved from 

http://ezproxy.lib.utexas.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true 
&db=pdh&AN=20i4-48298-ooi&site=ehost-live 
Flook, L., Smalley, S. L., Kitil, M. J., Galla, B. M., Kaiser-Greenland, S., Locke, J., ... Kasari, C. 
(2010). Effects of Mindful Awareness Practices on executive functions in elementary school 
children. Journal of Applied School Psychology, 26(1), 70-95. 
http://d0i.0rg/10.1080/15377900903379125 

Franco Justo, C., de la Fuente Arias, M., & Salvador Granados, M. (2011). Impact of a training 
program in full consciousness (mindfulness) in the measure of growth and personal self- 
realization. Psicothema, 23(1), 58-65. 

Gregoski, M. J., Barnes, V. A., Tingen, M. S., Harshfield, G. A., & Treiber, F. A. (2011). Breathing 
awareness meditation and LifeSkills training programs’ influence upon ambulatory blood 
pressure and sodium excretion among African American adolescents. Journal of Adolescent 
Health, 48(1), 59-64. http://d0i.0rg/10.1016/i.iad0health.2010.05.019 
2a Gould, L. F., Dariotis, J. K., Mendelson, T., & Greenberg, M. T. (2012). A school-based 

intervention for urban youth: Exploring moderators of intervention effects. Journal of 
Community Psychology, 40(8), 968-982. http://d0i.0rg/10.1002/jc0p.21505 


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J Haden, S. C., Daly, L. A., & Hagins, M. (2014). A randomised controlled trial comparing the impact 
of yoga and physical education on the emotional and behavioral functioning of middle school 
children. Focus on Alternative and Complementary Therapies, 19(3), 148-155. 
http://doi.org/io.iiii/fct.i2i.2Q 

la Hagins, M., Haden, S. C., & Daly, L. A. (2013). A randomized controlled trial on the effects of yoga 
on stress reactivity in 6th Grade Students. Evidence-Based Complementary and Alternative 
Medicine : eCAM, 2013, 607134. http://d0i.0rg/10.1155/2013/607134 

Huppert, F. A., & Johnson, D. M. (2010). A controlled trial of mindfulness training in schools: The 
importance of practice for an impact on well-being. The Journal of Positive Psychology, 5(4), 
264-274. http://d0i.0rg/10.1080/17439761003794148 

Joyce, A., Etty-Leal, J., Zazryn, T., & Hamilton, A. (2010). Exploring a mindfulness meditation 
program on the mental health of upper primary children: A pilot study. Advances in School 
Mental Health Promotion, 3(2), 17-25. http://d0i.0rg/10.1080/1754730X.2010.9715677 

Khalsa, S. B. S., Hickey-Schultz, L., Cohen, D., Steiner, N., & Cope, S. (2012). Evaluation of the 
mental health benefits of yoga in a secondary school: A preliminary randomized controlled 
trial. Journal of Behavioral Health Services & Research, 39(1), 80-90. 
http://doi.org/10.1007/s11414-011-9249-8 

Klatt, M., Harpster, K., Browne, E., White, S., & Case-Smith, J. (2013). Feasibility and preliminary 
outcomes for Move-Into-Learning: An arts-based mindfulness classroom intervention. The 
Journal of Positive Psychology, 8(3), 233-241. 
http://d0i.0rg/10.1080/17439760.2013.779011 

Koenig, K. P., Buckley- Reen, A., & Garg, S. (2012). Efficacy of the get ready to learn yoga program 
among children with autism spectrum disorders: a pretest-posttest control group design. 
AJOT: American Journal of Occupational Therapy, 66(5), 538-546. 

Kuyken, W., Weare, K., Ukoumunne, O. C., Vicary, R., Motton, N., Burnett, R., ... Huppert, F. 

(2013). Effectiveness of the Mindfulness in Schools Programme: non-randomised controlled 
feasibility study. The British Journal of Psychiatry, 203(2), 126-131. 
http:// doi.org/ 10. H92/bjp.bp.ii3. 126649 

Lau, N-S. & Hue, M-T. (2011). Preliminary outcomes of a mindfulness-based programme for Hong 
Kong adolescents in schools: well-being, stress and depressive symptoms. International 
Journal of Children’s Spirituality, 16(4), 315-330. Retrieved from 

http://ezproxv.lib.utexas.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true 

&db=rlh&AN= 6 p 6 o 3 P 63 &site=ehost-live 

Mehta, S., Mehta, V., Mehta, S., Shah, D., Motiwala, A., Vardhan, J., ... & Mehta, D. (2011). 

Multimodal behavior program for ADHD incorporating yoga and implemented by high 
school volunteers: A pilot study. ISRN Pediatrics, 2011, 1-5. doi: 10.5402/2011/780745 

Mehta, S., Shah, D., Shah, K., Mehta, S., Mehta, N., Mehta, V., ... Mehta, D. (2012). Peer-mediated 
multimodal intervention program for the treatment of children with ADHD in India: One- 
year follow up. ISRN Pediatrics, 2012, 1-8. 419168. doi: 10.5402/2012/419168 

2 Mendelson, T., Greenberg, M., Dariotis, J., Gould, L., Rhoades, B., & Leaf, P. (2010). Feasibility 
and preliminary outcomes of a school-based mindfulness intervention for urban youth. 
Journal of Abnormal Child Psychology, 38(7), 985-994. http://d0i.0rg/10.1007/s10802- 
010-9418-x 


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The Campbell Collaboration | www.campbellcollaboration.org 


Metz, S. M., Frank, J. L., Reibel, D., Cantrell, T., Sanders, R., & Broderick, P. C. (2013). The 
Effectiveness of the Learning to BREATHE Program on adolescent emotion regulation. 
Research in Human Development, io( 3), 252-272. 
http://d0i.0rg/10.1080/15427609.2013.818488 

Napoli, M., Krech, P. R., & Holley, L. C. (2005). Mindfulness training for elementary school 
students. Journal of Applied School Psychology, 21(1), 99-125. 
http://d0i.0rg/10.1300/J370v21n01_05 

Noggle, J. J., Steiner, N. J., Minami, T., & Khalsa, S. B. S. (2012). Benefits of yoga for psychosocial 
well-being in a U. S. high school curriculum: A preliminary randomized controlled trial. 
Journal of Developmental and Behavioral Pediatrics, 33(3), 193-201. 
http://d0i.0rg/10.1097/DBP.0b013e31824afdc4 

Parker, A. E., Kupersmidt, J. B., Mathis, E. T., Scull, T. M., & Sims, C. (2014). The impact of 
mindfulness education on elementary school students: evaluation of the Master Mind 
program. Advances in School Mental Health Promotion, 7(3), 184-204. 
http://d0i.0rg/10.1080/1754730X.2014.916497 

Peck, H. L., Kehle, T. J., Bray, M. A., & Theodore, L. A. (2005). Yoga as an intervention for children 
with attention problems. School Psychology Review, 34(3), 415-424. 

Ponitz, C. C., McClelland, M. M., Matthews, J. S., & Morrison, F. J. (2009). A structured 

observation of behavioral self- regulation and its contribution to kindergarten outcomes. 
Developmental psychology , 45(3), 605. 

Potek, R. (2012). Mindfulness as a school-based prevention and its effect on adolescent stress, 
anxiety, and emotion regulation. New York University. Retrieved from UMI 3493866. 

Powell, L. A., Gilchrist, M., Stapley, J., Lesley Powell, M. G., & Jacqueline, S. (2008). A journey of 
self-discovery: an intervention involving massage, yoga and relaxation for children with 
emotional and behavioral difficulties attending primary schools. European Journal of Special 
Needs Education, 23, 403-412. Retrieved from 

http://search.ebscohost.com/login.aspx9direct =true&db=bri&AN=BEI.i77074&site=ehost- 
live 

Quach, D. (2014). Differential effects of sitting meditation and hatha yoga on working memory, 
stress, anxiety, and mindfulness among adolescents in a school setting (Ph.D.). Alliant 
International University, Ann Arbor. Retrieved from ProQuest Dissertations & Theses Full 
Text. (1666812926) 

Quinn, P. D., & Fromme, K. (2010). Self- Regulation as a Protective Factor against Risky Drinking 
and Sexual Behavior. Psychology of Addictive Behaviors : Journal of the Society of 
Psychologists in Addictive Behaviors, 24(3), 376-385. http://d0i.0rg/10.1037/a0018547 

Raes, P., Griffith, J. W., Van der Gucht, K., & Williams, J. M. G. (2014). School-based prevention 
and reduction of depression in adolescents: A cluster-randomized controlled trial of a 
mindfulness group program. Mindfulness, 5, 477-486. http://d0i.0rg/10.1007/s12671-013- 
0202-1 

Ramadoss, R., & Bose, B. K. (2010). Transformative life skills: Pilot studies of a yoga model for 
reducing perceived stress and improving self-control in vulnerable youth. International 
Journal of Yoga Therapy, 20, 75-80. 


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Razza, R., Bergen-Cico, D., & Raymond, K. (2015). Enhancing preschoolers’ self-regulation via 
mindful yoga. Journal of Child and Family Studies, 24(2), 372-385. 
http://d0i.0rg/10.1007/s10826-013-Q847-6 

Ricard, R. L. , Lerma, E., & Heard, C. C. C. (2013). Piloting a Dialectical Behavioral Therapy (DBT) 
infused skills group in a Disciplinary Alternative Education Program. The Journal for 
Specialists in Group Work, 38(4), 285-306, DOI: 10.1080/01933922.2013.834402 
Richardson, M., Abraham, C., & Bond, R. (2012). Psychological correlates of university students' 
academic performance: a systematic review and meta-analysis. Psychological bulletin, 

138(2), 353. 

Salustri, M. E. (2009). Mindfulness-based stress reduction to improve well-being among 

adolescents in an alternative high school (Psy.D.). Hofstra University, Ann Arbor. Retrieved 
from ProQuest Dissertations & Theses Full Text. (304895452) 

Schonert-Reichl, K. A., & Lawlor, M. S. (2010). The effects of a mindfulness-based education 
program on pre-and early adolescents’ well-being and social and emotional competence. 
Mindfulness, 1(3), 137-151. 

Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & 
Diamond, A. (2015). Enhancing cognitive and social-emotional development through a 
simple-to-administer mindfulness-based school program for elementary school children: A 
randomized controlled trial. Developmental Psychology, 51(1), 52-66. Retrieved from 
http://ezproxv.lib.utexas.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true 

&db=pdh&AN=20i4-56463-oo2&site=ehost-live 
Semple, R. J., Reid, E. F. G., & Miller, L. (2005). Treating anxiety with mindfulness: An open trial 
of mindfulness training for anxious children. Journal of Cognitive Psychotherapy, 19(4), 
379-392. Retrieved from 

http://ezproxv.lib.utexas.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true 

&db=aQh&AN=iQ 7 . 227 iFi&site=ehost-hve 

Sektnan, M., McClelland, M. M., Acock, A., & Morrison, F. J. (2010). Relations between early 
family risk, children’s behavioral regulation, and academic achievement. Early Childhood 
Research Quarterly, 25(4), 464-479. http://d0i.0rg/10.1016/j.ecresq.2010.02.005 
Sibinga, E. M. S., Perry-Parrish, C., Chung, S., Johnson, S. B., Smith, M., & Ellen, J. M. (2013). 
School-based mindfulness instruction for urban male youth: A small randomized controlled 
trial. Preventive Medicine, 57(6), 799-801. http://d0i.0rg/10.1016/j.ypmed.2013.08.027 
Singh, N. N., Lancioni, G. E., Singh Joy, S. D., Winton, A. S. W., Sabaawi, M., Wahler, R. G., & 
Singh, J. (2007). Adolescents with conduct disorder can be mindful of their aggressive 
behavior. Journal of Emotional and Behavioral Disorders, 15(1), 56-63. 
http://d0i.0rg/10.1177/10634266070150010601 
Smith, B. H., Connington, A., McQuillin, S., & Crowder Bierman, L. (n.d.). Applying the 

deployment focused treatment development model to school-based yoga for elementary 
school students: Steps one and two. Advances in School Mental Health Promotion, 7(3), 
140-155. http://d0i.0rg/10.1080/1754730X.2014.920132 
Steiner, N. J., Sidhu, T. K., Pop, P. G., Frenette, E. C., & Perrin, E. C. (2013). Yoga in an urban 
school for children with emotional and behavioral disorders: A feasibility study. Journal of 
Child and Family Studies, 22(6), 815-826. http: / / doi.org/ 10.1007/ S10826-012-9636-7 


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Tharaldsen, K. (2012). Mindful coping for adolescents: beneficial or confusing. Advances in School 
Mental Health Promotion, 5(2), 105-124. doi: io.io 8 o/ 175473 oX. 2 Q 12 . 6 pi 8 i 4 

Van de Weijer-Bergsma, E., Langenberg, G., Brandsma, R., Oort, F. J., & Bogels, S. M. (2014). The 
effectiveness of a school-based mindfulness training as a program to prevent stress in 
elementary school Children. Mindfulness, 5(3), 238-248. http://d0i.0rg/10.1007/s12671- 
012-0171-9 

Viafora, D., Mathiesen, S., & Unsworth, S. (2015). Teaching mindfulness to middle school students 
and homeless youth in school classrooms. Journal of Child and Family Studies, 24(5), 1179- 
1191. http://d0i.0rg/10.1007/s10826-014-9926-3 

3 White, L. S. (2012). Reducing stress in school-age girls through mindful yoga. Journal of Pediatric 
Health Care, 26(1), 45-56. http://d0i.0rg/10.1016/i.pedhc.2011.01.002 

3a White, L. S. (2010). Reducing stress in school age girls: mindful awareness for girls through 
yoga (MAGY). Received from ProQuest Dissertations & Theses Full Text. (3404763). 

Wick, K. M. (2013). The effect of mindfulness meditation and loving kindness meditation on 

academic performance among female at-risk high school students (Dissertation). Walden 
University, Ann Arbor. Retrieved from ProQuest Dissertations & Theses Full Text. 
(1284937721). Retrieved from 

http:// ezproxy.lib.utexas.edu/login?url=http://search.proquest.com/ docview/ 12849377219a 
ccountid=7ii8 

Wisner, B. L. (2008, May). The impact of meditation as a cognitive-behavioral practice for 
alternative high school students. The University of Texas at Austin, Austin, TX. 

Worth, D. E. (2013). Mindfulness meditation and Attention-Deficit/Hyperactivity Disorder 
symptom reduction in middle school students (Ph.D.). Walden University, Ann Arbor. 
Retrieved from ProQuest Dissertations & Theses Full Text. (1465055788) 

Zahn, W. L. (2008). The effects ofTai Chi Chuan on mindfulness, mood, and quality of life in 

adolescent girls (Psy.D.). Alliant International University, San Diego, Ann Arbor. Retrieved 
from ProQuest Dissertations & Theses Full Text. (304820654). Retrieved from 
http://ezproxy.lib.utexas.edu/login?url=http://search.proquest.com/docview/30482o654?a 
ccountid=7ii8 

6.4 REFERENCES TO EXCLUDED STUDIES 


Barnes, V. A., Bauza, L. B., & Treiber, F. A. (2003). Impact of stress reduction on negative school 
behaviour in adolescents. Health & Quality of Life Outcomes, 1, 7-10. 

Beaumont, C., Royer, E., Bertrand, R., & Bowen, F. (2005). The effects of an adapted program of 
mediation by pairs of students with behaviour disorder. Canadian Journal of Behavioral 
Science, 37, 198-210. doi: 10.1037/I10087257 

Black, D. S., & Fernando, R. (2014). Mindfulness training and classroom behavior among lower- 
income and ethnic minority elementary school children. Journal of Child and Family 
Studies, 23(7), 1242-1246. http://d0i.0rg/10.1007/s10826-013-9784-4 

Bluth, K., & Blanton, P. W. (2014). Mindfulness and self-compassion: Exploring pathways to 
adolescent emotional well-being. Journal of Child and Family Studies, 23(7), 1298-1309. 
http:/ / doi.org/ 10.1007/ S10826-013-9830-2 


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Bogels, S., Hoogstad, B., van Dun, L., de Schutter, S., & Restifo, K. (2008). Mindfulness training for 
adolescents with externalizing disorders and their parents. Behavioral and Cognitive 
Psychotherapy, 36, 193-209. 

Campion, J., & Rocco, S. (2011). Minding the mind: The effects and potential of a school based 
mindfulness meditation programme for mental health promotion. Advances in School 
Mental Health Promotion, 2(1), 47-55. doi: 10. 1080/1754730X.2009. 9715697 
Ernould, M. L. (2012). Addressing lesbian, gay, and bisexual bullying: A mindfulness-based 
intervention manual. Retrieved from Sociological Abstracts. (1520344151; 201411851) 
Gordon, J. S., Staples, J. K., Blyta, A., Bytyqi, M., & Wilson, A. T. (2008). Treatment of 

posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: 
a randomized controlled trial. Journal of Clinical Psychiatry, 69, 1469-1476. 

Groom, R. C. (2014). The Brain Powers Project: A quantitative efficacy study of a social 

emotional learning intervention (Psy.D.). John F. Kennedy University, Ann Arbor. Retrieved 
from ProQuest Dissertations & Theses Full Text. (1639142367) 

Holstine, K. W. (2015). Effect of contemplative meditation on behavior of urban public middle 
school students. (Thesis). Walden University, Ann Arbor. Retrieved from Sociological 
Abstracts. (1667950567; 201511125) 

Keefe-Forbotnick, A. (2014). Influence of mindfulness practices on high school students (Ed.D.). 
Central Connecticut State University, New Britain, CT. Retrieved from ProQuest 
Dissertations & Theses Full Text. (1546987344) 

Kim, J-S. (2001). Effects of taekwondo exercise on the psychological well-being of school children 
and young adults (Order No. 0804874). Available from ProQuest Dissertations & Theses Full 
Text. (304740494). Retrieved from 

http://ezproxy.lib.utexas.edu/login?url=http://search.proquest.com/docview/ 304740494 ?a 

ccountid= 7 ii 8 

Kim, S., Kim, G., & Ki, J. (2014). Effects of group art therapy combined with breath meditation on 
the subjective well-being of depressed and anxious adolescents. Arts in Psychotherapy, 41(5), 
519-526. http://d0i.0rg/10.1016/i.aip.2014.10.002 
Mendelson, T. & Greenberg, M. T. (2012). Mindful yoga for urban youth. Better: Evidence-Based 
Education, 4, 10-11. 

Miller, J. P. (1999). Presence and soul and the classroom. Orbit, 47, 10-12. 

Miller, S., Herman-Stahl, M., Fishbein, D., Lavery, B., Johnson, M., & Markovits, L. (2014). Use of 
formative research to develop a yoga curriculum for high-risk youth: implementation 
considerations. Advances in School Mental Health Promotion, 7, 171-183. 

Oberle, E., Schonert-Reichl, K. A., Lawlor, M. S., & Thomson, K. C. (2012). Mindfulness and 
inhibitory control in early adolescence. Journal of Early Adolescence, 32(4), 565-588. 
http://doi.org/DOI: 10.1177/0272431611403741 
Ramadoss, R., & Bose, B. K. (2010). Transformative life skills: Pilot studies of a yoga model for 
reducing perceived stress and improving self-control in vulnerable youth. International Journal of 
Yoga Therapy, 20, 75-80. 


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Rommel, T. (2013 ). Action research project: The use of yoga to influence on-task behavior (Order 
No. 1538810). Available from ProQuest Dissertations & Theses Full Text. (1400505190). 
Retrieved from 

http: //ezproxy.lib.utexas.edu/login?url=http://search.proquest.com/docview/ 14005051 QQ? 

accountid= 7 ii 8 

Salustri, M. E. (2009). Mindfulness-based stress reduction to improve well-being among 

adolescents in an alternative high school (Order No. 3383891). Available from ProQuest 
Dissertations & Theses Full Text. (304895452). Retrieved from 

http://ezproxy.hb.utexas.edu/login?url=http://search.proquest.com/docview/ 304895452 ?a 

ccountid= 7 ii 8 

Semple, R. J. (2005). Mindfulness-Based Cognitive Therapy for Children: A randomized group 
psychotherapy trial developed to enhance attention and reduce anxiety (Ph.D.). Columbia 
University, Ann Arbor. Retrieved from ProQuest Dissertations & Theses Full Text. 
(305007863) 

Semple, R. J., Lee, J., Rosa, D., & Miller, L. F. (2010). A randomized trial of mindfulness-based 
cognitive therapy for children: Promoting mindful attention to enhance social-emotional 
resiliency in children. Journal of Child and Family Studies, 19, 218-229. 

Semwal, J., Juyal, R., Kishore, S., & Kandpal, S. D. (2014). Effects of yoga training on personality of 
school students. Indian Journal of Community Health, 26(1), 98-102. 

Smith, B. H., Connington, A., McQuillin, & Crowder Bierman, L. (2014). Applying the deployment 
focused treatment model to school-based yoga for elementary school students: steps one and 
two. Advances in School Health Promotion, 7(3), 140-155. doi: 
10.1080/1754730X.2014.920132 

Stewart, T., & Alrutz, M. (2012). Comparison of the effects of reflection and contemplation 
activiteis on service-learners' cognitive and affective mindfulness. McGill Journal of 
Education, 47- 303-322. 

Van de Weijer-Bergsma, E., Formsma, A. R., de Bruin, E. I., & Bogels, S. M. (2012). The 

effectiveness of mindfulness training on behavioral problems and attentional functioning in 
adolescents with ADHD. Journal of Child and Family Studies, 21(5), 775-787. doi: 
10.1007/S10826-011-9531-7 

van der Oord, Bogels, & Peijnenburg. (2012). The effectiveness of mindfulness training for children 
with ADHD and mindful parenting for their parents. Journal of Child and Family Studies, 21, 
139-147- doi: 10.007/S10826-011-9457-0 

Wall, R. B. (2005). Tai chi and mindfulness-based stress reduction in a Boston public middle 

school. Journal of Pediatric Health Care, 19(4), 230-237. doi: I0.i0i6/j.pedhc.2005.02.006 
West, A. M. (2008). Mindfulness and well-being in adolescence: An exploration of four 

mindfulness measures with an adolescent sample (Ph.D.). Central Michigan University, Ann 
Arbor. Retrieved from ProQuest Dissertations & Theses Full Text. (304824868) 


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6.5 ADDITIONAL REFERENCES 


American Psychological Assocation (2009). Stress in America. Washington, DC: American 
Psychological Association. 

Andersen, S. L., & Teicher, M. H. (2004). Delayed effects of early stress on hippocampal 
development. Neuropsychopharmacology, 29(11), 1988-1993. 

Andersen, S. L., & Teicher, M. H. (2009). Desperately driven and no brakes: developmental stress 
exposure and subsequent risk for substance abuse. Neuroscience & Biobehavior al Reviews, 
33(4), 516-524. doi: io.ioi6/j.neubiorev.20o8.09.oo9 

Association for Supervision and Curriculum Development. (2007). The learning compact 

redefined: A call to action— A report of the Commission on the Whole Child. Alexandria, VA: 
Author. Last retrieved Nov. 29, 2010 from http: / /www.ascd.org/learningcompact 

Associated Press. (2006). Meditation debate erupts at California school. Originally published 

October 21, 6006. Retrieved from http://usatoday30.usatoday.com/news/education/2006- 
10-19-meditati0n-sch00l_x.htm 

Barnes V. A., Bauza, L. B., &Trieber, F. A. (2003). Impact of stress reduction on negative school 
behavior in adolescents. Health and Quality of Life Outcomes, 1(10), 1-7. Retrieved from 
http: / /www.hqlo.com/ content /1/ l/io . 

Barnes, V. A., Treiber, F. A., & Davis, H. (2001). Impact of Transcendental Meditation on 

cardiovascular function at rest during acute stress in adolescents with high normal blood 
pressure. Journal of Psychosomatic Research, 51(4), 597-605. doi: 
http://dx.doi.org/io.ioi6/Soo22-.2QQQ(oi)oo26i-6 

Beauchemin, J., Hutchins, T. L., & Patterson, F. (2008). Mindfulness meditation may lessen 

anxiety, promote social skills, and improve academic performance among adolescents with 
learning disabilities. Complementary Health Practice Review, 13: 1, 34-45. doi: 
10.1177/1533210107311624 

Benson, P. L., Scales, P. C., Hamilton, S. F., & Sesma Jr., A. (2006). Positive youth development so 
far: Core hypotheses and their implications for policy and practice. Search Institute Insights 
& Evidence, 3(1), 1-13. 

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). 

Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 
11, 230-241. doi: I0.i093/clipsy/bph077 

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7 Information about this review 


7.1 REVIEW AUTHORS 

Lead review author: 

Name: 

Brandy R. Maynard 

Title: 

Assistant Professor 

Affiliation: 

Saint Louis University 

Address: 

Tegeler Hall, 3550 Lindell Blvd. 

City, State, Province or County: 

St. Louis, MO 

Postal Code: 

63103 

Country: 

USA 

Phone: 

314 - 977-7671 

Mobile: 

269-876-8903 

Email: 

Bmaynari @ slu.edu 

Co-Authors 

Name: 

Michael R. Solis 

Title: 

Assistant Professor 

Affiliation: 

Graduate School of Education 

University of California Riverside 

Address: 

1207 Sproul Hall 

City, State, Province or County: 

Riverside, CA 

Postal Code: 

92592 

Country: 

USA 

Phone: 

Mobile: 

928-310-2866 

Email: 

michael. solis @ucr. edu 


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Name: 


Veronica L. Miller 


Title: 

Field Trainer/ Analyst 

Affiliation: 

The University of Texas at Austin 

Address: 

1912 Speedway, SZB 228, D4900 

City, State, Province or County: 

Austin, TX 

Postal Code: 

78712 

Country: 

USA 

Phone: 

512-386-3286 

Mobile: 

832-754-2013 

Email: 

veronicalmiller@utexas.edu 


Name: 

Kristen Esposito Brendel 

Title: 

Assistant Professor 

Affiliation: 

Aurora University 

Address: 

347 S. Gladstone Rd 

City, State, Province or County: 

Aurora, IL 

Postal Code: 

60506 

Country: 

USA 

Phone: 

630-947-8934 

Mobile: 

630-474-5119 

Email: 

kbrendel@aurora.edu 


7.2 ROLES AND RESPONSIBILITIES 


Roles 

Name(s) 

Background, Skills, Areas of Expertise 

Content 

Maynard 

Miller 

Solis 

Brandy Maynard and Veronica Miller will be 
responsible for the substantive content related to 
mindfulness. Maynard has been trained in and 
implemented Dialectical Behavior Therapy and Miller 
also has been trained in and regularly practices 
mindfulness techniques. Solis will provide content 
area expertise related to educational research and 

outcomes. 


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Systematic 

Review 

Methods 


Maynard 

Solis 


Statistical Maynard 
Analysis 

Solis 


Information Maynard 
Retrieval 

Solis 

Miller 


Brandy Maynard and Michael Solis have significant 
experience and expertise in systematic review 
methods. Both Maynard and Solis have completed and 
published multiple systematic reviews/research 
syntheses. In addition, Maynard has been trained in 
Campbell methods and is actively involved in 
Campbell - she has produced two Campbell reviews 
and is co-author on two additional reviews, is an 
editorial board member of the ECG, is a Campbell 
methods trainer, and has been elected as co-chair of 
the social welfare group. Solis also participated in two 
days of Campbell methods training at the 2013 C2 
Colloquium. 

Brandy Maynard will be responsible for statistical 
analysis. Maynard has been trained in meta-analytic 
techniques, and Maynard, Solis, and Miller have 
conducted several meta-analyses. 

Maynard, Solis, and Miller are experienced in 
information retrieval. Maynard and Miller will also 
consult with information retrieval specialists within 
their institutions in the planning and execution of the 
search strategy. Dollars have also been budgeted to 
consult and procure services from an information 
retrieval specialist to search specialized, foreign 
databases to which the review team does not have 
experience or access. 


7.3 SOURCES OF SUPPORT 


We would like to thank the Campbell Collaboration Education Coordinating Group for providing 
financial support for this review. We would like to thank Jane Dennis for assisting with conducting 
database searches and Anne Farina for translating Spanish articles. 


7.4 DECLARATIONS OF INTEREST 


The authors declare no conflicts of interest. 


7.5 PLANS FOR UPDATING THE REVIEW 


This review will be updated in approximately three to five years by Brandy R. Maynard. 


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7.6 AUTHOR DECLARATION 


Authors’ responsibilities 

By completing this form, you accept responsibility for maintaining the review in light of new 
evidence, comments and criticisms, and other developments, and updating the review at least once 
every five years, or, if requested, transferring responsibility for maintaining the review to others as 
agreed with the Coordinating Group. If an update is not submitted according to agreed plans, or if 
we are unable to contact you for an extended period, the relevant Coordinating Group has the right 
to propose the update to alternative authors. 

Publication in the Campbell Library 

The Campbell Collaboration places no restrictions on publication of the findings of a Campbell 
systematic review in a more abbreviated form as a journal article either before or after the 
publication of the monograph version in Campbell Systematic Reviews. Some journals, however, 
have restrictions that preclude publication of findings that have been, or will be, reported 
elsewhere, and authors considering publication in such a journal should be aware of possible 
conflict with publication of the monograph version in Campbell Systematic Reviews. Publication 
in a journal after publication or in press status in Campbell Systematic Reviews should 
acknowledge the Campbell version and include a citation to it. Note that systematic reviews 
published in Campbell Systematic Reviews and co-registered with the Cochrane Collaboration may 
have additional requirements or restrictions for co-publication. Review authors accept 
responsibility for meeting any co-publication requirements. 

I understand the commitment required to update a Campbell review, and agree to 
publish in the Campbell Library. Signed on behalf of the authors: 

Lorm completed Date: 3/4/16 


by: 



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8 Appendix 


8.1 DOCUMENTATION OF SEARCH STRATEGIES IN ELECTRONIC 
DATABASES 


Database 

Date 


(host) 

Searched Cmmtry 

Strategy 


Academic search 

Complete May 2015 

(EBSCO) 


Australian Education 

Index May 2015 

(EBSCO) 


British Education 

Index May 2015 

(EBSCO) 


( 1) Intervention: mindful* OR meditat* OR 
yoga OR “breath* technique” OR 
“mindfulness based stress reduction” OR 
MBSR OR “Mindfulness-based cognitive 
therapy” OR MBCT OR “learning to 
breathe” OR MindUP OR “Meditation on 
the Soles of the Feet” OR “non-judgmental 
pjg awareness” OR “present-moment” ) AND ( 
evaluation OR intervention OR treatment 
OR outcome OR program OR trial OR 
experiment OR “control group” OR 
“controlled trial” OR “quasi-experiment*” 
OR random* ) AND ( “elementary school” 
OR “primary school” OR “high school” OR 
“secondary school” OR “middle school” OR 
kindergarten OR pre-kindergarten ) 
(mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR 
“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 
“present-moment”) AND (evaluation OR 
Austi alia intervention OR treatment OR outcome OR 
program OR trial OR experiment OR 
“control group” OR “controlled trial” OR 
“quasi-experiment*” OR random*) AND 
(“elementary school” OR “primary school” 
OR “high school” OR “secondary school” 

OR “middle school” OR kindergarten OR 
pre-kindergarten) 

(mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
v based stress reduction” OR MBSR OR 


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CBCA Education 
(ProQuest) 


ERIC 

(EBSCO) 


MEDLINE 

(EBSCO) 


ProQuest 
Dissertation and 
Theses (ProQuest 


June 2013 


May 2015 


May 2015 


May 2015 


“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 
“present-moment”) AND (evaluation OR 
intervention OR treatment OR outcome OR 
program OR trial OR experiment OR 
“control group” OR “controlled trial” OR 
“quasi-experiment*” OR random*) 
(mindful* OR meditat* OR yoga OR 
"breath* technique" OR "mindfulness 
based stress reduction" OR MBSR OR 
"Mindfulness-based cognitive therapy" OR 
MBCT OR "learning to breathe" OR 
MindUP OR "Meditation on the Soles of the 
Feet" OR "non-judgmental awareness" OR 
, "present-moment") AND (evaluation OR 
Canada intervention OR treatment OR outcome OR 
program OR trial OR experiment OR 
"control group" OR "controlled trial" OR 
"quasi-experiment*" OR random*) AND 
("elementary school" OR "primary school" 
OR "high school" OR "secondary school" 

OR "middle school" OR kindergarten OR 
pre-kindergarten) 

( mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR 
“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 
“present-moment” ) AND ( evaluation OR 
u & intervention OR treatment OR outcome OR 
program OR trial OR experiment OR 
“control group” OR “controlled trial” OR 
“quasi-experiment*” OR random* ) AND ( 
“elementary school” OR “primary school” 
OR “high school” OR “secondary school” 

OR “middle school” OR kindergarten OR 

pre-kindergarten ) 

(mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR 
“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 
“present-moment” ) AND ( evaluation OR 
u & intervention OR treatment OR outcome OR 

program OR trial OR experiment OR 
“control group” OR “controlled trial” OR 
“quasi-experiment*” OR random* ) AND ( 
“elementary school” OR “primary school” 
OR “high school” OR “secondary school” 

OR “middle school” OR kindergarten OR 

pre-kindergarten ) 

ab(mindful* OR meditat* OR yoga OR 
"breath* technique" OR "mindfulness 
US based stress reduction" OR MBSR OR 

"Mindfulness-based cognitive therapy" OR 
MBCT OR "learning to breathe" OR 


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PsychINFO 

(EBSCO) 


May 2015 


Social Science 

Citation Index May 2015 

(Web of Science) 


Social Services 

Abstracts May 2015 

(ProQuest) 


Sociological Abstracts 
(EBSCO) 


May 2015 


US 


US 


US 


US 


MindUP OR "Meditation on the Soles of the 
Feet" OR "non-judgmental awareness" OR 
"present-moment") AND ab(evaluation OR 
intervention OR treatment OR outcome OR 
program OR trial OR experiment OR 
"control group" OR "controlled trial" OR 
"quasi-experiment*" OR random*) AND 
ab(: "elementary school" OR "primary 
school" OR "high school" OR "secondary 
school" OR "middle school" OR 
kindergarten OR pre-kindergarten) AND 

pd(>i990i23i) 

(mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR 
“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 
“present-moment” ) AND ( evaluation OR 
intervention OR treatment OR outcome OR 
program OR trial OR experiment OR 
“control group” OR “controlled trial” OR 
“quasi-experiment*” OR random* ) AND ( 
“elementary school” OR “primary school” 
OR “high school” OR “secondary school” 

OR “middle school” OR kindergarten OR 

pre-kindergarten) 

(mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR 
“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 

“present-moment” ) 

(mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR 
“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 
“present-moment”) AND TOPIC: 
(evaluation OR intervention OR treatment 
OR outcome OR program OR trial OR 
experiment OR “control group” OR 
“controlled trial” OR “quasi-experiment*” 
OR random*) AND TOPIC: (“elementary 
school” OR “primary school” OR “high 
school” OR “secondary school” OR “middle 
school” OR kindergarten OR pre- 
kindergarten) 

(mindful* OR meditat* OR yoga OR 
"breath* technique" OR "mindfulness 
based stress reduction" OR MBSR OR 
"Mindfulness-based cognitive therapy" OR 
MBCT OR "learning to breathe" OR 
MindUP OR "Meditation on the Soles of the 
Feet" OR "non-judgmental awareness" OR 
"present-moment") AND (evaluation OR 
intervention OR treatment OR outcome OR 
program OR trial OR experiment OR 


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SPORTDiscus 


"control group" OR "controlled trial" OR 
"quasi-experiment*" OR random*) AND 
("elementary school" OR "primary school" 
OR "high school" OR "secondary school" 

OR "middle school" OR kindergarten OR 

pre-kindergarten) 

( mindful* OR meditat* OR yoga OR 
“breath* technique” OR “mindfulness 
based stress reduction” OR MBSR OR 
“Mindfulness-based cognitive therapy” OR 
MBCT OR “learning to breathe” OR 
MindUP OR “Meditation on the Soles of the 
Feet” OR “non-judgmental awareness” OR 
TT „ “present-moment” ) AND ( evaluation OR 
May 2015 intervention OR treatment OR outcome OR 

program OR trial OR experiment OR 
“control group” OR “controlled trial” OR 
“quasi-experiment*” OR random* ) AND ( 
“elementary school” OR “primary school” 
OR “high school” OR “secondary school” 

OR “middle school” OR kindergarten OR 
pre-kindergarten ) 


Note: search dates for all searches were limited from 1990 to present unless otherwise noted 


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8.2 DATA EXTRACTION FORM 


Mindfulness-Based Interventions for Improving Academic Achievement, Behavior, 
and Socio-Emotional Functioning of Primary and Secondary Students 

Screening Form 


1. Study ID#: [STID] 

2. Date of Screening: - - [SCDATE] 

3. Primary Author: [AUTH] 

4. Bibliographic info (APA format): [BIB] 

5. Is this study a: [STYPE] 

□ 1. RCT 

□ 2. QED 

□ 3. Single subject design 


□ 4. Single group pre-post design 

□ 5. None of the above- IF CHECKED THEN STOP 

6. Is this a study of a school-based intervention for children/youth (PK-12)? [PART] 

□ o. No- STOP 

□ 1. Yes 

□ 2. Unsure 

7. Is this study examining effects of a mindfulness-based intervention as defined in the protocol? 

[INT2] 

□ o. No- STOP 

□ 1. Yes 

□ 2. Unsure 

8. Does this study report at least one of the following outcomes: cognition, academic performance, 

behavior, socio-emotional functioning? [OUTCOME] 

□ o. No- STOP 

□ 1. Yes 

9. Is this study eligible for the review? [ELIG] 

□ o. No: Reason 

□ 1. Yes 

□ 2. Need more information to make decision 

10. Notes/Comments [SNOTE] 


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Mindfulness-Based Interventions Review 
Data Coding Form 

Study ID#: Coder: Date of coding: 

Section A - Source Descriptors 

At. Report Type [rtype] 

□ l. Journal Article 

□ 2. Book/book chapter 

□ 3. Gov't report (local, state, federal) 

□ 4. Conference proceedings 

□ 5. Thesis or Dissertation 

□ 6. Unpub report (non-gov’t, tech report) 

□ 7. Other (specify): 

□ 5. Expert Referral 

A2. Country [country] 

□ 1. USA 

□ 2. Canada 

□ 3. Australia 

□ 4. Europe 

□ 5. Asia 

□ 6. Other (specify): 

A3. Language if other than English [lang] 


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Section Bi— Group Design (RCT, QED, SGPP) 

Study Methods, Quality and Risk of Bias 

Bi.i. Method of assignment to condition(s) [grp_assign] 

□ l. Random, simple 

□ 2. Random, after matching, stratification, blocking, etc. 

□ 3. Quasi-random- assigned by some naturally occurring process 

□ 4. Matched or statistically SGPP study 

□ 5. N/A- SGPP study 

□ 99. Not specified / not enough information to determine 

B1.2. Unit of assignment to conditions [txassign] 

□ 1. Individual participant 

□ 2. Group/ Cluster: specify 

□ 3. Other: 

□ 4. N/A- SGPP study 

□ 99. Not enough information to determine 

B1.3. How was random assignment performed: [random] 

□ 1. Computer generated 

□ 2. Random numbers table 

□ 3. Coin toss/ dice/ shuffling 

□ 4. Not reported 

□ 5. Unclear description 

□ 6. N/A-No random assignment 

B1.4. What method was used to conceal allocation sequence? [alloc] 

□ 1. Sealed number/ coded envelope 

□ 2. Other 

□ 3. No concealment 

□ 4. Not reported 

□ 5. Unclear description 

□ 6. N/A- No random assignment 

B1.5. Were the outcome assessors blinded? [blind] 

□ o. No 

□ 1. Yes 

B1.6. Were participants blinded to condition? [blindpart] 

□ o. No 

□ 1. Yes 

B1.7. Did the study have high attrition (for RCT/QED, exceeds WWC attrition criteria; for SGPP, > 
20%)? [grp_attrit] 

□ 1. Yes 

□ 2. No 

□ 99. Not enough information to calculate 


B1.8. If matching was used, how were groups matched? [grp_match] 

□ 1. Matched on pretest measure 

□ 2. Matched on demographics 

□ 3. Matched on both of the above 

□ 4. Propensity Score Matching 

□ 5. Other matching technique: 

□ 6. N/A- SGPP study 

□ 7. Not enough information to determine 


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Bi. 9. Results of statistical comparisons of pretest differences [grp_pre] 

□ l. No comparisons made 

□ 2. No statistically significant differences 

□ 3. Significant differences judged unimportant by coder 

□ 4. Significant differences judged of uncertain importance by coder 

□ 5. Significant differences judged important by coder 

□ 6. N/A- SGPP study 

B1.10. If groups were non-equivalent at baseline, were statistical controls used? [grp_ctrl] 

□ 1. Yes 

□ 2. No 

□ 3. N/A- SGPP study 


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Section B2— Multiple Group (RCT, QED) 
Dependent Variables and Effect Size Information 


Continuous outcomes 


Construct 

ID 

Outcome 

Measure 

Valid 

? 

Source 

(participant, 

clinician, 

parent) 

Timing 
(end of 
treatment, 

3 month, 
etc.) 

Tx 

analytic 

sample 

size 

Control 

group 

analytic 

sample 

size 

Intervention 
group Baseline 
Mean (SD) 

Intervention 
group Post 
Mean (SD) 

Control 

group 

Baseline 

Mean 

(SD) 

Control 

group 

Post 

Mean 

(SD) 

Values 
for t, F, 
other 






















































Note: Construct ID- 1= Cognitive; 2= Academic performance; 3= Behavior; 4= Socio-emotional 

Dichotomous outcomes 


Construct 

ID 

Outcome 

Measure 

Valid 

Source 

(participant, 

clinician, 

parent) 

Timing of 
measurem 
ent (end of 
treatment, 

3 month, 
etc.) 

Tx 

analytic 

sample 

size 

Control 

group 

analytic 

sample 

size 

Intervention 
group % 
successful 

Interventi 
on group % 
not 

successful 

Control 
group % 
successful 

Control 
group % 
not 

successful 

Values 

for 

statistical 
tests (i.e. 
chi- 

square) 






















































Note: Construct ID- 1= Cognitive; 2= Academic performance; 3= Behavior; 4= Socio-emotional 


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Section C— Single Subject (SSD) 

Study Methods and Quality Determination 

Cl. SSD study design [ssd_design] 

□ l. Alternating treatments 

□ 2. Multiple baseline 

□ 3. Withdrawal design 

□ 4. Other: 

C2. The outcomes were measured by more than one assessor [ssd_assess] 

□ 1. Yes, number of assessors 

□ 2. No 

□ 99. Not specified 

C3. The assessors collected interrater agreement in each phase for 20% of observations (Kappa). 

[ssd_2op] 

□ 1. Yes 

□ 2. No 

□ 99. Not specified 

C4. Interrater reliability was =/ > .80 for each phase. [ssd_rel] 

□ 1. Yes 

□ 2. No 

□ 99. Not specified 

C5. The study included more than one phase. [ssd_phase] 

□ 1. Yes 

□ 2. No 

□ 99. Not specified 

C6. Each phase included at least three observations [ssd_phobs] 

□ 1. Yes 

□ 2. No 

□ 99. Not specified 

C7. The IV was systematically manipulated by the researcher(s) [ssd_ivman] 

□ 1. Yes 

□ 2. No 

□ 99. Not specified 


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Section D 


Participants, Intervention Agents, and Setting Descriptors 

Di. Mean Age of participants 

[age] 

D2. Grade level of participants 

[grd] 

□ 1. Elementary School (K-5) 

□ 2. Middle school (6-8) 

□ 3. High school (9-12) 

□ 4. Mixture of grade levels 

□ 99. Not enough information to determine 

D3. Race/Ethnicity 

[raceth] 

□ 1. African American % 

□ 2. Asian American % 

□ 3. European American % 

□ 4. Hispanic American % 

□ 5. Other % 

□ 99. Not specified 

D4. Sex 

[sex] 

□ Male % 

D5. Free or Reduced Lunch 

[frl] 

□ 1. Receiving % 

□ 2. Not Specified 

D6. Type of students in sample 

[stypei] 

□ 1. Regular / non-clinical/ non- special ed 

□ 2. Clinical or Special Ed Population: Specify 

□ 99. Not specified 

D7. If clinical/special ed sample, please specify: 

[stype2] 


D8. Type of School [schtyp] 

□ l. Public 

□ 2. Private 

□ 3. Alternative 

□ 4. Charter 

□ 5. Other (specify): 

□ 99. Not specified 

D9. Who provided the services? [intagt] 

□ 1. Non-School Master’s or PhD clinician 

□ 2. School Clinician (Social Worker, Psychologist, Counselor) 

□ 3. Teacher 

□ 4. Other school personnel 

□ 5. Researchers 

□ 6. Multiple providers (list) 

□ 7. Other: (list) 

□ 99. Not specified 

Dio. Did the provider receive special training on the intervention? [tr_intagt] 

□ 1. Yes 

□ 2. No 

□ 99. Not Specified 


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Section E 

Intervention Descriptors and Fidelity 

El. Name of intervention: 

E2. Stated goal/purpose of the intervention: (check all that apply) 

□ l. Cognitive performance 

□ 2. Academic Performance 

□ 3. Behavior 

□ 4. Socio-emotional functioning 

□ 5. Other 

□ 6. Not specified 

E3. What mindfulness strategies characterize the intervention? 

(SELECT ALL THAT APPLY) 

□ 1. Present moment work 

□ 2. Meditation 

□ 3. Relaxation skills training 

□ 4. Breathing techniques/breath awareness 

□ 5. Awareness of moment 

□ 6. Mindfulness exercises 

□ 7. Body scan 

□ 8. Yoga 

□ 12. Other- specify: 

E4. Was mindfulness the primary mechanism of interest in this study? [prim] 

□ o. No 

□ 1. Yes 

□ 2. Unsure 

E5. What non-mindfulness strategies were part of the intervention? [nonmind] 

(SELECT ALL THAT APPLY) 

□ o. None 

□ 1. Behavioral Strategies (Interventions involve the use of various behavioral 
techniques, such as rewards, token economies, contingency contracts, and the 
like to replace or modify behavior) 

□ 2. Cognitively-Oriented Programs (Interventions focus on changing thinking 
processes or cognitive skill) 

□ 3. Counseling, Talk Therapy (These programs utilize traditional 
talk/psychotherapy techniques) 

□ 4. Other (specify) 

E6. Is this a manualized program (did researchers or implementers use a written manual, 
protocol or guide to implement the program/intervention)? [manual] 

□ o. No 

□ 1. Yes 

□ 2. Unsure 

E7. Role of the evaluator/author/research team or staff in the program, [arole] 

□ 1. Researcher delivered the treatment 

□ 2. Researcher involved in planning, designing, supervising, or managing the 

treatment 

□ 3. Researcher independent of treatment- research role only 

□ 4. Cannot tell 


[name] 

[goal] 


[strategy] 


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E8. Treatment Format: (SELECT ALL THAT APPLY) [format] 

□ l. Individual (one-on-one) 

□ 2. Group 

□ 3. Individual & Group 

□ 4. Other: 

□ 5. Not enough information to determine 

E9. Were parents involved in the intervention? [parent] 

□ o. No 

□ 1. Yes: Describe parent involvement: 

□ 2. Unsure 

E10. Were teachers involved in the intervention? [teacher] 

□ o. No 

□ 1. Yes, as interventionist: Describe 

□ 2. Yes, as recipients: Describe 

□ 2. Unsure 


Eli. Length of treatment (# of weeks): [length] 

E12. Frequency of sessions (#per week) [freq] 

E13. Total # of sessions: [sessions] 

E14. Total minutes of tx sessions [hours] 

E15. Minutes of mindfulness practice in sessions [m-dose] 

E16. How much at-home practice was expected? [hmwork] 

Specify # of minutes 

E17. Did the study measure fidelity? [fidel] 

□ 1. Yes 

□ 2. No 

E18. How was fidelity assessed? [fidel_asses] 


□ 1. Researcher observations 

□ 2. Interviews of participants 

□ 3. Surveys of participants 

□ 4. Participant logs 

□ 5. Administrative records 

□ 6. Checklists 

□ 7. Other 

□ 99. Not specified 

E19. Level of adherence to the tx: [fidel_ad] 

□ 1. Percent or Level 

□ 99. Not specified 


Section F— Comparison Condition 

Fi. What did the control/ comparison group receive? [compcond] 

□ o. No comparison group 

□ 1. Nothing or wait list 

□ 2. “Treatment as usual”: Specify 

□ 3. Specified treatment: Specify 

□ 4. Other: 


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8.3 CHARACTERISTICS OF INCLUDED STUDIES: RCT AND QED STUDIES 


First Author 
(year ) 1 

Pub 

Status 

Program Name 

Intervention Description 

Country 

Design 

N 

Grade(Mean 
age or range) 

Sample 

Characteristics 

Provider 

Control 

Condition 

Bakosh (2013-1) 

NP 

Inner Explorer 

• Audio-guided mindfulness 
program based on MB SR 
developed by researcher 

• 10 minutes per day 

• Delivered via MP3 player 
and facilitated by the 
teacher. 

US 

RCT 

177 

2 (NR) 

General 

population 

Audio tape (recorded 
by MB SR trained 
instructors) played by 
Teachers 

Regular 

education 

program 

Bakosh 

(2013-2) 

NP 

Inner Explorer 

• Audio-guided mindfulness 
program based on MB SR 
developed by researcher 

• 10 minutes per day 

• Delivered via MP3 player 
and facilitated by the 
teacher.. 

US 

RCT 

206 

2 (NR) 

General 

population 

Audio tape (recorded 
by MB SR trained 
instructors) played by 
Teachers 

Regular 

education 

program 

Bakosh 
(20 1 5) 1 

P 

Mindfulness- 

based 

Socioemotional 
learning program 

• Audio-guided mindfulness 
program based on MB SR 
developed by researcher 

• 10 minutes per day 

• Delivered via MP3 player 
and facilitated by the 
teacher. 

US 

QED 

191 

2 (NR) 

General 

population 

Audio tape (recorded 
by MB SR trained 
instructors) played by 
Teachers 

Regular 

education 

program 

Barnes (2004) 

P 

Meditation group 

• A simple concentrative-type 
meditation technique that 

US 

RCT 

73 

3 (12.3) 

General 

population 

Teacher 

Health 

Education 


uses the breath as an object 
of focus and does not 
require changes in personal 
or spiritual beliefs. This is a 
beginner technique taught as 
Exercise 1 of the MB SR 
program. 

10-minute sessions at school 
and at home each day for 3 
months and 20 
minutes/week (average of 4 
minutes/day) of direct 


class 


84 


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First Author 
(year ) 1 


Pub 

Status 


Program Name 


Intervention Description Country Design 


N 


Grade(Mean 
age or range) 


Sample 

Characteristics 


Provider 


Control 

Condition 


contact time with the 
instructor spent discussing 
issues related to meditation 
sessions (e.g., feelings and 
physical changes during 
meditation, how to improve 
meditation experiences, 
benefits, etc.). 


Barnes (2008) 

P 

Breathing 

• BAM involves focusing US 

RCT 

56 4 (15.2) 

African American Teachers 

Weekly 20 



Awareness 

upon the moment. 



adolescents with 

minute 



Meditation 

sustaining one’s attention to 



high-normal 

session on 



(BAM) 

the breathing process, and 



systolic blood 

preventing 




passively observing 



pressure levels 

high blood 




thoughts. This technique is 




pressure using 




taught as Exercise 1 of 




guidelines for 




Mindfulness-based Stress 

Reduction Program. 




adolescents 




• 10-minute BAM sessions at 








school and at home each 
day for three months. 






Bergen-Cico 
(20 1 5) 1 


Mindful yoga 


Inspired by YogaKids, the 
mindful yoga intervention 
was designed to incorporate 
mindful yoga into the 
classroom. 

Integrated into class routine 
three times per week for 4 
minutes at the beginning of 
class. 


US 


RCT 


142 3 (11.4) 


General 

population 


Teachers 


Regular 

education 

program and 

didactic 

elements/disc 

ussion about 

mindfulness 


Bluth (2015) 1 P Learning to 

BREATHE 


• A mindfulness US RCT 23 4 (17) 

curriculum that has 
been created for an 
adolescent population. 

Based on themes and 
practices used in 
mindfulness based 
stress reduction, it 
uses developmentally 
appropriate hands-on 


High risk students 
in an alternative 
high school 


1 st author who was a 
trained mindfulness 
instructor/practitioner 


Evidence- 
based 
substance 
abuse class 


85 


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First Author Pub Grade(Mean Sample Control 

(year ) 1 Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

activities and guided 
discussions to teach 
standard mindfulness 
skills, including the 
body scan, sitting 
meditation, 
lovingkindness 
practice, walking 
meditation, and 
mindful movement. 

• Implemented in 1 1 
class sessions (approx. 

360 minutes total). 

• Formulated according US RCT 100 3 (11.8) General Teachers 

to Roth’s Integrative population 

Contemplative 
Pedagogy. The 
teacher led students in 
a short period of silent 
meditation at the 
beginning of the class 
period. Initial 
meditation periods 
lasted only 3 min, 
whereas the final 
meditation periods 
lasted as long as 12 
min. Breath awareness 
and breath counting 
were taught for the 
first 2 weeks, 
followed by 1 week 
each devoted to 
labeling of body 
sensations; labeling of 
thoughts, and 
emotions; and body 
sweeps. During the 
final 2 weeks, 


6 week 
curriculum on 
ancient 
African 
history 


Britton (20 14) 1 P 


Mindfulness 

Meditation 


The Campbell Collaboration | www.campbellcollaboration.org 


First Author 
(year ) 1 

Pub Grade(Mean Sample Control 

Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

students were free to 
select from among the 
various techniques. 

• The intervention was 
implemented over 6 
weeks. No home 
practice was reported. 

Broderick 

(2009) 

P Learning to • A mindfulness curriculum US QED 121 4(17.4-tx; Private catholic Primary researcher Regular 

BREATHE that has been created for an 16.4- control) high school for trained in mindfulness school 

adolescent population. girls curriculum 

Based on themes and 

practices used in 

mindfulness based stress 

reduction, it uses 

developmentally appropriate 

hands-on activities and 

guided discussions to teach 

standard mindfulness skills, 

including the body scan, 

sitting meditation, 

lovingkindness practice, 

walking meditation, and 

mindful movement. 

Workbooks and CDs for 
home meditation were 
provided to students. 

• Sessions (ranging from 32 
to 43 minutes in length) 
were delivered twice weekly 
during health class over five 
weeks for a total of 42 class 
sessions. 

Campbell 

(2015) 1 

NP .b • Includes a range of US QED 438 4 (16) General Trainers trained in the Regular 

mindfulness excercises. 2 population curriculum English class 

Includes an introduction to curriculum 

sitting mindful meditation 

practice, mindful body 

scans, mindful body 

activities relate to Tai Chi 

87 

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First Author Pub Grade(Mean Sample Control 

(year ) 1 Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

and youga, mindfulness in 
the context of feelings, and 
mindfulness training 
exercises for specific 
situations. 

• Six-week mindfulness 
curriculum (traditionally an 
8 week program with nine 

lessons) 


Chukwu NP 

Mindful 

• Included: 1) a preliminary US 

RCT 

40 3 (11.5) 

General 

T eachers 

Homeroom 

(2015)/Desmond 

Awareness 

group discussion of selected 



population 


period 

(20 10) 1 

Practices 

emotional, physical and 







social behavioral topics, 2) 
the practice of skills on 
MAP, including self- 
attention, concentration, 
planning and organization, 
and emotional control where 
the student focus shifts from 
external stimuli to internal 
awareness to sort out 
thoughts, emotions and 
physical behaviors in a non- 
reactive way; healthy 
breathing to promote 
slowing down and 
reflection; and physical 
movements with cognitive 
connection to release 
tension and stress; and 3) 
closing group reflections to 
allow students the 
opportunity for inquiry and 
comment. 


• Each lesson (24-45 minutes 
once weekly sessions for 10 
weeks) 


Deuskar (2007) 1 P 

Yoga Nidra 

• A combination of guided, India 

RCT 

101 4 (NR) 

General 

Audio-tape, unclear 

Unspecified 



aware relaxation, breathing 



population 

who facilitated 

(“no treatment 


The Campbell Collaboration | www.campbellcollaboration.org 



First Author 
(year ) 1 


Flook (20 1 5) 1 


Pub Grade(Mean Sample Control 

Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

exercises and imagery via control 

audio-tape. The tape began group”) 

with an induction consisting 

of instructions for slow, 

deep breathing, and a shift 

to an internal focus of 

attention. Subjects were 

instructed to make their 

resolve, at the beginning of 

the practice. This was 

followed by deep muscle 

relaxation, attention on the 

breath and imagery. 

Imagery focused on desired 
reduction in examination 
anxiety, and subsequent 
good performance. 

• 30-minute audio-tape 
delivered in a female voice, 
in vernacular language, and 
used by the students twice a 

week (total of 30 sessions). 


P 

Kindness 

• Mindfulness-based US 

RCT 

66 1 (4.7) 

General 

Experienced 

Standard 


Curriculum 

• prosocial skills training 



population 

mindfulness instructors 

school 



designed for preschool-age 





curriculum 


children. The foundation of 
the KC is mindfulness 
practice, aimed at 
cultivating attention and 
emotion regulation, with a 
shared emphasis on 
kindness practices (e.g., 
empathy, gratitude, sharing). 

• Two 20-30 min lessons 
each week over a 12-week 
period, totaling 
approximately 10 hrs of 
training. 


89 


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First Author 
(year) 1 

Pub 

Status Program Name 

Intervention Description 

Country 

Design 

N 

Grade(Mean 
age or range) 

Sample 

Characteristics 

Provider 

Control 

Condition 

Flook (2010)' 

P InnerKids/Mindful 

Awareness 

Practices 

• Mindful awareness practices 
(MAPs) are exercises that 
promote a state of 

US 

RCT 

64 

2(8.2) 

General 

population 

"instructor”- not 
clearly described 

Silent reading 
period 


heightened and receptive 
attention to moment-by- 
moment experience. The 
program is modeled after 
classical mindfulness 
training for adults and uses 
secular and age appropriate 
exercises and games to 
promote (a) awareness of 
self through sensory 
awareness, attentional 
regulation, and awareness of 
thoughts and feelings; (b) 
awareness of others (e.g., 
awareness of one’s own 
body placement in relation 
to other people and 
awareness of other people’s 
thoughts and feelings); and 
(c) awareness of the 
environment (e.g., 
awareness of relationships 
and connections between 
people, places, and things). 


• Twice a week over 8 weeks, 
for a total of 1 6 sessions. 


Gregoski (2011) P Breathing 

• The BAM exercise is one of US 

QED 

97 4 (15) 

African American Teachers 

Health 

Awareness 

the Mindfulness-Based 



youth at increased 

Education 

Meditation 

Stress Reduction Program. 



risk for 

lessons 

(BAM) 

Practice involves focusing 



development of 



upon the moment, 



cardiovascular 



sustaining attention on the 
breathing process, and 
passively observing 



disease 



• thoughts. 

• Sessions of 10-minute 






90 


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First Author Pub 

(year ) 1 Status Program Name Intervention Description Country 

duration were conducted 
during health education 
class and at home each week 
day. On weekends, subjects 
practiced 10-minute 

sessions twice daily. 

Haden(2014)/ P Yoga Practice • Yoga practice consisted of US 

Hagins (20 1 3) 1 physical postures, breathing 

practices and relaxation 
techniques in addition to 
short meditation practices 
and class rules that reflected 
the moral and ethical 
components of yoga. 

Specifically, each of the 
classes consisted of: (1) an 
opening ritual (centering, 
conscious breathing) for 3-7 
min; (2) 30-min asana 
practice (standing, seated, 
backbends/ inversions); (3) 
brief seated meditation; and 
(4) closing ritual of guided 
relaxation in savasana (body 
scan). Homework on a 
specific aspect of the 
practice was encouraged 
each week. 

• Sessions were three times 

per week for 12 weeks. 

Huppert (2010) P Mindfulness • The mindfulness training UK 

training was based on the 

programme developed by 
Kabat-Zinn, presenting the 
principles and practice of 
mindfulness meditation. The 
mindfulness classes covered 
the concepts of awareness 
and acceptance, and the 


91 


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Grade(Mean Sample Control 

Design N age or range) Characteristics Provider Condition 


RCT 30 3 (10.5) General Instructors trained/ Physical 

population certified in yoga and education 

with experience class 

(unclear if classroom 
teacher) 


QED 

134 6 (14-15) 

General Religious Teacher 

Religious 



population from 

education 



all-boys private 

classes 



school 




First Author Pub Grade(Mean Sample Control 

(year ) 1 Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

mindfulness practices 
included bodily awareness 
of contact points, 
mindfulness of breathing 
and finding an anchor point, 
awareness of sounds, 
understanding the transient 
nature of thoughts and 
walking meditation. 

Students received CD 
containing three 8-minute 
audio files of mindfulness 
exercises to be used at home 
(encouraged daily practice 
at home). 

• Four 40 min classes, one per 


week for 4 weeks, 

Justo 
(201 1 ) 1 

P 

Mindfulness 
training program 

• The after-school program 
included guidelines, 

1 . ..i -1 .. ! r- 

Spain 

RCT 

84 4 (17) 

General 

population 

Mindfulness instructor Not specified 


elements, and exercises of 
Kabat-Zinn's stress 
reduction program; 
mindfulness strategies 
utilized in "Acceptance and 
Commitment" therapy; 
metaphor discussion and 
exercises utilized in this 
therapy, with stories related 
to zen philosophy; vipassana 
meditation. 

• Ten weekly sessions, 90 
minutes in length with the 
following structure: 10 
minutes— comments from 
participants about the use of 
the mindfulness exercises 
between sessions, 10 
minutes-doing physical 
exercises, 10 minutes 


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First Author Pub Grade(Mean Sample 

(year ) 1 Status Program Name Intervention Description Country Design N age or range) Characteristics Provider 

presentation related to 
sessions about metaphors to 
explore, 30 minutes 
practicing mindfulness 
attention to breathing. Home 

practice encouraged. 

Khalsa (2012) 1 P Yoga Ed • Modified version of Yoga US RCT 100 4 (16.8) General Certified yoga 

Ed. A secular program that population instructor 

includes yoga postures, 

breathing exercises, 

visualization, and games 

with emphasis on fun and 

relaxation. 

• 30-40 minute sessions 2-3 
times per week for 1 1 
weeks. 


Koenig (201 2) 1 P 

Get Ready to 

• The GRTL program was US 

QED 

46 2 (9.6 - tx 

Students with 

DVD instruction 


Learn yoga 

implemented every school 


(8.6-control) 

autism spectrum 

facilitated by teachers 


program 

day 



disorders 



• for a period of 16 weeks. All 
teachers, assistants, and 
paraprofessionals 
participated either on a yoga 
mat or seated in a chair. The 
DVD was placed in a player 
and projected onto a screen 
or television monitor in 
view of all students. The 
occupational therapist 
modeled the program on the 
DVD, providing visual and 
verbal cues. The same DVD 
was used daily. The 
program itself began with 
breathing exercises 
(pranayamas), physical 
postures and exercises 
(asanas), deep relaxation 
(yoga nidra), and chanting 


Control 

Condition 


Regular P.E. 
class 


Standard 

classroom 

routine 


93 


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First Author 
(year ) 1 

Pub 

Status Program Name 

Intervention Description 

Country Design N 

Grade(Mean 
age or range) 

Sample 

Characteristics 

Provider 

Control 

Condition 

(kirtan). 

Kuyken (2013) 1 

P Mindfulness in 

School Project 
(MiSP) 

• The MiSP curriculum is a 
set of nine scripted lessons 
tailored to secondary 

4 QED 463 

5 (14.8) 

General 

population 

Teachers (either MiSP 
developers or trained 
by developers) 

Standard 

school 

curriculum 


schools, supported by 
tailored teacher training. It 
was designed in line with 
principles identified as 
important for effectiveness 
in several reviews of 
schools-based programs that 
promote mental health and 
well-being and teach social 
and emotional competence. 
These principles include: 
explicitly teaching skills and 
attitudes; shortening and 
adapting components to suit 
young people; using a range 
of age-appropriate, 
interactive, experiential and 
lively teaching methods; 
providing age appropriate 
resources to bring 
mindfulness to life 
(including a course booklet 
and a set of mindfulness 
exercises on CD or MP3 
audio files); intensive, 
focused teacher education to 
build teachers’ self-efficacy 
and well-being; and 
program implementation 
that pays close attention to 
clarity and fidelity, in this 
case supported by a manual 
and indicative script. 


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First Author Pub 

(year ) 1 Status Program Name 

Lau(2011) 1 P Mindfulness 

programme 


Mendelson P Mindfulness 

(2010)/Gould Intervention for 

(2012) 1 urban youth 


Intervention Description Country Design N 

• The programme was Hong QED 40 

modified and adapted from Kong 

MB SR. The program 
included four major 
activities: (1) gentle 
stretching exercise, which 
enhances the cultivation of 
mindfulness through 
awareness of body 
movement and sensation; 

(2) practice with daily 
activities, including sitting, 
standing, walking , lying 
down and eating which 
involves the awareness of 
body sensations, thoughts 
and emotions; (3) body 
scan, which consists of a 
guided movement of 
attention throughout the 
body from the head to the 
toes whilst sitting or lying 
down; (4) loving-kindness 
practice, which involves 
sending well wishes and 
blessings to oneself and all 
other people in the world. 

Students were encouraged to 
do 15 minutes of daily home 
practice. Offered after 
school. 

• Two hour session per week 
for six weeks and one day 

retreat. 

• Key intervention US RCT 82 

components included yoga- 

based physical activity, 
breathing techniques, and 

guided mindfulness 


Grade(Mean Sample 

age or range) Characteristics 

4(15.8) General 

population from 
public schools in 
Hong Kong 


2 (10) General 

Population/urban 

youth 


Control 

Provider Condition 

Instructor- an Not specified 

experienced teacher 
with MB SR training 


Instructors from local Regular 
non-profit organization school 

curriculum 


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First Author Pub Grade(Mean Sample Control 

(year ) 1 Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

practices. Each session also 
included a brief period of 
discussion prior to the 
guided mindfulness practice. 

• Sessions were 45 minutes in 
length 4 days per week for 
12 weeks. Home practice 
was encouraged. 

Metz (2013) 1 P Learning to • A mindfulness curriculum US QED 216 4(16.5) General Teachers Concert choir 

BREATHE that has been created for an population elective class 

adolescent population. 

Based on themes and 
practices used in 
mindfulness based stress 
reduction, it uses 
developmentally appropriate 
hands-on activities and 
guided discussions to teach 
standard mindfulness skills. 

Lesson content focuses on 
six core themes: (1) body 
awareness; (2) 
understanding and working 
with 

thoughts; (3) understanding 
and working with feelings; 

(4) integrating awareness of 
thoughts, feelings, and 
bodily sensations; (5) 
reducing harmful self- 
judgments; and (6) 
integrating mindful 
awareness into daily life. 

Workbooks and CDs for 
home meditation were 
provided to students. 

• 18 sessions over 16 weeks, 
typically once per week for 
15-25 minutes. 


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First Author Pub 

(year ) 1 Status Program Name Intervention Description Country 

Napoli (2005) P Attention • Exercises such as paying US 

Academy Program attention to the breath, 

(AAP) movement activities and 

sensory stimulating 
activities were used to 
facilitate “being in the 
moment”. The sequential 
structure of the classes was: 
breathing exercises, a body- 
scan visualization 
application, a body 
movement -based task, and a 
post-session de-briefing or 
sharing of instructor 
feedback with the class. 

• 12 each bi-monthly 45- 
minute held over a period of 

24 weeks. 

Noggle (2012) 1 P Kripalu-based • The yoga program used in US 

Yoga this study was completely 

secular and included 4 key 
elements of classical yoga: 
physical exercises and 
postures, breathing 
exercises, deep relaxation, 
and meditation techniques. 

In keeping with principles 
of Kripalu yoga, the overall 
emphasis was on self 
inquiry and not purely 
didactic teaching. 

Furthermore, it incorporated 
a distinct approach to 
emotion regulation in 
Kripalu yoga represented in 
the instruction to breathe, 
relax, feel, watch, and 
allow. Postures were taught 
as breath-coordinated 


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Design 

Grade(Mean 

N age or range) 

Sample 

Characteristics 

Provider 

Control 

Condition 

RCT 

194 2 (NR) 

General 

population 

Professionally trained 
mindfulness training 
instructors 

Reading or 
other quiet 
activities in 
class 


RCT 


51 4 (NR) 


General 

population 


Certified Yoga 
instructors 


P.E. class 



First Author Pub Grade(Mean Sample Control 

(year ) 1 Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

movements, and breathing is 
considered the central tool 
for cultivating 
nonjudgmental, 
compassionate self- 
awareness. 

• Two to three 30-minute 
sessions a week (alternating 
weekly due to the school 
schedule) over 10 weeks (28 





yoga sessions total). 






Parker (201 4) 1 

P 

Master Mind 

• The Master Mind program US 

is divided into four sections 
and each section represents 

RCT 

111 2(10) 

General 

population 

T eachers 

Regular 

education 

curriculum 


one of the four foundations 
of mindfulness. Embedded 
within the four sections are 
the five key features of the 
Master Mind program: (1) 
mindful breathing, (2) 
mindful journeys, (3) 
mindful movements (e.g., 
developmentally appropriate 
yoga poses), (4) real-world 
applications, and (5) daily 
practice. 

• Once a day for 

approximately 15 minutes 
over a four week period for 
a total of 20 lessons. 


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First Author 
(year ) 1 


Potek (2012) 1 


Powell (2008) 1 


Pub 

Status Program Name 
NP Learning to 
BREATHE 


P Self Discovery 

Programme 


Intervention Description Country Design N 

• Specific, experiential guided US RCT 30 

lessons (adapted from the 

MB SR 

to meet the developmental 
needs of adolescents). Each 
session focused on a 
particular mindfulness skill. 

(see page 52 for a detailed 
outline of the overview and 
activities for each session). 

Sessions included 
discussion of homework and 
collection of homework 
logs, introduction of a 
specific skill and a brief 
practice of that skill, formal 
guided meditation, followed 
by group discussion and 
questions. 

• Six weeldy, 40 to 45 minute 
periods. 

• The SDP consisted of UK QED 107 

sessions designed to 

facilitate children’s self- 
discovery (i.e., senses, 
feelings, psychological and 
physical well-being). The 
primary themes of the SDP 
included sensory 
awareness, touch therapy 
(e.g., peer massage), yoga, 
breath work, 
communication and 
relaxation. 

• 12 sessions delivered 
weekly and lasting 
approximately 45 minutes. 


Grade(Mean Sample 

age or range) Characteristics Provider 

4 (15) General Researcher/trained 

population instructor 


2 (9) Special education Holistic therapists 

needs, emotional, 
behavioral, and 
learning 

difficulties, and at 
risk for being 
excluded from 
school 


Control 

Condition 

Regular 

education 

curriculum 


Regular 

school 

programming 
and additional 
support as 
needed 


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First Author 
(year ) 1 


Pub 

Status 


Program Name 


Intervention Description Country Design 


N 


Grade(Mean 
age or range) 


Sample 

Characteristics 


Provider 


Control 

Condition 


Quach (20 14) 1 


NP 


Seated meditation 


The sitting meditation 
condition consisted of three 
parts: (a) breathing 
techniques, (b) meditation, 
and (c) discussion. The 
curriculum was based on the 
MB SR program and was 
modified to suit the interests 
and developmental level of 
the adolescent population. 
Met 45 minutes twice 
weekly for 4 weeks. Home 
practice: Encouraged to 
practice 15-30 minutes per 
day. 


US 


RCT 


103 5 (13.2) 


General 

population 


Trained Instructors 
(researcher was non- 
participating 
observer/assistant) 


Physical 

Education 

Class 


Raes (2014)' 

P 

Mindfulness 

• A mindfulness group Belgium RCT 

357 4 (15.4) 

General 

Trained Mindfulness 

Regular 



Group Program 

training developed 


population 

instructors(Psychologis 

school 




specifically for adolescents 
integrating elements of 

MBCT and MB SR. 



ts and MD) 

program 




• Eight weekly 1 00 minute 








sessions. Home practice: 15 
minutes of mindfulness 
practice each day 






Ramadoss 

P 

Yoga-Based 

• TLS is a multimodality US 

QED 

557 4 (NR) 

General 

Certified yoga teachers 

Regular 

(20 10) 1 


Transformative 

intervention consisting of 



population (urban 

(non-profit org.) 

school 



Life Skills 

Yoga poses, breathing 
techniques, and meditation. 

Sessions involved the 
following components: an 
initial moment of silence 
(centering), a “check-in”, a 
sequence of yoga poses and 
breathing exercises, and a 
final “check-out”. 



school) 


program 




• Sessions were provided for 









15 minutes per day for 18 
weeks. 







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First Author Pub 

(year) 1 Status Program Name Intervention Description Country 

Razza (2015) 1 P Modified version • The mindful yoga program US 

of Yoga Kids was a modified version of 

the standardized YogaKids. 

The daily practice included 
breathing and sun 
salutations during morning 
circle, yoga postures linked 
to literacy activities in the 
afternoon, and breathing 
exercises during transition 
periods. Thus, the practice 
was incorporated into the 
curriculum and used across 
the school day in the 
intervention classroom. 

• The average length of time 
increased gradually across 
the school year, from 10 
min per day in the fall to 30 
min per day in the spring. In 
total, the children received 
approximately 40 h of 
mindful yoga across 25 

weeks. 

Ricard (2013) 1 P Teen Talk • This program was a US 

Dialectical Behavioral 
Therapy (DBT) Infused 
skills group- authors 
adapted activities from the 
standard DBT skills 
curriculum. The adaptation 
of DBT modules was aimed 
at teaching emotional and 
behavioral self-preservation 
skills, while facilitating an 
awareness of the impact of 
behavior on others. 

• Eight to ten 45-50 minute 

group counseling sessions 


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Design 

N 

Grade(Mean 
age or range) 

Sample 

Characteristics Provider 

Control 

Condition 

QED 

29 

1 (4.3) 

General Teacher 

population 

Regular 

classroom 

program 


QED 303 5 (NR) At-risk students Counselling student Treatment as 

attending a interns (including first usual at the 

Disciplinary author) alternative 

Alternative education 


Education program 

Program 




First Author 
(year ) 1 

Pub 

Status 

Program Name 

Intervention Description 

Country 

Design 

N 

Grade(Mean 
age or range) 

Sample 

Characteristics 

Provider 

Control 

Condition 




two times each week for 4 
weeks. 








Schonert-Reichl 

(2010)' 

P 

Mindfulness 

Education 

• The ME program is a 
classroom-based universal 
preventive intervention 

US 

QED 

246 

5(11.4) 

General 

population 

Teachers 

Standard 

educational 

programming 


designed to foster children's 
positive emotions, self 
regulation, and goal setting. 
Key components include (1) 
universal involvement of all 
children in the classroom, 

(2) a 10-lesson manualized 
curriculum with clear 
lessons that are grounded in 
theory and research, and (3) 
an emphasis on taking 
lesson content and 
extending the key 
components (e.g., positive 
thinking) to other aspects of 
the curriculum and to other 
dimensions of children’s 
lives outside of school. 

• Approximately once a week, 
with each lesson lasting 
approximately 40-50 min. 
The daily core mindfulness 
attention exercises were 
done three times a day for 
up to at least 3 min each 
session. 


Schonert-Reichl P 

Mind UP 

• MindUP is a simple-to- US 

RCT 

99 2 (10.2) 

General 

Teachers 

Business as 

(2015) 1 


administer mindfulness- 



population 


usual social 



based education SEL 





responsibility 



program. The core 
mindfulness practices in the 
program (done every day for 

3 min three times a day) 
consist of focusing on one’s 





program 


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First Author Pub 

(year ) 1 Status Program Name Intervention Description Country 

breathing and attentive 
listening to a single resonant 
sound. The curriculum 
includes lessons that 
promote EFs and self- 
regulation (e.g., mindful 
smelling, mindful tasting), 
social- emotional 
understanding (e.g., using 
literature to promote 
perspective-taking skills and 
empathy), and positive 
mood (e.g., learning 
optimism, practicing 
gratitude). 

• 12 lessons taught 
approximately once a week, 
with each lesson lasting 
approximately 40-50 min. 

Sibinga (2013) 1 P Mindfulness- • MB SR is a structured US 

Based Stress program of instruction in 

Reducation mindfulness, a practice of 

(MBSR) purposeful, non judgmental 

attention to the happenings 
of the present moment. 

• 12 weekly 50-minute 

sessions. 

Sibinga (2016) 1 NP Adaptation of • Adapted from MBSR, the US 

Mindfulness- intervention consisted of a 

Based Stress structured program of 

Reduction instruction in the cultivation 

(MBSR) of mindfulness, a practice of 

purposeful non-judgmental 
attention to the happenings 
of the present moment. 

MBSR programs consist of 
three components: (1) 
didactic material related to 
mindfulness, meditation. 


103 


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Grade(Mean Sample 

Design N age or range) Characteristics 


Provider 


Control 

Condition 


RCT 

41 

3(12) 

Urban boys with 

Mindfulness trained 

Health 




financial need and 

instructor 

education 




academic 


program 




potential 




RCT 


300 5 (NR) 


General 

population 


MBSR trained 
instructor 


Healthy 

Topics 



First Author Pub Grade(Mean Sample Control 

(year ) 1 Status Program Name Intervention Description Country Design N age or range) Characteristics Provider Condition 

yoga, and the mind-body 
connection; (2) experiential 
practice of various 
mindfulness meditations, 
mindful yoga, and body 
awareness during group 
meetings and 
encouragement of home 
practice; and (3) group 
discussion focused on the 
application of mindfulness 
to everyday situations and 
problem-solving related to 
barriers to effective practice. 

The MB SR program 
includes a number of formal 
and informal techniques, all 
of which share the goal of 
enhancing non-judgmental 
present-focused awareness, 
aimed to reduce 
dysregulated focus on the 
past, i.e., rumination and 
worries about the future, 
i.e., anxiety. 

• 12-week program 


Smith (2014) 1 P YogaKidz 


• After school yoga group. US RCT 77 2 (9.4) 

Lessons were organized into 
six lesson sets that 
concentrated on a particular 
theme, for example respect, 
hope, and gratitude. Each 
session consisted of class 
discussion of a theme (5 
minutes), physical poses 
(20-30 minutes), breathing 
techniques (5-10 minutes), 
and relaxation practices (5- 


Students from Certified Yoga 
schools with high Instructors 
poverty and low 
test scores 


Health Eats 
program 


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First Author 
(year ) 1 

Pub 

Status Program Name 

Intervention Description 

Country 

Design N 

Grade(Mean 
age or range) 

Sample 

Characteristics Provider 

Control 

Condition 



10 minutes). 

• Twice weekly for about 40 
minutes per class for up to 

28 weeks. 






Tharaldsen 

(2012) 1 

P Concious Coping 

"Bevisst mestring" 

• CC (inNorwegian, 
‘Bevisstmestring’) is an 

MBC skill training program 

Norway 

QED 72 

4(17.3) 

General Interventionists 

population 

Regular 

school 

program 


aimed at teaching high 
school students mindfulness 
practices and cognitive 
coping skills to prevent 
mental health problems in 
four modules: awareness of 
the present, coping with 
distress, our emotional life 
and interpersonal 
interaction. The programme 
is heavily inspired by other 
interventions that combine 
mindfulness practices and 
coping strategies to varying 
degrees. 


• 14, 90-minute meetings 


Van de Weijer 

P 

MindfulKids 

• Children participate in 

The QED 

199 2 (9.3) 

General 

Mindfulness Trainer 

Regular 

(2014) 



secular and age appropriate 

Netherla 


population 

(teachers present) 

school 




meditation practices 
focusing on non-judging 
awareness of sounds, bodily 
sensations, the breath, 
thoughts, and emotion. The 
program is modeled after 
the MB SR and MBCT 
training for adults and 
inspired by the Mindful 
Schools program. 

nds 




program 




• Trainer visits each class for 









12 sessions of 30 min during 

6 weeks (two sessions per 
week). 







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First Author Pub 

(year ) 1 Status Program Name Intervention Description Country 

Viafora (20 1 5) 1 P Planting Seeds & • Every class followed the US 

Still Quiet Place same general format of 

mindfulness exercises, 
typically beginning with a 
mindful listening exercise, 
followed by mindful eating, 
and then a short class 
discussion of the previous 
week’s home practice 
exercises. Each week the 
instructor led the class in a 
guided breathing exercise 
lasting several minutes. 

• The mindfulness course was 
delivered in 8 weeks, with 
45 min weekly sessions. 

White (2012) 1 P Mindful • The MB SR program US 

Awareness for developed by Kabat-Zinn 

Girls through (1990/ 2005) is an 8-week 

Yoga intervention including (a) 

2.5-hour weekly classes, (b) 
sitting meditation, (c) body 
scanning (that is, awareness 
of different parts of the 
body), (d) yoga, (e) mindful 
eating and walking, (f) 
approximately 45 minutes of 
daily homework guided by a 
compact disk and a 
workbook and (g) one full- 
day retreat. 

• Met approximately 60 
minutes immediately after 
school 1 day per week for 8 
weeks and completed 10 
minutes of yoga homework 

6 days a week. 


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Grade(Mean Sample Control 

Design N age or range) Characteristics Provider Condition 

QED 48 3 (11-13) General Mindfulness instructor Regular 

population (teachers present) education 

program 


RCT 


155 2 (9.9) 


General 

population 


Interventionist and 
research assistants 


No treatment 



First Author 
(year ) 1 

Pub 

Status 

Program Name 

Intervention Description 

Country 

Design 

N 

Grade(Mean 
age or range) 

Sample 

Characteristics 

Provider 

Control 

Condition 

Wick (2013)' 

NP 

Mindfulness and 

Lovingkindness 

Meditation 

• Students did Loving 
Kindness meditation and 
journaling on 1 day and 

US 

QED 

38 

4(16) 

At-risk high 
school girls 

Researcher (who was 
school counsellor) 

Regular 

education 

programming 


participated in short 
mindfulness meditation 
focusing on breathing on the 
2 nd day each week. 

• Two days per week for 30 
minutes for 1 0 weeks. 

Notes: 1 Included in at least one meta-analysis; Propensity score matched sample; NR = Not Reported; Publication Status: P = published, NP = not published; Grade level: 1= 
Preschool, 2=Elementary School (k-5 or equivalent); 3= Middle school (6-8 or equivalent); 4 = High school (9-12 or equivalent); 5 = Mixture of grade levels; 6 = unable to 
determine; Teachers refer to regular classroom teachers (who may or may not have received training). Instructors refer to providers who are trained instructors in the intervention 
who are not the classroom teachers. 


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8.4 CHARACTERISTICS OF SINGLE GROUP PRE-POST TEST STUDIES 


1 st Author 
(year) 

Intervention 

Intervention Description 

N 

Grade Level 

Outcomes 

Author Reported Results 

Beauchemin 

(2008) 

Mindfulness 

meditation 

45-minute initial training session, 
followed by 5-10 minute meditation 
sessions daily for 5 consecutive 
weeks. 

34 

High school 

Cognition: 

cognitive 

interference 

Socioemotional: 

social skills, 
anxiety 

Results present only a 
relationship between mindful 
meditation and outcome 

measures. 

Bei (2013) 

Cognitive- 

behavioral 

mindfulness 

training 

Six 90 minute sessions weekly over 

7 weeks. Additional at-home tasks 
were assigned weekly. 

62 

9th grade 

Behavior: 

objective sleep, 
subjective sleep 

Socioemotional: 

anxiety 

Results suggest training may 
improve sleep, but impacts on 
anxiety are inconclusive. 

Carmona 

(2014) 

Mindfulness 

Training 

Initial training, followed by daily 
practice during one class (Physical 
Education class) for 12 weeks. 

84 

7th grade 

Academic 

Performance: 

academic 

competence 

Found that mindfulness 
practices were not impactful on 
stress or mindfulness. 






Socioemotional: 

stress, social 
skills, quality of 
life 


Edwards 

(2014) 

Mindful ness- 
Based Stress 
Reduction for 
Teens 

Eight weekly 50-minute group 
sessions. Used Biegel's 
Mindfulness-Based Stress 

Reduction for Teens manual. 
Participants were also encouraged 
to develop at-home daily 
mindfulness practices. 

20 

Middle and 
High school 

Cognition: 

attention 

Behavior: 

Socioemotional: 

self-compassion, 
perceived stress, 

No significant changes in 
student’s hostility, anxiety, or 
mindfulness (p >. 05). 

Significant change was found in 
students’ perceived stress, 
depression, and self- 
compassion. 


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1 st Author 
(year) 

Intervention 

Intervention Description 

N 

Grade Level 

Outcomes 

Author Reported Results 






depression, 

anxiety 


Mehta 

Climb-Up 

One -year, peer-mediated 

76 

2nd to 5th 

Cognition: 

Results show "that the majority 

(2011,2012) 


interventional program consisting of 
yoga, meditation, and behavioral 
play therapy. Twice weekly 60- 
minute sessions, initially for six 
weeks by unspecified adults. High 
school student volunteers were then 
trained to conduct the program 
beginning at week 5 and continue 
for one year. 

(2011) 

69 

(2012) 

grade 

students with 

ADHD 

attentiveness 

Academic 

Performance: 

performance 

impairment 

of 

children reported improved 
performance in school, which 
was sustained for the year." 

Joyce (2011) 

Mindful 

meditation 

Programmed as ten 45 -minute 
sessions, but implemented as 
classroom teachers saw fit. 

Classroom teachers also encouraged 
to implement additional practice 
throughout the school day. 

120 

5th to 6th 
grade 

Cognition: 

inattention 

Behavior: 
conduct problems 

Socioemotional: 

emotional 

symptoms, peer 
relationship 
problems, pro- 
socialiality 

Results "indicate improvements 
in 

emotional health, especially for 
students scoring in the 
‘borderline’ and ‘abnormal’ 
categories before the program." 

Wisner 

Mindfulness 

90 minute sessions, twice weekly 

35 

10th to 12th 

Cognition: 

Findings "provide support for 

(2008) 

meditation 

for 8 weeks. Additionally, 10 
minute meditation periods were 
held during weeks 3-8 twice 
weekly. 


grade 

attention 

Academic 

Performance: 

thinking skills 
Socioemotional: 

coping, stress 

psychosocial, 
cognitive, and behavioral 
benefits to students" 


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1 st Author 
(year) 

Intervention Intervention Description 

N 

Grade Level 

Outcomes 

Author Reported Results 

Worth 

(2013) 

MAPs for ADHD Half-hour daily sessions for eight 
weeks. 

17 

Middle 

school 

Cognition: 

executive 

functioning, 

attention, 

psychomotor 

speed 

Findings indicated that "five of 
seven indices of ADHD found 
to have statistically significant 
improvements" after 
mindfulness training. 


Zahn (2008) Tai Chi Chuan 

90 minute sessions of Tai Chi, once 12 

High school Cognition: 

"Students reported decreased 


weekly for 9 weeks. An additional 

mindfulness 

tension and anxiety... and 


20 minutes of practice was assigned 

Academic 

increased relaxation and 


three times weekly. 

Performance: 

participation 

Behavior: 

behavioral 

regulation 

Socioemotional: 

psychological 
distress, self- 
perception, mood 

calmness..." Additionally 
results suggest improvement in 
mood and quality of life. 


8.5 CHARACTERISTICS OF SINGLE SUBJECT DESIGN STUDIES 


1 st Author 
(year) 

Name of 

Intervention 

Intervention Description 

Study 

Design 

Grade level 

or age 

Outcomes 

Author Reported Results 

Carboni 

(2014) 

Mindfulness 

training 

30-45 minute, one-on-one sessions 
twice weekly for a minimum of ten 
sessions. Utilized mindfulness-based 

stress reduction course materials and 

A-B-A 

Age: 8 years 

Academic 

Performance: 

academic 

engagement 

Results indicated "mindfulness 
training was effective in 
increasing 


no 


The Campbell Collaboration | www.campbellcollaboration.org 


1 st Author 
(year) 

Name of 

Intervention 

Intervention Description 

Study 

Design 

Grade level 

or age 

Outcomes 

Author Reported Results 



mindfulness practices to build 
emotional intelligence. 



Behavior: 

On-task behavior, 

hyperactive 

behaviors 

the percentage of intervals of 
on-task behavior for 
participants." 

Felver 

(2014) 

Soles of Feet 

20-30 minute one-on-one sessions 

with trained interventionist over five 
consecutive days. Used Meditation 
on the Soles of the Feet by Singh as 
treatment manual. Follow-up then 
tracked behaviors until the end of 
the school year. 

A-B-A 

Grade: 3 

Academic 

Performance: 

task engagement 
Behavior: 
disruptive and off- 
task behavior 

Results suggest "that 
elementary school 
students with high rates of 
disruptive behavior who 
complete 

the SOF intervention spend 
more time being academically 
engaged in the classroom and 
less time displaying off-task 
behavior." 

Klatt (2013) 

Move-Into- 
Learning 
(Mindfulness 
with yoga and 
arts) 

45 minute sessions, once weekly for 
eight consecutive weeks. Based on 
an adult model previously studied 
by Klatt. 

A-B-A 

Grade: 3 

Cognition: 

cognitive 

problems/ 

inattention 

Behavior: 

oppositional 

behavior 

hyperactivity 

Socioemotional: 

"Preliminary observational data 
of the teachers assessing 
student behavior, on both an 
ADFID index and in 
cognitive/inattentive behavior, 
showed decreases in these 
disruptive behaviors" 

Peck (2005) 

Yoga 

programming 

30 minute, twice weekly yoga 
sessions for 3 weeks. Utilized "Yoga 
Fitness for Kids" video tapes, 
published by Gaiam. 

A-B-A 

Grade: 1 to 

3 

Cognition: 

attention (time on 
task) 

Researchers reported large 
effect sizes for all groups, with 
a decrease in effect size at 
follow-up; however all effect 
sizes remained medium-to- 
large. 


Ill 


The Campbell Collaboration | www.campbellcollaboration.org 



1 st Author 
(year) 

Name of 

Intervention 

Intervention Description 

Salustri 

Mindfulness- 

16 in-school sessions, conducted 

(2012) 

based stress 

over 8 weeks for 45 minutes per 


reduction 

session. Utilized Kabat-Zinn’s 


(MB SR) 

Stress Reduction and Relaxation 
Program manual. 


Semple Cognitively 6 sessions, conducted over 6 weeks 

(2005) oriented for 45 minutes weekly. Program 

mindfulness materials adapted from Kabat- 

Zimm’s mindfiilness-Based Stress 
Reduction and Segal et al.’s 
Mindfullness-Based Cognitive 
Therapy 


1 5 minute one-on-one sessions with 
trained therapist, three times a week 
for 4 weeks. Used Meditation of the 
Soles of the Feet as treatment 

112 The Campbell Collaboration | www.campbellcollaboration.org 


Singh Soles of Feet 

(2007) 


Study Grade level 

Design or age Outcomes Author Reported Results 

A-B-A Grade: high Cognition: “Results lend support to the 

school Mindfulness conclusion that the current 

Academic mindfulness program was 

Performance: effective in teaching the 

absences, number participants how to increase 

of assignments their awareness of and attention 
completed to the present moment.” 

Behavior: late 
class arrivals 
Socioemotional: 
total life 
satisfaction, 
positive & 
negative affect 

A-B-A Age: 7-8 Cognition: “some improvements were 

Grade: 2-3 attention problems reported for all 

Academic of the children in at least one 

Performance: area — academic functioning, 

academic internalizing problems, or 

functioning externalizing 

Behavior: problems.” 

internalizing and 

externalizing 

behaviors 

Socioemotional: 

anxiety, depression 

A-B-C- Grade: 7 Behavior: Results suggest “when 

A aggression, adolescents 

bullying, fire 
setting, cruelty to 



1 st Author Name of 

(year) Intervention Intervention Description 

manual. Following initial training, 
met for 1 5 minutes once a month 
with therapist over 25 weeks. 


Steiner Yoga Twice weekly yoga sessions 

(2013) programming conducted for 3.5 months. Utilized 

(Yoga Ed) the Yoga Ed Protocol, a national 

yoga protocol for children. 


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Study Grade level 

Design or age Outcomes Author Reported Results 

animals, choose to change their 

noncompliance behavior, whether reluctantly 

or otherwise, 

they can indeed self-regulate 
specific behaviors in settings 
of their choice, and for as long 
as they wish.” 

A-B-A Grade: 4 to Cognition: "...reported improved attention 

5 adaptive skills, in class and adaptive skills and 

attention reduced depressive symptoms, 

Academic behavioral 

Performance: symptoms, and internalizing 

school problems symptoms." Students and 

Behavior: parents reported no significant 

internalizing changes, 

behaviors, 
externalizing 
behaviors, 
behavioral 
symptoms 
Socioemotional: 
deportment, 
anxiety, well- 
being, parent 
relations, social 
support, peers, 
social competence 



8.6 EXCLUDED STUDIES 


Study 

Reason for exclusion 

Barnes et al. (2003) 

Intervention- Study examined effects of Transcendental Meditation 

Beaumont (2005) 

Intervention- Study examined effects of Transcendental Meditation 

Bluth (2010) 

Study design- Not an intervention study 

Black (2014) 

Study design- Study examined the effects of mindfulness meditation 
of varying duration across two groups. 

Bogels et al. (2011) 

Intervention- Not school-based 

Campion & Rocco 
(2011) 

Study design- Qualitative Design 

Ernould (n.d.) 

Study design- Not an intervention study (treatment manual) 

Gordon et al. (2008) 

Intervention- Not mindfulness-based 

Groom (2014) 

Intervention- Included a mantra and aspects of Transcendental 
Meditation 

Holstine (2015) 

Intervention- - Study examined effects of Transcendental Meditation 

Keefe-Forbotnick 

(2014) 

Study not available; author did not respond to request 

Kim (2001) 

Intervention- Not mindfulness-based (Taekwondo) 


Intervention- Not mindfulness-based; study examined effects of a 

Kim et al. (2014) 

multicomponent intervention that was primarily group art therapy 
with some breath meditation 

Mendelson & 
Greenberg (2010) 

Study Design- Not an intervention study 

Miller (1999) 

Study design- Not an intervention study 

Miller (2014) 

Study design- Not an intervention study; formative study using 
qualitative methods to design an intervention for a future study 

Oberle et al. (2012) 

Study design- Not an intervention study 

Ramadoss (2010) 
(Pilot study #1) 

Intervention- Not a school-based intervention 

Rommel (1012) 

Intervention- Not mindfulness-based (yoga movement only with no 
mindfulness component) 

Salustri (2012) 

Study design- Did not establish experimental control for withdrawal 
design 


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Study 

Reason for exclusion 

Semple (2005) 

Intervention- not school-based (University-based clinic reading 
tutoring program) 

Semple (2010) 

Intervention- not school-based (University-based clinic reading 
tutoring program) 

Semwal et al. (2014) 

Outcomes- Study examined introversion and extroversion, which are 
personality traits and not social-emotional outcomes 

Smith (2014) 

1 st study reported 

Participants- not students (teachers were included) 

Stewart & Alrutz 
(2012) 

Intervention- not a mindfulness-based intervention (service learning 
and contemplation) 

Van de Weijer- 
Bergsma et al. 

(2012) 

Intervention- not school-based 

van der Oord et al. 
(2012) 

Intervention- not school-based 

Wall (2005) 

Study design- Not an intervention study 

West (2008) 

Study design- Not an intervention study 


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8.7 RISK OF BIAS TABLE 


School-based mindfulness interventions 
Study name: Bakosh (2015) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to group 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome assessment 
(detection bias) 

High risk 

No blinding of outcome assessors 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Authors designed the treatment intervention 

Study name: Bergen-Cico (2015) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Students randomly assigned by classroom 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment procedures not 
described 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or some personnel 
(Yoga teacher); blinding of participants to 
researchers 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

One teacher provided the intervention; one 
teacher in the control condition 


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Study name: Bluth (2015) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Students randomly assigned by computer 
program 

Allocation concealment 
(selection bias) 

Low risk 

Allocation concealment procedures not 
described 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires 

Incomplete outcome data 
(attrition bias) 

High risk 

Differential attrition- high attrition in control 
group, no attrition in treatment group 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

One of the authors created the intervention 
curriculum and another of the authors was the 
instructor of the mindfulness classes 

Study name: Britton (2014) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Randomization of classrooms by simple coin 
flip 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment was not described 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

Unclear risk 

Authors’ role in the intervention is unclear - 
appears to be independent 


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Study name: Campbell (2015) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires used 

Incomplete outcome data 
(attrition bias) 

Unclear risk 

High attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

Low risk 

No confounds. Author appears independent 
from intervention 

Study name: Chukwu (2015) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Assignment to group by principal alternating 
through the list of students whose parents had 
given consent 

Allocation concealment 
(selection bias) 

Unclear risk 

Concealment procedures not reported 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of outcome assessors 

Incomplete outcome data 
(attrition bias) 

High risk 

High attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

Low risk 

No evidence of researcher involvement in the 
intervention 


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Study name: Deuskar (2007) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Clusters randomly assigned 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment procedures not 
described 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report measure used 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Confounded (each class in the school 
consisted of two divisions- one of the two 
divisions was randomly selected to the 
treatment and the other to the control group). 
Unclear whether the author was involved in 
intervention development. 

Study name: Flook (2010) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Participants were assigned to groups using 
block randomization; randomization 
procedures not described. 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment not described 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of assessors 

Incomplete outcome data 
(attrition bias) 

Low risk 

No attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Intervention curriculum developed by one of 
the authors 


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Study name: Flook (2015) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Classrooms randomly assigned to condition 

Allocation concealment 
(selection bias) 

Low risk 

Allocation concealment not described 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of outcomes assessors (teachers); 
also used self-report 

Incomplete outcome data 
(attrition bias) 

High risk 

High attrition for some measures 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Author developed the intervention curriculum 

Study name: Haden (2014) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Random assignment- research assistant not 
involved in the evaluations pulled names out 
of a hat. 

Allocation concealment 
(selection bias) 

Low risk 

Research assistant who drew names and was 
not involved in the evaluations, conveyed 
group assignment to the teachers 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

Participants and personnel were not blinded to 
condition 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Assessors were blinded to group assignment 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

Low risk 

Authors appear independent of the 
intervention 


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Study name: Justo (2011) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Random assignment- procedures unclear 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment unclear 

Blinding of participants and 
Personnel (performance bias) 

Unclear risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment detection bias) 

High risk 

No blinding of outcome assessors 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Confound- one mindfulness instructor. 

Authors’ role in intervention unclear. 

Study name: Khalsa (2012) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Authors report that participants were 
randomly assigned by class 

Allocation concealment 
(selection bias) 

Unclear risk 

Authors did not report any infonnation about 
allocation concealment 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

All outcomes were assessed using self-report 
questionnaires 

Incomplete outcome data 
(attrition bias) 

Low risk 

Reported outcome data for 100/121 
participants (17% attrition across groups) 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Funded by Kripalu Center for Yoga and 

Health; 3 study authors affiliated with Kripalu 
Center for Yoga and Health (consultants or 
paid staff). Unclear what role the authors had 
in the development of the program. 


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Study name: Koenig (2012) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment used- “classes were 
chosen by school administrators so that the 
intervention and control group classes were 
comparable on the basis of similar levels of 
Adaptive functioning.” 

Allocation concealment 
(selection bias) 

High risk 

Allocation not concealed- classes were 
allocated by school administrator. 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

Participants and personnel were not blinded. 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

Assessors (research assistants and classroom 
teachers involved in delivery of intervention) 
were not blinded to condition. 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition rate (4%) 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

The intervention was developed by one of the 
authors. 

Study name: Kuyken (2013) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition. 
Intervention schools were selected on basis of 
whether there was an intervention (MISP) 
developer or had been trained by an MISP 
developer. 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

All outcomes assessed using self-report 
questionnaires 

Incomplete outcome data 
(attrition bias) 

Low risk 

Attrition for unadjusted analyses reported was 
low (<20%). 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Authors are co-founders of the intervention 


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Study name: Lau (2011) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

Allocation not concealed 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

All outcome measures were self-report 
questionnaires 

Incomplete outcome data 
(attrition bias) 

High risk 

Authors reported to include only those 
participants who attended at least 80% of the 
programme classes, which was 61.5% of the 
sample. 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Experimental condition confounded- one 
instructor taught all mindfulness classes, thus 
there is no way to distinguish between the 
effect 

of the intervention from that of the instructor. 

Study name: Mendelson (2010) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Randomly assigned schools to condition 

Allocation concealment 
(selection bias) 

Unclear risk 

Concealment not reported 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

Participants and personnel were not blinded to 
condition 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

All outcome measures were self-report 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition balanced across groups 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Two researchers were involved in the 
development of the intervention in 
collaboration with the Holistic Life 

Foundation who implemented the 
intervention. 


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Study name: Metz (2013) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (performance bias) 

Unclear risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

All outcome measures were self-report 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

One of the authors developed the 
intervention. Intervention confounded at the 
school level (one school per condition). 

Study name: Noggle (2012) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Group allocation was conducted by blindly 
and randomly drawing paper slips. 

Allocation concealment 
(selection bias) 

Low risk 

Group allocation was conducted by blindly 
and randomly drawing paper slips. 

Blinding of participants and 
Personnel (perfonnance bias) 

Unclear risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

All outcome measures were self-report 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

The two lead yoga instructors created and 
implemented the intervention and were 
teaching faculty at the Kripalu Center for 

Yoga and Health. Study was funded (in part) 
by the Kripalu Center for Yoga and Health 
and 2 study authors were affiliated with 

Kripalu Center for Yoga and Health 
(consultants). The control condition was 
confounded at the classroom level (one class 
in the control condition). 


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Study name: Parker (2014) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Authors reported that schools were randomly 
assigned to condition. 

Allocation concealment 
(selection bias) 

Unclear risk 

Concealment procedures were not described 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

Teachers completed some assessments and 
were not blinded to condition. Other 
assessments were self report. 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Authors involved in the development of the 
program. Confounded by school- one school 
assigned to treatment and one assignment to 
control. 

Study name: Potek (2012) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Students were randomly assigned by drawing 
names from a hat. 

Allocation concealment 
(selection bias) 

Unclear risk 

There was not enough infonnation reported. 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

Participants and personnel were not blinded to 
condition. 

Blinding of outcome 
assessment 
(detection bias) 

Unclear risk 

A research assistant not otherwise involved in 
the intervention or study collected data from 
both groups, although it is not clear whether 
the 

assistant was blinded to condition. 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

The researcher led the mindfulness classes. 


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Study name: Powell (2008) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non random assignment 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of assessors 

Incomplete outcome data 
(attrition bias) 

Unclear risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Intervention developed by the author 

Study name: Quach (2014) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Author reported that participants were 
randomly assigned to condition 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment not described 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

All outcome measures were self-report 

Incomplete outcome data 
(attrition bias) 

Unclear risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Researcher attended some of the intervention 
groups to be “available to assist instructors as 
a non-participating observer” and to monitor 
fidelity, but researcher did not report doing 
the same for the control group. 


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Study name: Raes (2014) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Randomization sequence generated by online 
random number generator 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment not described 

Blinding of participants and 
Personnel (performance bias) 

Unclear risk 

Participants and personnel were not blinded to 
condition. 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self report questionnaire was used 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

High risk 

Study protocol was not found. Authors 
reported one outcome in the paper, but stated 
that they had included several measures that 
were not reported in the manuscript- the Five- 
Factor Mindfulness Questionnaire (internal 
consistency was too low to be trusted) and the 
Mood Disorders Questionnaire (authors 
reported the sensitivity and specificity were 
not well know at this time in English or Dutch 
so did not use it as an endpoint). 

Other biases 

(research allegiance, funding, 
confounds) 

Low risk 

Researcher appeared independent of the 
development or implementation of the 
intervention. No confounds noted. 

Study name: Ramadoss (2010) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self report measures used 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition balanced across both groups 

Selective outcome reporting 
(reporting bias) 

High risk 

Protocol not found. Authors did not report 
adequate data at posttest on one measure. 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Authors were affiliated with the organization 
that provides the intervention. 


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Study name: Razza (2015) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

Outcome assessors were not blinded 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition balanced across both groups 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Treatment confounded at the classroom level 
(one classroom/teacher per each condition). 

Study name: Ricard (2013) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of outcome assessors 

Incomplete outcome data 
(attrition bias) 

Unclear risk 

Authors provide sample size for those that 
participated in the groups; it is unclear 
whether all of those students are included in 
the analysis 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Authors involved in development of 
intervention 


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Study name: Schonert-Reichl (2010) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of assessors 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Study funded by the Hawn Foundation, 
developer of the intervention; unclear whether 
authors played a role in program development 

Study name: Schonert-Reichl (2015) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Randomization by coin flip 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment not described 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of outcome assessors 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Study funded by the Hawn Foundation, 
developer of the intervention 


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Study name: Sibinga (2013) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Randomly assigned by “computer generated 
scheme” 

Allocation concealment 
(selection bias) 

Unclear risk 

Concealment not described 

Blinding of participants and 
Personnel (perfonnance bias) 

Low risk 

“Prior to program assignment, all participants, 
and the study and school staff were blinded to 
program Allocation.” There was an active 
control group, so it is reasonable that the 
participants and personnel could be blinded to 
which intervention was the treatment in this 
study. 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

“Prior to program assignment, all participants, 
and the study and school staff were blinded to 
program allocation.” 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

High risk 

Study protocol was not found. Authors reported 
data for all outcomes measured at posttest, 
although not sufficiently for including in meta- 
analysis; 3 month follow-up not reported. 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Study had confound- one instructor provided 
intervention; author involved in the 
adaptation/development of the intervention 

Study name: Sibinga (2016) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Students were randomly assigned by school and 
grade 

Allocation concealment 
(selection bias) 

Unclear risk 

Allocation concealment not described 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants; personnel were 
blinded to group assignment at the data 
management, analysis and interpretation levels 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires 

Incomplete outcome data 
(attrition bias) 

High risk 

High attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Authors involved in the adaptation/development 
of the treatment intervention 


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Study name: Smith (2014) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Students were randomly assigned to condition 

Allocation concealment 
(selection bias) 

Unclear risk 

Concealment procedures not reported 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

High risk 

No blinding of outcome assessors 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

One of the study authors developed the 
curriculum 

Study name: Tharaldsen (2012) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment- classes were selected by the 
high school administrator 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires used 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Author developed the intervention 


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Study name: Viafora (2015) 


Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants and 
Personnel (performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires used 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Confounded- one instructor. Unclear if authors 
were involved in the development or 
implementation of the intervention 

Study name: White (2012) 

Type of bias 

Judgement 

Support for judgement 

Random sequence generation 
(selection bias) 

Low risk 

Author reported schools were randomized, but 
not indicate the randomization procedures 

Allocation concealment 
(selection bias) 

Unclear risk 

Authors did not report allocation concealment 
procedures 

Blinding of participants and 
Personnel (perfonnance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires used 

Incomplete outcome data 
(attrition bias) 

Low risk 

Low attrition 

Selective outcome reporting 
(reporting bias) 

Unclear risk 

Study protocol was not found 

Other biases 

(research allegiance, funding, 
confounds) 

High risk 

Confounded at school level (one school per 
condition). The author conducted the 
intervention sessions. 


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Study name: Wick (2013) 


Type of bias 

Judgement 

Support for judgement 

Random sequence 
generation 
(selection bias) 

High risk 

Non-random assignment to condition 

Allocation concealment 
(selection bias) 

High risk 

No concealment 

Blinding of participants 
and Personnel 
(performance bias) 

High risk 

No blinding of participants or personnel 

Blinding of outcome 
assessment 
(detection bias) 

Low risk 

Self-report questionnaires used 

Incomplete outcome 
data 

(attrition bias) 

High risk 

High attrition (<80%) from treatment group. 

Selective outcome 
reporting 
(reporting bias) 

Unclear 

risk 

Study protocol was not found 

Other biases 
(research allegiance, 
funding, confounds) 

High risk 

The author worked in the school in which the study was 
being conducted. The intervention group was taken from 
one academic year and the comparison group from the 
prior academic year (matched). 


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8.8 COGNITIVE OUTCOMES BY STUDY INCLUDED IN META- 

ANALYSIS 



Study 

Measure 

Bergen-Cico (2015) 

ASRI total regulation 

Britton(20i4) 

YSR attention problems 

Chukwu (2015) 

MI 

Flook (2010) 

BRIEF - Teacher Global Executive Composite 

BRIEF - Parent Global Executive Composite 

Flook (2015) 

DCCS - All trials 

Flanker task 

Parker (2014) 

Flanker fish task 

Powell (2008) 

CBPS - concentration/attention skills 

Quach (2014) 

AOSPAN 

Razza (2015) 

Pencil-tap - executive function 

HSKT 

Drawing task - focused attention 

Drawing task - lack of attentional impulsivity 

Schonert-Reichl (2015) 

EF - Flanker switch - response time 

EF - Flanker vs. reverse flanker - response time 

EF- hearts and flowers - response time 

EF- Flanker switch - accuracy 

EF- Flanker vs. reverse flanker - accuracy 

EF- hearts and flowers - accuracy 


Note. ASRI = Adolescent Self- Regulation Index; YSR = Youth Self Report; MI = Metacognition 
Index; BRIEF = Behavior Rating Inventory of Executive Function; DCCS = Dimensional Change 
Card Sort Task; Child Behavior Profile Scores; AOSPAN = Automated Operation Span Task; HSKT 
= Head Shoulders Knees and Toes; EF = Executive Function 


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8.9 ACADEMIC OUTCOMES BY STUDY INCLUDED IN META- 
ANALYSIS 


Study 

Measure 

Flook (2015) 

Grades-Learning 

Grades- Health 

Grades- Socioemotional 

Grades-Cognitive 

Grades-Language 

Bakosh (2015) 

Grades- Reading 

Grades- Science 

Grades- Math 

Grades- Writing 

Grades- Spelling 

Grades-Social Studies 

Schonert-Reichl (2015) 

Grades- Math 

Smith (2014) 

Grades 

Wick (2013) 

Grades 

Academic credits 


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8.10 BEHAVIORAL OUTCOMES BY STUDY INCLUDED IN META- 
ANALYSIS 


Study 

Measure 

Britton (2014) 

YSR Externalizing 

Chukwu (2015) 

BRI 

Flook (2015) 

Self Stickers 

Delay - all trials 

Haden (2014) 

CBCL - Reactive Aggression 

CBCL - Proactive Aggression 

CBCL - Externalizing Behavior 

Khalsa (2012) 

BASC-2 - School Problems Composite 

BASC-2 - Inattention/hyperactivity 

Koenig (2012) 

ABC - community (teacher) 

Parker (2014) 

CBCL- Aggression problems 

CBCL- Attention 

Ricard (2013) 

YOQ-30.2 - Aggression (student report) 

YOQ-30.2 - Conduct problems (student report) 

YOQ-30.2 - Hyperactivity/ distractibility (student report) 

YOQ-30.2 - Aggression (parent report) 

YOQ-30.2 - Conduct problem (parent report) 

YOQ-30.2 - Hyperactivity/ distractibility (parent report) 

Schonert-Reichl (2010) 

TRSC- Aggressive behaviors 

TRSC - Oppositional behavior/dysregulation 

Schonert-Reichl (2015) 

Behavior- starts fights 

Behavior- breaks rules 

Smith (2014) 

CHP - Behavior Tracking System 

Sibinga (2015) 

SCL-90-R - Hostility 

Aggression 

Wick (2013) 

Absences 

Tardies 

Behavior 

Note. YSR = Youth Self Report; BRI = Behavioral Regulation Index; Delay = delay of gratification; 
CBCL = Childe Behavior Check List; BASC-2 = Behavior Assessment Survey for Children Version 2; 
ABC = Aberrant Behavior Checklist; YOQ-30.2 - Youth Outcome Questionnaire; TSRC = Teacher 
Rating Scale of Social Competence; CHP = Challenging Horizons Program; SCL-90-R = Symptom 

Checklist-90-R 



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8.11 SOCIOEMOTIONAL OUTCOMES BY STUDY INCLUDED IN META- 
ANALYSIS 


Study 

Measure 

Bluth (2015) 

CAMM 

SCS-SF 

soc 

PSS 

STAI 

SMFQ 

Britton (2014) 

STAI - Total Affect Disturbance 

STAI - Positive Affect 

YSR - Internalizing 

CAMS-R - Total 

Campbell (2015) 

PSS 

I-PANAS-SF - Negative Affect 

I-PANAS-SF - Positive Affect 

DERS - Impulse Control Difficulties 

DERS - Lack of Emotional Awareness 

DERS - Difficulties Engaging in Goal-Directed Behaviors 

Deuskar (2007) 

TAI 

Flook (2015) 

TSC - total 

Haden (2014) 

PANAS - Positive Affect 

PANAS - Negative Affect 

SPPC-GSWS 

CBCL - Internalizing Behavior 

Justo (2011) 

Coping ability, operability, and persistence 

Self-concept and self-esteem 

Empathy and social skills 

Khalsa (2012) 

BASC-2 - Anger control 

BASC-2 - Ego Strength 

BASC-2 - Emotional Symptoms Index 

BASC-2 - Internalizing Problems composite 

BASC-2 - Mania 

BASC-2 - Personal Adjustment Composite 

BASC-2 - Text Anxiety 

PSS 

POMS - Total 

IPPA 

RS 

Kuyken (2013) 

WEMWBS 

PSS - Stress 

CES-D - Depression 


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Study 

Measure 

Lau (2011) 

MAAS 


FMI 


SPWB 


DASS 


PSS 

Mendelson (2010) 

EPI - Positive affect 

EPI - Negative affect 

SMFQ 

PIML - Trust in friends 

PIML - Communication with friends 

PIML - Teacher affiliation 

PIML - Dissatisfaction with Teacher 

RSQ = Involuntary engagement 

Metz (2013) 

Stress level (l-item measure) 

Difficulties in emotion regulation (total score) 

Psychosomatic complaints scales 

Affective self-regulatory efficacy scale 

Noggle (2012) 

POMS-SF- Total 

PANAS-C Positive affect 

PANAS-C negative affect 

PSS 

IP PA- positive psychological attributes 

IPPA- life purpose and satisfaction 

IPPA- Self confidence during stress 

RS 

STAXI-2 - Inward anger suppression 

STAXI-2 - Outward anger suppression 

STAXI-2 - Anger expression control 

CAMM 

Parker (2014) 

CBCL - Social Problems 

CBCL - Anxiety boys 

CBCL - Anxiety girls 

SCRS - boys 

SCRS - girls 

Potek (2012) 

MASC 


PSS 


DERS 


FFMQ 

Powell (2008) 

Self-confidence 


Social confidence with peers 
Social confidence with teachers 
Communication with peers 
Communication with teachers 


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Study 

Measure 


Self-control 

Contribution 

Eye contact 

SDQ 

Quach (2014) 

PSS 

SCARED 

Raes (2014) 

DASS-21-D- Depression only 

Ramadoss (2010) 

TSCS-13 

Razza (2015) 

CBQ attentional focusing 

CBQ inhibitory control 

Toy wrap - effortful control 

Toy wait - effortful control 

Ricard (2013) 

YOQ somatic student report 

YOQ social isolation student report 

YOQ depression/anxiety student report 

YOQ somatic parent report 

YOQ social isolation parent report 

YOQ depression/anxiety parent report 

Schonert-Reichl (2010) 

RI - optimism subscale 

PANAS - positive affect 

PANAS - negative affect 

TRSC - Social-emotional competence 

Schonert-Reichl (2015) 

IRI -empathic concern subscale 

IRI -perspective/taking subscale 

RI- optimism subscale 

RI- Emotional Control 

SDQ - School self-concept 

MASC 

Social Goals Questionnaire- Social responsibility 

SPQC - Depressive symptoms subscale 

SGQ - goals 

SGQ- trustworthy 

SGQ- Helpful 

SGQ- Takes others' views 

SGQ- Kind 

SGQ- Liked by peers 

Sibinga (2013) 

Mindfulness- Observe 

Mindfulness- w/ 0 judgement 

Mindfulness- Act with awareness 

MASC - anxiety 

SCL-90-R- anxiety 


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Study 

Measure 


SCL-90-R- somatization 

SCL-90-R- hostility 

Depression 

Perceived Stress 

Sibinga (2015) 

CDI-S 

STAXI-2 - temperamental expressivity 

STAXI-2 - reactive expressivity 

DES - interest 

DES - enjoyment 

DES - sadness 

DES - anger 

DES - guilt 

DES - contempt 

DES - fear 

DES - self-hostility 

DES - shame 

DES - shyness 

CSE 

MASC - anxiety 

CPSS 

MCS - Awareness 

MCS - Distraction 

MCS - Preventing negative emotions 

MCS- Constructive self-assertion 

SCL-90-R- life satisfaction 

CPSS 

CAMM 

AFQY = Avoidance Fusion Questionnaire for Youth 

SCS-C 

FBS- perceived Stress 

SCSI- frequency 

SPPC-GSWS 

Tharaldsen (2012) 

MCS- Awareness 

MCS-Distraction 

MCS- Preventing negative emotions 

MCS- Constructive self-assertion 

SCLR-90-R- Life satisfaction 

GSI 

Viafora (2015) 

CAMM 

AFQY 

SCS-C 

White (2012) 

Perceived stress- Feel bad scale 

Schoolagers coping strategies- frequency subscale 


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Study Measure 

GSWS 

MTACA- health self regulation subscale 

Note. CAMM = The Child and Adolescent Mindfulness Measure; SCS-SF = Self-Compassion Scale- 
Short Form; SOC = Social Connectedness; PSS = Perceived Stress Scale; STAI = State-Trait Anxiety 
Inventory; SMFQ = Short Mood and Feelings Questionnaire; YSR = Youth Self Report; CAMS-R = 
Cognitive and Affective Mindfulness Scale; I-PANAS-SF = International Positive Affect and 
Negative Affect Scale; DERS = Difficulties in Emotion Regulation Scale; TAI = Teacher Anxiety 
Inventory; PANAS = Positive and Negative Affect Scale; SPPC-GSWS = Self Perception Profile for 
Children Global Self Worth; TSC = Teacher-rated social competence; CBCL = Child Behavior 
Checklist; BASC-2 = Behavior Assessment Survey for Children Version 2; POMS = Profile of Mood 
States; IPPA = Inventory of Positive Psychological Attitudes; RS = Resilience Scale; WEMWBS = 
Warwick-Edinburgh Mental Well-being Scale; CES-D = Center for Epidemiologic Studies 
Depression Scale; MAAS = Mindfulness Attention Awareness Scale; FMI = Freiburg Mindfulness 
Inventory; SPWB = Scales of Psychological Well-being; DASS = Depression Anxiety Stress Scales; 
EPI = Emotional Profile Inventory; SMFQ = Short Mood and Feelings Questionnaire - Child 
Version; PIML = People In My Life; RSQ = Response to Stress Questionnaire; STAXI State-Trait 
Anger; Expression Inventory-2; SCRS = Self-control Rating Scale; MASC = Multidimensional 
Anxiety Scale for Children; FFMQ = Five Factor Mindfulness Questionnaire; SDQ = Strengths and 
Difficulties Questionnaire; SCARED = Screen for Child Anxiety and Related Emotional Disorders; 
DASD-21-D = Depression Anxiety Stress Scales - depression; PSS-10 = Perceived Stress Scale-10; 
TSCS-13 = Tangney's Self-Control Scale; CBQ = Children’s Behavior Questionnaire; YOQ = Youth 
Outcome Questionnaire; RI = Resiliency Inventory; TRSC = Teacher Rating Scale of Social 
Competence; IRI = Interpersonal Reactivity Index; SPQC = Seattle Personality Questionnaire for 
Children; SGQ = Social Goals Questionnaire; BC = Brief COPE; CRSQ = Children’s Response Style 
Questionnaire; CSE = Coping Self-Efficacy; CDI-S = Children’s Depression Inventory-Short Form; 
DES = Differential Emotions Scale; CPSS = Children’s Post-Traumatic Symptoms; MCS = Mindful 
Coping Scale; SCL-90-R = Symptom Checklist-90-Revised; AFQY = Avoidance Fusion 
Questionnaire for Youth; SCS-C = Self-Compassion Scales-Children; FBS = Feel Bad School; SCSI 
= Schoolagers Coping Strategies Inventory; MTACA = Mindfulness Thinking and Action Scale for 
Adolescents. 


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8.12 RISK OF BIAS BY STUDY 


Study Name 

1 

2 

3 

4 

5 

6 

7 

Bakosh (2015) 

• 

• 

• 

• 

• 

• 

• 

Bergen-Cico (2015) 

• 

• 

• 

• 

• 

• 

• 

Bluth (2015) 

• 

• 

• 

• 

• 

• 

• 

Britton (2014) 

• 

• 

• 

• 

• 

• 

• 

Campbell (2015) 

• 

• 

• 

• 

• 

• 

• 

Chukwu (2015) 

• 

• 

• 

• 

• 

• 

• 

Deuskar (2007) 

• 

• 

• 

• 

• 

• 

• 

Flook (2010) 

• 

• 

• 

• 

• 

• 

• 

Rook (2015) 

• 

• 

• 

• 

• 

• 

• 

Haden (2014) 

• 

• 

• 

• 

• 

• 

• 

Justo (2011) 

• 

• 

• 

• 

• 

• 

• 

Khalsa (2012) 

• 

• 

• 

• 

• 

• 

• 

Koenig (2012) 

• 

• 

• 

• 

• 

• 

• 

Kuyken (2013) 

• 

• 

• 

• 

• 

• 

• 

Lau (2011) 

• 

• 

• 

• 

• 

• 

• 

Mendelson (2010) 

• 

• 

• 

• 

• 

• 

• 

Metz (2013) 

• 

• 

• 

• 

• 

• 

• 

Noggle (2012) 

• 

• 

• 

• 

• 

• 

• 

Parker (2014) 

• 

• 

• 

• 

• 

• 

• 

Potek (2012) 

• 

• 

• 

• 

• 

• 

• 

Powell (2008) 

• 

• 

• 

• 

• 

• 

• 

Quach (2014) 

• 

• 

• 

• 

• 

• 

• 

Raes (2014) 

• 

• 

• 

• 

• 

• 

• 

Ramadoss (2010) 

• 

• 

• 

• 

• 

• 

• 

Razza (2015) 

• 

• 

• 

• 

• 

• 

• 

Ricard (2013) 

• 

• 

• 

• 

• 

• 

• 

Sehonert-Reichl (2010) 

• 

• 

• 

• 

• 

• 

• 

Schonert-Reichl (2015) 

• 

• 

• 

• 

• 

• 

• 

Sibinga (2013) 

• 

• 






Sibinga (2016) 

• 

• 

• 

• 

• 

• 

• 

Smith (2014) 

• 

• 

• 

• 

• 

• 

• 

Tharaldsen (2012) 

• 

• 

• 

• 

• 

• 

• 

Viafora (2015) 

• 

• 

• 

• 

• 

• 

• 

White (2012) 

• 

• 

• 

• 

• 

• 

• 

Wick (2013) 

• 

• 

• 

• 

• 

• 

• 


142 


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8.13 FUNNEL PLOTS 


Funnel Plot of Standard Error by Fledges's g 



Cognitive Outcomes: Funnel Plot of Standard Error of Hedges’ g 



-2.0 -U -1.0 -0.S 00 0.5 10 IjS 2.0 


HMflM'S g 

Behavioral Outcomes: Funnel Plot of Standard Error of Hedges’ g 


143 


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Standard Error 


Funnel Plot of Standard Error by Hedges's g 



Socioemotional Outcomes: Funnel Plot of Standard Error of Hedges’ g 


144 


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J CampbellCollaboration 


About this review 

With the diverse application and findings of positive effects of mindfulness practices with 
adults, as well as the growing popularity with the public, MBIs are increasingly being used with 
youth. Over the past several years, MBIs have received growing interest for use in schools to 
support socioemotional development and improve behavior and academic achievement. 

This review examines the effects of school-based MBIs on cognitive, behavioral, 
socioemotional and academic achievement outcomes with youth in a primary or secondary 
school setting. MBIs are interventions that use a mindfulness component, broadly defined 
as "paying attention in a particularly way: on purpose, in the present moment, non- 



The Campbell Collaboration Mailing address: Visiting address: 

info@campbellcollaboration.org P.O. Box 4404, Nydalen Pilestredet Park 7 

Phone: (+47) 23 25 50 00 N-0403 Oslo, Norway (Entrance from Stensberggata) 


Website: 

www.campbellcollaboration.org