Mindfulness and Education : Research and Practice [1 ed.] 9781443878609, 9781443816885

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Mindfulness and Education

Mindfulness and Education: Research and Practice Edited by

Tamara Ditrich, Royce Wiles and Bill Lovegrove

Mindfulness and Education: Research and Practice Edited by Tamara Ditrich, Royce Wiles and Bill Lovegrove This book first published 2017 Cambridge Scholars Publishing Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2017 by Tamara Ditrich, Royce Wiles, Bill Lovegrove and contributors All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-4438-1688-4 ISBN (13): 978-1-4438-1688-5

TABLE OF CONTENTS

Acknowledgements ................................................................................... vii Introduction ................................................................................................ ix Tamara Ditrich and William Lovegrove I: Theorising Mindfulness: Conceptualisations and Research Chapter One ................................................................................................. 3 The Conceptualisation and Practice of Mindfulness: Buddhist and Secular Perspectives Tamara Ditrich Chapter Two .............................................................................................. 33 How Strong is the Evidence that Mindfulness Produces Healthy Psychological Changes in Children? Steven Roodenrys, Amalia Badawi and William Lovegrove II: Mindfulness in School Settings Chapter Three ............................................................................................ 57 Mindfulness Stripped Bare: Some Critical Reflections from the Mindfulness at School Evaluation Kathy Arthurson Chapter Four .............................................................................................. 77 Mindfulness in Education as a Whole School Approach: Principles, Insights and Outcomes Nimrod Sheinman and Linor L. Hadar Chapter Five ............................................................................................ 103 Mindful Aotearoa: Promoting the Benefits of Mindfulness Grounded in Local Content and Understanding Grant Rix

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Chapter Six .............................................................................................. 125 Meditating Mindfully: Teachers go Within to Ensure Their Students do not go Without Gaylene Denford-Wood III: Mindfulness in Tertiary and Related Settings Chapter Seven.......................................................................................... 153 The Relationship between Mindfulness and Burnout and the Role of Emotion Regulation in University Students Laura Gaymer Chapter Eight ........................................................................................... 183 From Perceiving to Believing: The Relationship between Mindfulness and Self-efficacy in a Student Population Rebecca L. Harth Chapter Nine............................................................................................ 217 Reappraisal Strategy in Interpersonal Relationships: Mindfulness and Attachment Crystal Pearce Chapter Ten ............................................................................................. 245 Investigating the Underlying Mechanisms of Mindfulness in a University Sample: The Theory of Deautomatisation Helena Rontziokos Chapter Eleven ........................................................................................ 279 The Shared Relationship of Mindfulness and Self-control within Psychological Distress Natasha J. Shalala Chapter Twelve ....................................................................................... 307 VipassanƗ Meditation and the Role of Mindfulness in the Experiential Understanding of Core Buddhist Doctrines Glenys Eddy Contributors ............................................................................................. 325 Index ........................................................................................................ 331

ACKNOWLEDGEMENTS

This volume has been a collaborative effort, with many people involved both within Australia and overseas, and we are grateful to all of them. Particular thanks goes to Venerable Manko, the Abbess of Nan Tien Temple (Wollongong), who generously helped Nan Tien Institute host the successful conference Mindfulness and Education in 2014, from which the inspiration for this volume originated. We would also like to thank the staff at Nan Tien Institute for their on-going support, and in particular to Jamila Choubassi, who has assisted unstintingly with many aspects of the editorial preparation and polishing of this volume.

INTRODUCTION

With an apparent tide of mindfulness practices and programmes sweeping in to a range of academic, therapeutic and other domains, applications of mindfulness (however diversely defined and understood) have also begun to flow into educational settings. Consequently, and necessarily, research on the efficacy of various mindfulness-based interventions and practices has been increasing in the last decade. Being still in its infancy, a considerable number of fundamental research-related issues remain unresolved, untheorised or perhaps even unidentified as yet. In light of these considerations, the present volume aims to contribute to the nascent field of mindfulness research in education, exploring its practical implementations as well as theoretical concerns within a range of educational contexts. The inspiration for this volume stems from the conference “Mindfulness, Education and Transformation” (September 2014) held in Wollongong, Australia, where valuable research papers on a variety of topics related to implementations of mindfulness in education were presented; participants from this conference have contributed to the present volume. Most chapters focus on the research and practice of mindfulness in Australia and New Zealand, reflecting the growing interest in mindfulness in the region. To reflect the diversity of approaches, the papers are divided into three sections: (1) theoretical conceptualisations of mindfulness come first, and then two sections presenting research on aspects of mindfulness interventions in (2) schools and (3) tertiary educational settings. The first section (two chapters) discusses theoretical presentations and the current state-of-the-art research into mindfulness. In chapter one, the concept of mindfuness is introduced; the contemporary understanding of, and research on, mindfulness is compared to, linked and contrasted with its representations and models within traditional Buddhist contexts. The chapter gives an overview of traditional Buddhist and modern conceptualisations and applications of mindfulness and then discusses major methodological issues arising from the processes of the cultural deand re-contextualisation of mindfulness from Buddhist into Western paradigms. The main foci in Western mindfulness approaches and research are outlined and linked to broader epistemological questions, stemming from the disjunctures between traditional Buddhist presentations

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Introduction

of mindfulness and contemporary Western conceptualisations, identifying the latter as situated within a therapeutic framework and Western constructs of knowledge, which historically exclude any category perceived as “religious.” This chapter also suggests ways in which the current approaches to, and research on, mindfulness could benefit from appropriate reconnections with the source tradition(s). It suggests that the re-linking of mindfulness with values, ethics, and understanding interconnectedness of all beings, which are at the core of Buddhist discourses, could broaden current Western perceptions and applications of mindfulness programmes in education, and add a new lens for exploring current social, environmental and other issues. Chapter two reviews current research on mindfulness interventions with children, evaluating their educational, psychological, cognitive and behavioural outcomes. A number of quantitative studies and metaanalyses are reviewed, encompassing clinical and nonclinical populations, mostly delivered in school settings among children and adolescents. The authors identify several methodological issues occurring in most studies, such as failing to use control groups and not measuring any changes in mindfulness itself. The review points out that evidence for the efficacy of mindfulness intervention programmes among children is generally weak, with only a few studies showing significant outcomes, and that many studies have poor research design. As suggested in the chapter, research on the role of mindfulness in education would need to consider the broader context of family, peers and the broader culture of the school over longer periods. The review gives several recommendations for future research directions, such as determining which groups, at which ages, are most responsive to mindfulness training; whether the efficacy of programmes varies with different mindfulness techniques applied; and what the role of teachers in mindfulness intervention programmes is. The authors conclude that there is sufficient evidence in the studies reviewed for the effectiveness of mindfulness interventions to justify further implementations and research. The next four chapters present research on various aspects of mindfulness programmes in schools. In chapter three, the major focus is methodological issues, which are discussed through a critical evaluation of processes involved in the teaching of, and research on, mindfulness in school settings. The study is based on the research outcomes of a pilot mindfulness-based teaching programme implemented at a primary school in Adelaide, South Australia. This evaluation is particularly valuable because very few studies to date have investigated mindfulness programmes introduced in classroom settings among middle school

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students. The author raises questions related to ambiguities around the definition of mindfulness, which “is commonly used as an allencompassing or shorthand term for a complex array of theoretical constructs and associated practices and activities.” The more general problem of defining mindfulness is reflected in the variety of teaching approaches and specified goals in the existing mindfulness-based programmes in education, leading to a lack of clear guidelines for their evaluation. The author insightfully links this issue to the lack of an appropriate ethical framework for implementing mindfulness-based programmes in school settings and identifies broader consequences and risks involved, such as not addressing the unacceptable social situations and circumstances of children, especially in socioeconomically disadvantaged groups. In such cases, mindfulness interventions may “deflect awareness away from underlying structural and societal factors that caused the problem behaviours in the first place.” Thus, the chapter links ethical issues with those of social justice, pointing to a very important gap in current secular mindfulness programmes in schools. Chapter four presents a long-term, whole-school approach to the implementation of a mindfulness programme applied in several primary schools in Israel since 2000. Most mindfulness-based interventions to date have only been carried out over a shorter period, in a rather fragmented manner. This study is therefore particularly valuable since it provides a model for the full integration of mindfulness into the whole school curriculum over a longer term, involving not only children but also teaching staff and parents. The authors describe the programme and present experiences of this whole-school approach emerging from sixteen years of implementation. Over the years, this programme has had several evaluations, from which the authors have drawn insights. The main benefits, as reported by children, include improved ability to relax and concentrate, a better sense of control, greater self-awareness, improved interpersonal skills, emotional intelligence, and self-healing. In addition, the authors show that this long-term whole-school approach substantially increases mindfulness scores, improves children’s coping skills and enhances empowerment through their increased ability to recall meditation skills and apply them in stressful situations. It is underlined that it is only through such a long-term holistic practice that gradual transformation in children can take place, enabling them to positively change their coping habits. The authors show that a whole-school mindfulness programme over the long term influences the entire school culture and brings about better academic outcomes. The study indicates,

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through the benefits evaluated, that a whole-school approach over extensive periods of time is worth implementing and researching further. In chapter five, we move to the other side of the globe, to AotearoaNew Zealand, where an innovative model of teaching mindfulness in schools was developed, called “Pause, Breathe, Smile,” which was modified to support the New Zealand Education Curriculum and incorporate a holistic wellbeing perspective from indigenous MƗori culture. The programme has been initiated, supported and promoted by the Mental Health Foundation of New Zealand, which founded Mindful Aotearoa, and has been facilitating its delivery and training of the programme’s facilitators. The author outlines key developments of this programme and the results of several studies, which again point to positive outcomes, encompassing significant increases in wellbeing and improved behaviour of children involved. The programme endeavours to integrate holistic perspectives, drawing from the rich repository of wisdom in MƗori indigenous tradition, which views the world as an interconnected whole, embracing humans and the natural environment in their interdependence and multiple interrelations. This model has many parallels with the Buddhist paradigm—from which mindfulness stems in the first place—such as its foundational teachings about the interrelatedness and interdependence of all phenomena. Thus, Mindful Aotearoa seems a very valuable enhancement of the prevailing, largely clinically-based “one size fits all” models of mindfulness interventions, and shows that these may be enriched by engaging meaningfully with models from culturally diverse indigenous traditions in a manner relevant to the local cultural contexts. The role of the teacher in the implementation of mindfulness programmes in schools has received relatively scant scholarly attention to date. Therefore, the study with a focus on teachers’ meditation practice, discussed in chapter six, is an important contribution to this underresearched area. In this chapter, using a qualitative approach, the author seeks a deeper understanding and effects of contemplative practices of a group of twenty-two educators across school sectors in various educational settings in Australia and New Zealand. It aims to learn about the participants’ motivations and inspiration for their contemplative practices, outlines the types of meditation they have practiced, and identifies the main outcomes, as perceived by the participants in terms of their personal and professional life. One of the most significant insights from this study is that most participants view their meditation practice as having been transformative not only for themselves but also for their students. The study exemplifies, in the author’s words, that for a teacher

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“going within means striving to ensure that the students do not ‘go without.’” The outcomes of this study signal that including contemplative practices into teacher education and professional learning could be beneficial for the entire school culture. The final section includes five studies on mindfulness conducted in university settings. In these chapters, research focuses on student and general populations, with research approaches and methodological tools of psychology, based strongly on quantitative methods. The studies involve a mixture of cross-sectional and mindfulness intervention designs to investigate trait mindfulness in relation to various areas such as burnout, emotional regulation, self-efficacy, self-control attachment, and deautomatisation. Generally, these studies show how various psychological variables contribute both to mindfulness and to improved psychological health, thus providing some insight into psychological mechanisms contributing to higher levels of trait mindfulness. Chapter seven addresses the growing problem of burnout commonly experienced by many work groups. In particular, it investigates the relationship between emotion regulation and burnout in university students, using a range of validated questionnaires. Importantly, it shows that students who were more mindful on the questionnaire’s measures of mindfulness reported less burnout. Even though such students used adaptive emotion regulation strategies more and nonadaptive strategies less, emotion regulation only accounted for a small part of the effect of mindfulness on burnout. The next chapter investigates the relationship between various forms of self-efficacy and trait mindfulness. The results show that attributional mindfulness was moderately positively correlated with general, coping and learning self-efficacy measures. Further investigation found significant partial mediation by mindfulness self-efficacy when the dependent variable was coping self-efficacy or general self-efficacy, but not when it was learning self-efficacy. The results suggest that there may be a reciprocal relationship between some forms of self-efficacy, and mindfulness: training on one attribute may assist development of the other. Both chapters nine and ten investigate aspects of mindfulness and the processes of decentering and deautomatisation. Decentering refers to detaching from one’s thought and is viewed to contribute to deautomatisation—a process in which one’s previously established tendency to effortlessly and unconsciously engage in maladaptive behavioursbecomes conscious and controlled. Deautomatisation is a concept used in a number of theories of mindfulness to explain how

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Introduction

mindfulness interrupts habitual ways of thinking, feeling and behaving. In terms of its manifestation, it may be comparable (in a qualified way) to the Buddhist concepts of mindfulness, clear comprehension and equanimity. Chapter nine explores the relationship between secure attachment and different measures of mindfulness, and evaluates how well Garland, Gaylord, and Park’s “mindful coping model” (2009) explains this relationship in both a cross-sectional study on university students and in a MBSR training study. Contrary to expectations, a positive relationship between trait mindfulness and insecure attachment was found, along with an inverse relationship between mindfulness and reappraisal strategies. In the MBSR study, it was found that even though the MBSR training did increase mindfulness and decentering, there was an unexpected decrease in positive reappraisal and no change in attachment. The conclusion was that cognitive positive reappraisal is antithetical to the acceptance concepts of mindfulness. It is possible that these results may be more consistent with the Buddhist notions of “simply noting” thoughts rather than trying to place different interpretations on them. The importance of decentering is further investigated in chapter ten. In particular, this chapter investigates several predictions based on a recent model, suggesting mindfulness leads to deautomatisation. The proposal was that through decentering and nonelaborative processing, mindfulness would facilitate decreases in suppression and reappraisal, leading to lower levels of psychological distress. Results from this cross-sectional study revealed that an inverse relationship between mindfulness and psychological distress was mediated by both decentering and reappraisal, independently, suggesting that the deautomatisation model of mindfulness is promising and warrants further investigation. Recent research has established the importance of self-control or will power for successful living on almost any criteria. Chapter eleven seeks to better understand the relationship between will power and mindfulness. Self control, which may be understood as an individual’s ability to withhold a predominant response, or persevere through a situation to achieve desirable outcomes, has significant longitudinal effects on an individual’s daily life, as well as on their psychological health. The study showed that selfcontrol and mindfulness were positively related to one another and that they made overlapping contributions to psychological distress. This finding suggests that self control and mindfulness reflect some similar mechanisms or processes. In addition, this study examines the benefits of mindfulness meditation for overcoming a reduction in self-control resources, known as ego depletion (ED), in line with the strength model .

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of self-control. However, statistically significant support was not found for the presence of an ED effect, or the benefits of mindfulness meditation in improving performance on a self control task. The book begins by introducing the roots of mindfulness in Buddhist teachings and ends by returning to the Buddhist framework. Chapter twelve presents the results of a study that explores the experiences of a group of participants in a contemporary insight (vipassanƗ) meditation retreat in Australia, conducted through interviews and participant observation. It aims to identify the ways in which participants in the retreat, based on mindfulness practices, learn about the underpinning teachings of Buddhism. It investigates how they understand, experientially and conceptually, mindfulness (understood to comprise bare attention, clear comprehension and nonjudgmental awareness) and how they interpret their experiences from a Buddhist perspective, through Buddhist vocabulary and frameworks. The author suggests that participation in such retreats can bring about valuable insights, and the retreat framework may be useful also for mindfulness educators and other professionals in their endeavours to implement mindfulness in educational settings. In addition, as pointed out in this chapter, the format of an intensive retreat, particularly over longer periods, may be a suitable context for future research into effects of mindfulness training. A major theme emerging from the work reported in this book is the need to bring together the contemporary uses of mindfulness as therapy and some core Buddhist concepts originally linked to mindfulness. Perhaps the major Buddhist teaching of relevance is that mindfulness should be practiced along with living a life according to Buddhist ethics, as argued in chapter one. The research and analyses used in chapters seven to eleven lend themselves to this sort of proposed investigation, asking whether mindfulness training techniques are more efficacious when taught along with Buddhist ethics. In particular, the importance of lovingkindness, compassion, empathetic joy and equanimity in contributing to psychological health in children warrants investigation along with further investigations of mindfulness. In a similar way, the results reported in chapter nine show that positive appraisal did not operate as was expected. It would be useful to investigate whether the Buddhist strategy of simply noting thoughts and “letting them go” is a more effective strategy than either positive or negative reappraisal. Finally, the processes of decentering and deautomatisation discussed in chapters nine and ten appear to be quite similar to the Buddhist concept of equanimity. It is likely that a fuller understanding of what occurs in

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Introduction

mindfulness training and its effectiveness can both be enhanced by a research framework, which investigates these concepts together. This volume attempts to reflect and capture the enthusiasm and diversity of mindfulness programmes implemented in contemporary education. The research interests and directions in evidence are equally rich and diverse, involving methods and approaches of many disciplines, with the identified outcomes offering a spectrum of findings and themes related to mindfulness and education. From the evidence adduced, we can conclude that the implementations of mindfulness programmes as well as research efforts about them are worthwhile, especially in educational contexts, involving as they do the very lives and wellbeing of new generations. Tamara Ditrich and William Lovegrove Wollongong, 1 October, 2016

I: THEORISING MINDFULNESS: CONCEPTUALISATIONS AND RESEARCH

CHAPTER ONE THE CONCEPTUALISATION AND PRACTICE OF MINDFULNESS: BUDDHIST AND SECULAR PERSPECTIVES TAMARA DITRICH

Abstract Mindfulness, as a component of Buddhist meditation practice, was recontextualised and popularised in the twentieth century and eventually, through the process of secularisation, entered a range of new settings, especially in therapeutic contexts. This chapter aims to discuss the conceptualisation and practice of mindfulness from two different perspectives, i.e., Buddhist and secular. Firstly, it situates mindfulness within Buddhist discourse, outlines its definition, main roles and functions, and proposes some of the main indicators that point to the establishment, progress and efficacy of mindfulness. The chapter then outlines the process of the transplantation of mindfulness from the Buddhist context (specifically the TheravƗda) into Western paradigms, identifying some of the historical conditions that facilitated this transition. Some implications of the secular definitions and interpretations of mindfulness are outlined, and the main issues arising from the processes of cultural translation from ancient Asia into the global societies of the twenty-first century discussed. In the last section, the rapidly expanding modern research on mindfulness is commented upon, especially in terms of education, exploring how the different definitions and aims of mindfulness practice affect research models, methods and evaluations within the current scientific discourse.

1. Defining mindfulness In current scholarly and popular literature, two types of mindfulness are often distinguished, Buddhist (or “Eastern”), and secular (or “Western”) (Aronson 2004; Purser and Milillo 2015; Wilks 2014). This division reflects, among other determinants, the polarisation of religion

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Chapter One

and science in Western discourses. Mindfulness is rooted in an ancient Indian contemplative tradition, with its beginnings usually situated in the fifth century BCE, transmitted within the tradition we today term “Buddhism.” In old Indian cultures and languages (such as Sanskrit or PƗli) there was no specific category, word or concept for “religion” (nor was there one for “philosophy” or “psychology”). Only in the encounter with the West, during colonisation in the nineteenth and early-twentieth centuries, were various Asian traditions categorised and labelled as specific “religions,” Buddhism being one of them (McMahan 2008). The label Buddhism was applied as an umbrella term to various disparate living traditions of Asia, which (more or less) centred around the notion of the Buddha and his teachings, and thus gradually became perceived as one of the world religions. With the popularisation of mindfulness in the late-twentieth century and its introduction into a variety of secular settings, mindfulness began to be reinterpreted as a secular method, primarily applied for the development of greater attention and increased wellbeing. Consequently, its links to Buddhism, perceived as a religion, had to be sidestepped and all the components of the practise of mindfulness, which were regarded to be related to religion, stripped off (Wallace 2012). This appropriation (with associated de-contextualising) and the subsequent decanting of secular mindfulness from Buddhist mindfulness has had several implications, which have recently received some scholarly attention (Aronson 2004; Kirmayer 2015; Lutz, Dunne and Davidson 2007; Samuel 2014), and will be discussed in this chapter. The main purpose of this chapter is to re-link contemporary treatments of, and research on, mindfulness with its extensive representations within the Buddhist tradition. The first section below presents the Buddhist approach to mindfulness, which inevitably involves the complexities of traditional Buddhist exegesis and analysis. The second part of the chapter overviews the modern conceptualisations and applications of mindfulness and discusses the main methodological concerns arising from the processes of cultural translation and recontextualisation. The current issues in Western mindfulness approaches and studies are linked to broader epistemological questions, namely the juxtaposition of two very disparate sets of categorisations, i.e., traditional Buddhist analyses and elaborations of mindfulness in therapeutic intervention, where Western constructs of knowledge have rigorously excluded “religious” categorisations. This article attempts to outline some of this disjuncture and its consequences and then identifies ways in which the current approach to mindfulness could perhaps benefit from a (necessarily critical but nevertheless

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genuinely appreciative) relinking with the source tradition, as exemplified in the TheravƗda canon.

1.1 Mindfulness in the Buddhist tradition1 1.1.1 Representations of mindfulness in the TheravƗda Buddhist canon “Mindfulness” is the translation of the PƗli term sati2 (Sanskrit sm‫܀‬ti), which occurs in Buddhist texts in a range of meanings, such as “memory, recollection, recognition, mindfulness, wakefulness, alertness” (PED, sv). The word sati most frequently refers to meditative awareness, which is situated within the broader context of Buddhist soteriological goals, to be achieved through ethical and meditative training. It is commonly presented as an ethical guardian, watching with attention the cognitive processes occurring from moment to moment (Vism 464). It does not intervene with the phenomena arising, however there are other components in the process of meditation training that are to evolve together with mindfulness, such as effort and ethical or moral development, which have a more active role, aiming to prevent the arising and continuation of unskilful (akusala) or harmful states (e.g., anger, greed), and maintain and encourage skilful/wholesome ones (e.g., kindness, generosity). In the TheravƗda Buddhist model, mindfulness is not deemed to be practiced on its own but rather in conjunction with other mental qualities and faculties to be cultivated on the path to liberation from suffering (nibbƗna). As “right mindfulness” (sammƗ3 sati), it is an innate component of the fundamental structure of Buddhist teachings, the four truths, which: (1) expound the nonsatisfactoriness of existence (dukkha) or suffering, based on ignorance about the nature of all phenomena (i.e., that they are impermanent and without an intrinsic self); (2) position craving (ta۪hƗ) as the precondition for the arising of suffering, explained as “thirst” or desire for ongoing pleasurable experiences and freedom from unpleasant phenomena; (3) affirm the possibility of the complete extinction of suffering (nibbƗna); and (4) delineate the eightfold path, which leads to liberation from suffering, achieved through ethical training, meditation practice and cultivation of wisdom (S V 420–424). The components of the eightfold path are not developed in a linear manner; each of them is conditioned by, and connected to, all the other ones. The aim of the Buddhist eightfold path is awakening, which is accomplished by the cultivation of wisdom (paññƗ). Wisdom itself has two components: right or appropriate understanding (sammƗ di‫ܒܒ‬hi) that all phenomena are impermanent, interlinked and without an intrinsic

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Chapter One

permanent self (M I 46–55); and secondly, right intention (sammƗ sa۪kappa), which cultivates wholesome mental states and renounces unwholesome ones (Vibh 235). The next three components of the eightfold path concern morality/ethics (sƯla):4 right speech (sammƗ-vƗcƗ), right action (sammƗ kammanta) and right livelihood (sammƗ ƗjƯva), i.e., the cultivation of speech and actions that do not cause suffering to oneself or others (Vibh 235). In Buddhist teachings, there are no equivalent terms for the categories ethics and morality, as understood in Western philosophy (Keown 1992, 2–3). However, it may be argued that ethics is the foundation of Buddhist teachings, underpinning all its main theoretical representations, such as the five aggregates, the formula of dependent origination (pa‫ܒ‬iccasamuppƗda), and the Abhidhammic analysis of cognitive processes; these can be understood and applied only through the notion of non-self (in conjunction with impermanence and nonsatisfactoriness). The fundamental premise for cultivation of sƯla is the notion of wholesomeness (kusala), meaning that moral speech and actions are grounded in wholesome mental states or, in the language of the TheravƗda Abhidhamma, accompanied by wholesome mental concomitants (cetasika), which include mindfulness, kindness and wisdom. The attribute wholesome (kusala) refers here to those constituents implicated in cognitive processes, which are appropriate or skilful (i.e., free from delusion, desire and aversion), viewed in Buddhist teachings as essential for development of wisdom and liberation from suffering. The last three components of the eightfold path, closely interlinked with wisdom and ethics, are concerned with meditative training, namely: right effort (sammƗ vƗyƗma) to cultivate wholesome (kusala) mental states, and avoid unwholesome (akusala) ones (Vibh 235); right mindfulness (sammƗ sati), presented as ethical awareness, without desires and discontent, practised towards four domains (the body, feelings, cognition and mental phenomena) (Vibh 236); and right concentration (sammƗ samƗdhi) on a meditation object, such as breathing, leading to deep states of meditative absorption (jhƗna) (Vibh 236). Thus, right mindfulness (sammƗ sati) is intrinsically situated in, and linked to, all the other components of the eightfold path, leading to liberation from ignorance and suffering. As mentioned earlier, the mere presence of mindfulness protects from negatives states (such as anger, greed, envy, conceit) and conditions development of wisdom (paññƗ), which understands mental and physical phenomena as impermanent, empty of a permanent intrinsic identity. Conversely, in the Buddhist paradigm any presence of these negative states in the mind indicates the absence of mindfulness.

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Thus, in the PƗli canon right mindfulness is presented as one of the essential components of the Buddhist soteriological framework. It is defined, explained and taught in several canonical texts, usually in the context of the four foundations of mindfulness (cattƗro satipa‫ܒܒ‬Ɨna), most extensively in the Satipa‫ܒܒ‬hƗnasutta (M I 5563; D II 290315; AnƗlayo 2010). According to this text, mindfulness is to be practiced with regard to four domains, the body (kƗya), feelings (vedanƗ), cognition (citta), and mental constituents (dhamma), in conjunction with other qualities. The text states that the meditator is to be “diligent, clearly comprehending and mindful, having abandoned desires and discontent regarding the world.”5 Diligent (ƗtƗpƯ) refers to energetic extinguishing of negative mental states (kilesa) (Ps I 244), clearly comprehending (sampajƗno) means understanding how to cultivate wholesome and skilful qualities and abandon harmful ones (A I 13; Dhs 16), while having (temporarily) abandoned desires and discontent (vineyya abhijjhƗdomanassaۨ) concerning the world (loke) (Ps I 244; Vibh 195). The Buddhist term mindfulness (sati) is often also understood and represented in English by the words “attention” or “awareness,” especially in contemporary secular interpretations. However, in the Buddhist context, the two concepts are very clearly differentiated. The term “attention” would be a rendition of the PƗli term manasikƗra, expounded as a cognitive component or concomitant (cetasika), which directs or adverts to the object (Vism 466) before it is identified and conceptualised (Bodhi 1993, 81). In cognitive processes (as analysed by the TheravƗda Abhidhamma), attention (manasikƗra) is present at every moment of cognition, in any mental state, either wholesome or not, whereas mindfulness (sati) occurs only in wholesome or skillful (kusala) states (Bodhi 1993, 79). The aim of mindfulness practice, as presented in the PƗli canon, is not only paying attention to phenomena occurring in the present moment, but rather the cultivation (bhƗvanƗ) of wholesome, skilful, “wise attention” (yoniso manasikƗra) (Dhs 229), which arises together with wholesome components such as mindfulness (sati) and clear comprehension (sampajañña) (A V 115). The concepts attention (manasikƗra) and mindfulness (sati) from the TheravƗda Buddhist perspective are two very different concomitants (cetasikas) in cognitive processes attention being always present, whereas mindfulness only in connection with wholesome mental states. When both arise together, then attention is called “wise attention” (yoniso manasikƗra) which, in conjunction with other wholesome components, facilitates cultivation of wisdom. To summarise, mindfulness is firmly embedded in Buddhist soteriological structures (such as the eightfold path), as being one of the essential

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Chapter One

conditions for, as well as the outcomes from, ethical training and wisdom. Consequently, within Buddhist frameworks, mindfulness cannot be presented as a meditation method per se, i.e., to lead on its own to liberation from suffering, but can be practised only in conjunction with other aspects of meditational and ethical training. It is an inalienable component of broader underlying premises of Buddhist teachings, which include the notion of “non-self” (anattƗ): mindfulness cannot be regarded as a permanent reference point or “witnesses,” aware of the phenomena occurring from moment to moment, but is rather one of the integral constituents of cognitive processes, which are all impermanent, changing from moment to moment.

1.1.2 Mindfulness and cognition Among different, albeit interrelated, representations and models of the Buddhist teachings, cognitive processes are most comprehensively analysed and discussed in the Abhidhamma, a collection of texts traditionally dated in the third century BCE, in which the main structural foundations of Buddhist discourse are systematically defined and analysed. In these texts, human cognitive processes are investigated and their “deep structure” delineated by identifying a number of fundamental components of complex, lived experiences, which (according to the tradition) are analysed at a deeper, nonconceptual level. These basic components, elements or events, called dhammas, surmised to be involved in, or condition the mental and physical phenomena arising moment to moment, are listed, defined and discussed (Warder 1971). The entire structure is presented under four main categories: cognition (citta), mental constituents (cetasika), materiality (rnjpa), and nibbƗna. Cognition (citta) is defined as the “knowing” of an object (As 63); it arises every moment in conjunction with a group of mental constituents (cetasika), which determine how the object is known; for example, a visual object can be cognised with anger, restlessness and delusion, or with peace, joy and mindfulness. The Abhidhamma lists over fifty such mental constituents (cetasika), which can occur in various groupings (Dhs 9, 75– 76; 87; 120). They are classified, on an ethical basis, as wholesome (e.g., trust, joy, peace, lightness, mindfulness, wisdom)6 (Dhs 9), unwholesome (e.g., anger, greed, restlessness, delusion, conceit) (Dhs 75–87) or variable (e.g., feeling, volition, perception, attention) (Bodhi 1993, 79). The wholesome constituents always appear together in a group and are not compatible with the unwholesome ones and vice versa; for example, in a given moment of cognition, fear or greed cannot be grouped together with mindfulness or compassion. Mindfulness is listed as one of the wholesome

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constituents (cetasikas),7 always arising with other wholesome ones, such as trust (saddhƗ), non-greed (alobha), non-aversion (adosa), mental equilibrium (tatramajjhattatƗ), peace (passaddhi), lightness (lahutƗ), gentleness (mudutƗ) (Dhs 9), but incompatible with the unwholesome ones. It means that the presence of mindfulness indicates and is indicated by the other mental constituents (cetasikas) that arise with it, such as trust, peace, kindness, and wisdom. These wholesome constituents (dhammas), which include mindfulness, are considered essential for cultivation of ethics and meditation. The foundational cognitive structures or psychological “maps,” outlined in the Abhidhamma and other Buddhist texts, identify and discuss only those constituents of an experience that are pivotal for liberation from suffering, because the motivation and aim of the complex investigations of cognitive processes is to develop a deep understanding (in theory and practice) of the nature of physical and mental phenomena to the extent that is necessary for liberation form suffering; this is the rationale for all Buddhist teachings (Bodhi 1993, 4). Mindfulness is thus perceived as one of the components (albeit an exceptionally important one) that facilitates an understanding and insight into the “deep structure” of experiences, beyond the conceptual level, and prompts the development of wholesomeness; for example, it encourages the development of loving kindness, compassion, wisdom, while it discourages or prevents the negative components of cognition, either through understanding their harmfulness or by prompting wholesome states to develop instead. Cognition accompanied by mindfulness can condition the arising of wisdom, i.e., an insight that all constituents of an experience, including mindfulness and cognition itself, are without a permanent intrinsic nature, and that any clinging to, or identification with, any of the components of experience, stem from ignorance and craving, and only lead to conflict and suffering.

1.1.3 Indicators of mindfulness from the Buddhist perspective As discussed earlier, the main functions and roles of mindfulness within the soteriological framework of Buddhist practice are: to protect from reacting to experiences, as they arise, with desire, aversion and other unwholesome states; to establish the right conditions for understanding as to whether mental states are wholesome or not; and, in conjunction with other wholesome mental constituents, to prepare the grounds for wisdom to arise, which, in turn, is viewed as an indispensable condition for liberation, nibbƗna. Consequently, within Buddhist doctrinal structures and meditation “maps,” the presence, progress and effectiveness of

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mindfulness may be indicated through several components, aspects or variables. Below, some of these indicators are identified, which may serve as evaluation tools in research on mindfulness. Firstly, in the Buddhist context, “progress” in mindfulness meditation may be indicated and evaluated through an ethical lens. As frequently stated in Buddhist texts, well-established mindfulness diminishes or even temporarily extinguishes the five hindrances (nƯvara۬a)—unwholesome mental states rooted in greed (lobha), aversion (dosa) and delusion (moha). These encompass: (1) sensory desires (kƗmacchanda), seeking, craving and delighting in pleasures derived through the senses (Dhs 204); (2) ill-will (vyƗpƗda), encompassing hatred, annoyance, resentment, hostility, irritation, anger (Dhs 204); (3) sloth and torpor (thƯna-middha), referring to dullness, rigidity, stolidity, and unwieldiness of the mind and body (Dhs 204–205); (4) restlessness and worry (uddhacca-kukkucca), explained as agitation, unrest, distraction, remorse and anxiety (Dhs 205); and (5) doubt (vicikicchƗ), referring to perplexity, hesitation, uncertainty, the lack of trust (Dhs 205). As noted in Buddhist teachings, the diminishment or (temporary) abandonment of these five hindrances is an indication that mindfulness and concentration have become fairly well established, and these, in turn, are a precondition for wisdom and insight to occur (e.g., A III 63–64; S V 127). Hence, diminishment or absence of these five hindrances may serve as good indicators of progress and efficacy of mindfulness meditation. Secondly, according to the analysis expounded in the Abhidhammattha Sa۪gaha, mindfulness is a mental constituent (cetasika) that is always accompanied by eighteen other wholesome mental constituents (cetasika), comprising: trust (saddhƗ), mindfulness (sati), reluctance at doing wrong (hiri), regard for consequences (ottappa), absence of greed (alobha), absence of hatred (adosa), mental balance (tatramajjhattatƗ), tranquility of mental body (kƗyapassaddhi) and cognition (cittapassaddhi), lightness of mental body (kƗyalahutƗ) and cognition (cittalahutƗ), malleability of mental body (kƗyamudutƗ) and cognition (cittamudutƗ), wieldiness of mental body (kƗyakammaññatƗ) and cognition (cittakammaññatƗ), proficiency of mental body (kƗyapƗguññatƗ) and cognition (cittapƗguññatƗ), and rectitude of mental body (kƗyujukatƗ) and cognition (cittujukatƗ) (Bodhi 1993, 79). These mental constituents, which arise together with mindfulness as a group at every moment of wholesome cognition, may serve as indicators for presence of mindfulness; for example, tranquillity, lightness, confidence, absence of greed or anger may indicate that mindfulness is present or well established.

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Furthermore, understanding the supporting nature of certain mental constituents for the development of wholesome mental states is a significant insight from the traditional exegesis. According to the Abhidhamma, mindfulness is compatible with, and mutually enhancing for, the arising and strengthening of both loving kindness (mettƗ) (Dhs 188–189), and compassion (karu۬Ɨ); these are wholesome mental constituents and therefore, meditation on loving kindness and compassion are important (perhaps vital) components of Buddhist meditative practice. Loving kindness meditation (mettƗ)—literally “friendliness”—is included in the group of the so-called four immeasurables or sublime states (brahmavihƗras), i.e., loving kindness (mettƗ), compassion (karu۬Ɨ), appreciative joy (muditƗ) and equanimity (upekkhƗ) (Vibh 272284; Aronson 1980).8 The practice of the four sublime states may be followed by mindfulness meditation or, alternatively, mindfulness can be practised in conjunction with meditation on loving kindness and other sublime states (S V 119–120). According to the traditional analysis of mental states, loving kindness and the other three sublime states are (by definition) accompanied by mindfulness, since all of them are wholesome mental constituents (Bodhi 1993, 79). Hence, the practice of loving kindness and compassion conditions and enhances the development of mindfulness and vice versa. From a Buddhist perspective, an increased kindness, compassion, appreciative joy and equanimity may be good indicators for progress and positive effects of mindfulness meditation. Thirdly, as discussed above, mindfulness can facilitate and condition the arising of wisdom (paññƗ), which, according to the Abhidhamma, can only arises together with mindfulness; however, the converse does not hold—i.e., the presence of mindfulness does not necessarily mean that wisdom has arisen (Vibh-a 311). Wisdom is presented as one of the wholesome (kusala) mental constituents (cetasika), it understands or has an insight into the three marks (ti-lakkha۬a), i.e., impermanence, nonsatisfactoriness and non-self of all mental and physical events and processes (Vism 436–438). The progress of mindfulness may be indicated by an increased occurrence of wisdom, usually manifested as an insight into impermanence, which is regarded as one of the first stages of insight into the nature of changing physical and mental phenomena (Vism 639– 640).9 Many Buddhist texts (e.g., S IV 142–143; A III 2) put forward that seeing the momentary arising and passing away of all phenomena leads on to the final soteriological goal of Buddhist practice, liberation from suffering. Thus any insight into impermanence indicates the presence of wisdom, which in turn points to a solid establishment of mindfulness as its precondition.

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Fourthly, another key aspect of wisdom (paññƗ) is an insight into the absence of permanent, intrinsic self (anattƗ), as often reiterated in the Buddhist teachings (e.g., S IV 147–156; Vism 632–634). This insight, which is manifested as freedom from clinging to, or identifying with, physical and mental phenomena or events, yet again, strongly indicates a solidly founded mindfulness and usually occurs when meditation practice is well established (Vism 628–629). This insight reduces the sense of “I” and consequently reduces polarisation between “myself” and “other,” which is signalled by an increased freedom from conflicts, both inner (i.e., within oneself) and outer (i.e., with other people or circumstances). Therefore, a diminished experience of conflicts may be a good indicator of wisdom, which in turn signals a well-established mindfulness. In summary, the aspects and indicators related to the presence of mindfulness presented above, which are based on, and draw from, the Buddhist understanding of the structure and dynamics of cognitive processes, may be considered variables in constructing new theoretical models of mindfulness and may serve as indicators to be included in research about the functioning and efficacy of mindfulness.10

1.2 Modern interpretations of mindfulness 1.2.1 Mindfulness and modern Buddhism As Buddhism expanded over centuries across Asia, new interpretations, schools of thought and practices evolved, but as far as the roles and interpretations of mindfulness are concerned, the most significant changes seem to have occurred only in the last hundred years, initiated by the historical events in the late-nineteenth century (Ditrich 2016a). This was the time of the colonisation of Asia and the encounters between Buddhist traditions and European paradigms, resulting in the birth of “modern” Buddhism, which was reinvented by both Westerners and Asian Buddhists with an aim to represent Buddhism as a world religion and a philosophical system compatible with European ideas of the time. The main parameters, reflected and involved in the formation of modern Buddhism were: encounters with Christianity (McMahan 2008, 6773); European science and rationalism (Lopez 2002, xi–xii; Sharf 1995, 252); European Romanticism, which particularly influenced the positioning of meditative experience at the forefront (Sharf 1995); and more recently psychology, significantly impacting on the interpretation of meditation through a psychological lens (McMahan 2008, 48). In addition, particular historical developments during the colonial period in Burma (current day Myanmar) greatly contributed to situating mindfulness at the centre of Buddhist

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teachings. The Burmese responded to colonisation by moving to strengthen their Buddhism, which was no longer under patronage of the kings, and turned to the lay population for support. In this process, Buddhism was reinterpreted; meditation, traditionally practised only by a small number of monastics, was positioned as one of the most important Buddhist practices for the lay population (Braun 2013, 150–155). In this shift, mindfulness came to be the most appropriate element of meditation to be practised by the laity in everyday life and consequently, the methods had to be simplified; for example, the time dedicated to formal meditation was significantly shortened, and the expectations of quick results greatly increased (Sharf 1995, 256). With growing popularisation of mindfulness in Burma, the first meditation centres for laity were established, and several noted teachers, among them Mahasi Sayadaw (1904–1982) and U Ba Khin (1899–1971) and, later on, his disciple Goenka (1924–2015), were subsequently instrumental in popularising mindfulness meditation worldwide; their methods constitute a large part of today’s contemporary mindfulness applications in secular contexts. Though Burmese teachers modified their approaches to practice of mindfulness, meditation remained embedded in the Buddhist discourse. In the twentieth century, revitalised and simplified mindfulness meditation was spreading rapidly among the laity, firstly in Burma, then in other Asian Buddhist countries, and in the postcolonial period, particularly from the 1970s onwards, this movement gradually expanded across the globe. Initially, meditation courses that were offered in the West followed the methods and structures developed in Burma, such as the ten day meditation retreat, facilitated by Goenka, which still remains one of the most popular Buddhist meditation training models. Already, early on in the late 1970s, and more so in the 1980s, mindfulness programmes in the West, especially in the US, started to draw from and integrate different meditation methods from other Buddhist and non-Buddhist traditions (Braun 2013, 162–64) as well as include psychotherapeutic approaches. Subsequently, mindfulness practice started to be increasingly viewed as a training in attention, with the aim to improve psychological wellbeing, and thus prepared the grounds for its secularisation.

1.2.2 Secularisation and new representations of mindfulness The introduction of the programme “Mindfulness-Based Stress Reduction” (MBSR) in the late 1970s may be viewed as a major milestones that greatly contributed to the secularisation of mindfulness. This (by now well-known) eight-week programme was developed by Kabat-Zinn and initially introduced at the Mindfulness Based Stress

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Reduction Clinic at the University of Massachusetts in 1979; in subsequent decades, it expanded worldwide. MBSR typically consists of weekly meditation classes, a one day retreat, and regular home practice in daily life. Mindfulness meditation, largely extracted from modern Burmese methods, especially those developed by Mahasi Sayadaw and U Ba Khin, incorporates formal sitting meditation, “body scan,” some yoga postures and mindfulness in daily activities. The MBSR programme has also been modified and incorporated into various types of psychotherapy, one of the most prominent among them being “Mindfulness Based Cognitive Therapy” (MBCT), which was developed as an intervention for prevention of depression relapse (Segal, Williams and Teasdale 2002). In addition, mindfulness is applied in dialectical behaviour therapy (DBT) (Lineham 1993), acceptance and commitment therapy (ACT) (Hayes, Strosahl, and Wilson 1999) and many others, addressing a wide range of disorders (both clinical and sub-clinical), such as anxiety, depression, pain management, eating disorders, substance abuse, and relationship enhancement, to name a few. Mindfulness has also entered other new environments, such as the corporate world, schools, prisons, the military, wellness industries, and is used as a tool for enhancement of wellbeing at work (Follette, Palm, and Pearson 2006; Germer 2016). In these contexts, it is often promoted as another self-help method or attention-enhancing tool, promising improved focus and productivity, better decision making and greater acceptance of given situations. The secularisation of mindfulness and its introduction into new domains has inevitably been reflected in new conceptualisations and practices. Most commonly, secular mindfulness is defined as a bare awareness that “emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment to moment” (Kabat-Zinn 2003, 145), or “nonelaborative, nonjudgmental, presentcentred awareness in which each thought, feeling or sensation that arises in the attentional field is acknowledged and accepted as it is” (Bishop et al. 2004, 232). It is necessary to highlight here that the presentation of mindfulness as “bare attention” does not stem from Buddhist traditional teachings, but seems to have been introduced in the 1960s by ÑƗ৆apo৆ika, the author of enormously influential pioneering work The Heart of Buddhist Meditation (1962), and since then it has strongly influenced the modern definitions of mindfulness (Gethin 2011, 267). The attribute “nonjudgmentally” does not originate from the Buddhist traditions; instead it seems to have been coined by Kornfield (1977, 13). Some authors translate/interpret mindfulness as encompassing two aspects, awareness and attention, i.e., being aware of an experience, paying attention to it and

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defining it as awareness of present experience with acceptance (Germer 2016, 5–7); or, propose three central components of mindfulness, namely, intention as personal motivation, attention as sustained focus and flexibility; and attitude as nonjudgment and acceptance (Shapiro et al. 2006). Often it is also interpreted as “choiceless awareness,” a term coined by Krishnamurti (2001), a very influential Indian teacher of the twentieth century, who introduced a contemplative method, often compared to mindfulness, which he presented as an awareness without discrimination. In summary, the common denominator of the new definitions of mindfulness may be articulated as: a nonjudgmental awareness and intentional attention to the present moment.

1.2.3 Comparison of different conceptualisations of mindfulness In distinction to modern understandings of mindfulness as “paying attention nonjudgmentally,” meditation training in the Buddhist context seems not to aim to isolate and develop attention on its own but rather pursues cultivation of skilful, wise attention (yoniso manasikƗra), i.e., attention that is accompanied by other wholesome components of cognition. As discussed earlier, wise attention implies an understanding of whether mental states observed are wholesome or not, and consequently whether they condition ethical responses or not. Furthermore, since mindfulness is only one component within the broader Buddhist soteriological project, it cannot be viewed as a meditation “method” on its own, but it is always practiced, embedded in, and concurrent with other constituents of the eightfold path. Consequently, in the Buddhist context, mindfulness cannot be viewed as a practice, conducted in a nonjudgmental manner, but rather requires development of clear discrimination between wholesome and unwholesome mental states, as evidenced in the Buddhist canon (e.g., S IV, 194), where mindfulness is represented as the guardian of the senses, allowing only wholesome mental states to arise. This discrimination stems from the underpinning Buddhist premise that unwholesome mental states are intrinsically linked to suffering, whereas wholesome ones are the portal for the arising of wisdom (i.e., the understanding of impermanence and non-self), which is the precondition for liberation from suffering, nibbƗna. The differences between the definitions of Buddhist and secular mindfulness are linked to divergent goals. From the Buddhist perspective, the aim and intention of meditation would subtly (but significantly) affect the entire process of meditation itself, its outcomes and evaluations.11 For example, if one’s intention was to obtain a greater pleasure or worldly success as an outcome of meditation, it would (for the Buddhist model)

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create further clinging and attachment to that particular goal, which would eventually lead to suffering, and thus subvert the cultivation of wisdom. The ancient Buddhist tradition does not position for its highest goal flourishing in human life, but rather aims to transcend it, through “awakening” (bodhi), a deep existential transformation, presented as a complete liberation from the entanglements, rooted in desires, craving, fear, ignorance and other unwholesome states. On the presumption that a total liberation from human suffering is possible, its goal is to develop, through a deep investigation of cognitive processes, an insight into the empty nature of all phenomena and events, i.e., viewing all phenomena (dhammas) as empty of self (M 1 230; A I 286; S 3 133; Dhp 279). In contrast, modern secular mindfulness practice mainly aims to reduce stress and other forms of psychological or physical suffering as well as increase wellbeing, happiness, adaptability, resilience, efficiency at work place, to name a few. In consequence, these aims are reflected in the choice of modern research design of mindfulness, the methods applied, and expected outcomes. The two approaches to mindfulness also differ in their ethical foci. As outlined above, Buddhist meditation is set within a framework of teachings, underpinned by an ethical structure founded on the notion of wholesomeness; meditation in this tradition that is divested of ethics would be unthinkable. Since ethical considerations within the Western discourse of the twentieth century have been mostly shifted to the background, especially in the context of scientific objectivity and increasing awareness that values and ways of life are relative and culturally specific, seeking a universal ethics have become viewed as problematic. Therefore, incorporating Buddhist ethical thought and moral principles into secular mindfulness training would raise challenges, such as exploration of the concept of karma, the role of intention, interdependent origination (pa‫ܒ‬icca-samuppƗda) and the question on nonself, to name a few. In the context of psychotherapy, the ethical considerations have recently been discussed by several scholars (e.g., McCown 2013); health professionals have their own specific ethical structures, however this does not mean that ethics is a part of mindfulness training provided to the client or patient in question. It seems that the ethical implications of the de- and re-contextualisation of mindfulness have come to the fore with the introduction of mindfulness into various work environments, from corporations to the military, intending to improve work performance, productivity, and success. Lately, the debates about ethics and secular mindfulness have been increasing (e.g., Monteiro, Musten, and Compson 2015), noting that mindfulness can perhaps be

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misappropriated in the military (Purser 2014) or used as a means for maintaining the status quo in unacceptable work environments, to maintain power and increase profits (Purser and Millilo 2015). Another difference between the two conceptualisations of mindfulness stems from different presumptions about self. Mindfulness is viewed (axiomatically) in the Buddhist context as one of the foundations for realisation or direct insight into non-self, which is equated with freedom from suffering. The primary aim of ancient Buddhist discourse was apparently not the investigation of normality as culturally bound narratives, or how to live more successfully in this world, but rather to transcend the entanglements with the world, in order to develop a fuller human potential. Thus the Buddhist focus is on seeing the deep structure of cognition and its mechanisms and nature rather than the content or a personal narrative. Although modern Buddhism has modified this goal by placing more emphasis on living in the society and in everyday life, it has still retained, though often at the background, the ultimate goal of liberation (for oneself as well as for all living beings) from all the bonds, i.e., attachments and aversion, to this world. Hence, the aim of Buddhism is transcendent awakening (bodhi), presumably a profound transformation of human consciousness, reached through ethical and meditative training, and, for the monastics, renunciation of worldly life. One of the pivotal (and presumably non-negotiable) conditions for liberation from suffering and awakening (bodhi) is full insight into non-self, i.e., that there is no permanent identity, person, or individual, separated from everything else. In contrast, although psychotherapy and other domains that employ mindfulness also result in loosening of identification with experiences and increased adaptability, the identity is generally not questioned, nor is this possibility raised in Western applications of mindfulness. Being situated in Western psychological paradigms, mindfulness is viewed instead as a method to enhance psychological health, perceived as a sense of stable identity, with well-defined boundaries and self-esteem. Consequently, representations, applications and research on modern secular mindfulness are based a priori on a presumption of identity, a separate self, and thus discussed in the context of current cultural goals such as individual satisfaction, and self-fulfilment. The two conceptualisations of mindfulness also have commonalities; above all, they share the common goal of alleviation of suffering (albeit with somewhat different understandings of “suffering”). Both traditions recognise that suffering in some form is a part of human condition and aim to change the person’s response or relation to suffering. As mentioned above, Buddhism attempts to addresses all aspects of human suffering as a

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clinging response to experience, and postulates that humans have the potential to become completely liberated from suffering, whereas therapeutic applications of mindfulness, though similarly pursuing mitigation of suffering, aim rather for a normal, balanced life, welladjusted to the current social circumstances. Although the therapeutic aim of mindfulness is unquestionably very valuable and research evidence indicates its efficacy, this immediate therapeutic focus may reduce the scope and potential of mindfulness meditation, which may be, as Buddhism informs, a component of a potentially larger project, involving deep exploration of life and its potentials, an investigation of human consciousness and its potentials for profound transformation. The abundant contemplative knowledge transmitted in Buddhist traditions, presented through different models and cognitive structures and “maps,” may be able to enrich and contribute to re-thinking and re-theorising current Western scientific assumptions rather than reducing them (Samuel 2014). The similarities and difference between the two representations of mindfulness open the question of how to bridge the two discourses, or in other words, how they may contribute to each other.

2. Research into mindfulness 2.1 Methodological approaches, methods and outcomes With the expanding ubiquity of mindfulness, research into its efficacy has been expanding, as evidenced by the seemingly exponentially rapid growth of research publications (e.g., AMRA 2015), most prevalently in psychology, and also to a lesser degree in the various fields of medical and social sciences. The effectiveness of mindfulness intervention for a range of psychological disorders has been indicated by numerous studies that overview them in psycho-therapeutic settings (e.g., Chen et al. 2012; Davis and Hayes 2011) and point out that mindfulness promotes mental and physical health and may augment and enhance psychotherapy. In most studies a moderate effectiveness in the alleviation of psychological and physical symptoms is shown, typically including stress reduction and improvement in a broad range of disorders such as anxiety, depression, or reduced psychotic symptoms. In a comprehensive meta-study by de Vibe et al. (2012), which evaluated the effect of mindfulness-based stress reduction (MBSR) in adults, an overall moderate effect size is determined, showing positive outcomes such as enhanced quality of life, increased empathy, and improved somatic health. Similarly, in the analysis by Khoury et al. (2013), the efficacy of mindfulness was indicated

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particularly for treatment of depression and anxiety and for general improvement of psychological wellbeing. Very rarely, were negative effects discussed; for example, Dobkin, Irving, and Amar (2011) report increased anxiety, depression, depersonalisation and even the triggering of psychosis. This indicates that further investigation is needed; the suggestion here is that Buddhist knowledge about various stages of insight in meditation, which also include unpleasant mental states, may contribute to modern research. Because research into mindfulness is a new area of scientific enquiry, many new questions and many methodological issues remain to be addressed (Fox et al. 2014; Sedlmeier et al. 2012; Thomas and Cohen 2014). A large part of the research is based on the assumption that mindfulness is a mental state or trait that can be measured objectively or empirically. Consequently, research approaches in investigations of mindfulness encompass mainly quantitative methods and, to a far lesser extent, qualitative (McCown 2013, 201). Currently, one of the most prevalent approaches is measuring the effects of mindfulness, with a number of self-report questionnaires developed to measure mindfulness as a state or a trait, such as the Mindful Attention Awareness Scale (Brown and Ryan 2004), Toronto Mindfulness Scale (Lau et al. 2006), or Five Facet Mindfulness Questionnaire (Baer et al. 2006). The latter measures five facets of mindfulness: observe (experiences), describe (labelling internal experiences by words), actaware (awareness in attending one’s activities), nonjudge (not judge inner experiences), and nonreact (allowing inner experiences to come and go) (Veehof et al. 2011). These facets are clearly based on the modern secular definition of mindfulness, focusing on awareness and nonjudgmental attention, showing how crucial is the role of definition for the entire research design and consequent outcomes. On the other hand qualitative (or even joint) approaches are rare; although they may potentially provide greater understanding of the psychological parameters involved in mindfulness training (Grossman and Van Dam 2013, 235), to date, the limited outcomes from qualitative research do not seem to be significantly different to those of quantitative research (e.g., Ames et al. 2014; Sibinga et al. 2014). Further investigation of issues related to these methods is needed. The main challenges for modern research into mindfulness seem to be methodological: there is still a lack of theoretical models used in research (Bergomi, Tschacher, and Kupper 2013, 198; Chiesa and Malinowski 2011; Grossman and Van Dam 2013, 235). Methodological shortcomings were pointed out in a meta-analysis by Sedlmeier et al. (2012), which initially identified 595 scholarly studies on mindfulness but had to exclude

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almost 75% from the overview due to methodological problems. The authors reported that most studies were conducted without sufficient theoretical background, in a largely atheoretical manner, and concluded that the focus of research should be on how and why meditation works rather than the current preoccupation with the question of whether or not it works. The study recommended the development of more precise theories and measurement devices for future research, which should aim to identify the components of meditation practice from which predictions could be drawn about its effects. Since research on mindfulness is still in its infancy, it is only in the last decade that a few models aiming to identify mechanisms of mindfulness have been developed, with particularly interesting attempts occurring in cognitive science. These investigations are largely based on research in neuroscience and phenomenology, most frequently through exploring first- and third-person approaches. The first indications of a relationship between meditation and structural changes in the brain were noted already in the 1970s (e.g., Davidson, Schwartz and Rothman 1976), followed by many studies, especially in the last decade (e.g., Davidson et al. 2003; Lazar et al. 2005; Tang, Hölzel, and Posner 2015), when the neurobiology of mindfulness became a growing field of research, investigating neuroplasticity in relation to mindfulness and other types of meditation.12 Within the framework of the cognitive sciences, issues around definition and interpretation of mindfulness are also frequently noted, e.g., Lutz et al. (2015) identify three main domains of the current understanding of mindfulness: (1) as a cognition process, presented by a single definition, i.e., paying attention in a particular way, which has a limitation that it does not account for the variety of practices; (2) interpreted as a mental trait, measured with questionnaires (e.g. FFM), which is limited by the interpretation of the scales and measures, assuming that mindfulness is static; (3) viewed as a “spiritual” path, a commitment to a way of life with a strong ethical component, however, it involves a collection of practices, which are too broad to measure. To address these three domains, each with its own limitations, Lutz et al. (2015) propose a potentially very useful theoretical model, a phenomenological space with three dimensions: (1) object orientation (attention to an object); (2) dereification (de-centering, phenomenological reduction, cognitive diffusion); (3) meta-awareness (conscious present

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reflexive awareness). This model seems to be a noteworthy contribution to the endeavour to theorise more panoramic approaches to research on mindfulness. To date, very few attempts have been made to investigate the extent to which current theoretical models could be informed by the Buddhist contemplative traditions from which mindfulness stems in the first place. As indicated above, Buddhist conceptualisation of mindfulness and its embeddedness in the Buddhist soteriological project, which could be called theory of transformation, may provide indications of effects of mindfulness training, especially reduction of unwholesome mental states, changes in cognition by penetrating below the surface level, understanding the impermanence and interrelatedness of all processes and forms of life, and consequent changes in perception of identity.

2.2 Research on mindfulness in education Since the application and research on mindfulness in educational settings is the main topic of all the other chapters in this volume, here only the main features and methodological approaches are outlined, followed by some suggestions on how Buddhist models may inform implementations of mindfulness in education. Following the growing evidence of the efficacy of mindfulness practice among adults, mindfulness has been introduced among youth, mostly through a repurposing of existing mindfulness intervention models with age appropriate modifications. Thus, for example, the MBCT-C programme for children is based on MBCT, or the MBSR-T programme for adolescents is developed on the model of MBSR, with positive outcomes indicated, such as alleviation of stress, anxiety and depression (Biegel et al. 2009). Many programmes for youth are implemented outside a school setting or taught in school after-hours; typically, such programmes are conducted within a rather shorter period, somewhere between eight and twelve weeks, with only a few exceptions (e.g., the twenty-four-week programme, see Napoli, Krech, and Holley 2005; also the chapter by Sheinman and Hadar in this volume). More recently, especially since 2010, a growing number of programmes have been designed to be incorporated into daily school curriculum, such as the programmes MindUP (Maloney et al. 2016) and Inner Kids (Galla, KaiserGreenland, and Black 2016), which aim at contributing to both pro-social behaviour and psychological wellbeing (Schonert-Reichl et al. 2015). Typically, the main goals of these programmes include stress reduction, increased attention, emotional balance, compassion, and enhancement of academic achievements. In addition, several programmes have been

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developed for teachers to alleviate stress and develop skills to implement mindfulness practice with students, such as the Inner Resilience (Lantieri et al. 2016) and CARE programmes, which incorporate emotional skills, caring and listening practices, and mindfulness (Jennings 2016). Although mindfulness training programmes for youth have recently been expanding rapidly, the research into their efficacy to date is relatively scant, especially in comparison with a very large body of research publications on mindfulness interventions for adults. According to the latest review of research publications by Schonert-Reichl and Roeser (2016, 4), since 2009 the increase in research publications is notable. Generally, research suggests positive outcomes among clinical as well as general populations of children. For example, a comprehensive survey by Kuyken et al. (2013) showed that a mindfulness intervention (522 young participants, in twelve secondary schools) lowered stress and depressive symptoms and enhanced greater wellbeing. Similarly, a meta-study by Zenner, Herrnleben-Kurz, and Walach (2014) on the effects of mindfulness interventions in schools, based on twenty-four studies, indicated, among the main benefits, improvements in cognitive performance and resilience to stress. However, a comprehensive analysis by Zoogman et al. (2015) of twenty studies of mindfulness interventions with youth, mostly in school environments, demonstrated an overall small effect size, with better outcomes in clinical settings than in the general population. The review by Black (2015), which included forty-one studies, concluded that mindfulness programmes contributed to improved attention, reduced anxiety, depressive symptoms and rumination, and developed prosocial skills. Similar outcomes were indicated in a more recent review (Schonert-Reichl and Roeser 2016, 3-4), which showed increased attention, better emotional regulation, improved wellbeing and health among youth in the general as well as in clinical populations. Methodologically, the studies of the efficacy of mindfulness in education generally follow the same research design as studies of the adult population: predominantly, they measure different psychological facets through quantitative methods, based on the data obtained from questionnaires. Most meta-studies (e.g., Black 2015; Burke 2010; Rempel 2012; Zenner, Herrnleben-Kurz, and Walach 2014) identified weaknesses in research designs, recommending more methodological rigour, validated measures and the use of active controls. Greenberg and Harris (2011) recognised the need for a longer term follow up, clearer descriptions of mindfulness intervention, its frequency and duration. Qualitative studies are rare though often recommended in view that they may reveal the experiences of meditators and teachers during

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mindfulness training programmes (Grossman 2011). As pointed out by Black (2015, 299), the outcomes of the existing studies were mainly based on self- or second-person reports (i.e., from parents and teachers), and consequently more objective measures are needed to avoid potential bias. Davidson et al. (2012) propose an introduction of contemplative practices in education and more rigorous evaluations that would involve transdisciplinary research involving contemplative practices, education, developmental studies, cognitive science and neuroscience research to assess the efficacy of new educational practices. More recently, Zajonc (2016) positioned mindfulness practice within a broader framework of contemplative teaching and learning as a way of cultivating the holistic development of students, and noted a need to develop a theory of contemplative education as a foundation for a high quality research and teaching. To summarise, most mindfulness programmes are based on short-term interventions, more or less replicating mindfulness interventions and research design models for adults. Research on mindfulness in education indicates small to moderate size results in terms of stress relief and improved wellbeing. The main issues raised in research approaches include: frequent ambiguities around definitions of mindfulness and identification of variables involved; a lack of clarity about duration, frequency and long term effects of mindfulness training; and the competencies of facilitators or teachers of those programmes. As summarised by Schonert-Reichl and Roeser (2016, 1214), future research and implementations will need to pay more attention to developmentally and culturally appropriate mindfulness programmes, the integration of mindfulness at a whole school level, improved research design with multidisciplinary approaches, qualitative assessment and longitudinal studies. Most programmes aim at alleviating stress and improving physical, psychological and social wellbeing for students, teachers and the educational setting as a whole. However, perhaps more focus could be placed on exploring the roots of stress and suffering in educational and, more generally, in the societal settings through mindfulness, contemplation, silence, reflection, and discussions. In this regard, Buddhist teachings, from where the practice of mindfulness originates, may inform the current implementation of mindfulness in education. As shown above, in Buddhism, mindfulness is a component of a greater projecthow to be liberated from suffering through the cultivation of ethics, meditation and wisdom. If mindfulness practice is approached in such a holistic way, practiced in conjunction with a focus on values and ethics, reflections and

24

Chapter One

contemplation, it would require longer periods of practice, over years, and thus develop new methodological approaches to learning and teaching, as recently suggested by Gates and Gilbert (2016) and Zajonc (2016). Mindfulness cultivated within such a broader framework would need to be integrated into the entire school curriculum, not viewed as primarily a method of stress relief or relaxation, but rather as a new approach to learning and living. The interlinkages between values, ethics, kindness, mindfulness, interdependence of all beings, friendship and identity, which are at the core of Buddhist discourse, could add a new facet or lens for explorations of current social, environmental and other problems that new generations will inevitably face.

Abbreviations Abbreviations and the quotation system of PƗli sources follow the Critical PƗli Dictionary (Epilegomena to vol. 1, 1948, pp. 5*36*, and vol. 3, 1992, pp. IIVI). The numbers in the quotations of PƗli sources refer to the volume and page of the PTS edition (e.g., MN I 21 refers to the Majjhima NikƗya, vol 1, p. 21) A As D Dhs Dhp M MW PED Ps

S sv Vibh

A۪guttaranikƗya. [1885–1900] 1999–2013. Edited by Richard Morris et al. Oxford: Pali Text Society (PTS). AtthasƗlinƯ. [1897] 2011. Edited by Edward Müller, revised by L. S. Cousins. London: PTS. DƯghanikƗya. [1890–1911] 1995–2007. Edited by Thomas William Rhys Davids and J. Estlin Carpenter. Lancaster: PTS. Dhammasa۪ga۬i. [1885] 2001. Edited by Edward Müller. London: PTS. Dhammapada. 1994. Edited by Oskar von Hinüber and Kenneth R. Norman. Oxford: PTS. MajjhimanikƗya. [1888–1902] 2003–2013. Edited by Vilhelm Trenckner. Bristol: PTS. Monier Monier-Williams, [1899] 1988. A Sanskrit-English Dictionary. Oxford: Oxford University Press. Reprinted, Delhi: Motilal Banarsidass. PƗli-English Dictionary. 19211925. Thomas William Rhys Davids and William Stede. Bristol: PTS. PapañcasnjdanƯ, MajjhimanikƗyƗ‫ܒܒ‬hakathƗ of Buddhaghosa. [19221938] 19761979. Edited by James H. Woods, Dharmananda KoĞambi, Isaline B. Horner. London: PTS. SaۨyuttanikƗya. [1884–1898] 1975–2006. Ed. by L. Feer. 5 vols. PTS. sub voce Vibha۪ga. [1904] 2003. Edited by Caroline Augusta Rhys Davids. London: PTS.

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Vibh-a SammohavinodanƯ. [1923] 1980. Edited by A. P. Buddhadatta. London: PTS. Vism Visuddhimagga. [1920–1921] 1975. Edited by Caroline Augusta Rhys Davids. London: PTS.

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Notes 1

2

3

4

5 6

7

8

For a comprehensive discussion about Buddhist perspectives on mindfulness and its embeddedness within different models of Buddhist teachings, see Ditrich 2016b. Contemporary (re)interpretations of mindfulness (both Buddhist and Western) almost always refer back to TheravƗda sources (which are written in PƗli); therefore, in this overview of the roots of mindfulness, technical terms (in parentheses) are given in PƗli. The term sammƗ is explained in the PƗli-English dictionary as “thoroughly, rightly, properly, best, perfectly” (PED, sv); thus right mindfulness would indicate mindfulness that is appropriate for, or leading to, liberation from suffering. The term “morality/ethics” is used here as an equivalent for the PƗli word sƯla, usually translated as “character, habit, behaviour; moral practice, good character, Buddhist ethics, code of morality” (PED, sv). M I 56; D II 290: ƗtƗpƯ sampajƗno satimƗ vineyya loke abhijjhƗ-domanassaۨ. As with most Buddhist technical terms, these are precisely and exhaustively defined in the Abhidhamma literature. In contradistinction to the presentation of sati in the PƗli Abhidhamma, the lists of mental constituents (cetasikas) in other Buddhist schools are to some degree different, e.g., in the SarvƗstivƗda school, mindfulness (sm‫܀‬ti) is listed among universal mental constituents (Buswell and Lopez 2014, 1095). These may be practiced each in turn; loving kindness brings about freedom from ill-will (Vibh 272), compassion engenders freedom from cruelty (Vibh 273), appreciative joy counteracts jealousy (Vibh 274), and equanimity liberates from distraction (Vibh 276).

32 9

10

11

12

Chapter One The great importance of insight into impermanence is also indicated by its position in the refrain of the Satipa‫ܒܒ‬hƗnasutta (M I 5563; D II 290315) as one of the most important aspects of mindfulness contemplation. The integration of traditional Buddhist knowledge and “maps” into contemporary psycho-therapeutic and related disciplines is for the most part beyond the skill set of any single individual; a collaborative approach with input from individuals in relevant fields (including those skilled in the traditional Buddhist teachings) seems a possible way forward for research design and an ultimate theorising of mindfulness. Here it is briefly explored what traditional approaches may offer to the current secular models. For a detailed study of the presentation of intention in the PƗli canon, see Heim 2014. For an overview of research on neurobiology of mindfulness, see Lazar 2016; Zeidan 2015.

CHAPTER TWO HOW STRONG IS THE EVIDENCE THAT MINDFULNESS PRODUCES HEALTHY PSYCHOLOGICAL CHANGES IN CHILDREN? STEVEN ROODENRYS, AMALIA BADAWI AND WILLIAM LOVEGROVE

Abstract This chapter reviews quantitative studies examining the impact of mindfulness-based interventions with children on a range of psychological, cognitive, behavioural and educational outcomes. These include studies conducted with clinical populations, as well as nonclinical populations, often conducted in schools as this offers a highly structured environment, which facilitates the delivery of mindfulness programmes. Methodological considerations in the design of such studies are described, along with some common problems in the literature. In addition to reviewing individual studies, we describe the outcomes of a number of systematic reviews and meta-analyses of studies examining the impact of mindfulness interventions with children and adolescents. This review shows that much of the evidence for an impact of mindfulness on psychological wellbeing is relatively weak, with most studies failing to use control groups or to demonstrate an actual change in mindfulness, often because mindfulness was not directly measured. A small number of very recent studies with stronger methodologies do provide good evidence for an impact of mindfulness on negative psychological factors in children, which align with those reported in the adult literature. We conclude that more welldesigned studies are required, and suggest some key issues that need to be examined in further studies.

34

Chapter Two

Introduction Mindfulness has transitioned from being a fundamental aspect of Buddhist philosophy and practice to being accepted within Western popular culture. The mindfulness concept, in some form, has spread through the modern Western consciousness into many areas of life, from golf to share trading, so it should not be surprising that people are interested in whether mindfulness can be of benefit to children. In fact, many people are claiming that it is. An internet search of the phrase “mindfulness for children” brings up over seventy thousand hits while the words “mindfulness” and “children” bring up over twenty-six million. Books, websites and educational programmes for schools are all available and aimed at improving mindfulness in children. As with any treatment activity, intervention or device promoted as having beneficial effects, a careful examination of the evidence should be made before we can unequivocally endorse it. Although many individuals may attest to the efficacy of an intervention, we cannot rule out bias or placebo effects as being responsible. Such testimonials alone do not provide appropriate evidence for the benefits of an activity or intervention. It is, therefore, important to know if an effect of current Western approaches to mindfulness training in children actually exists. If so, it is also important to ask which aspects of psychological function are influenced by mindfulness training and what sort of groups are affected in different ways. The evidence showing the benefits of increasing mindfulness in adults seems strong. However, there is less evidence for an effect of mindfulness training in children. This chapter reviews that evidence, particularly in relation to the implementation of mindfulness training in educational settings.

What is mindfulness? There are many definitions of mindfulness. Probably the most common definition in Western literature comes from Kabat-Zinn, “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn 2003, 145). Mindfulness is not a final destination, but is a way of being that is cultivated and deepened through engagement with ongoing practices, which allows for the present moment to be more fully experienced. The construct of mindfulness embodies both the practices that enhance present moment awareness and the subsequent expanded awareness (Kabat-Zinn 2003). The initial practice involves

Mindfulness Produces Healthy Psychological Changes in Children?

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specific techniques for building attentional capacities, such as focusing on the breath or particular body parts. Over time, attention is then extended to sensory, cognitive and affective aspects (Farb, Anderson, and Segal 2012). The studies reviewed here use a range of definitions but many of them are consistent with Kabat-Zinn’s definition. Mindfulness training often involves engagement in stillness meditation practices, or movement-based practices such as yoga. In each practice, emphasis is on paying attention to the present moment, which is aided by using an anchor point such as the breath, while observing with equanimity (Zenner, Herrnleben-Kurz, and Walach 2014). Cultivating mindfulness involves continued and repetitive practice, in much the same way as learning to read or draw does (Flook et al. 2010). Therefore, teaching mindfulness skills during the pre-adult developmental period, when brain plasticity is more readily available, may confer benefits over the immediate and longer terms. Studies on the effect of mindfulness may be based on quantitative measures or qualitative experiences. In studies investigating mindfulness on psychological processes, data is frequently collected from questionnaires designed to measure different psychological characteristics. These questionnaires have usually been normed for the populations being assessed and have significant levels of validity and reliability. It is sometimes argued that using only quantitative measures derived from questionnaires omits important experiential data that can only be measured by qualitative reports from participants. Ideally, studies should use both types of measures. In this chapter the main focus is on studies using quantitative measures.

Some methodological considerations Before discussing the research evidence, a few comments on research methodology are necessary. The best evidence for effects of an intervention or treatment comes from properly conducted scientific studies. The gold standard for such studies is the randomised control trial (RCT). In this type of study, individuals are randomly assigned to receive the treatment of interest or a control treatment. The treatment or intervention is delivered, as closely as possible, in the same manner to all the participants receiving it. This is important because if the mode of delivery varies, it becomes impossible to draw clear conclusions from the study, because we cannot separate natural variation amongst the participants from variation induced by the intervention. Hence, studies try to keep the programme implementation consistent as it is then possible to

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draw firmer conclusions about whether that implementation has an effect or not. It is always possible that another implementation will be more or less effective, but we can at least say something about the implementation in the study with some confidence. A second important aspect of an RCT is that there is a control group to compare the intervention against. The best form of control group is one which attempts to control for placebo effects by offering an alternative which, to the naïve participant, seems just as likely to have an effect as the intervention of interest. The reason for this is to control for the expectancy effect about what should happen, on the part of both the researchers and the participants as expectancies have been shown to influence a wide range of phenomena. In the case of medications, this is relatively easily done by preparing an identical looking pill which contains an inert substance (the original notion of a placebo) but this can be much more difficult in the case of interventions aimed at psychological functions. To really control for expectancy effects, the placebo control condition must involve something that is just as convincing as the intervention as having a potential benefit on the outcome of interest, whether that is mood or cognitive function. Such expectancy or placebo effects occur across a wide range of phenomena, being well-documented in relation to pain, for example. Participants in RCT studies usually do not know if they are receiving the intervention of interest or the placebo treatment. The control condition also provides a comparison measure of factors other than expectancy that might influence the outcome. For example, an intervention might have an impact on some other variable, such as selfesteem or self-efficacy, which might then impact on the outcome. Although such an effect on the outcome might be attributed to the intervention in a broad sense, it is not due to the proposed causal agent, and to conclude that it was would be a mistake. As a concrete example, a mindfulness programme could reduce stress because it involves relaxation as well as mindfulness. Only a comparison against a relaxation control group can rule this out as a possible explanation of the effect of the mindfulness programme. Such comparisons have, of course, been done in the mindfulness literature and there are many studies which support the conclusion that mindfulness has beneficial effects. In intervention studies, it is also important to measure changes in mindfulness itself, as well as the effect of mindfulness on other variables. In order to conclude that mindfulness training leads to changes in depression and anxiety, for example, it is important to know that the training did in fact lead to changes in mindfulness itself. Even though this point may appear self-evident, many studies purporting to measure the

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effects of changes in mindfulness have failed to determine whether the intervention of interest did modify levels of mindfulness. This methodological consideration will be applied to the studies considered below.

Mindfulness training in adults A recent meta-analysis of mindfulness-based therapy in adults (Khoury et al. 2013) included over 200 studies that had investigated mindfulness training as a treatment for a wide range of conditions, disorders and in nonclinical groups. This analysis showed it is an effective treatment, particularly for depression and anxiety, even when compared to some psychological treatments. Importantly, the size of the effect of the mindfulness intervention on clinical outcomes across the different studies was moderated by the size of the effect on measures of mindfulness itself. That is, studies showing bigger changes in mindfulness also showed bigger changes in the other outcome measures. This is an important point because this is what we would expect to see if increased mindfulness is causing the change in the other outcomes. In addition to effects on psychological wellbeing, studies have demonstrated that mindfulness training can improve cognitive function in adults, particularly in relation to the control of attention. Jha, Krompinger, and Baime (2007) and Tang (2007) both found that mindfulness improves attentional processes, while Mrazek et al. (2013) found that it improves working memory capacity and reduces mind wandering. Such cognitive benefits should lead to improved academic outcomes in children, along with the psychological benefits. Although there is good evidence of the beneficial effects of mindfulness practice in adults, it cannot be assumed that these benefits will also be seen in children. A major element of mindfulness practice is the control of attention, which is known to develop throughout childhood. It seems reasonable to assume that there is some minimal development of attentional control required in order to engage in mindfulness exercises, although this may be achieved relatively early in childhood. There is also the question of how early children can understand the concepts of mindfulness, such as the notion of nonjudgmental acceptance, and the degree to which attitudes such as this can be adopted voluntarily. Both of these factors suggest there may be a minimum age at which mindfulness can be taught, or that the effect of mindfulness training will be less in younger children. Despite the lack of research addressing these issues, there are mindfulness programmes for children as young as the first year

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of school and there is anecdotal evidence of an effect, at least, on children’s behaviour.

Mindfulness in children As in adults, mindfulness interventions with children and teenagers have been investigated for possible beneficial effects in psychological disorders, and on wellbeing in population samples. Research into the suitability of using mindfulness-based interventions (MBIs) with youth suggests there are strong benefits in clinical samples. For example, adolescents in a psychiatric outpatient facility reported decreased levels of depression, anxiety and somatic distress, along with increases in quality of sleep and self-esteem after participation in a manualised, eight-week mindfulness-based stress reduction (MBSR) (Kabat-Zinn 1990) programme (Biegel et al. 2009). Benefits of participation in MBSR and mindfulness-based cognitive therapy (MBCT) (Teasdale et al. 2000) programmes for children with attention deficit hyperactivity disorder (ADHD) have also been demonstrated, with participants and their parents reporting reductions in symptoms (Van der Oord, Bögels, and Peijnenburg 2012; van de Weijer-Bergsma et al. 2012). In addition to minimising risk for future pathology, MBIs may be of benefit in helping children thrive. Mental health involves positive functioning in psychological, social and emotional domains, along with the absence of mental illness (Keyes 2007; World Health Organisation 2015). For example, mindfulness practices may increase sense of autonomy and self-efficacy as a child chooses their response to a situation rather than simply reacting to stimuli. Increases in awareness of one’s own emotions and behaviour may lead to interpersonal gains such as decreases in impulsive, aggressive behaviours and more readily recognising and understanding others’ emotions (Huppert and Johnson 2010). Promoting wellbeing in children is an essential component of supporting children’s mental health. Through positive mood, student wellbeing can support the traditional focus of education and academic achievement. Positive mood tends to enhance important abilities for learning, such as increases in creative thinking and broadening attention capacity (Seligman 2011). The interrelationship between academic outcomes, social and emotional proficiency, and physical and emotional wellbeing, suggests that by enhancing any one of these domains, multiple domains are likely to be impacted (Diamond 2010). As student learning takes place within a system involving peers, teachers and family, children’s intrapersonal and

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interpersonal socio-emotional skills can enhance or disrupt academic performance (Durlak et al. 2011). Mindfulness-based programmes that are specifically designed for school settings may therefore be of benefit in mitigating risk for psychopathology and helping children thrive.

Mindfulness training programmes The majority of MBIs for children stem from the adult versions of MBSR and MBCT. Other programmes included in the literature are Integrated Body-Mind Therapy (IBMT) (Tang 2007), Mindful Awareness Programs (MAP) (e.g., Flook et al. 2010), Mindful Schools (Mindful Schools 2012), Learning to BREATHE (Broderick 2013), Attention Academy Program (Napoli, Krech, and Holley 2005), and MindUP (Hawn Foundation 2011). Consideration is given to each of these programmes below. MBSR (Kabat-Zinn 1990; 2003) is one of the most clinically researched and utilised programmes for the adult population. The programme consists of weekly sessions of two and a half hours, delivered over an eight-week period, and often requires a full day of silent retreat for completion. Homework forms an integral part of the programme with participants engaging in thirty-five to forty-five minutes of daily practice outside of the sessions. The MBSR-T (Biegel et al. 2009) programme for adolescents aged thirteen to eighteen is a modified version of the adult programme with sessions being of shorter duration, the silent retreat day excluded and emphasis being placed on stressors within the participants’ social context. MBSR-T may be a difficult programme to implement as part of the school curriculum as sessions are each one and a half hour in length, indicating implementation may be more appropriate in after-hours or community settings. MBCT is an adult group psychotherapeutic intervention (Teasdale et al. 2000) grounded in MBSR and cognitive therapy for depression (Beck et al. 1979). MBCT-C (Semple, Lee, and Miller 2006) was initially developed to assist children experiencing clinical depression or anxiety. The programme consists of ninety-minute sessions delivered weekly, for twelve weeks, by experienced clinicians. MBCT-C appears to be more appropriate for clinical symptomology as it is comprised of lengthy sessions and requires clinician facilitation. Application within a general school setting does not appear to be feasible. Programmes stemming from MBSR and MBCT include IBMT (Tang 2007), Mindful Schools (Mindful Schools 2012), Learning to Breathe (L2B) (Broderick 2013), and AAP (Napoli, Krech, and Holley 2005).

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These programmes incorporate common mindfulness-based activities such as focusing attention, attending to breath and body sensations, and bringing awareness to the present moment without judgment. More specifically, IBMT incorporates a relaxation component and Mindful Schools includes activities such as mindful eating and walking. Emotional awareness also forms part of the Mindful Schools and L2B programmes. Limitations for use of these programmes in school settings include the need for facilitators to have undertaken meditation training or be specifically trained in the curriculum (e.g., IBMT, L2B). Further, delivery of the programme may require that a large space be made available so that students can spread mats or blankets (e.g., AAP). While these are not criticisms of the programmes, the need for specialised mindfulness training by teachers and the variable availability of large spaces may impact on a school’s ability to implement a specific MBI. MindUP (Hawn Foundation 2011) is a fifteen-lesson programme designed for classroom implementation, it focuses on fostering social and emotional awareness, enhancing psychological wellbeing and promoting academic success. At its core, the programme focuses on mindful breathing and attention, which are incorporated into the daily curriculum as a foundation for learning and interacting. The programme also includes information on the brain in each session followed by activities to help consolidate the new knowledge. A major goal of the programme is to help children develop greater awareness so that they may respond to the world from a reflective, rather than reflexive, position. The programme is grounded in the concept of joyful engagement in order to help children flourish by building on skills sequentially, from sense-based and cognitive-based experiences, through to active practices of gratitude and kindness.

Research outcomes What does the available evidence suggest about the impact of mindfulness interventions with children? The task of reviewing the literature has been made easier by some recent systematic reviews and meta-analyses, including some that focus specifically on interventions in school settings. These reviews and meta-analyses use clearly specified, and often very demanding, criteria for including a study in the review so that only high quality research studies are examined, or at least the quality of the studies is clear. Many studies have attempted to measure the broader impact of the intervention by examining other outcomes in addition to mindfulness. Some of these have focused on psychological symptoms

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while others have examined social functioning and this is reflected in the reviews. Not surprisingly, these reviews overlap considerably in the sets of studies included. Zoogman et al. (2015) report the results of a meta-analysis of the twenty studies conducted prior to 2012 that met their criteria. The latter required mindfulness to be the chief component of the intervention, and studies which included mindfulness as only one component of a multifaceted intervention were excluded (as it is not possible to know which aspect of these interventions is responsible for any change). Meta-analysis is a statistical technique whereby the results of separate studies can be combined to provide better evidence than a single study can provide, and can be used to examine if the effect of the intervention varies with any other reported variables, such as age of the participants. In the studies they analysed, the average effect of the mindfulness intervention, across all the different outcome measures used, was small, 0.227.1 The size of this effect was moderated by only one factor, the source of the sample of participants. In the four studies that used a clinical sample, the effect size for the mindfulness intervention was 0.5, compared to 0.197 for the remaining studies using nonclinical samples. However, even in these studies with participants from a psychological clinic, an examination of the individual papers shows the evidence from these studies is not as strong as might be hoped, for general usage in schools. Bögels et al. (2008) tested only fourteen children with a range of diagnoses and no control group. The children varied in age between eleven and eighteen and although the results showed an improvement in some measures, the lack of a control group means alternative explanations cannot be ruled out. For example, the children did perform better on a short test of attention, however this could be due to a practice effect on the task. They showed a consistent improvement on a self-report measure of problem behaviours but on a similar measure completed by a parent, the changes were much smaller and mostly not significant. Similarly, Semple, Reid, and Miller (2005) examined the effect of mindfulness training on five children aged seven or eight who were reported by a teacher to be experiencing anxiety. The study did not include a control group or report statistical testing. The meta-analysis statistics reported by Zoogman et al. (2015) for both of these studies do not support the conclusion that mindfulness training had any beneficial effect. The finding of Zoogman et al. (2015) of a greater effect in clinical samples comes from two studies which do show stronger effects, but only one was an RCT and the other had no control group.

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Beauchemin, Hutchins, and Patterson (2008) provided mindfulness meditation training to thirty-four students with a learning disability aged between thirteen and eighteen. They found a significant improvement in anxiety levels, problem behaviours and social skills after five weeks. However, they did not measure mindfulness and they did not include a control group, so we cannot be confident that the effects were due to an improvement in mindfulness. Biegel et al. (2009) reported the only RCT of mindfulness with a clinical sample included in the Zoogman et al. (2015) meta-analysis. There were 102 participants initially (only seventy-four completed the study) who were fourteen to eighteen years old and recruited from a hospital psychiatry department. They completed either an eight-week, modified MBSR programme in addition to their treatment or received treatment as usual. The study found large effects of the MBSR programme in comparison to the control group on a number of measures of psychological symptoms such as anxiety, depression and obsessive thoughts and behaviour. This study offers some of the strongest evidence for the beneficial effect of mindfulness training in adolescents. However, it must be acknowledged that the study did not actually measure mindfulness. Stronger evidence would be provided if it was possible to show that an increase in mindfulness was correlated with decreases in symptom severity. The sixteen studies included by Zoogman et al. (2015) with child participants from nonclinical sources show weaker effects on a range of measures. Twelve of these studies were RCTs, but in Zoogman et al.’s (2015) analysis only three of the twelve had effect sizes that were significant. That is, only three of the studies provided results where we can be confident that mindfulness training had a positive effect. Two of these are the studies with the largest sample sizes and therefore most likely to find effects if they exist. Liehr and Diaz (2010) gave seventeen students around ten years of age either a mindfulness intervention (Mindful schools) or a health education intervention whilst they attended a nonresidential summer camp. They found that the mindfulness group levels of depression decreased significantly more than the control groups, and the decrease in anxiety approached significance. Given the small sample size involved in this study, the effect size for the intervention needed to be large to reach significance. Indeed, this study has the largest effect size of any included in the Zoogman et al. (2015) meta-analysis at 1.14, while in most studies it was less than 0.25. This is surprising given it was also the shortest intervention with ten classes over a two week period.

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Napoli et al. (2005) conducted one of the longest interventions, delivering the Attention Academy programme in twelve sessions over a period of twenty-four weeks. They measured the effect of the intervention in 228 first-, second- and third-grade children. The results showed a significantly greater improvement in test anxiety, teacher-rated social skills, and attention, both teacher-rated and objectively measured by performance on cognitive tasks. There are, however, a number of potential issues with this study. The lack of an active control group means that we cannot rule out motivational or placebo effects, and the use of subjective ratings by teachers who were probably not blind to which group the children were in, allows teacher expectations to influence the outcome. The more objective measure of attention is a positive feature of the study, however it is not reported whether the children in the two groups were equivalently distributed across the three grades. As the pre- to postmeasurement period would allow for improvement with maturation, it is possible that the group differences reflect differences in the rate of growth in attentional function between the different grades, if they were not matched across the groups. Schonert-Reichl and Lawlor (2010) reported an evaluation of the school-based Mindfulness Education programme, later renamed MindUP, with a waitlist control group. Classes were assigned to the intervention or control condition and a total of 246 fourth to seventh grade children were included. The intervention involved ten lessons delivered over the same number of weeks by the classroom teachers, from a manual after they had completed a one day training programme. The teachers were encouraged to extend the major components into other activities. Mindful attention exercises were to be practiced for three minutes, three times per day. The results showed that the intervention group improved significantly, in comparison to the control group, on a self-report measure of optimism and on teacher rated social competence, including improved attention, and social and emotional competence, and decreased aggression and oppositional behaviour. Even this study leaves open the possibility that the changes are due to the children’s and teachers’ expectation of change rather than an actual effect of mindfulness. Once again, this study also did not measure mindfulness to see if it changed over the course of the intervention, so we cannot be sure that the changes in the children’s behaviour were due to increased mindfulness, although it is perhaps the best study included in the meta-analysis of Zoogman et al. (2015). In discussing their study, Schonert-Reichl and Lawlor (2010) acknowledged a number of weaknesses in the design of the research and

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suggested the next step was to conduct an RCT. Schonert-Reichl et al. (2015) reported such an RCT too recent to be included in the metaanalysis of Zoogman et al. (2015). As in their previous study, SchonertReichl et al. (2015) evaluated a classroom-based social and emotional learning programme with a strong mindfulness component, MindUP, but this time with only fourth and fifth grade children. They followed two classes randomly assigned to the twelve-lesson MindUP programme and two classes assigned to the usual social responsibility programme of the schools, with ninety-nine children in total. The children were assessed on some objective measures of cognitive processes, focusing on executive function, self-report measures of psychological wellbeing, and, importantly, mindfulness itself. The results showed that, from pre-test to post-test, the children in the MindUP group increased in mindfulness by the same amount that the control group decreased. This pattern was present in all the self-report measures, the controls getting worse and the MindUP group improving. These included significant effects on empathy, perspective taking, optimism, emotional control and depression, with effect sizes of between 0.40 and 0.59. Children’s attitudes towards school also improved more than the control group, as did peer ratings of many of their prosocial behaviours. The cognitive tasks used by Schonert-Reichl et al. (2015) required the children to inhibit processing of distracting stimuli or of more automatic responses in order to give the correct response as quickly as possible. They found that after the intervention the children in the MindUP group responded faster but just as accurately as the children in the control group. Mathematics grades at the end of the year showed a marginally significant advantage for those children in the MindUP group over those in the control group. Until the study of Schonert-Reichl et al. (2015), the evidence for an effect of mindfulness training in children was rather weak with many studies being poorly powered, lacking control groups and failing to measure mindfulness. The meta-analytic techniques combine data from multiple studies, and suggest there is an effect across the studies involved (Zoogman et al. 2015), however they do not overcome problems with the quality of the studies themselves, such as a lack of control comparisons, and undermine our confidence in that conclusion. Some of the strongest evidence for an effect of mindfulness in adults is for effects on psychological wellbeing (Khoury et al. 2013). The MBSR programme is aimed at reducing the negative impact of stress on mental wellbeing and MBCT was specifically developed to reduce the likelihood

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of relapse in depression sufferers. Beneficial effects of both are well documented. Kallapiran et al. (2015) recently reported a meta-analysis of the fifteen RCT studies of mindfulness with children or adolescents that met their criteria for inclusion, including studies published to the end of 2013, which included psychological outcome measures. Only two of the studies investigated clinical populations. The number of studies allowed a number of different groupings and comparisons to be made regarding the effect size compared to controls. The most relevant of these looked at standard mindfulness interventions. Kallapiran et al. (2015) examined the effect of MBSR or MBCT in nonclinical populations in comparison to a nonactive control condition and found an effect size of 0.31 for measures of stress, 0.96 for anxiety and 0.42 for depression, although each of these was based on only two or three studies. Three studies compared other mindfulness-based interventions (including yoga) against non-active controls and obtained effect sizes of 0.67 for stress, 0.87 for anxiety and 0.42 for depression. The confidence intervals for depression included zero so it cannot be taken as a significant effect. The authors also conclude on the basis of the meta-analysis statistics that publication bias is likely. That is, it is possible that similar studies have been performed but not published because they failed to find an effect. This seriously undermines confidence in the estimates of effect size, with the true effect most likely being smaller than that reported, and possibly not significant. The implementation of mindfulness training with children can be greatly facilitated if it occurs as part of a school curriculum. The advantages of having a highly structured environment where many children can be part of a training programme are obvious. As a consequence, there have been a number of studies involving the implementation of mindfulness in a school setting. Once again, we are fortunate that there have been recent reviews and a meta-analysis of these studies. In their review of the literature, Felver et al. (2015) selected only studies in which the primary component of the intervention was mindfulness and included at least one objective measure by their description, although non-self-report may be a more accurate description. The resulting twenty-eight studies, published up until June 2014, involved a mix of research designs including waitlist controls through to multiplebaseline, single-subject designs. Ages ranged between eight and seventeen years and most of the studies utilised interventions in the classroom during normal school hours. A number of the studies described above were included in this review by Felver et al. (2015), in addition to more recent studies than those included by Zoogman et al. (2015).

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Black and Fernando (2014) evaluated the impact of implementing the Mindful Schools programme in a single school with children from kindergarten to grade six. There was a comparison of a group who received the Mindful Schools programme for five weeks with one who received additional sessions for a further seven weeks, however there was no separate control condition. Teachers rated student behaviour in a number of domains before and after the programme. Improvement in the total ratings show an effect size of 0.5, however the two groups did not differ after the initial five-week or the final twelve-week period. The lack of a control group makes it difficult to conclude that the effect was purely a result of the mindfulness training and not an expectancy effect on the part of the teachers, or a more general motivation effect on the children as a consequence of their own expectations about what the outcome should be. Many of the other studies reviewed by Felver et al. (2015) used a single group, pre-/post-comparison design and report improvements in teacher-rated behaviour and self-reported wellbeing but they do not provide the strongest evidence that the effects are a result of increased mindfulness. Britton et al. (2014) reported an RCT of 100 sixth grade children who completed either a mindfulness training programme integrated with an Asian history class or an African history class with an experiential component. Common mindfulness exercises were performed (e.g., breath awareness, body scan) each day for six weeks by the intervention group. The active control for the mindfulness exercises was completing a life-size model of a pharaoh’s tomb. The students in the intervention group completed a record of their subjective experience of the exercises each day and both groups completed standardised measures of psychological factors. The intervention group showed a greater reduction in affect disturbance and increase in positive affect than controls, both of which only approached significance, but the same level of improvement as the controls in measures of anxiety/depression, self-rated behaviour and attention. Unlike many other studies, Britton et al. (2014) measured mindfulness using a standardised questionnaire. They found no significant change in mindfulness over the six-week period. Nevertheless, there was a correlation of around 0.4 between the change in mindfulness scores and changes in affect, suggesting there is some effect of the mindfulness training. The results may suggest that the individual response to mindfulness training is highly variable–some children must have decreased on the mindfulness measure

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in order for this correlation to arise without a change in the average scores across time. Sibinga et al. (2013) conducted an RCT of the MBSR programme, compared to a health education control with forty-one seventh and eighth grade boys. They also found no significant change in mindfulness over the intervention even though the mindfulness group did improve more on anxiety, and reported less rumination, than the controls. Felver et al. (2015) concluded from their review that the results are encouraging for mindfulness interventions within schools. They are clearly feasible and some positive effects have been found, however there is a strong need for further RCTs with active control conditions. Zenner, Herrnleben-Kurz, and Walach (2014) reported the results of a meta-analysis of studies published to August 2012 of mindfulness interventions in schools, which included twenty-four studies (including several unpublished ones), and outcome measures including psychological factors and cognitive performance. They calculated the statistical power for the studies and concluded that although twelve were adequately powered to detect a pre-post difference, only three studies had sufficient power to detect a difference relative to a control group. The mean effect size was 0.4 for both the pre-post comparisons and the control comparison. This was reduced to 0.31 when only adequately powered studies were included. Variation in effect size across different studies was related to the total number of minutes of mindfulness practice involvedstudies with more practice tend to produce bigger effects on the outcome variables. Effect sizes were larger for measures of cognitive performance, largely measures of attention, and smaller for measures of anxiety or emotional problems, stress and wellbeing. Zenner, Herrnleben-Kurz, and Walach (2014) point out that there is a large degree of heterogeneity amongst the studies. They vary considerably in the number, age and background of participants, the outcome measures used and the intervention used. All of these factors probably contribute to the large variation in effect sizes. Zenner, Herrnleben-Kurz, and Walach (2014) also point out the weakness that none of the studies used a good active control group, thus the real role of mindfulness cannot be determined. The best evidence for an effect of mindfulness comes from the correlation between the size of the effect and the amount of mindfulness practice in the different studies. More recently a number of studies have been published that used improved methodology, as recommended by Zenner, Herrnleben-Kurz, and Walach (2014). Sibinga et al. (2016) investigated the effect of mindfulness instruction on a range of psychological measures in an RCT

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study. The study was very well controlled: it used a large number of students and trained instructors, included an active control group, had good buy-in from the school, data were collected independently of the researchers, and the statistical analyses were robust. They found “that the students in the intervention group had lower levels of depressive symptoms, self-hostility, somatisation, negative mood, negative coping and post-traumatic symptoms” (2016, 5). Importantly, this study did show increases in mindfulness as a result of the training. In a study using seven to nine year olds (Vickery and Dorjee 2016), mindfulness training was delivered within a regular school curriculum by the teachers. The results showed significant decreases in negative affect. It was also shown that there were significant negative correlations between changes in mindfulness and scores on emotion regulation measures between baseline and both post-test and follow-up. Blyth et al. (2015) conducted a mindful Self-Compassion programme on fourteen to seventeen year olds. Their study used a wait-list control group. As well as showing significant improvements on measures of depression, anxiety and stress, this study also showed improvements in mindfulness and selfcompassion over the training period. Importantly, the regression analyses showed that decreases in depression and anxiety were predicted by the increases in mindfulness. This is what would be expected if there was a causal connection between mindfulness and the psychological symptoms.

Academic outcomes Attending to processes that broadly underpin performance may increase achievement on cognitive tasks (Slagter et al. 2011). For example, the inability to maintain focus on a task without shifting attention to extraneous concerns—mind wandering—has been associated with decreased performance on measures relating to general aptitude and working memory capacity (Mrazek, Smallwood, Franklin et al. 2012). Emerging research indicates that the relationship between mind wandering and mindfulness is oppositional, with higher levels of mindfulness being negatively correlated with mind wandering in undergraduate students. The finding that even a brief (eight minutes) mindful breathing session has been associated with decreased mind wandering when measuring task vigilance in comparison to reading or relaxation (Mrazek, Smallwood, and Schooler 2012) suggests that mindfulness may be a mechanism by which focus and performance on tasks can be enhanced in younger children also. Additional support in relation to the mechanism of mind wandering is indicated by Mrazek et al.’s (2013) study, demonstrating the benefits of

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mindfulness on measures of reading comprehension and working memory capacity. In their study, participants completed eight forty-five-minute mindfulness sessions over a two-week period. However, mind wandering was found to mediate the benefits of mindfulness on performance for participants with a baseline propensity for mind wandering. A second mechanism by which mindfulness may improve academic outcomes is through reductions in anxiety. Negative anxieties have been associated with decreased academic performance across a range of age groups (Chapell et al. 2005; Seipp 1991), with cognitions such as worry and self-doubt depleting working memory (Cunha and Paiva 2012). Support for this premise was demonstrated in the results of Bellinger, DeCaro, and Ralston’s (2015) studies whereby the effect of mindfulness on accuracy of mathematics scores was mediated by levels of state anxiety in relation to impending examinations in both laboratory and university settings.

Conclusions Bringing mindfulness into the education setting is an important step toward normalising the process of mindfulness and bringing a sense of routine to assist with adherence. As children operate within broad systems of parental, school and peer influence, inquiry into the role of mindfulness in education likely needs to consider how these systems impact on the efficacy of any intervention. For example, do outcomes vary when external and experienced facilitators are used for training as compared to teachers with limited experiential practice? Do outcomes vary when mindfulness is regarded as simply another module to be completed as compared to when the school embodies mindfulness into its value system and culture? Although academic, social and emotional measures are quantifiable through self- and other-reports, the implementation of mindfulness programmes in education settings needs to be considered within the broader culture of each school. Fisher, Frey, and Pumpian (2012) state that the integration of school culture and “academic press” is necessary for overall school improvement to be maintained over the longer term. By making explicit not only the academic curriculum but also, the implicit school culture, it is believed that students will be better placed to sustain changes over the long term. Young (2006) writes that goals of mindfulness training include incrementally increasing levels of baseline clarity and equanimity, rather than seeking only to temporarily experience these states. Further

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consideration need also be given to whether mindfulness in the classroom is generalisable to other areas of a child’s life, such as mindful eating, communication and task completion. That is, by what mechanisms can gains made in the school setting be extended to various contexts, thereby increasing levels of dispositional mindfulness? This chapter has reviewed the research literature investigating the effects of mindfulness training in children on a range of psychological, cognitive, behavioural and educational outcomes. The overall picture is mixed with some studies showing significant outcomes and others failing to do so. Many studies suffer from poor experimental design, which makes it difficult to draw any causal conclusions. Some other studies showing significant outcomes have failed to measure changes in mindfulness per se, so it is not clear whether the perceived changes result from changes in mindfulness or from changes in some other underlying mechanism or process. More recently, there are some better controlled studies showing significant positive outcomes on psychologically important measures as a result of mindfulness training. Given that group mindfulness training is more efficient than most forms of individual counselling, further research is warranted to more fully identify the size of these effects, which groups or conditions are most responsive to mindfulness training, at which age mindfulness training becomes effective, and whether different sorts of mindfulness techniques vary in effectiveness. Further research is also needed on two other potentially important topics. One concerns the role of the teacher in mindfulness training: does it matter whether the teacher is a mindfulness practitioner or not? The second concerns the possible negative emotional outcomes that sometimes occur in adults during mindfulness meditation training. Little is known about this in children but it should be further investigated and standardly reported in studies using children. While the evidence on the effectiveness of mindfulness training in children is mixed, there are strong suggestions in the literature that such training may be effective and further research is strongly justified.

Bibliography Beauchemin, James, Tiffany L. Hutchins, and Fiona Patterson. 2008. “Mindfulness Meditation may Lessen Anxiety, Promote Social Skills and Improve Academic Performance Among Adolescents with Learning Disabilities.” Complementary Health Practice Review 13(1): 3445. doi: 10.1177/1533210107311624. Beck, Aaron T., A. John Rush, Brian F. Shaw, and Gary Emery. 1979. Cognitive Therapy of Depression. New York: The Guilford Press.

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Bellinger, David B., Marci S. DeCaro, and Patricia A. S. Ralston. 2015. “Mindfulness, Anxiety, and High-stakes Mathematics Performance in the Laboratory and Classroom.” Consciousness and Cognition 37: 123132. doi: 10.1016/j.concog.2015.09.001. Biegel, Gina M., Shauna L. Shapiro, Kirk Warren Brown, and Christine M. Schubert. 2009. “Mindfulness-based Stress Reduction for the Treatment of Adolescent Psychiatric Outpatients: A Randomized Clinical Trial.” Journal of Consulting and Clinical Psychology 77(5): 855866. doi: 10.1037/a0016241. Black, David S., and Randima Fernando. 2014. “Mindfulness Training and Classroom Behavior Among Lower-income and Ethnic Minority Elementary School Children.” Journal of Child and Family Studies 23(7): 12421246. doi: 10.1007/s10826-013-9784-4. Blyth, Karen, Susan A. Gaylord, Rebecca A. Campo, Michael C. Mullarkey, and Lorraine Hobbs. 2015. “Making Friends with Yourself: A Mixed Methods Pilot Study of a Mindful Self-compassion Program for Adolescents.” Mindfulness 7(2): 479492. doi: 10.1007/s12671-015-0476-6. Bögels, Susan, Bert Hoogstad, Lieke van Dun, Sarah de Schutter, and Kathleen Restifo. 2008. “Mindfulness Training for Adolescents with Externalizing Disorders and their Parents.” Behavioural and Cognitive Psychotherapy 36(2): 193209. doi: 10.1017/S1352465808004190. Britton, Willoughby B., Nathaniel E. Lepp, Halsey F. Niles, Tomas Rocha, Nathan E. Fisher, and Jonathan S. Gold. 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): 263278. doi: 10.1016/j.jsp.2014.03.002. Broderick, Patricia C. 2013. Learning to Breathe: A Mindfulness Curriculum for Adolescents. Oakland, CA: New Harbinger. Chapell, Mark S., Z. Benjamin Blanding, Masami Takahashi, Michael E. Silverstein, Brian Newman, Aaron Gubi, and Nicole McCann. 2005. “Test Anxiety and Academic Performance in Undergraduate and Graduate Students.” Journal of Educational Psychology 97(2): 268274. doi: 10.1037/00220663.97.2.268. Cunha, Marina, and Jacinta Paiva. 2012. “Text Anxiety in Adolescents: The Role of Self-criticism and Acceptance and Mindfulness Skills.” The Spanish Journal of Psychology 15(2): 533-543. Diamond, Adele. 2010. “The Evidence Base for Improving School Outcomes by Addressing the Whole Child and by Addressing Skills and Attitudes, Not Just Content.” Early Education and Development 21(5): 780793. doi: 10.1080/10409289.2010.514522. Durlak, Joseph A., Roger P. Weissberg, Allison B. Dymnicki, Rebecca D. Taylor, and Kriston B. Schellinger. 2011. “The Impact of Enhancing Students’ Social and Emotional Learning: A Meta-analysis of School-based Universal Interventions.” Child Development 82(1): 405432. doi: 10.1111/j.14678624.2010.01564.x.

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Farb, Norman A.S., Adam K. Anderson, and Zindel V. Segal. 2012. “The Mindful Brain and Emotion Regulation in Mood Disorders.” Canadian Journal of Psychiatry 57(2): 7077. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303604/pdf/nihms361626.pdf. Felver, Joshua C., Cintly E. Celis-de Hoyos, Katherine Tezanos, and Nirbhay N. Singh. 2015. “A Systematic Review of Mindfulness-based Interventions for Youth in School Settings.” Mindfulness 7(1): 3445. doi: 10.1007/s12671-0150389-4. Fisher, Douglas B., Nancy Frey, and Ian Pumpian. 2012. “How to Create a Culture of Achievement in Your School and Classroom.” Alexandria, Va: ASCD. Flook, Lisa, Susan L. Smalley, M. Jennifer Kitil, Brian M. Galla, Susan KaiserGreenland, Jill Locke, Eric Ishijima, and Connie Kasari. 2010. “Effects of Mindful Awareness Practices on Executive Functions in Elementary School Children.” Journal of Applied School Psychology 26(1): 7095. doi: 10.1080/15377900903379125. Hawn Foundation. 2011. The MindUP Curriculum: Brain-focused Strategies for Learning and Living. New York, NY: Scholastic Inc. Huppert, Felicia A., and Daniel M. Johnson. 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): 264274. doi: 10.1080/1743976100394148. Jha, Amism P., Jason Krompinger, and Michael J. Baime. 2007. “Mindfulness Training Modifies Subsystems of Attention.” Cognitive, Affective, & Behavioural Neuroscience 7(2): 109119. doi: 10.3758/CABN.7.2.109. Kabat-Zinn, Jon. 1990. Full Catastrophe Living. New York: Delta Publishing. —. 2003. “Mindfulness-based interventions in context: Past, Present, and Future.” Clinical Psychology 10(2): 144156. doi: 10.1093/clipsy.bpg016. Kallapiran, Kannan, Siew Koo, Richard Kirubakaran, and Karen Hancock. 2015. “Effectiveness of Mindfulness in Improving Mental Health Symptoms of Children and Adolescents: A Meta-analysis.” Child and Adolescent Mental Health 20(4):182194 doi: 10.1111/camh.12113. Keyes, C.L.M. 2007. “Toward a Science of Mental Health.” In Oxford Handbook of Positive Psychology, edited by S.J. Lopez, & C.R. Snyder, 8995. New York, NY: Oxford University Press. Khoury, Bassam, Tania Lecomte, Guillaume Fortin, Marjolaine Masse, Phillip Therien, Vanessa Bouchard, Marie-Andrée Chapleau, Karine Paquin, and Stefan G. Hofmann. 2013. “Mindfulness-based Therapy: A Comprehensive Meta-analysis.” Clinical Psychology Review 33(6): 763771. doi: 10.1016/j.cpr.2013.05.005. Liehr, Patricia, and Naelys Diaz. 2010. “A Pilot Study Examining the Effect of Mindfulness on Depression and Anxiety for Minority Children.” Archives of Psychiatric Nursing 24(1): 6971. doi: 10.1016/j.apnu.2009.10.001. Mindful Schools. 2012. Mindful schools. http://www.mindfulschools.org/ Mrazek, Michael D., Jonathan Smallwood, Michael S. Franklin, M, Benjamin Baird, Jason M. Chin, and Jonathan W. Schooler. 2012. “The Role of Mind-

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wandering in Measurements of General Aptitude.” Journal of Experimental Psychology: General 141(4): 788798. doi: 10.1037/a0027968. Mrazek, Michael D., Jonathan Smallwood, and Jonathan W. Schooler. 2012. “Mindfulness and Mind-wandering: Finding Convergence Through Opposing Constructs.” Emotion 12(3): 442–448. doi: 10.1037/a0026678. Mrazek, Michael D., Michael S. Franklin, Dawa Tarchin Phillips, Benjamin Baird, and Jonathan W. Schooler. 2013. “Mindfulness Training Improves Working Memory Capacity and GRE Performance While Reducing Mind Wandering.” Psychological Science 24(5): 776781. doi: 10.1177/0956797612459659. Napoli, Maria, Paul Rock Krech, and Lynn Holley. 2005. “Mindfulness Training for Elementary School Students.” Journal of Applied Psychology 21(1): 99125. doi: 10.1300/J370v21n01_05. Schonert-Reichl, Kimberley A., and Molly Stewart Lawlor. 2010. “The Effects of a Mindfulness-based Education Program on Pre- and Early Adolescents’ Wellbeing and Social and Emotional Competence.” Mindfulness 1(3): 137151. doi: 10.1007/s12671-010-0011-8. Schonert-Reichl, Kimberley A., Eva Oberle, Molly Stewart Lawlor, David Abbott, Kimberley Thomson, Tim F. Oberlander, and Adele Diamond. 2015. “Enhancing Cognitive and Social-emotional Development Through a Simpleto-administer Mindfulness-based School Program for Elementary School Children: A Randomized Controlled Trial.” Developmental Psychology 51(1): 5266. doi: 10.1037/a0038454. Seipp, Bettina. 1991. “Anxiety and Test Performance: A Meta-analysis of Findings.” Anxiety Research 4(1): 2741. doi: 10.1080/08917779108248762. Seligman, Martin. 2011. Flourish. North Sydney, NSW: Random House Australia Pty Ltd. Semple, Randye J., Jennifer Lee, and Lisa F. Miller. 2006. “Mindfulness-based Cognitive Therapy for Children.” In Mindfulness-based Treatment Approaches: Clinician’s Guide to Evidence Base and Applications, edited by Ruth A Baer, 143–165. San Diego: Elsevier Academic Press. Semple, Randye J., Elizabeth F. G. Reid, and Lisa Miller. 2005. “Treating Anxiety with Mindfulness: An Open Trial of Mindfulness Training for Anxious Children.” Journal of Cognitive Psychology: An International Quarterly 19(4): 379392. doi: 10.1891/088983905780907702. Sibinga, Erica M. S., Carisa Perry-Parrish, Shang en Chung, Sara B. Johnson, Michael Smith, and Jonathan M. Ellen. 2013. “School-based Mindfulness Instruction for Urban Male Youth: A Small Randomized Controlled Trial.” Preventive Medicine 57(6): 799–801. doi: 10.1016/j.pmed.2013.08.027. Sibinga, Erica M. S., Lindsey Webb, Sharon R. Ghazarian, and Jonathan M. Elle. 2016. “School-based Mindfulness Instruction: An RCT.” Pediatrics 137(1): e20152532e20152532. doi: 10.1542/peds.2015-2532. Slagter, Heleen A., Antoine Lutz, Lawrence L. Greischar, Andrew D. Francis, Sander Nieuwenhuis, James M. Davis, and Richard J. Davidson. 2007. “Mental Training Affects Distribution of Limited Brain Resources.” PLoS Biology 5(6): e138. doi: 10.1371/journal.pbio.0050138.

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Tang, Y-Yuan. 2007. Multi-intelligence and Unfolding the Full Potentials of Brain. China: Dalian University of Technology Press. Teasdale, John D., Sindel V. Segal, J. Mark G. Williams, Valerie A. Ridgeway, Judith M. Soulsby, and Mark A. Lau. 2000. “Prevention of Relapse/Recurrence in Major Depression by Mindfulness-based Cognitive Therapy.” Journal of Consulting and Clinical Psychology 68(4): 615623. doi: 10.1037/0022006X.68.4.615. Van der Oord, Saskia, Susan Bögels, and Dorreke Peijnenburg. 2012. “The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents.” Journal of Child and Family Studies 21(1): 139147. doi: 10.1007/s10826-011-9457-0. van de Weijer-Bergsma, Eva, Anne R. Formsma, Esther I. de Bruin, and Susan M. Bögels. 2012. “The Effectiveness of Mindfulness Training on Behavioral Problems and Attentional Functioning in Adolescents with ADHD.” Journal of Child and Family Studies 21(5): 775787. doi: 10.1007/s10826-011-9531-7. Vickery, Charlotte, and Dusana Dorjee. 2016. “Mindfulness Training in Primary Schools Decreases Negative Effect and Increases Meta-cognition in Children.” Frontiers in Psychology 6: 2025. doi: 10.3389.fpsyq.2015.02025. World Health Organisation. 2015. “Mental Health: Child and Adolescent Mental Health.” http://www.who.int/mental_health/maternal-child/child_adolescent/en/ Young, Shinzen. 2006. “What is Mindfulness?” Retrieved from www.shinzen.org/Retreat%20Reading/What%20is%20Mindfulness.pdf Zenner, Charlotte, Solveig Herrnleben-Kurz, and Harald Walach. 2014. “Mindfulness-based Interventions in Schools – A Systematic Review and Meta-analysis.” Frontiers in Psychology 5(Article 603): 120. doi: 10.3389/fpsyq.2014.00603. Zoogman, Sarah, Simon B. Goldberg, William T. Hoyt, and Lisa Miller. 2015. “Mindfulness Interventions with Youth: A Meta-analysis.” Mindfulness 6(2): 290. doi: 10.1007/s12671-013-0260-4.

Notes 1

Effect size is a measure of the difference between treatments which takes into account the variability in the data. For example, an average improvement of five points on a measure where the pre-test data vary between scores of fifty and sixty is obviously much more notable than if the scores varied between thirty and 100. In practice, an effect size of 0.2 is regarded as small, 0.5 as moderate and 0.8 as large.

II: MINDFULNESS IN SCHOOL SETTINGS

CHAPTER THREE MINDFULNESS STRIPPED BARE: SOME CRITICAL REFLECTIONS FROM THE MINDFULNESS AT SCHOOL EVALUATION KATHY ARTHURSON

Abstract The adoption of mindfulness (or contemplative based approaches) is escalating across many sectors, including as part of teaching and learning programmes in schools. There is, however, little evaluation or knowledge of how younger students and adolescents experience these sorts of programmes introduced to classroom settings. This chapter reports on some key reflections that arose for the researcher from the experience of evaluating one such project, the pilot “Mindfulness at School” teaching programme. The programme was taught as part of “Health and Personal Development” with a class of thirty year-seven students at a primary school in Adelaide, South Australia. The pilot programme consisted of one 45 minute class per week (for nine weeks) incorporating elements of the Mind-up curriculum (Daniel Siegal, US), the Australian-based Smiling Mind Education Program and Meditation Capsules Mindfulness Program (Etty-Leal 2010). The research methods included a self-completed student questionnaire and Smiley Face Emotions evaluation sheets, interviews with teachers and classroom observations. Critical reflections that arose for the researcher from reviewing the literature and conducting the evaluation were: the conceptual confusion about what a mindfulness-based programme or teaching approach entails; the importance of ethical principles and frameworks for implementing mindfulness-based approaches in middle-school settings; issues of safety and wellbeing, specifically a duty of care for when emotions bubble to the surface for children experiencing trauma in their lives; and, that programmes are generally conducted in private schools where student populations are limited in socio-economic and cultural diversity. The latter situation poses questions about the implications of adopting mindfulness approaches with diverse socioeconomic and cultural groups along with access and equity

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Introduction The adoption of mindfulness (or contemplative based approaches) is escalating across many sectors in Australia and internationally. In the United Kingdom, for instance, an All Party Parliamentary Mindfulness Group (2015) was recently set up, to look at the benefits of bringing mindfulness into public policy. The anticipated benefits of adopting mindfulness practices are numerous. In part, this is encouraged by a rapidly growing academic and grey literature purporting to present the benefits of mindfulness. Mindfulness is associated with increased general wellbeing and improved psychological health (Brown and Ryan 2003). Studies report that people who practice mindfulness-based stress reduction techniques do experience reduced stress compared to people who do not participate in any meditation or who participate in standard relaxation techniques. Participants in mindfulness-based activities also report reduced ruminative thinking and anxiety (Brown and Ryan 2003) along with increased selfcompassion and empathy (Chiesa and Serretti 2009). In addition, a metaanalysis of studies (Grossman et al. 2004) investigated the effectiveness of mindfulness-based stress reduction programmes, and concluded that mindfulness improves coping for both clinical and nonclinical populations and also reduces reactions to experiencing stress in everyday life. These results were present across different psychological measures, such as anxiety and depression, and were associated with improved physical health, and experiences of medical symptoms and physical pain. Neuropsychologists and scientists have also given mindfulness credibility through measuring positive changes in brain chemistry and physiology in individuals that practice mindfulness. Engaging in mindfulness practices is linked to improved concentration and mental performance. Study findings suggest that enhancements in mood associated with increased mindfulness may also be responsible for significant improvements in cognitive functions (Zeidan et al. 2010). Specifically, mindfulness meditation programmes typically focus on maintaining a relaxed state of mind through concentrating on the breath and other bodily sensations. Participants are thus encouraged to recognise distracting thoughts that arise during mindfulness practice and re-focus their attention to their breathing and bodily sensations. In this way, it is argued, mindfulness meditation

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works to increase conscious awareness of cognitive processes and sustained attention, and reduces the amount of task-irrelevant information (Posner and Rothbart 1998). As mindfulness is associated with improved self-regulation of emotions, this is also suggested as a key factor in improved cognition (Moore and Malinowski 2009) and reductions in mind-wandering. Alternatively, uninhibited mind wandering, it is argued, reduces the amount of attention that can be focused on the task at hand affecting propensity for learning (Smallwood et al. 2009). Also related to the processes of learning, mindfulness stimulates a relaxation response. It evokes a reduction in autonomic nervous system hyper-arousal that mediates the actions of the hypothalamic, pituitary and adrenal glands, which maintains homeostasis of the nervous system. In turn this reduction in the stress response enhances cognitive abilities, such as the capacity to maintain attention, which is related to positive learning outcomes (Kass 2014, 7). Is it little wonder then that mindfulness practices are eagerly sought after in a contemporary world that is consumed with working harder and faster, and individuals achieving many goals simultaneously with resultant high levels of stress experienced. Given the anticipated benefits of adopting mindfulness-based approaches and links made to aspects of improved learning, it is hardly surprising that mindfulness-based practices are now increasingly taken up as part of teaching and learning programmes in schools. Within this context, to date, mindfulness approaches have various aims, including expectations of enhancing experiential and contemplative learning, increasing compassion in students, improving relationships between students, training attention for enhanced performance through increasing the ability to concentrate and reducing stress among both students and teachers (Albrecht et al. 2012, 34). However, to date, there is a deficit of studies that explore or evaluate how middle school students in particular experience these sorts of programmes introduced to classroom settings (Viafora et al. 2015). In addition, as many of these programmes are commonly taught by independent instructors (hired externally), there is a lack of knowledge about the effectiveness of programmes implemented by the regular class teacher or school counsellor during school hours (Britton et al. 2014). Knowledge is also lacking about what exactly is meant by a mindfulness-based teaching practice in schools or what such programmes entail (Viafora et al. 2015). This chapter reports on some of the key reflections and questions that arose for the researcher from the experience of evaluating one such programme, the pilot “Mindfulness at School” teaching programme implemented with a class of thirty, year-seven students at a primary school

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in the southern region of Adelaide, South Australia. The pilot programme was taught as part of Health and Personal Development and consisted of one, forty-five-minute class per week (for nine weeks). The evaluation methods included a self-completed student questionnaire and Smiley Face Emotions evaluation sheets, interviews with teachers and classroom observations. The more extensive findings and conclusions from the evaluation are reported elsewhere (Arthurson 2015) and are not fully reported on here. Rather, this chapter explores the critical reflections that arose directly for the researcher from the experiences of reviewing the literature and conducting the evaluation. The first of these issues is concerned with the conceptual confusion about what a mindfulness-based programme or teaching approach entails. Second, questions arose about the ethical underpinnings and principles or frameworks for implementing mindfulness-based approaches in middle-school settings. Third, there are important issues of safety and wellbeing, specifically a duty of care when emotions bubble up to the surface for children doing mindfulness practices that have experienced (or are currently experiencing) some sort of trauma in their lives, such as bullying or emotionally abusive home lives. Fourth, the existing programmes are generally conducted in private schools, with few exceptions with higher socio-economic student populations that are limited in socioeconomic or cultural diversity. This situation poses questions about the appropriateness of adopting mindfulness approaches with diverse socioeconomic and cultural groups, along with the implications in terms of access and equity and social justice. In having laid out the terrain for this chapter it is important to note that it is not the author’s intention to dampen enthusiasm for mindfulness type approaches, as I have long been a mindfulness practitioner and experienced the benefits first hand. Rather, it is an appeal to proceed with care. There is some discomfit felt with the rush to implement mindfulness approaches across divergent areas, and the oft-times messianic focus on positive mindfulness as a somewhat “magic bullet” for the malaise of contemporary life. Given this situation, it seems important to step back and take a critical approach to examine some of the difficulties and essential questions related to mindfulness practices, especially in middle schools with children where these practices are rapidly growing in popularity.

The conceptual confusion about mindfulness A key observation from the Mindfulness at School Project, and exploration of the literature, is that “mindfulness” is commonly used as a catchall or “shorthand” term for a complex array of theoretical constructs and

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associated practices and activities. The use of the term in the West in secular applications (or non-Buddhist contexts) poses numerous conceptual and analytical difficulties, which some commentators are grappling with in the broader debates about mindfulness. These difficulties seem to stem in part from attempts to merge the eastern origins of mindfulness with a goaldirected Western worldview (Chiesa and Serretti 2013). In general, within the literature, and specifically in the practice of secular mindfulness, where the practices are adopted outside the traditional Buddhist meditative context and used as interventions in a variety of settings, including schools, the term mindfulness is often referred to with a lack of precision. The relationship between mindfulness and meditation, for instance, is confusing with “mindfulness” and “meditation” often used interchangeably and substituted as terms for one another as if they are the same thing. Although closely inter-related, mindfulness is distinct from meditation. It is both a state (that is, experienced) and a process or practice (either formal or informal) that leads to mindfulness. Thich Nhat Hahn (1978, 7) drawing from the Sutra on mindfulness, depicts the experience of mindfulness as follows: when walking being conscious of walking, and when sitting being conscious of sitting, and so on in various daily activities. Thus, no matter what position the body is in the practitioner is conscious of that position. Many (but not all) of the broader studies on mindfulness focus on the use of mindfulness meditation, (as adopted by Jon Kabat-Zinn in the Mindfulness-based Stress Reduction (MBSR) Program), and his well-known definition of mindfulness as meaning to pay “attention in a particular way; on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn 1994). It is important to recognise that this is not the only type of meditation practice that is contemplative. Other traditions may utilise intention (for instance, using imagery for the purpose of healing) or inquiry, where one may focus on questions such as “what is my life purpose.” Within these styles of meditation, there are also a variety of practices. Some practices focus on meditation using breath awareness, awareness of thoughts, awareness of bodily sensations, sound meditation, loving kindness, or focusing on a point of light (Britton et al. 2014). There are also a myriad of mindfulness practices that have a more active physical basis to the practice. In many contemplative traditions the physically based practices are preparative for the body subsequently sitting in meditation, qi gong for instance is a traditional form of meditative exercise, and other physical forms include some types of yoga, tai chi and walking meditations. Without clarifying the nuance of what the mindfulness practices entail it is like stating that one practices yoga but without providing any detail of the specific yoga tradition. Drawing on this

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analogy, there are many different types of yoga; some involve gentle Ɨsana (postures) and meditative practice while others (especially in the West) are primarily Ɨsana based and physically strong practices. The result of this ambiguity about what the mindfulness practice involves leads to confusion about the nature of mindfulness. In turn, the relationship between mindfulness and other notions, such as attention and concentration, is unclear (Williams et al. 2011). Further adding to the complexity of conceptualising mindfulness in the West, a diverse array of practitioners have developed their own definitions, aims, expectations and questions about what mindfulness is and its purpose. These include, but are not limited to, Buddhist teachers, meditation practitioners, neuroscientists, school teachers, social workers, psychologists, psychiatrists, school counsellors and other professional practitioners. Thus, one individual may adopt a mindfulness practice for spiritual reasons, while another may seek to improve children’s learning at school, or another might use it as a treatment modality in clinical practice. In clinical practice, for instance, reflective contemplation (as supported through mindfulness practices) is proposed as a way of developing psychological resilience and the ability to cope with change or deal with emotional tension and respond calmly to external events through selfreflection (Kass, 2014, 7). Different modalities specialise in starting participants in diverse practices to develop mindfulness; it might involve, for instance, calming and relaxation, practicing compassion, devotion or creative activities like art or music based mindfulness programmes (Rosch 2007). Within the limited literature that explores the adoption of mindfulness in schools, the programmes seem to reflect a myriad of activities and approaches, although details of what exactly is involved are limited. As pointed out by others (Schoeberlein and Koffler 2005 in Wisner 2014), many mindfulness meditation practices are a loose implementation of MBSR. The Mindfulness at School project combined aspects from several existing programmes, including the Mind-up Curriculum developed by Daniel Siegal through the US based Hawn Foundation (2014), along with the Australian based Smiling Mind education programme and Janet EttyLeal (2010) Meditation Capsules Mindfulness Program (2015). Some of the specific activities used were: introducing brain anatomy and function and neuroplasticity; calming the amygdala, the fight or flight response; progressive muscle relaxation; soles of the feet meditation; mindful eating using sultanas; mindful movements; and identifying how students could calm their heart rate, with heart rates measured before and after meditation practice. In using the US based programmes in some instances it was nec-

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essary to revise them slightly to make them contextually relevant to the Australian education system. Other studies, for instance, use the “Mindful Schools” curriculum (Black and Fernando 2014), a secular mindfulness intervention developed by the researcher (Wisner 2014), and drawn from work developed by Hanh (2011) in Planting Seeds: Practicing Mindfulness with Children and Amy Saltzman, Still Quiet Place (2008) (both cited in Viafora et al. 2015). Overall, there are multiple definitions and understandings of mindfulness and imprecision with the secular use of terms such as mindfulness and meditation, which make mindfulness a difficult concept to define and operationalise. Grossman (2008) suggests that mindfulness as contextualised within Buddhist culture eludes comprehension by means of intellectual thinking and is thus outside of the sphere of academic thought. From his perspective, an authentic understanding requires extensive meditation and introspective insight by the practitioner. The implication is that experiential practice rather than intellectual searching or reading about mindfulness is the key to understanding it. Hence, many academic discussions on mindfulness that attempt to provide definitional clarity do not necessarily achieve this goal. In practice, there is a tendency to conflate the term with other concepts as discussed, such as meditation and much of the literature on mindfulness is shorthand for the range of different processes and practices that may or may not be intertwined. So does this conceptual muddiness matter? Clearly when introducing mindfulness into middle schools with children it is important to differentiate between the theoretical constructs and practices (or different activities) of mindfulness, and the goals of introducing mindfulness along with the related ethical considerations.

Ethical considerations for contemporary uses of mindfulness Despite the good intentions of adopting a secular form of mindfulness in the West, what might be lost in the process of transference (Greenberg and Mitra 2015)? From the Buddhist perspective, mindfulness is meant to lead to awakening and realisation of the impermanence of life in order to breakthrough to a more authentic life. As such, the traditional Buddhist perspective of mindfulness is underpinned by a framework emphasising ethics, ethical constraints, ethical contemplation and how to conduct life in an ethical way. In the Buddhist sense, mindfulness was not intended for use as a clinical technique to treat particular ailments or reduce tension, nor as a tool to improve learning in classrooms (Gordon 2009). This is not

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to argue that mindfulness should not be adopted in non-Buddhist contexts. Clearly if adopting mindfulness leads to increased wellbeing then it is a good thing. However, despite increasing academic literature dedicated to exploring secular mindfulness and its practices in the West, there is a lack of attention within this literature to incorporation of the ethical aspects of adapting mindfulness in this context. An initial search of the Medline database on “mindfulness and ethics,” for instance, yielded only three articles specifically focused on ethical issues with Mindfulness-based Interventions (MBIs) as used in clinical applications (McCown 2013, 17). More recently, an edition of the journal Mindfulness was dedicated to questions about the role of ethics in the teaching of contemporary or secular mindfulness, as raised in a lead article by Monterio et al. (2015) and a number of associated commentary articles. Monterio et al. (2015) raised several concerns from the Buddhist community about the teaching of what is termed “contemporary mindfulness” as delineated from “traditional mindfulness.” The former is described as not explicitly based in Buddhist practice or teaching, nor does it include ethics as part of the teaching or related self-contemplation about objectionable thoughts, speech and actions. Of key concern is that the lack of an ethical framework in secular mindfulness means that it can be easily adopted without ethical reflection, which risks the misuse of the practices and could lead to harm. A related argument, expressed in the wider literature, is that the lack of ethical contemplation stems from viewing mindfulness within an information-processing paradigm, focused on technical and process aspects of mindfulness. This perspective does not require contemplation about how to live a better life or consideration of the consequences of one’s actions. An example cited is whereby mindfulness is used in the defence forces to enhance the ability for recruits to harm others, rather than focusing on compassion towards “the enemy” (Stanley 2013, 158). Perhaps the way forward, as Purser (2015, 42) argues, is that rather than misinterpreting “Buddhist ethics through a Western lens, a secularised ethics would focus on the relation between behaviour and its effect on one’s own and others’ genuine wellbeing.” This form of ethics would not require grounding in religion or concepts of faith so could well suit secular applications of mindfulness. Likewise, where secular mindfulness is currently merged with educational practices and children in schools, consideration of the role of ethics in terms of developing a coherent set of values about human conduct or motives is also lacking. Nevertheless, the use in a goal-driven context of schools may remove contemplative practices from the traditional focus on

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present moment awareness, life-long practice and ongoing contemplation and reflection. Instead it might be used merely as a goal-oriented technique to improve individual performance on secondary outcomes. Will it be used, for instance, to assist children to improve their grades in undertaking the National Assessment Program- Literacy and Numeracy (Naplan)? Such an approach may favour the pursuit of individual gain at the expense of collective benefit, a blurring between self and others and development of a social conscience. The question arises that if links are drawn between increased classroom performance and mindfulness, will too much be expected from mindfulness practice? Will the approach then be rejected if improvements or achievement of specific goals are not quickly seen? Yet the benefits of mindfulness may not always be obvious. Increased awareness may still occur over time but this is hard to measure objectively (Zeltzer 2005 in Goodman and Kaiser Greenland 2009, 426). It may not be achieved with short term adoption, as in a six- or eight-week course implemented in a classroom. Or, alternately, will mindfulness be used as a way to pacify or deal with “problem” children? Without ethical contemplation, the teaching of mindfulness may encourage a focus on changing the way a child perceives a deleterious situation or manages stress, deflecting awareness away from the underlying factors that caused the problem behaviours or stress in the first place. The former approach locates the source of the problem within the individual’s perceptions rather than focusing on the structural forces and circumstances that may cause and perpetuate injustice and inequality. In schools this might translate to seeking to make children happier and increasing their grades while leaving them in damaging family or other circumstances. In turn, this situation raises issues of duty of care and safety and wellbeing in the teaching of mindfulness in schools.

Safety and wellbeing and duty of care Using mindfulness-based approaches with children is a fairly new intervention. As Viafora et al. (2015, 1181) point out, it has “little empirical foundation” and even less “is known about mindfulness with children who suffer from post-traumatic symptoms.” In a classroom of typically around thirty students, it is highly likely that several students will have experienced or currently be experiencing some form of trauma or stress in their day-to-day lives. In the Mindfulness at School Project, a lot of students reported experiencing stress “almost always” or for up to “half of the time”: 41.3% (week one), 48.2% (week three) and 42.3% (week nine) (Arthurson 2015). While mindfulness-type approaches can bring deep-

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rooted issues to the surface and, with appropriate support, can lead to healing, for other individuals the process of engaging in these practices may be overwhelming. Some examples of these latter instances (with adults) are detailed by Willoughby Britton at Brown University in the US as part of the “Dark Night of the Soul Project.”1 The Mindfulness at Schools Project clearly identified that there were several children, as expressed here—specifically in the meditations—who became overwhelmed by traumatic emotions and feelings of stress and anxiety: “My mind opens up too much, emotions, problems, everything just overwhelms my mind. It has not helped me at all.” “I just remember feeling sad or uncomfortable.”

In these cases, the key point for consideration seems not so much a questioning of the value of implementing mindfulness practices in classrooms, but rather about whether a child’s experience of trauma, distress or negative emotions is actually recognised and then subsequently handled so that the situation leads to healing rather than more trauma. For a teacher managing a busy classroom of thirty or so children these experiences may go unnoticed. In addition, mindfulness classes are delivered by a range of people, including classroom teachers, school counsellors and facilitators running private businesses contracted by schools. Many of the instructors are from outside the schools and not familiar with the children or aware of their backgrounds and experiences on a day-to-day basis (Williams et al. 2011). They may just come into the school to implement a short six- to eight-week course. This lack of familiarity with the children may also be true even for a school counsellor working in a school where there are several hundred children. Nevertheless, even if the teacher or instructor is made aware of a child’s distress, they may not have the skills and qualifications to deal with the issue effectively. Goodman and Kaiser Greenland (2009, 420421), for instance, reported occurrences of teaching mindfulness to children who had experienced domestic violence and abuse, whereby one child could not lie on the floor or close her eyes as a result of the latter experience. Highly developed clinical skills are critical to deal with these sorts of situations. In the Mindfulness at Schools Project, the facilitator of the mindfulness classes was a school counsellor and was well able to deal with the issues at hand. There were also two people present in the classes at all times, the regular class teacher and school counsellor, making it more likely that at least one person would notice if a child was

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experiencing distress. Thus, an experienced counsellor or other practitioner with well-developed clinical skills needs to be on hand to deal appropriately with these situations should they arise. More research is also needed to investigate the appropriateness of certain mindfulness interventions and practices with populations of children (Burke 2010). However, due to the nature of working with children, many considerations need to be made about this type of research. Associated with this issue is the importance of giving children a choice about whether or not they want to participate in particular mindfulness-based activities in classrooms. Again, by raising these duty of care issues it is not suggesting that mindfulness approaches should not be undertaken with children, but rather that these aspects require consideration when teaching mindfulness to children in classroom contexts. With the explosion of mindfulness-based practices and interventions, one of the most pressing issues relates to the standards that need to be maintained, and the ways in which mindfulness should be taught and practiced within school settings. The initial process of integrating mindfulness into contemporary settings was developed through a small number of teacher training organisations that were predominantly led by first and second-generation leaders. There is concern that the rapidly expanding mindfulness training programmes risk diluting the integrity of programmes (Crane et al. 2012). An internet search using the key words “mindfulness course” yields hundreds of online courses, programme manuals and instruction books. This finding poses an important question about whether, through this propagation, an integral part of mindfulness practice is lost. Specifically, being taught by a person who themselves participates in ongoing mindfulness practices. As in the current Mindfulness at School project, within other school settings, people with a wide range of qualifications and experiences are teaching mindfulness. This ranges from Buddhists with no teacher training, to volunteers with meditation experience, and teachers integrating mindfulness-based techniques on their own, with or without personal practice. While there are advantages in terms of bringing in new experiences to broaden students’ perspectives, there are issues with maintaining the central principles of mindfulness for people who are not mindfulness teachers, and with teachers that have no personal experience and are teaching it based on manuals that they have acquired. The literature suggests that the quality of mindfulness teaching is related to the understanding and depth of practice that the teacher has (Kabat-Zinn 2011). The question of how long one should have practiced their own mindfulness practice before being qualified to teach children is

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the subject of vigorous debate in the field. It is generally argued within the literature that in order to teach mindfulness, teachers/users of mindfulness practices should have personal experience and practice mindfulness regularly before incorporating mindfulness into the classroom context. Essentially, it is argued that this is because they need to apply the mindfulness practices in their own life and embody the qualities of mindfulness in order to teach it. Debate on this issue is continuing and, in response, several organisations have stipulated guidelines for the teaching of mindfulness (see Crane et al. 2010, 2012 for a summary of specific initiatives for Mindfulness-based Cognitive Therapy (MBCT) teachers). To date, though, little thought has been given to the relevance or issue of current mindfulness approaches to groups with socioeconomic and cultural diversity.

Mindfulness and social and cultural diversity The Mindfulness at School Project was conducted at a private school. For the evaluator, this posed the question of whether there was any research into the use of mindfulness practices in schools that constituted children from less advantaged social and cultural backgrounds; if so, to what ends within these contexts mindfulness practices might be used. In reviewing the literature, despite the overall proliferation of research on mindfulness, few studies were found that focus specifically on people from low socioeconomic backgrounds, let alone disadvantaged schoolchildren. A study on mindfulness undertaken with a severely economically distressed population in Canada (Hick and Furlotte 2010, 283) similarly noted that, at the time, there were only two published studies internationally (both US based) that explored mindfulness approaches with disadvantaged groups. The researchers’ key point, though, was to raise questions about the suitability of using mainstream secular mindfulness approaches with disadvantaged groups. Specifically, the earlier studies on mindfulness omitted to examine important institutional barriers and societal differences experienced by disadvantaged groups. As such, Hick and Furlotte’s (2010) explorations pointed to deficits in knowledge and information about the benefits or suitability of applying mainstream mindfulness approaches with diverse population groups. Thus, in their pilot study, Hick and Furlotte (2010) modified the MBSR programme in order to accommodate the financial, transport and language constraints and cultural differences of their study participants. Since then, with few exceptions, research studies that explore mindfulness with members from disadvantaged groups are as

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part of a clinical treatment population, for instance, as treatment for depression or anxiety. There are very few studies that explore mindfulness-based approaches in socially or culturally diverse school settings. Black and Fernando (2014) implemented a five-week programme, comprised of mindful meditative practices, with low-income ethnic minority schoolchildren in kindergarten through to sixth grade. The findings suggested that mindfulness training might benefit teachers’ perceptions of improved classroom behaviour in the children. While this has implications for improving the classroom learning environment, the authors pointed out that the findings were limited due to the lack of a control group. Klatt et al. (2012), also in a US-based study, implemented a “Move into Learning Program” consisting of mindfulness meditation and breathing exercises with a third-year class at a low-income primary school. The teachers reported less hyperactive behavior, ADHD and inattentiveness of children. Two other exploratory studies with low socio-economic groups of schoolchildren investigated the effects of mindfulness on stress. First, Britton et al. (2014) found that meditators in their study were less likely than controls to develop self-harming thoughts and behaviours or ideas about suicide. Second, Costello and Lawler (2014) reported that there were significant reductions in children’s stress post the mindfulness intervention. Another study of homeless youth in a classroom situation found that mindfulness helped the youth to deal with feelings of anger and stress (Viafora et al. 2015). Wisner (2014) found that high school students attending a compensatory school perceived that mindfulness led to a calmer more peaceful school climate. The students rated this benefit of mindfulness as the most important to their functioning at school. Nevertheless, none of these studies specifically consider the questions posed by Hick and Furlotte (2010) about the suitability of using existing mainstream mindfulness approaches with disadvantaged groups, and their key point of needing to take account of important institutional barriers and societal differences that they experience. These aspects may include family disruptions, lack of financial resources, language barriers and mental health concerns. Returning to Hick and Furlotte’s (2010) analysis, they move the debate about mindfulness beyond a focus on the pursuit of personal wellbeing or individual change to incorporating issues of societal change and collective engagement. They argue that it is important to investigate how mindfulness can assist in affecting social change through combining mindfulness and social justice approaches. While they apply this to their specific field of social work, the issues raised appear applicable to other domains. They envisage a role for mindfulness as an approach to working

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with clients in a “mindful social action” type of method, to develop awareness of the dynamics of oppression and understanding of the systemic roots of their poverty. To this end, they attempt to incorporate the wider structural aspects of poverty rather than just individualised psychological afflictions. In this model, it is not just about addressing inner problems but situating them in relation to oppressive societal structures, which they convincingly argue is necessary for transformative social change (Hick and Furlotte 2010). While recognising the theoretical and practical challenges of applying this approach, the critical starting point is to use mindfulness to examine both internalised and externalised oppression within a structural framework that is both felt and lived in practice rather than just cerebral. From this perspective, a narrowly defined or reductive concept of mindfulness is inadequate. The promise of mindfulness, which could complement other programmes that seek transformation of suffering or elimination of inequality, will not be fulfilled unless awareness is actively focused on the nature of wider societal structures and processes causing poverty and inequality—which drives behaviours and relations with others. Without encapsulating a focus on diversity and social justice all sorts of questions arise about the utility of secular mindfulness approaches in schools with children. Will it seem like something positive is being done while the focus is on individual behavior change, and making children “happier” within situations of entrenched inequality and systemic injustice? The risk in school settings with vulnerable children is that mindfulness may encourage a focus on changing the way a child perceives a situation rather than changing that situation or certain things in their life, therefore locating the source of the problem within the child’s perceptions rather than focusing on the situations, which may lead to and perpetuate the issues. Dreyfus (2011, 52), for instance, argues that an over-emphasis on the non-judgmental nature of mindfulness, and the argument that problems stem from the way people conceptualise their problems, risks a one-sided understanding of mindfulness “as a form of therapeutically helpful spacious quietness.” Will the goals merely focus on improving attention and productivity and relieving stress? In turn, these questions lead back to issues raised in the earlier sections about “Ethical Considerations,” and the “Conceptual Confusion about Mindfulness.” One way forward perhaps is using mindfulness as part of a wider social determinants of health approach that starts from the point of holistic health and wellbeing. From this viewpoint health and wellbeing is created by complex multi-directional interactions between people and the environment at multiple levels including individual, group and community.

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Conclusion While the use of mindfulness-based programmes in classroom settings is escalating, the findings reported here illustrate that we need to progress with care. There are a number of key issues requiring further consideration: the conceptual confusion around what a mindfulness-based programme or teaching approach entails; the lack of ethical principles and frameworks for implementing secular mindfulness-based approaches in school settings; and a duty of care when introducing mindfulness to children experiencing trauma in their lives. In a practical sense, what do these findings mean for persons implementing mindfulness-based approaches in schools? First, that concepts and terms must be clearly defined. It is critical to differentiate between the theoretical constructs and practices, or different activities, of mindfulness as well as the goals of introducing mindfulness in classroom settings. Second, in order to protect vulnerable children, ethical principles and frameworks for implementing secular mindfulness-based approaches are vital. Third, staff need appropriate skills and personal practice of mindfulness, not just to teach mindfulness, but also for appropriately responding to and assisting vulnerable children. Despite the large body of research on mindfulness, there are still gaps in the literature. From an access and equity and social justice perspective, knowledge is lacking about implementing programmes with culturally and socio-economically diverse student populations. These groups differ from others in that they grapple with major institutional barriers and societal differences. As such, a narrowly defined or reductive concept of mindfulness would be inadequate for working with these groups. This is a key area for further exploration. Additional research is also required about how contemporary secular applications of mindfulness in educational settings can incorporate ethical reflection and ethical frameworks. The methods of conducting research are also important for expanding our understandings. Most of the studies of mindfulness in schools use quantitative methods and do not specifically explore the children’s perspectives (Costello and Lawler 2014). More studies are needed (as in the current Mindfulness at Schools evaluation) that use qualitative methods to explore mindfulness from the children’s unique perspectives. These approaches provide the personal and nuanced accounts that are not possible with quantitative research. In conclusion, despite the uncertainties discussed above about mindfulness in middle schools, along with the areas identified for further re-

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search—there seems to be general consensus, as Stanley (2013, 153) contends, that mindfulness is a “good thing.”

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Interventions: Learning from the UK Experience.” Mindfulness 1(2): 7486. doi: 10.1007/s12671-010-0010-9. Crane, Rebecca S., Willem Kuyken, J. Mark G. Williams, Richard P. Hastings, Lucinda Cooper, and Melanie J. V. Fennell. 2012. “Competence in Teaching Mindfulness-based Courses: Concepts, Development and Assessment.” Mindfulness 3(1): 7684. doi: 10.1007/s12671-011-0073-2. Dreyfus, Georges. 2011. “Is Mindfulness Present-centered and Non-judgmental? A Discussion of the Cognitive Dimensions of Mindfulness” Contemporary Buddhism 12(1): 4154. doi: 10.1080/14639947.2011.564815. Etty-Leal, Janet. 2010. Meditation Capsules: a Mindfulness Program for Children. Melbourne: Meditation Capsules. Goodman, Trudy, and Susan Kaiser Greenland. 2009. “Mindfulness with Children: Working with Difficult Emotions.” In Clinical Handbook of Mindfulness, edited by Fabrizio Didonna, 417429. New York: Springer. Gordon, David Jacobs. 2009 "A Critical History of Mindfulness-Based Psychology". Honors Thesis, Wesleyan University. http://wesscholar.wesleyan.edu/etd_hon_theses/246. Greenberg, Mark T., and Joy L. Mitra. 2015. “From Mindfulness to Right Mindfulness: The Intersection of Awareness and Ethics.” Mindfulness 6: 7478. doi: 10.1007/s12671-014-0384-1. Grossman, Paul, Ludge Niemann, Stefan Schmidt, and Harald Walach. 2004. “Mindfulness-based Stress Reduction and Health Benefits: A Meta-analysis.” Journal of Psychosomatic Research 57(1): 3543. doi: 10.1016/S00223999(03)00573-7. Grossman, Paul. 2008. “On Measuring Mindfulness in Psychosomatic and Psychological Research.” Journal of Psychosomatic Research 64(4): 405408. doi: 10.1016/j.jpsychores.2008.02.001. Hahn, Thich Nhat. 1978. The Miracle of Mindfulness. Boston: Beacon Press. Hick, Steven F., and Charles Furlotte. 2009. “An Exploratory Study of Radical Mindfulness Training with Severely Economically Disadvanatged People: Findings of a Canadian Study.” Australian Social Work 63(3): 281298. doi: 10.1080/0312407X.2010.496865. The Hawn Foundation. 2014. “Mindup: Creating a World Where Children Thrive.” http://thehawnfoundation.org/mindup/. Kabat-Zinn, Jon. 1994. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion Books. —. 2011. “Some Reflections on the Origins of MBSR, Skillful Means, and the Trouble with Maps.” Contemporary Buddhism 12(01): 281306. doi: 10.1080/14639947.2011.564844. Kass, Jared D. 2014. “Person-centered Spiritual Maturation: A Multidimensional Model.” Journal of Humanistic Psychology 55(1): 5376. Doi: 10.1177/0022167814525261. Klatt, M., E. Browne, K. Harpster, and J. Case-Smith. 2012. “Sustained Effects of a Mindfulness-Based Classroom Intervention on Behavior in Urban,

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Underserved Children.” BMC Complementary and Alternative Medicine 6(2): 2139. doi: 10.1186/1472-6882-12-S1-P305. McCown, Donald. 2013. The Ethical Space of Mindfulness in Clinical Practice. London: Jessica Kingsley. Monteiro, Lynette M., R. F. Musten. And Jane Compson. 2015. “Traditional and Contemporary Mindfulness: Finding the Middle Path in the Tangle of Concerns.” Mindfulness 6: 113. doi: 10.1007/s12671-014-0301-7. Moore, Adam., and Peter Malinowski. 2009. “Meditation, Mindfulness and Cognitive Flexibility.” Consciousness and Cognition 18(1): 176186. doi: 10.1016/j.concog.2008.12.008. Posner, Michael I., and Mary K. Rothbart. 1998. “Attention, Self–regulation and Consciousness.” Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 353(1377): 19151927. doi: 10.1098/rstb.1998.0344. Purser, Ronald E. 2015. “Clearing the Muddled Path of Traditional and Contemporary Mindfulness: a response to Monteiro, Musten, and Compson.” Mindfulness 6: 2345. doi: 10.1007/s12671-014-0373-4. Rosch, Eleanor. 2007. “More than Mindfulness: When you have a Tiger by the Tail, Let it Eat You.” Psychological Inquiry 18(4): 258264. http://www.talispiritualeducation.org.il/en/file/160. Smallwood, Jonathan, Annamary Fitzgerald, Lynden K. Miles, and Louise H. Phillips. 2009. “Shifting Moods, Wandering Minds: Negative Moods Lead the Mind to Wander.” Emotion 9(2): 271276. doi: 10.1037/a0014855. Smiling Mind. 2015. http://smilingmind.com.au/. Stanley, Steven. 2013. “‘Things Said or Done Long Ago are Recalled and Remembered’: The Ethics of Mindfulness in Early Buddhism, Psychotherapy and Clinical Psychology.” European Journal of Psychotherapy & Counselling 15(2): 151162. doi: 10.1080/13642537.2013.795338. Viafora, David P., Sally G. Mathiesen, and Sara J. Unsworth. 2015. “Teaching Mindfulness to Middle School Students and Homeless Youth in School Classrooms.” Journal of Child and Family Studies 24(5): 11791191. doi: 10.1007/s10826-014-9926-3. Willams, J. Mark. G., and Jon Kabat-Zinn. 2011. “Mindfulness: Diverse Perspectives on its Meaning, Origins, and Multiple Applications at the Intersection of Science and Dharma.” Contemporary Buddhism 12(1): 118. Doi: 10.1080/14639947.2011.564811. Wisner, Betsy L. 2014. “An Exploratory Study of Mindfulness Meditation for Alternative School Students: Perceived Benefits for Improving School Climate and Student Functioning.” Mindfulness 5(6): 626638. doi: 10.1007/s12671013-0215-9. Zeidan, Fadel, Susan K. Johnson, Bruce J. Diamond, Zhanna David, and Paula Goolkasian. 2010. “Mindfulness Meditation Improves Cognition: Evidence of Brief Mental Training.” Consciousness and Cognition 19(2): 597605. doi: 10.1016/j.concog.2010.03.014.

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http://www.theatlantic.com/health/archive/2014/06/the-dark-knight-of-thesouls/372766/

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CHAPTER FOUR MINDFULNESS IN EDUCATION AS A WHOLE SCHOOL APPROACH: PRINCIPLES, INSIGHTS AND OUTCOMES NIMROD SHEINMAN AND LINOR L. HADAR

Abstract Mindfulness in schools is a growing field, which is evident by the rapid increase of mindfulness in education programmes around the world. The interest is apparent by the growing number of reports, publications and peer reviews. Until recently, most of the published data examined interventions that were carried out over periods of weeks (420), were not implemented in the whole school, and were not continued as an integral part of the school's curriculum and culture. A long-term mindfulness in education project, designed from a whole school perspective, is a relatively new concept. As a mode of intervention, the best framework for such an approach seems to be the 'Health Promoting Schools' initiative of the World Health Organization, which has been defined, applied and studied. A whole school mindfulness-based model, when designed by these principles, involves full integration of mindfulness in the school curriculum, engagement of schoolteachers, incorporation of parents, and a gradual long-term process which influences the school's culture and climate. This chapter describes Israel's Whole School Mindfulness in Education (WSMED) programme, which has been implemented in various public primary schools (300500 students each) since 2000. The programme was primarily designed for local health promoting schools, but has been implemented since in other schools with different orientations. In the WSMED model, mindfulness-based lessons become an integral part of the school's curriculum, are offered to all the classes on a weekly basis, and continue year after year as a mandatory topic. Although studies on mindfulness in schools have shown various shortterm benefits and outcomes, the effect of a whole school approach is still

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Introduction: Mindfulness in Education Integrating mindfulness-based principles and practices through a whole-school approach is a relatively new topic. Although mindfulness in education has become apparent in many countries and schools around the world (Felver et al. 2016; Meiklejohn et al. 2012; Schonert-Reichl and Roeser 2016; Zenner et al. 2014; Zoogman et al. 2015), most intervention projects so far were carried out for limited periods of weeks (Felver et al. 2016; Zenner et al. 2014; Zoogman et al. 2016), were not implemented in a whole school context, and were not continued on a year to year basis as an integral part of the school's curriculum and educational approach. In the last decade, interest in mindfulness with children (and adolescents) and mindfulness in schools has gone through a rapid expansion. The interest can be linked to the significant body of research documenting the clinical outcomes of mindfulness-based interventions with adults (Gotink et al. 2015), the contribution of mindfulness to healthy adults (Khoury 2015), and the positive impact of mindfulness on children and youth (Weare 2012; Zoogman et al. 2015). The growing interest is supported by promising clinical outcomes of mindfulness with children and youth (Greenberg and Harris 2012), the feasibility of school-based mindfulness (Felver and Jennings 2016; Kuyken et al. 2013; Mendelson 2010; Napoli et al. 2005; Zenner, Herrnleben-Kurz, and Walach 2014; Weare 2012), and the need for a more integrative and meaningful education intended to balance deficiencies and gaps in today's contemporary education (Davidson et al. 2002; Hart 2004; Zajonc 2016). In addition, the contribution of mindfulness-based practices to children seems to have potential in many nonpathogenic and education-relevant domains, such as attention training, emotional regulation, health promotion, stress management, social and emotional learning, compassion, resilience and wellness (See Schonert-Reichl and Roeser 2016 for updated

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reviews). As an experience, a life-skill and a resource for learning, mindfulness might be a unique asset to contemporary education. Schools provide the most effective and efficient way to reach young people, as well as educators, children's families and community members. Promoting health through schools enhances both health and the capacity of pupils to learn (World Health Organization 2004). Therefore, with the potential benefits of mindfulness to children, school appears to be a relevant and excellent location for mindfulness in education initiatives (Felver et al. 2016; Greenberg and Harris 2012; Rempel 2012; Zenner et al. 2014). Until now, many in-school interventions were based on the mindfulness-based stress reduction model with adults (see reviews in Meiklejohn 2012 and Zenner et al. 2014), which is grounded in 8 weekly sessions of about 2.5 hours. Each session is structured to integrate didactic presentations, instructional material, mindfulness-based practices, group dialogue, group inquiry and guidelines for “formal” and "informal" home practice (Santorelli 2014). Positive outcomes of these programmes rely on this integrative combination, as well as on the daily home practiceabout 60 minutes per day, 6 days per weekrequired for the two months duration of the course (Carmody and Baer 2008; Cullen 2011). Many mindfulness in education projects were designed and structured around this 8-week model principle, be they in England (Kuyken et al. 2013), New Zealand (Bernay et al. 2016), Australia (Ager et al. 2015; Arthurson 2015), and the US (Meiklejohn et al. 2012; Viafora 2014). However, unlike a typical mindfulness-based stress reduction session, a typical school session lasts 45 minutes (or less), which does not allow 'good enough' time for integration of presentation, explanation, exploration, practice, inquiry and troubleshooting. Beyond that, the daily practice component, the main ingredient for positive outcome with adults, is not a required component with children. Although short term benefits have been found in various mindfulness in school studies, the actual long-term benefits are still unknown (Felver 2016). Moreover, any short-term stand-alone model will be limited in its ability to impact the school's culture, to influence the school's climate and to enhance a whole-school change, which seem to be desired objectives (see Shonert-Reichel and Roeser 2016, 12). Research in the social and emotional learning field have already found that short-term programmes tend to produce short-lived results. On the other hand, programmes that were system-based, multi-component and multi-year were found more likely to foster the desired enduring benefits. Review of social and emotional learning projects have led to the

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recommendation to move away from piecemeal and fragmented approaches, and move toward a more comprehensive and coordinated plan and implementation (Greenberg et al. 2003). Corresponding reviews of school's mental health promotion programmes support the superiority of programmes which adopt a whole-school approach, with changes in school climate and continuous implementation over extensive periods of time, i.e., a year or longer (Wells 2003). A programme that is confined to changes in the curriculum or to changes in the classroom teacher's approach, need to be defined as a classroom approach (Well et al. 2003). A whole school approach, on the other hand, is one which tends to reach all the students and teachers, involves aspects of the social environment of the school, and engages the wider community (Well et al. 2003). From this perspective, implementation and integration of mindfulness at a whole-school level has so far been advocated but not yet achieved.

The Whole School Approach: mindfulness and the Health Promoting Schools model Mindfulness in schools is intimately linked to children's mental health (Joyce et al. 2010; Kuyken et al. 2013) and social and emotional health (Schonert-Reichl and Lawlor 2010; Semple et al. 2010), which are two important outcomes of a health promoting school (World Health Organization 2004). Schools have been recognised for many years as important settings for health enhancement. Health and education are strongly connected: healthy children achieve better results at school, and that in turn is associated with improved health later in life (Langford et al. 2014; Mukoma and Flisher 2004). Initially, school's health education focused on providing information, developing skills and guiding individuals toward healthy lifestyle choices. These approaches, however, failed to demonstrate significant success in the long term (Langford et al. 2014). In recognition of the limited success, a new holistic approach was developed in the late 1980's, influenced by the principles of the World Health Organization’s Ottawa Charter (World Health Organization 1986). The application of these principles into schools led to the ‘health promoting schools’ concept, whereby health is promoted through the whole school environment and not just through ‘health education’ in the curriculum (Langford et al. 2014; Mukoma and Flisher 2004). Unlike a curriculum-based approach, a whole school approach aims to provide children with integrated and positive experiences through the

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formal as well as the hidden curriculum (World Health Organization 1996). Health promoting schools focus on conditions that promote health, life skills and caring, and aim to build capacities for peace, justice, equity and sustainable development. They display support and commitment to enhance the emotional, social, physical and moral wellbeing of the students, as well as the school community (World Health Organization 2004). The multifaceted approach of the health promoting school model can be organised into three layers of a school's life (see Table 1): the school curriculum, the school ethos, and engagement with families or community (Langford et al. 2014).

School's curriculum

Health education topics are integrated into the school's formal in-class curriculums in order to help the students learn the desired knowledge, attitudes and skills.

School's culture and/ or environment

Providing an in-school supportive environment in relationship to the topics. Students and staff well-being is promoted through the "hidden" or "informal" curriculum, which encompasses the values and attitudes promoted within the school, its physical environment and setting.

Families and/or communities

Schools enables students to take action and/or seek to engage with families, community and outside agencies, recognising the influence of these other spheres on children's attitudes, behaviours and health.

Table 1: The Health Promoting Schools framework (adapted from Langford et al. 2014 and World Health Organization 2014).

Systematic reviews of the effectiveness of mental health promotion in schools strongly support this multifaceted perspective of the whole school approach. Programmes with a single strategy approach, or an individual behavioral approach, or a curriculum only approach, were less likely to show effectiveness (Wells et al. 2003; World Health Organization 2004). The most effective health promotion school programmes were the more holistic and multifactorial ones. They involved activities in more than one domain (i.e., curriculum, school environment and community), and were implemented over a long period of time (World Health Organization 2004).

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Israel's Whole-School Mindfulness in Education model Israel's whole-school mindfulness in education (WSMED) model, The Mindful Language programme (in Hebrew, Sfat Hakeshev), was initiated in 19981 in response to a request from a health promoting school, and was supported by the health promoting school division in the Ministry of Education. The programme was designed for elementary school children, first to sixth grade (age 6 to 12) and for their teaching staff, and was launched in 2000 in a South Tel-Aviv public primary school. Since its inception, this WSMED programme was introduced to about 20 elementary schools around the country (250500 children each). In most schools, the intervention was sustained for 23 years. In a few schools, the programme is now part of the school's identity and culture. In one primary school, the programme has been an integral part of the school's curriculums, culture and climate over the last 15 years. According to the WSMED model, mindfulness-based classes are integrated into each grade's curriculum, are being offered to all classes on a weekly basis, and continue year after year as a mandatory lesson. Class sessions consist of a synthesis of mindfulness, yoga and imagery-based processes, adapted for children and the school context. The model’s hypothesis is that children can experience, know and understand themselves “from within,” hence progressively develop wisdom and skills. The sessions are designed to resonate with specific themes known as important in child development: the urge for experience, the urge for mastery, the urge for wellness, the urge for the inner world of imagination and the urge for social connectedness (Olness and Gardner 1988). Since its initiation, the basic assumptions and foundations of the programme were inspired by theoretical and practical insight from a variety of fields: meditation and mindfulness perspectives (Gunaratana 1991; Hanh 1987; Hanh 1991; Kornfield & Goldstein 1987; Titmuss 1998; Kabat-Zinn 1990; Kornfield 1993), transformative processes with groups (Macy and Brown 1998), mind-body principles (Goleman 1993; Moyers 1993), imagery work (Murdock 1987; Rossman 1987), yoga for children (Khalsa 1998; Stewart et al. 1992), learning through movement (Barlin 1971), positive psychology (Seligman 1998) and salutogenic principles (Antonovsky 1979; Antonovsky 1987). The core principles include: incorporation of mindfulness in the school's curriculum; weekly lessons to all the classes; teaching throughout the whole year, year after year; emphasising experiential-based learning to promote health on a body, mind and spirit levels; training the teachers; informing the parents; paying attention in respect to age; promoting self-

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esteem, self-confidence and life skills; establishing clear rules and boundaries; and creating a positive climate. All these principles actually reflect the World Health Organization core guidelines, described in the Health Promoting Schools approach (Langford et al. 2014; World Health Organization 1996; World Health Organization 2004).

The Mindfulness Language Characteristics (See also Table 2) x Mindfulness-based sessions of one academic hour (45 minutes), taught once a week as an integral part of each class’s annual curriculum. x Each session is taught to the class as a whole (2535 children), with age appropriate adaptations and adjustments to class “personality.” x Sessions take place (for the most part) in a “mindfulness room,” without chairs and desks, designated by the school for the activity. There are personal mattresses for each child. x Sessions are taught by experienced mindfulness in education instructors. x Parents receive information and updates about the programme, and are invited to attend an introductory presentation or occasional short workshops. Parents are permitted to visit a class. x The homeroom teacher is required to attend the weekly mindful sessions, either as an observer, participant or both. x The school’s core faculty is trained and supervised in order to enable teachers to integrate short mindfulness-based practices in their own classes. Typically, teachers (most, not all) become comfortable to guide their classes (or to apply mindful principles in their own life) after the first or second year. x After about 12 years in each school, the in-class mindfulness “dose” is enhanced via various daily or weekly mindfulness sessions led by the homeroom teachers.

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School's curriculum

Weekly mindfulness-based sessions, integral to each grade's curriculum, are offered to all classes on a weekly basis year after year. Sessions are taught by mindfulness facilitators, with each class's homeroom teacher present. Experiential learning is enhanced by inquiry, mindful-journaling and class discussions. Students are coached to apply mindfulness-based skills during school time as well as in real-life situation.

School's culture and/or environment

A special room is designated by each school, without chairs and desks and with mattresses for each student. Each homeroom teacher is present in the weekly mindful sessions of their class. A monthly faculty meeting enhances teachers' gradual mindfulness-based teaching and learning. Mindfulness, led by teachers or children, is practiced before exams, at the beginning or end of a week, or when needed. Mindfulness is added to physical education classes, art classes, or as a short session at the beginning of a regular class. Mindfulness is being added to teachers' meetings.

Families and/or communities

Parents receive introductory information on the program. Parents receive updates on the mindfulness in schools project. Parents are invited to an introductory evening. Parents are invited to short mindfulness-based workshops for parents. Mindfulness is being practiced at school gatherings. Children are coached to introduce or teach mindfulness to their family members.

Table 2: The Mindful Language through the Health Promoting School framework.

A Typical Mindful Language Session Format Sessions are characterised by the following (See also Table 3): x Sessions integrate mindfulness, movement (yoga based) and specific imagery processes, blended with occasional short didactic explanations,

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x

x x x x x x x x x

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inquiry time, playful time, one-on-one interactions, and reminders about possible self-guided applications. Children are guided to pay attention to posture, breath, sounds, body boundaries, sensation, movements, images, emotions, thoughts and self-talk. There is ample use of metaphors as a way to explain a concept (i.e., the breath as a wave, the body as a mountain, the heart opening like a bud flowering, the arms soft like a cooked spaghetti), to explain a posture (i.e., become as tiny as a mouse, lie on your side straight like a ruler, stand tall and rooted like a strong tree), or describe a movement (i.e., moon walk for mindful walking). There are specific imagery-based scripts to enhance awareness or mindfulness-based outcomes, such as sense of safety (a “safe place” script), opening the heart (meeting an imagery compassionate animal), being with thoughts (noticing thoughts as if watching soap bubbles), being aware of emotional charges (searching for an emotion and giving it an image), or finding insights (inviting and dialoguing with an imaginary wise animal/figure). Children take off their shoes, enter the classroom one by one, walk to their personal mattress and lie down on their back. Sessions begin with children lying in their “private space,” guided through mindfulness of body, sensations, breath awareness and breath counting. Children are guided through small movements (while lying down), and/or though rubbing their palms and placing them at a body area that “wants” to be touched. Children are instructed to shift mindfully to a sitting position, and are guided through mindfulness to body, breath, body postures and possible balancing challenges. Children are guided to shift mindfully to a standing position, and are led through mindful movements, postures, breath awareness and balancing challenges. Children are guided to shift mindfully to lying down, and are led through body scan practice, compassion-based practice and/or imagery practice. Children are reminded to reflect on their experiences and insights, and to explore what they may want to remember as a useful possible “take home” tool. Children are reminded to write and express themselves in a personal mindful journal, later in the day or at home. Children are guided to leave the class mindfully, usually row by row or one by one.

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Activity Entering "ritual"

Description Each child is greeted at the door. Children walk to their personal mattress and lie down on their back.

5 minutes

Gathering attention

Mindfulness to the earth support, to body sensations, to the "inner story" of the presence, to sounds, and to the breath.

23 minutes

Small movements

Rubbing hands, massaging face, stretching in all directions.

1 minute

Transition to sitting

Gradual mindful shift from lying to sitting.

5 minutes

Inquiry

Reflections on the here and now, inquiry about experiences and insights, inquiry about self-applications, reflections on a chosen topic.

5 minutes

Movement while sitting

Mindful movement, breath awareness, posture awareness.

1 minute

Transition to standing

Gradual and conscious transition to standing.

510 minutes

Movement while standing

Mindful movement, breath awareness, posture awareness.

5 minutes

Playfulness

Mindfulness-based games, mindful work in couples.

1 minute

Transition to lying

Gradual gong-led transition to lying on the back.

5 minutes

Mindfulness and imagery

Mindfulness to the "inner story" at the end of the session. Guided Imagery: finding a safe place, inviting a caring or loving figure, meeting a wise animal, and more.

1 minute

Reminders

Guidance to reflect on today's class: experiences, challenges, insights, and possible "take home" skills.

5 minutes

Ending "ritual"

Leaving the room one by one or row by row, mindfully walking out (and putting shoes on).

Table 3: The Mindful LanguageA Sample of a Class.

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The teachers’ engagement factor While the implementation of in-class mindfulness sessions can be done by external facilitators, a whole school context requires the engagement of teachers. In any given school, each teacher's attitude towards the Mindful Language programme could either be supportive, neutral or negative, with corollary effect on the class. Studies on health promotion interventions in schools confirm that the teacher's contribution is essential for successful outcomes. The research also asserts that it should not be assumed that teachers will readily embrace a given concept, and therefore support for their process is recommended (MNJkoma and Flisher 2004). The success and sustainability of a school-based mental health programme is, to a large degree, teacher dependent. From a long-term perspective, it's critical (and challenging) to motivate teachers to have a positive attitude, to deepen their understanding, and to lead them to implement and to continue to implement the programme with fidelity and adherence to programme principles (Hans and Weiss 2005). To achieve that with each school's faculty, the Mindful Language model requires teachers' orientation session at the beginning of each year, the presence of each homeroom teacher at the weekly mindfulness session, and a monthly group faculty meeting for ongoing inquiry, guidance and supervision. Articles, handouts and verbatim scripts are delivered. Teachers are coached to gradually implement mindfulness activities in their own classes (hence “to keep the mindful flame going”), or to apply mindfulness-based skills in their own life.

The Mindfulness Language Programme research insights Since the programme's initiation in 2000, several evaluations and research programmes were conducted in various schools. Most of these focused on outcomes related to children, while some focused on the teachers' perspectives, the school's climate or the school’s academic achievements. In this section, we shall present some central insights gained from these investigations. We shall first present results that emerge from our own research, and later present findings from other assessments in different school contexts. The first study on the Mindful Language programme was a qualitative assessment conducted at the completion of the first year of the programme (Sheinman et al. unpublished manuscript). The study aimed to explore students’ experiences, perceptions, thoughts, and perceived benefits.

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Participants were 190 students in 3rd to 6th grade (912 years old) from a south Tel Aviv primary school. Children completed an open-ended questionnaire which included the following questions: (1) What (in your opinion) was the mindful class project meant to teach you? (2) Sometimes we apply what we've learned in this programme – tell us how. (3) Are there any other situations in which the skills might be of help? Give options for class time, home time and for being with friends. (4) Has the project improved the class climate? If so, how? (5) What did you like most about the mindful class experience? Data analysis was performed using qualitative thematic coding (Bentz and Shapiro 1998; Braun and Clark 2006, 77101; Strauss and Corbin 1994, 273285). Categorising children's responses revealed nine domains in which they have experienced the programme's benefits. Emerging themes included ability to relax and calm down, better sense of control, and improved concentration abilities. Further categories were improved self-awareness, improved self-image, improved interpersonal skills, emotional intelligence, and self-healing (see table 4 for specific examples). Category

Children quotes

Better ability to relax and calm down

"The programme helps me to calm down the rocking and shaking inside my body, and it is fun" (3rd grade).

Body awareness

"With mindfulness, I feel as if all my tensions pass away like clouds in the sky. I love the class because after each session, I feel calmness and goodness in myself" (6th grade). "You connect to your body and to the peace in the body, and to freedom" (5th grade). "Mindfulness showed me that it is possible to listen to the breath, to release the muscles and to become calm and relaxed. Even before exams" (5th grade).

Concentration skills

"I feel more centred and concentrated before an exam. It helps me to think more openly" (5th grade). "I specialise in chess, and now I even beat my teacher. When I feel a threat, I breathe in, relax myself, and it helps me to concentrate and win" (5th grade).

Mindfulness in Education as a Whole School Approach Better sense of control

"In the class, when my body is restless and tense, I can lie down and relax. At home, before going to sleep, I can practice noticing the breath. Yesterday, in the swimming pool, under the water, I was so quiet that I could hear my heart beat" (5th grade). "I know that I can let go of anger, because I can tune in, become aware, and rest within myself" (3rd grade).

Improved selfawareness

"I've learned to enjoy the classes and to get to know myself better. Last year, in 5th grade, friends kept telling me that I have issues and problems, but I didn't understand what they wanted from me. This year I started to see how restless I am, and how reactive I can be" (6th grade).

Improved selfimage

"I was very shy and couldn't talk in class. Now, thanks to mindfulness, I feel confident to speak" (5th grade). "I understood that I can contribute through my peacefulness, because I am part of the whole. It helped me to be more friendly and open, and it helped the whole class be more quiet and pleasant. Last year I've distanced myself, but now I became friendly, and many kids want to be close to me" (6th grade).

Emotional intelligence

"In the beginning I thought it's very stupid. Why do I need to relax if I'm so quiet and relaxed anyway? In the beginning I interrupted and disturbed, but when I started to listen to the instructions, I became a different personmore peaceful, more relaxed, more friendly. Now I am more successful in school because I am not angry with the teachers and I am not disturbing them. I love it. It relaxes me" (4th grade). "I was a bad person, angry without the power to stop myself, without the ability to say no to myself. I've caused lots of damage. Without the classes, I could have done nothing to control it. Now I am in charge" (6th grade).

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90 Interpersonal skills

"The programme helped me to become a better me, and to help myself with people and friends" (3rd grade). "The mindful class came to teach me how to listen to friends and to become caring and pleasant" (3rd grade).

Self-healing

The classes helped me to release difficult feelings, which is very helpful at home because Mum and Dad can understand me" (4th grade). "When I have a stomach ache, I take a few deep breaths and help myself, and the same with a headache. When I have tension in my shoulders, I do the postures, which help me to heal myself and also to heal someone else in pain, like my Mum or my Dad (2nd grade).

Table 4: Students’ understanding and use of the mindfulness language programme.

Based on these encouraging results, which emerged after only one year of engagement in the Mindful Language programme, we conducted a large scale multi-year multi-school research, exploring students’ disposition to use mindfulness-based practices in challenging situations in their daily living (Sheinman et al. in press). Our working model was based on the previous findings, which highlight the situations where children's disposition to apply mindfulnessbased strategies seem to be the highest. Accordingly, a 5-item open-ended “Situation Questionnaire” instrument was built. The instrument presented five daily-life challenging scenarios, and children were asked to generate and describe what they actually do in each. The five situations included: feeling stressed before an upcoming exam; difficulty in falling asleep; facing an angry and annoying person; needing to concentrate; and disappointed at oneself. Our research assessed 646 students grade 3rd6th (age 912), from three different school environments. In school A (n=218), the Mindful Language programme has been integrated for the last 13 years. In school B (n=212), the programme has completed its' first year. School C (n=216) had no mindfulness in education programme and served as control. Data coding of students' responses followed two steps. In the first step, we used qualitative thematic coding (Bentz and Shapiro 1998; Braun and Clark 2006, 77101; Braun and Clark 2012, 5771; Strauss and Corbin

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Mindfulness score

1994, 273285), generating categories representing students’ coping strategies. Altogether, twenty-four coping strategies emerged. In the second step, we used a quantitative procedure, in which each strategy was given a 'mindfulness index', representing its relation to mindfulness-based practices, from no connection (i.e., I eat a chocolate bar) to strong connection (I breath mindfully and count my breaths). A total mindfulness score for each student was computed by creating a sum score out of the indexes given to each category (see Sheinman et al. in press, for full description of the scoring system). Comparing between schools, the findings show significant differences in mindfulness scores (F(2,645)=50.622, P