Deep Dive: Mindfulness education could be doing more harm than good

Deep Dive: Mindfulness education could be doing more harm than good

A growing body of research shows that cultivating skills that are grounded in mindfulness can help young people improve their mental health and help them form positive friendships, manage difficult emotions, and get unstuck from bad habits.

In Australia, more than half of all teachers currently use some form of mindfulness training in the classroom. Such programs promise to promote wellbeing and prevent poor mental health among children and have been backed by millions of dollars in government funding.

But do these programs deliver on what they promise?

A team of researchers led by Professor Willem Kuyken from the University of Oxford recently completed the largest ever mindfulness study, involving more than 28,000 children, 650 teachers, 100 schools and 20 million data points. 

The MYRIAD (MY Resilience In ADolescence) trial found that a school-based mindfulness program – added on top of regular social and emotional learning programs – had no impact whatsoever on students’ mental health, with some students feeling worse after learning mindfulness.

The trial contradicts the findings of many smaller studies which suggest mindfulness training benefits school children, and suggests more work needs to be done so that sound advice is given to educators and policymakers.

Associate Professor Nicholas Van Dam, Dr Chris McCaw, and Dr Julieta Galante from the University of Melbourne's Contemplative Studies Centre tell The Educator about the MYRIAD trial, its findings and their implications for Australian schools.

TE: What was most surprising about the results of the MYRIAD trial?

Contrary to many people’s expectations, the MYRIAD study—the largest ever mindfulness study undertaken with school-children—found no evidence that adding a school-based mindfulness intervention to the curriculum has a positive impact on the mental health of school students aged 11-14 years old. In fact, on some measures, some students who participated in the program actually had worse mental health outcomes. This study contradicts the findings of many smaller studies which purport to show the benefits of embedding mindfulness training in schools’ curricula.  It poses a clear challenge to the generally high levels of confidence and enthusiasm for mindfulness programs in schools—which often bring with them strong claims of being ‘evidence-based’.

Even though MYRIAD is only one study, these findings should really change how we think about mindfulness in schools in Australia. MYRIAD trial was truly impressive in its scale and rigour—including over 8,300 student participants. To put this in perspective, a comprehensive review of mindfulness in school studies from 2017, combining the findings of 76 existing studies, totalled only 6,121 participants. The schools and students in the study were extremely representative of the United Kingdom population, so the negative results weren’t due to something quirky about them. Moreover, the research team, which included internationally recognised experts from some of the most prestigious universities in the world, followed the most rigorous methods available, so the MYRIAD results are far more reliable than the average study.

The quality and intensity of the training provided to teachers was also of a high standard. The mindfulness program in the MYRIAD trial was taught by teachers who undertook an eight-week mindfulness program themselves (minimum of 16hrs training plus regular home mindfulness practice) before completing a 4-day training workshop and first teaching the program, as a practice-run, to a group of students not included in the study. Despite the thoroughness of the training provided to teachers, as measured by this thorough study, mindfulness training simply was not a value-add to what average UK schools already do.  

TE: Can you tell us about the evidence-based status of mindfulness and meditation (contemplative practices)?

Most of what we know about the benefits of mindfulness training comes from the study of mindfulness-based programs: structured, multiple-week training programs, totalling dozens of hours of training and learning. Most mindfulness curriculum in schools involves far less intensive training and practice experience, in comparison. It would be inaccurate to conclude, from studies of more intensive, structured programs, that adopting a mindful attitude for a few minutes a day in class is generally helpful.  

When we look at the evidence, a recent comprehensive review has found that mindfulness-based programs are helpful for a wide variety of people (e.g., students, adults, older adults), in various settings, for a number of issues (e.g., anxiety, depression, pain, physical illness, wellness).  However, there is no evidence that mindfulness-based programs are more beneficial than other treatment approaches, such as relaxation training or cognitive behavioural psychotherapy. When we consider digital adaptations of these programs, in the form of meditation apps, much less is known but they do seem to have some benefit on average. A major challenge of such approaches though is keeping people engaged, with one estimate suggesting that fewer than 10% of people continue to engage with mobile apps just one week after downloading them.

The training in the MYRIAD study, for the teachers, and for the students, was based on the programs assessed by this comprehensive review. However, the review almost exclusively looked at programs that people chose to take part in. In contrast to this, for the students included in the MYRIAD study, taking part in the mindfulness training was a requirement, just as any other activity in the curriculum. The non-optional nature of participation in MYRIAD may go some way to explaining the low recorded rates of engagement of students in actual mindfulness practice during the study.

TE: Your research found that meditation can be harmful, even leading to trauma if this is not done under the right guidance. How can schools that are providing mindfulness education programs minimise this harm?

How can we understand why some students got worse after undertaking the mindfulness intervention in MYRIAD trial? First, it’s important to note that the students who got worse tended to have existing, underlying mental health difficulties. From here, if we think about how mindfulness actually works, there is a fairly simple and plausible explanation. Consider that many mindfulness activities involve the person bringing their attention to bodily sensations, the breath, or to thoughts. For those with existing mental health issues, or a history of trauma, sustained attention like this can actually bring about unwelcome thoughts, feelings and sensations more clearly into awareness. This, understandably, can be unpleasant. In short, mindfulness is unlikely to cause trauma, but it certainly can cause the re-experiencing of traumatic memories for some meditators. And these traumatic memories may be even harder to manage for adolescents, whose emotional regulation skills are still in development.

More broadly, research is making it clear that negative or adverse events during meditation are surprisingly common, even with people undertaking mindfulness practice at relatively low intensity. These vary in intensity and impact on the individual, and can include experiences such as anxiety, agitation, insomnia, executive impairment or impairments in social functioning. The good news is that there is a growing understanding of how to teach and practise mindfulness in ways that reduce the likelihood of adverse events, and reduce the likelihood of them leading to ongoing impairment when they do occur. However, these approaches, and related findings about adverse events, are rarely included in the minimal training provided for teachers. Without proper training or support, teachers are unlikely to recognise, or be able to manage, when adverse events occur for students.

TE: What are some examples of harmful meditation?

Ironically, the most common types of negative unexpected experiences from meditation are those issues that meditation is most often said to help: anxiety, depression, and issues thinking or focusing. Notably, however, negative experiences can be far worse, including psychotic-like experiences, dissociation or depersonalisation, and even suicidal behaviours. It is unknown to what extent these negative outcomes represent challenging issues that were present prior to meditation, as opposed to, a direct result of engaging in meditation. However, research strongly suggests that, in some cases, meditation does cause these outcomes.

TE: What are some suggestions for teachers and policymakers on how to make mindfulness effective in Australian schools?

Despite all the claims on the websites, certification by BeYou, and various tiers of funding support, it remains unknown whether popular Australian programs actually work. We don’t know because rigorous evaluation studies needed to answer these questions haven’t been done. The negative results from the MYRIAD trial put the effectiveness of popular Australian mindfulness programs in serious doubt.

The most popular mindfulness program in Australia offers comparably less training for teachers themselves. The training is self-paced, and is a maximum of six hours (unless teachers opt to be “mindful champions” and do a 3-day training program). In direct contrast to MYRIAD, it does not require that teachers first learn mindfulness for themselves.

Leaving teacher training nuances aside, the main lesson to be learned from the MYRIAD trial is that universal mindfulness training (i.e., requiring all students to do mindfulness training, and the same training) doesn’t work.  Student engagement with mindfulness training is thought to be crucial, and in the MYRIAD trial, students’ engagement with mindfulness homework was low. Moreover, many students complained about the intervention and reported preferring to do other activities. Low engagement and acceptability may play a significant role in the lack of benefit seen from universal school-based mindfulness training.

For engagement and acceptability to improve, there should be greater consultation and co-design in the development of school-based mindfulness programs.  This means involving the teachers and students when putting together the programs, so that we ensure that the end-product can be taught effectively and engages students. Participation in these programs should be on an opt-in basis, or at the very least give students much greater agency and choice when participating in mindfulness activities. This way, those who find them unappealing or challenging can put their time to better use. Where teachers agree that they have the time and resources to offer mindfulness, we must also ensure rigorous, high-quality training (both for personal practice and for teaching the practice to students), as well as ongoing support and supervision. This will help teachers to deliver useful and safe mindfulness classes. Once mindfulness programs are co-developed, their effectiveness and safety should be assessed by independent research teams using rigorous, randomised controlled trials.   

In Australian education, school-based mindfulness programs are largely implemented on a universal basis—delivered to whole classes, year-levels, or schools in a compulsory and standardised way. We urge service-providers, policymakers, and school administrators to familiarise themselves with the MYRIAD study and seriously reconsider the way they are designing and implementing mindfulness in schools.  If we’re going to continue funding school-based mindfulness training in Australia, we need rigorous intervention development and evaluation.  

TE: In what ways does the Contemplative Studies Centre help educators cut through confusion about mental health to help members of the public who are interested in health and wellbeing?

The University of Melbourne’s recently launched Contemplative Studies Centre aims to clarify confusion around mindfulness, meditation, and other contemplative practices in a number of ways. We regularly host events aimed at a wide variety of topics and a wide range of audiences to help clarify what meditation is and is not and what it can and cannot do. We are developing resources to help the public understand how to start and progress a meditation practice, as well as how to deal with difficulties that may arise along the way. We offer regular, free to access, guided meditation sessions from a number of traditions and teachers. We are developing educational offerings for university students and the wider public. We consult organisations and companies to help them clarify how mindfulness and meditation might best work within a given context. We are undertaking research to examine a number of questions around mindfulness and meditation.