Funding: NIH/NCRR Southern California Clinical and Translational Science Institute; Grant No. UL1RR024131

Overview. We propose to conduct an open trial to evaluate an innovative and theoretically well-grounded stress-management curriculum. Our aim is to help underserved, low-income, minority children cultivate more adaptive stress-management skills and increase social-emotional competencies. Collecting preliminary effectiveness data will increase the likelihood of success in a future, appropriately powered, randomized trial. This collaboration between USC, the Pasadena Unified School District (PUSD), and the ABC-Unified School District (ABC-USD) creates a multidisciplinary team with expertise in mindfulness-based therapies, childhood anxiety, translation of clinical services to community settings, and principles of effective teaching.

Scope of the problem. Stress and anxiety are the most common mental health problems in youth, and they are also the most costly. Symptoms frequently begin in childhood, tend to be persistent, and often lead to subsequent medical, emotional, or behavioral disorders. Early remediation can reduce future difficulties, such as adolescent depression, alcohol or substance abuse, and academic, legal, or conduct problems. Stress and anxiety affect millions of children and cost the United States billions of healthcare dollars every year.

Background. Mindfulness training has been found to reduce rumination, behavioral avoidance, and emotional reactivity; enhance attention, increase well-being and social-emotional resiliency; promote flexible management of anxiety-provoking situations; and improve decision-making skills.

Mindfulness-Based Cognitive Therapy for Children (MBCT-C) [2] is an innovative group psychotherapy for anxious children that is modeled on an empirically supported adult protocol. It uses novel, creative, and developmentally appropriate interventions to reduce anxiety, enhance attention, and bolster social-emotional competencies. MBCT-C was co-developed by the PI. From her previous work, we now have an adaptation of MBCT-C that has been translated to a school-based curriculum.

The translated curriculum is Mindfulness Matters, which is conducted by teachers in classrooms. It aims to help children (1) enhance present-focused awareness; (2) bolster social-emotional resiliency; (3) increase cognitive flexibility; (4) make more skillful behavioral choices; (5) promote adaptive changes in how they relate to thoughts, emotions, and body sensations; and (6) cultivate acceptance of things that cannot be changed.

Specific Aims.

AIM 1: Translation of MBCT-C into a classroom curriculum that promotes social-emotional competencies.

• Collaborate with PUSD and ABC-USD teachers and students to refine an existing draft curriculum.
• Train four teachers to implement the Mindfulness Matters curriculum in the classroom.
• Refine curriculum using feedback from teachers, mental health professionals, and mindfulness experts.

AIM 2: Conduct two focus groups with representative students in grades 3 through 5.

• Introduce Mindfulness Matters to children in a focus group format.
• Refine the curriculum based on feedback from the student focus group members.

AIM 3: Pilot the revised 12-week curriculum with 3 trial groups of students from PUSD (2) and ABC-USD (1).

• Evaluate the feasibility and acceptability of Mindfulness Matters for the teachers and students.
• Collect preliminary data on the effectiveness of Mindfulness Matters across five domains: (1) clinical symptoms, (2) mindfulness, (3) executive functioning, (4) emotion regulation, (5) behavioral functioning.

Impact. The nation faces an escalating public health crisis in mental healthcare for youth. Mindfulness-based therapies promote social-emotional competency through the cultivation of present-focused attention. They are effective in managing stress and anxiety. However, clinic-based programs are not accessible to many underprivileged minority children. In order to reach these children, we must bring effective programs into their schools. The broader impact of developing an accessible, cost-effective, classroom-based stress-management program will be to conserve scarce US healthcare resources and improve the lives of millions of children.