Mindfulness-Based Cognitive Therapy for Children (MBCT-C) for Prevention of Internalizing Difficulties: a Small Randomized Controlled Trial with Australian Primary School Children

Abstract

The use of mindfulness-based programs (MBP) with children is rapidly growing, but calls for well-designed randomized controlled trials (RCTs) of existing programs. Mindfulness-Based Cognitive Therapy for Children (MBCT-C) has preliminary evidence for targeting internalizing symptoms in children. Within MBCT-C (and MBPs more broadly), attention is thought to be a key component of change, but mediation has been relatively unexplored. The overall aim of this small RCT was to compare MBCT-C to cognitive behavior therapy (CBT), as a preventive program for children experiencing internalizing difficulties. A mixed factorial design was used, with 2 (program group) by 2 (pre- and post-intervention) conditions. Children from 3 primary schools were randomized to MBCT-C (n = 45) or CBT (n = 44) using random permuted blocks, with stratification by school, gender, and age. Main analyses were multi-level mixed models. Contrary to the hypotheses, only limited differences were found between programs. Both programs had small effects on symptoms of anxiety and depression, quality of life, attention control, and parent- and teacher-SDQ Total Difficulties, as well as moderate-large effects on shifting attention. There were no statistically significant changes in mindfulness or sustained attention. This RCT provides a robust test of MBCT-C in a “real life” setting, demonstrating that it may be used as a clinically oriented preventive program in schools to reduce internalizing symptoms. The results challenge whether attention (as measured in this study) is a unique component of change for MBCT-C.