Mindfulness, Self-Compassion and Family Well-Being Conference Agenda

Objectives: Three studies were conducted to evaluate the effectiveness of a brief (6-week) mindfulness-based behavioral parenting program designed to be offered in community settings to parents of infant and preschool-age children living in low-income or high-adversity contexts. The program. SEACAP, includes behavioral parenting, DBT emotion regulation, mindfulness and self-compassion practices.

Methods: Study 1 was part of a larger study offering new mothers an in-person parenting program when infants were 2-4 months (N=52). All mothers were living in a low-income context. Study 2 was a quasi-experimental, waitlist control study conducted in person with parents living in low-income contexts with children attending Head-start or similar early childhood program (N=52). Study 3 evaluated the program when it was delivered synchronously online with parents living in transitional housing or who were unhoused whose children attended an early learning program (N=28). The samples were racially and ethnically diverse (across the 3 studies): 28% African American or Black, 10% Asian American, 25% Latine or Hispanic, 6% Native American or Alaska Native, 1% Pacific Islander, 28% White, 2% other. Assessments included parent-report of mindfulness, mental health symptoms, parenting and child social competence, internalizing and externalizing problems. Study 1 and 2 also included observational ratings of parenting behaviors. Engagement efforts included offering compensation for attendance, offering the programs at sites where families were already receiving services, collaborating with community sites in scheduling the offerings, providing food and childcare.

Results: Participants in the three studies showed program related improvements in maternal mental health symptoms, observed parenting, and child adjustment. Satisfaction with the program was high in the three studies. Attendance rates in the infant study were very low (36%), and attendance in the preschool interventions improved from 59% in Study 2 to 71% in Study 3 when the program was delivered online.

Conclusions: Promising preliminary results suggest that this brief mindfulness-based behavioral parenting program can be effective in improving maternal mental health, parenting behaviors, and children’s adjustment. The program is acceptable to parents and feasibly implemented both in person and online in community settings with parents in low-income contexts. However, improved engagement efforts to enhance access could include more flexible scheduling to work with families’ difficult work schedules, more support for transportation, increased opportunities for individual in-person contact with facilitators to tailor program content, increased time for families to engage and connect with each other to build community.

This presentation will highlight how the essential elements of mindfulness (awareness and acceptance) can play an important role in program evaluation. Specifically, the talk will provide an overview of an ongoing evaluation of a school-based mindfulness program that has been evolving since 2015. The CASEL-endorsed Inner Strength program has served over 16,000 inner city high school students in Philadelphia and has been integrated into diverse school climates. The challenges and turns that the evaluation faced along the way, both pre- and post-pandemic, will be shared along with solutions that required awareness and acceptance with respect to implementation and assessment.

This presentation will describe Project CaLM (Children Learning Mindfulness). This was a pilot project implemented in Head Start programs serving racially and ethnically diverse children and families. Using a participatory action research approach, researchers and teachers examined how mindfulness techniques could be integrated into classroom routines. Guided by a similar approach, parent workshops on teaching preschoolers sleep routines and mindfulness practices were designed and conducted with these Head Start programs during the years following the implementation of Project CaLM. The development of relationships with site directors and teachers will be described. The Project CaLM logic model as well as components and materials of the intervention and workshops will be outlined. In addition, results from limited-efficacy testing and examination of Project CaLM’s implementation will be reviewed. Although these analyses lacked adequate statistical power, when comparing the well-being of children who did and did not receive the intervention, most results were in the expected direction, but were non-significant. Still, findings show that teachers generally implemented Project CaLM at greater frequencies and duration than expected. Furthermore, acceptability of the intervention as well as demand for such an intervention will be discussed, based on surveys and open-ended questions posed to teachers and parents. Results revealed favorable views of and interest in mindfulness practices. Future research should consider extending Project CaLM in terms of sample size and context. Discussion of Project CaLM and its subsequent workshops will address the challenges faced by researchers. The presentation will conclude by situating this work and related research and practice within the broader context of current discussions held by scholars such as Thema Bryant, Ph.D. and Shelly Harrell, Ph.D. in the field of psychology and Michael Yellow Bird Ph.D. in the field of social work regarding mindfulness, decolonization, and the dismantling of systemic racism.

Background: Depression and anxiety during pregnancy is associated with a constellation of detrimental maternal and child health outcomes. Psychological resources (e.g., hope, optimism, self-efficacy, resilience collectively referred to as psychological capital or psycap) and social resources (e.g., social support, social capital) may aggregate and interact during the perinatal period to collectively influence prenatal, birth and postpartum outcomes. Unfortunately, individuals facing low socioeconomic status experience disproportionately high rates of poor perinatal mental health, have fewer resources and have a decreased ability to replenish resources over time. The “Resource Capacity Model” highlights how these resource deficiencies contribute to associations between socioeconomic disadvantage and physical and mental health outcomes. As resources travel in caravans and collectively impact mental health and well-being, a “shotgun” approach in which individuals practice cultivating multiple protective factors across the perinatal period may be more effective than focusing on one particular resource.
Methods: Pregnant individuals living in Colorado are currently being recruited using non-probability purposive sampling techniques (n=300). Individuals who meet the following criteria are eligible: 1) 8-12 weeks gestational age, 2) >=18 years of age, 3) English- or Spanish-speaking, 4) experiencing at least one risk factor related to socioeconomic disadvantage. Mixed-methods data are being collected at four timepoints, the majority of which align with standard of care appointments: 1st trimester, 3rd trimester, 6-weeks postpartum, and 12-weeks postpartum. We are currently investigating point-estimates of psycap at all four timepoints followed by latent growth modeling and growth mixture modeling to explore psycap trajectories. Regression modeling is being used to investigate cross-sectional associations between the four psycap constructs, social resources and depression, anxiety, and well-being, controlling for birth outcomes and covariates. All analyses are being conducted with Mplus Version 8.
Results: The final logistic regression model predicting prenatal depression risk was statistically significant, X2 (7, N = 266) = 30.11, p < .01. Age, race, ethnicity, and marital status were not associated with depression risk. Higher levels of optimism were associated with lower odds of experiencing prenatal depression compared to lower levels of optimism (OR=.82, 95% CI [.72, .92]). Individuals with more social support also had lower odds of experiencing depression compared to individuals with less social support (OR=.98, 95% CI [.96, .99]). The final logistic regression model predicting anxiety risk was statistically significant, X2 (7, N = 266) = 17.14, p = .02). Age, race, ethnicity, and marital status were not associated with anxiety risk. Higher levels of optimism were associated with lower odds of experiencing anxiety compared to lower levels of optimism (OR=.89, 95%CI [.79, .99]).
Conclusions: These preliminary findings have significant implications for the development of strengths-based interventions to promote perinatal well-being. Mindfulness and optimism are psychological constructs that have been shown to be strongly correlated and collectively associated with mental health; therefore, evidence-based mindfulness interventions that integrate positive psychology strategies focusing on the cultivation of psychological and social resources targeted towards low-resourced pregnant individuals may help to mitigate the risk for experiencing perinatal mood disorders and promote the intergenerational transmission of resilience.

Developmental Origins of Health and Disease research has established that maternal prenatal distress heightens risk for health problems in women and their offspring. Much less is known about “positive” programming effects, such as whether scalable interventions during pregnancy might both prevent harm and benefit women and their children.
To address this gap, we conducted a series of studies to investigate the effects of an 8-week, group-based prenatal mindfulness-based stress-reduction intervention (Mindful Moms Training) on maternal and child health outcomes. A diverse, prospective sample of predominantly low-income mothers were assigned to Mindful Moms Training (MIND) or treatment-as-usual (TAU) in pregnancy and followed postnatally. Leveraging the established efficacy of the intervention at reducing maternal stress and depression across pregnancy and through 6 months postpartum, we examined whether maternal effects were sustained throughout an 8-year period, including during the COVID-19 pandemic, and whether the intervention benefitted offspring biological and behavioral development.
Individuals followed postnatally (N=162) did not differ from the original intervention sample (N = 215) on demographics or key study variables (36% Black, 17% White, 2% Asian/American Indian, 46% Mixed Race/Other; 40% Hispanic). MIND (N=89) and TAU (N=73) groups were equivalent on all sociodemographic factors except gestational age at enrollment and duration between baseline and some follow-up assessments. Separate linear mixed effects and generalized linear mixed effects models were used to examine treatment group differences in: 1) maternal depression (PHQ-9 at postnatal 1-, 2-, 3.5-, 5-, 6-, and 8 years), and 2) 6-month infant outcomes (sympathetic nervous system indicator, pre-ejection period; coded self-regulatory behavior during the Still Face challenge).
Baseline maternal depressive symptoms did not differ between MIND and TAU. Symptoms at all follow-up assessments through 8 years were significantly lower among women in MIND compared TAU (Bs= -1.31 to -3.69, ps<.01; mean differences = -1.9 to -3.2, ps<.05). By the 8-year mark, the mindfulness group reported a lower prevalence of moderate or more severe depressive symptoms (12% vs. 25%). For offspring, relative to those in the TAU group, infants in the intervention group showed robust sympathetic activation and subsequent recovery across a stress task (whereas TAU infants showed delays), as well as higher proportions of self-regulatory behavior during the challenge.
Findings provide evidence that maternal participation in a low-cost, short-term mindfulness-based intervention during pregnancy is associated with consistent, sustained improvements in women’s depression through 8 years (including during COVID), as well as the development of biobehavioral reactivity and regulation in their infants. Our findings from this diverse, understudied sample suggest a modest investment during pregnancy may benefit two generations.

Although limited in number and size, RCTs examining mindfulness-based interventions carried out during pregnancy or the early postpartum support the effectiveness of these intervention efforts on maternal mental health and parenting behaviors. However, additional evidence suggests that these effects may not be as robust in samples of women living in the context of low income, where existing support efforts may be cost intensive and difficult to scale. In addition, there are practical barriers to accessing such interventions by families living in the context of low income. In an initial study conducted by this research team, we found effects of peripartum mindfulness and parenting programs in supporting the mental health and parenting practices of new moms living in the context of low income. Classes were rated as highly acceptable and satisfying, however, levels of group intervention attendance were low. Qualitative interviews suggested that an online program would address participation barriers. The current study presents preliminary findings surrounding program acceptability and feasibility of an online adaptation of the postpartum parenting intervention, finding high levels of class satisfaction in the online format and high levels of attendance among enrolled participants. Recruitment for the intervention was challenging, despite recruitment partnerships with community organizations. Overall, findings support the potential benefits of task-sharing partnerships to broaden the reach of interventions to the communities who have been historically distant from such supports.

The early caregiving environment plays a critical role in the development of physiological systems that regulate stress reactivity. Early experiences of adversity can influence the development of psychopathology through the biological embedding of adversity exposure via epigenetic changes, such as DNA methylation (DNAm). Despite significant progress in social epigenomic research on risk processes, a basic understanding of how the biological embedding of adversity can be prevented or reversed has yet to be achieved. There is little understanding of the role of protective factors that impact these developmental trajectories. However, biological and behavioral plasticity during early development presents a uniquely sensitive period for early intervention to reverse the biological effects of disruptions in the early caregiving environment and promote lifelong well-being. This presentation highlights three primary studies that have implications for the potential of mindfulness-enhanced behavioral parent training (BPT) to prevent or reduce the biological embedding of adversity. First, prospective longitudinal findings on how parental mindfulness can promote adaptive parenting practices and improve coparenting relationships are reviewed. Next, recent results on how parental mindfulness can impact the initial efficacy of BPT as well as the long-term maintenance of outcomes are presented. Finally, emerging findings are introduced on how increasing observed positive parenting or decreasing negative parenting through BPT may reduce or prevent adversity-related epigenetic age acceleration in young children from predominately ethnic/racial minoritized backgrounds. The results show that BPT has an impact on DNAm of a range of stress-related gene pathways, including the HPA-axis, oxytocin, and inflammation systems. The presentation will conclude with potential future directions to explore how mindfulness-enhanced BPT could establish a biological foundation that promotes resiliency and prevents the development of psychopathology.

Over 8.1 million children in the United States live in divorced/separated families. Divorce confers risks of mental health problems to children. Divorced adults report higher psychological distress, lower wellbeing and life satisfaction, and use mental health services more than non-divorced adults (Colman et al., 2012).
The New Beginnings Program (NBP) was developed and tested in three randomized controlled trials. The researchers found that the positive effects of the NBP on children’s post-divorce mental health problems persisted up to 15 years later. However, the NBP lacked such positive effects for distressed parents: children’s improvement in externalizing problems following the NBP was less likely to persist at 6 months later, when their mothers reported higher distress at baseline. The NBP also showed limited success in reducing parental psychological distress: it yielded a small effect in reducing maternal distress at posttest. These findings point to a key need to develop interventions that directly and sustainably reduce parental distress, because for high-risk families, reducing parental distress directly, which in turn strengthens improvements in child outcomes, can be more efficient than reducing parental distress indirectly via improving child outcomes.
To address these research gaps, combining mindfulness training with the NBP may yield optimized intervention effects for divorced parents who already experience distress. but that effect did not persist at follow-up.
To increase reach, the group-based NBP was adapted into electronic NBP (eNBP), a fully self-administered 10-module online program that focuses on behavioral parenting skills. A randomized controlled trial supported its feasibility, acceptability, and efficacy. Also, considering the growing interests in digital mindfulness interventions, a model of digital mindfulness-informed eNBP was developed for psychologically distressed divorced parents. In this intervention model, parents will continue their mindfulness practice during eNBP after the mindfulness intervention, to yield stronger improvements. Consistent with the parenting literature, the model highlights the role of parenting in predicting children’s post-divorce mental health. Specifically, parenting is defined to include 4 domains: parental warmth, discipline, mindful parenting, and emotion-related parenting practices.
This presentation will include the research background and report preliminary findings from the formative research phase where stakeholders including family courts, mandatory divorcing parenting class providers, and parents themselves provided important input to guide researchers in the design of online mindfulness modules.

Parents of children with autism spectrum disorder (ASD) and other developmental disabilities (DD) typically experience high levels of parenting stress, which are associated with deleterious consequences for parent mental and physical health and child functioning. Despite urgent calls to action, parenting stress is rarely addressed directly in interventions for families of children with ASD/DD, and less so in underserved and racial/ethnic minority populations where clinical needs are greater. This paper will review the results of two recent randomized clinical trials (RCTs) examining the efficacy of mindfulness interventions for parents of children with ASD and other DDs. We will also examine the collateral benefit of parent stress-reduction following the mindfulness interventions in improving parenting behavior, decreasing child behavior problems, and optimizing parent engagement in parenting interventions, specifically behavioral parent training (BPT).

The Stress-reduction Techniques for Enhancing Parenting Skills (STEPS) Project tested the efficacy of Mindfulness-Based Stress Reduction (MBSR), compared to a Psychoeducation and Support (PE) intervention, in reducing parenting stress among diverse families of preschoolers with ASD. Participants (N = 117) were randomly assigned to the MBSR or PE groups; assessments were conducted at baseline, immediately post-intervention, and 6- and 12-months post-intervention. Results indicated significant reductions in parenting stress across both the MBSR and PE intervention conditions; however, reductions in parenting stress were greater for parents in MBSR than in PE. Furthermore, the benefit of MBSR relative to PE increased over time, with significant group differences in parenting stress detected at 12-month follow-up. Additionally, comparable efficacy was observed across modalities of intervention delivery (in-person vs. online), suggesting the potential to further expand access to vital stress-reduction interventions through use of telehealth technology.

Future analyses will investigate the primary outcomes of the Partnerships in Research for Optimizing Parenting (PRO-Parenting) Project which is an RCT that investigates the potential benefit of adding a mindfulness intervention to a BPT program to enhance the efficacy of BPT. This study involves over 250 parents of young children from diverse backgrounds (N=100 monolingual Spanish-speaking) with DD, the majority of who have a diagnosis of ASD. Parents are randomly assigned to the behavioral parent training plus mindfulness-based stress reduction (MBSR; Kabot-Zinn, 1990; BPT-M) or behavioral parent training plus a psychoeducation control (BPT-E) condition. Both conditions included a 10-week standard BPT (McIntyre, 2008; Webster-Stratton, 2013). The BPT-M adds a 6-week MBSR and the BPT-E adds a 6-week psychoeducation control delivered prior to the standard BPT intervention. Assessments were conducted at baseline, immediately post-intervention, and 6- and 12-months post-intervention. This trial will conclude on May 31, 2023 and we plan to present the primary outcomes at this conference. Future analyses will investigate the following aims: (1) Test the efficacy of BPT-M, which adds a parent stress-reduction intervention (MBSR), compared with BPT-E (BPT + psychoeducation control), for reducing child behavior problems; (2) Examine if parenting behavior mediates the relation between intervention and child behavior problems, and (3) Determine if the improvements in parenting behavior are, in turn, mediated by reductions in parenting stress, a proximal target of the BPT-M intervention.

Disrupting the transmission of stress-linked mental health inequities is increasingly understood to benefit from early intervention programs that target dual-generation (i.e. parent and child) needs. The recovery from the COVID-19 pandemic offers a unique opportunity to advance the reach of such programming through advances in scalable eHealth methods, which were rapidly innovated in response to pandemic stressors. This presentation will focus on 2 mindfulness-based mental health and parenting programs developed in response to the pandemic that have benefitted from ongoing co-development with a parent-partner advisory board (PAB). The parents hold lived experience managing family mental health challenges and are not afraid to communicate when an idea is out-of-touch or impractical. Programs include the BRIDGE “Building Regulation in Dual Generations” Program, that treats maternal mental illness (MI) using Dialectical Behaviour Therapy Skills with a paired curriculum that promotes non-reactive and emotionally validating parenting, as well as the App-based BEAM program, developed based on identified priorities of connecting therapists and mothers in a secure online setting. Amplifying voices of parents with lived experience is underscored as critical for innovating relevant and accessible programs. Learning objectives include recommendations for successful and ethical engagement with parent-partners across settings. Audience participation is welcome and encouraged.

Due to the psychological toll COVID-19 has had on emerging adults, as well as normative mental health challenges of this developmental period, emerging adults are struggling more than ever with depression and loneliness. In fact, a cross-national sample reported that loneliness, anxiety, depression, and stress were highest among emerging adults compared to middle-aged adults and older adults in the first months of the pandemic. The objective of this study was to assess feasibility, acceptability and preliminary psychosocial outcomes of Embracing Your Life, a self-compassion program for emerging adults, as self-compassion is associated with less anxiety, depression, stress, and loneliness. Thirty-nine emerging adults (Mage=23.7, 67% female) enrolled in a 6-session, 90 minutes/session online self-compassion program from July 2020 to January 2022 participated in this study. This program, Embracing Your Life, is adapted from the established 8-week adult Mindful Self-Compassion program. Results indicated that Embracing Your Life was feasible; 81% of participants attended at least 5 out of 6 sessions. Qualitative feedback indicated high acceptability, indicating that the program had a warm, connected atmosphere where participants felt it was “welcoming and inclusive” and “a safe space to learn”. Participants also recommended changes to make the program more interactive, such as the use of an online discussion board. Also suggested was a weekly “roadmap” or workbook to accompany the program. Quantitative analyses revealed that participants reported significant improvements in self-compassion, resilience, loneliness, depression, stress, and emotion regulation from before to after the program. Future research studies with larger samples and control groups should be implemented both to confirm these findings and generalize them to other populations. Conclusions are that Embracing Your Life is a promising, accessible intervention that can be brought into campus counseling centers, college residence halls, and work-related wellness offerings to address the mental health of emerging adults.

The transition to college and young adulthood is a key phase of human development. As today’s undergraduates prepare for adulthood, they must grapple with political upheaval, movements for racial justice, the COVID pandemic, online social networks, and the climate crisis. Research has shown that, in this context, undergraduates are struggling with anxiety, depression, and loneliness at unprecedented rates. Mental health challenges and lack of belonging are associated with poor academic outcomes including challenges with retention, academic performance, and constructively addressing societal challenges today. There is evidence that mindfulness-based and other contemplative resources are well-suited to support undergraduates navigate challenges and flourish as individuals and members of thriving communities. In this presentation, we will provide an overview of our work creating and implementing an ecosystem of mindfulness-based resources for undergraduates at the University of Colorado Boulder. We highlight problems of practice, preliminary research findings, and key lessons learned for those seeking to provide mindfulness-based resources to undergraduate populations

Julia Zigarelli, PhD
Renée Crown Wellness Institute
julia.cantrickzigarelli@colorado.edu

Dispositional mindfulness has been correlated with less substance use and psychopathology, including anxiety and depression (Karyadi et al., 2014; Tomlinson et al., 2018). However, only a few studies have examined the association between mindfulness and psychopathology symptoms in adolescents or using longitudinal methods. In one initial study, Cortazar and Calvete (2019) found that adolescents’ dispositional mindfulness predicted fewer internalizing and externalizing symptoms across six months. Similarly, Royuela-Colomer et al. (2021) found that mindfulness was correlated with lower stress, depressive symptoms, and impulsivity in adolescence. However, more work is needed to understand mindfulness buffering effects during adolescence, given that adolescence is a critical period for the development of psychopathology and substance use. The present study addressed this by investigating mindfulness effects on longitudinal changes in internalizing and externalizing symptoms over one year in early to middle adolescence.
As part of a larger study of a mindful parenting intervention, one hundred 12-16 year olds (48 female, M Age = 13.92) completed self-report questionnaires on dispositional mindfulness [Mindful Attention Awareness Scale (MAAS)], substance use [Youth Risk Behavior Survey (YRBS)], and psychopathology (Youth Inventory (YI)] at four time-points (baseline, 2 month, 6 month, and 1 year follow-up). Hierarchical linear modeling (HLM) was used to estimate the impact of dispositional mindfulness at baseline on growth (from baseline through 1 year follow-up) in substance use (yes/no) and symptoms of generalized anxiety disorder (GAD), major depressive disorder (MDD), and oppositional defiant disorder (ODD), using four separate models. HLMs examined the effect of baseline mindfulness on both the intercept and the slope of each outcome variable. Child’s sex and age were included as covariates along with whether the parent completed a mindful parenting intervention or a control intervention.
Results from the HLM models showed a significant decrease in symptoms of GAD, MDD, and ODD across one year on average but not a significant change in substance use. Adolescents’ mindfulness at baseline had a significant effect on the intercepts and slopes for GAD, MDD, and ODD symptoms. Greater mindfulness at baseline predicted lower GAD, MDD, and ODD symptoms at baseline (intercept) and greater mindfulness at baseline predicted greater decreases in GAD, MDD, and ODD symptoms over one year.
In this sample of adolescents, mindfulness at baseline predicted decreases in symptoms of GAD, MDD, and ODD (but not substance use) over one year of follow up. The lack of findings for substance use may be due to limited growth of use in this sample and future studies with greater variability in use patterns should test mindfulness associations with substance use. Our findings for internalizing and externalizing symptoms indicate that having greater levels of mindfulness in early adolescence may buffer youth from the development of both internalizing and externalizing symptoms. Some of our decreases in symptoms may have been due to the parent mindfulness intervention, however effects of adolescents’ dispositional mindfulness on later psychopathology symptoms remained after controlling for intervention group. Overall, our findings support adolescent mindfulness as a target for prevention and treatment of psychopathology.

Transgender adolescents often face enormous mental health challenges. Statistics show that these adolescents experience depression at a four fold higher rate than their cisgender peers; over half are diagnosed with depression and experience suicide ideation, and a third attempt suicide. Self-compassion, an internal psychological resource in which one is supportive towards oneself while recognizing the universality of experiencing difficult emotions, is associated with less depression, anxiety, stress and factors related to suicidal ideation. Furthermore, self-compassion has been shown to be modifiable, in that one can be taught self-compassion skills that strengthen and cultivate their self-compassion. In this study, Mindful Self-Compassion for Teens, an 8-session, 90 minute/session self-compassion program adapted from Mindful Self-Compassion for adults was taught online to two cohorts of transgender and gender diverse adolescents age 13-17. Participants were recruited through gender clinics, social media, community groups, and electronic flyers sent to schools. A community advisory board comprised of transgender teens, a parent of a transgender teen, transgender young adults, an LGBTQIA+ social worker in a transgender clinic, and transgender community leaders provided input on recruitment methods, tailoring the curriculum to be optimal for transgender adolescents and best methods for dissemination of study findings. Participants were assessed on various outcomes including depression, perceived burdensomeness, thwarted belongingness, self-harm, minority stressors and self-compassion pre-program, post-program, and at two month follow-up. Suicide ideation was measured pre-program, mid-program, post-program and at 2-month follow-up. Results are forthcoming.