Background: Mindfulness-based interventions (MBIs) are increasingly used in the management of various mental health disorders in children and adolescents. However, there is limited evidence about the efficacy of various interventions used. Method: A systematic review was performed to examine the effects of different MBIs on mental health symptoms and quality of life in both clinical and nonclinical samples of children and adolescents using data from only randomized control trials. The studies were also assessed for quality. Based on the type of MBI, study population, and control arm we had three comparisons for meta-analyses. Results: Fifteen studies were included in the qualitative analysis but only 11 trials with comparable interventions and controls were included for meta-analyses. Mindfulness-based stress reduction/mindfulness-based cognitive therapy arm was more effective than nonactive control in the nonclinical populations. Acceptance commitment therapy was comparable to active treatments in patients in the clinical range. Other MBIs were also effective improving anxiety and stress but not depression in nonclinical populations compared to nonactive control. Conclusions: Mindfulness-based interventions can be effective in children and adolescents with mental health symptoms. As there were significant limitations these results must be interpreted with caution. Key Practitioner Message• MBIs are a useful addition to the armamentarium for the treatment of children and adolescents • The methodological rigor of the studies evaluating the impact of MBIs is improving • Acceptance commitment therapy and MBSR appear to fulfill the criteria for empirically supported therapy in young people • Further studies focusing on the process of change and mediators of positive outcomes are necessary • Publication bias is an important limitation in this area of research.

Acceptance and Commitment Therapy (ACT) has a growing empirical base in the treatment of anxiety among adults and children with other concerns. This study reports on the main outcomes of a randomized controlled trial of ACT and traditional cognitive behavioral therapy (CBT) in children with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety disorder. Participants were 193 children from urban Sydney, Australia, who were block-randomized to a 10-week group-based program of ACT or CBT or a 10-week waitlist control (WLC). Completers included 157 children (ACT = 54, CBT = 57, WLC = 46; M = 11 years, SD = 2.76; 78% Caucasian, 58% female). Pretreatment, posttreatment, and 3 months posttreatment assessments included clinician/self/parent-reported measures of anxiety, quality of life (QOL; anxiety interference, psychosocial and physical health-related QOL), and acceptance/defusion outcomes. Completer and intention-to-treat analyses revealed that ACT and CBT were both superior to WLC across outcomes, reflecting statistically and clinically significant differences, with gains maintained at 3 months posttreatment. Both completer and intention-to-treat analyses found ACT and CBT to produce similar outcomes. There was some support for ACT having greater effect sizes for QOL outcomes but not for avoidance/fusion. Although this study does not suggest that ACT is equivalent to CBT or should be adopted in its place, it does provide evidence that ACT might be another empirically supported treatment option for anxious youth. Further research is needed to replicate these findings.

BackgroundAnxiety disorders affect approximately 10% to 20% of young people, can be enduring if left untreated, and have been associated with psychopathology in later life. Despite this, there is a paucity of empirical research to assist clinicians in determining appropriate treatment options. We describe a protocol for a randomized controlled trial in which we will examine the effectiveness of a group-based Acceptance and Commitment Therapy program for children and adolescents with a primary diagnosis of anxiety disorder. For the adolescent participants we will also evaluate the elements of the intervention that act as mechanisms for change.Methods/designWe will recruit 150 young people (90 children and 60 adolescents) diagnosed with an anxiety disorder and their parent or caregiver. After completion of baseline assessment, participants will be randomized to one of three conditions (Acceptance and Commitment Therapy, Cognitive Behavior Therapy or waitlist control). Those in the Acceptance and Commitment Therapy and Cognitive Behavior Therapy groups will receive 10 × 1.5 hour weekly group-therapy sessions using a manualized treatment program, in accordance with the relevant therapy, to be delivered by psychologists. Controls will receive the Cognitive Behavior Therapy program after 10 weeks waitlisted. Repeated measures will be taken immediately post-therapy and at three months after therapy cessation.DiscussionTo the best of our knowledge, this study will be the largest trial of Acceptance and Commitment Therapy in the treatment of children and young people to date. It will provide comprehensive data on the use of Acceptance and Commitment Therapy for anxiety disorders and will offer evidence for mechanisms involved in the process of change. Furthermore, additional data will be obtained for the use of Cognitive Behavior Therapy in this population and this research will illustrate the comparative effectiveness of these two interventions, which are currently implemented widely in contemporary clinical practice. Anticipated difficulties for the trial are the recruitment and retention of participants, particularly adolescents. To avert these concerns and maximize recruitment, several strategies will be adopted to optimize referral rates as well as reduce participant drop-outs.Trial registrationThis trial is registered with the Australian and New Zealand Clinical Trials Registry, registration number: ACTRN12611001280998

Objective: Anxiety disorders in children are the most prevalent of mental health conditions, but also the most treatable. However, a significant number do not benefit from treatment and these places them at risk for future psychiatric disturbance. Whilst Acceptance and Commitment Therapy (ACT) is gaining rapid evidence for its utility in treating a variety of disorders, research in children and adolescence is at an early stage. This paper reports on 2 year follow-up (2YFU) outcomes of the first randomized controlled trial of ACT and traditional cognitive behavioral therapy (CBT) in children with a DSM-IV diagnosis of anxiety disorders. Method:Of the 111 children from urban Sydney, Australia who completed treatment (10-week group-based program of ACT or CBT). A total of 79 (40 ACT and 39 CBT) were assessed at 2YFU. Pre-treatment, posttreatment, 3 months (3MFU) and 2YFU assessments included clinician/self/parent-reported measures of anxiety, anxiety-related quality of life (QOL) and acceptance/defusion outcomes. Several baseline predictors of anxiety outcome were also examined.Results: Positive findings were obtained for both ACT and CBT in terms of long-term maintenance of gains. Across measures, highly significant improvements observed at post and 3MFU were maintained at 2YFU. At post approximately one-third of participants in both treatment groups no longer met criteria for any anxiety disorder, with further improvement evident at 3MFU. Continued improvement was observed at 2YFU, with 45% of ACT and 60% of CBT participants diagnosis free (non-significant difference). Both completer and intention to treat analyses found ACT and CBT to produce similar outcomes. The only significant predictors in the short-term were pre-treatment severity and age. At 2YFU, no significant predictors were identified. However, most participants were in the severe anxiety category pre-treatment, limiting the exploration of severity as a predictor. Conclusion:Both ACT and CBT have shown similar long terms benefits for children with anxiety disorders. There was no clear or strong pattern of baseline predictors of outcomes. Further research is needed to explore this area.