In-person vs. eHealth Mindfulness-based Intervention for Adolescents with Chronic Illnesses: A Pilot Randomized Trial

Abstract

Background: Mindfulness-Based Interventions (MBIs) can improve mental health and well-being in adolescents with chronic illnesses. However, there are many barriers such as reduced mobility and distance which compromise accessibility to MBIs. Objective: The aim of this study was to determine the effectiveness of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program in youth with chronic illnesses delivered in person or via eHealth. Method: In this mixed method randomized controlled trial, participants received weekly 90- minute long MARS-A sessions for 8 weeks, either in person or via a secure eHealth audiovisual platform allowing group interactions in real time. Data was collected at baseline, immediately after and two months post-MBI through saliva analyses, electronic participant logs and validated questionnaires assessing mindfulness skills and mental health outcomes. Results: Seven participants per group completed the intervention (total n=14, completion rate 77.8%). Paired t-test analyses revealed a significant reduction in depression/anxiety scores immediately post-intervention (p=0.048, Cohen’s d=0.934) and a significant reduction in pre-post mindfulness cortisol levels at week 8 (p=0.022, Cohen’s d=0.534) in the eHealth group. Frequency and duration of weekly individual home practice (eHealth: 6.5 times; 28.8 minutes; in-person: 6.0 times; 30.6 minutes) were similar in both groups and maintained at follow-up. Conclusion: This is the first study comparing in-person and eHealth delivery of an 8-week MBI for adolescents with chronic illnesses. Although the study was limited by the small size of the sample, our results suggest that eHealth delivery of MBIs may represent a promising avenue for increasing availability in this population.

State of the Research: Physical and Mental Health Benefits of Mindfulness-Based Interventions for Children and Adolescents

“…Six studies used a structured protocol or treatment manual. Detailed treatment fidelity assessment procedures were reported in only one study, with each session being videotaped and reviewed by an expert MBSR facilitator [45]. Two other studies reported that facilitators received supervision or telephone consultation during the program [44,46].…”

“…Four of the seven studies used a validated mindfulness measure. Only one used a biological measure (salivary cortisol levels) to assess intervention effects [45].…”

“…In the only study that included a biological measure (salivary cortisol), a sub-set of participants provided salivary cortisol samples at weeks 1 and 8, twice each day, which for the intervention group, was pre-post their mindfulness session [45]. Significant reductions in cortisol levels were reported only for the pre-post session measures (d = 0.77).…”

“…At present, measuring mindfulness is often done by proxy-with assessments related to attention, executive function, observable behaviors, or clinical symptomology. Only a few youth studies have used fMRI [86] or other physiological measures [45,88]. Self-report questionnaires are the most common method in use-all of which have major limitations [89].…”

Mind–Body Physical Activity Interventions and Stress-Related Physiological Markers in Educational Settings: A Systematic Review and Meta-Analysis

“…Research implementing mindfulness-based interventions for the purpose of treating child and adolescent physical and mental health conditions is encouraging [ 70 , 76 , 77 , 78 ]. Results have revealed reduced symptoms of depression, anxiety, withdrawal, craving, chronic pain, and illness [ 70 , 76 , 77 , 78 , 79 ]. Psychological outcomes in educational settings have been extensively researched in terms of applying mindfulness [ 59 , 69 , 80 , 81 , 82 , 83 , 84 , 85 ].…”