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Making Friends With Yourself: A Mixed Methods Pilot Study of a Mindful Self-Compassion Program for Adolescents

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The aims of this mixed-method pilot study were to determine the feasibility, acceptability, and preliminary psychosocial outcomes of “Making Friends with Yourself: A Mindful Self-compassion Program for Teens” (MFY), an adaptation of the adult Mindful Self-compassion program. Thirty-four students age 14–17 were enrolled in this waitlist-controlled crossover study. Participants were randomized to either the waitlist or intervention group and administered online surveys at baseline, after the first cohort participated in the intervention, and after the waitlist crossovers participated in the intervention. Attendance and retention data were collected to determine feasibility, and audiorecordings of the 6-week class were analyzed to determine acceptability of the program. Findings indicated that MFY is a feasible and acceptable program for adolescents. Compared with the waitlist control, the intervention group had significantly greater self-compassion and life satisfaction and significantly lower depression than the waitlist control, with trends for greater mindfulness, greater social connectedness, and lower anxiety. When waitlist crossover results were combined with that of the first intervention group, findings indicated significantly greater mindfulness and self-compassion, and significantly less anxiety, depression, perceived stress, and negative affect post-intervention. Additionally, regression results demonstrated that self-compassion and mindfulness predicted decreases in anxiety, depression, perceived stress, and increases in life satisfaction post-intervention. MFY shows promise as a program to increase psychosocial well-being in adolescents through increasing mindfulness and self-compassion. Further testing is needed to substantiate the findings.
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1 23
Mindfulness
ISSN 1868-8527
Mindfulness
DOI 10.1007/s12671-015-0476-6
Making Friends with Yourself: A Mixed
Methods Pilot Study of a Mindful Self-
Compassion Program for Adolescents
Karen Bluth, Susan A.Gaylord, Rebecca
A.Campo, Michael C.Mullarkey &
Lorraine Hobbs
1 23
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ORIGINAL PAPER
Making Friends with Yourself: A Mixed Methods Pilot Study
of a Mindful Self-Compassion Program for Adolescents
Karen Bluth
1
&Susan A. Gaylord
1
&Rebecca A. Campo
1
&Michael C. Mullarkey
2
&
Lorraine Hobbs
3
#Springer Science+Business Media New York 2015
Abstract The aims of this mixed-method pilot study were to
determine the feasibility, acceptability, and preliminary psy-
chosocial outcomes of BMaking Friends with Yourself: A
Mindful Self-compassion Program for Teens^(MFY), an ad-
aptation of the adult Mindful Self-compassion program.
Thirty-four students age 1417 were enrolled in this waitlist-
controlled crossover study. Participants were randomized to
either the waitlist or intervention group and administered on-
line surveys at baseline, after the first cohort participated in the
intervention, and after the waitlist crossovers participated in
the intervention. Attendance and retention data were collected
to determine feasibility, and audiorecordings of the 6-week
class were analyzed to determine acceptability of the program.
Findings indicated that MFY is a feasible and acceptable pro-
gram for adolescents. Compared with the waitlist control, the
intervention group had significantly greater self-compassion
and life satisfaction and significantly lower depression than
the waitlist control, with trends for greater mindfulness, great-
er social connectedness, and lower anxiety. When waitlist
crossover results were combined with that of the first inter-
vention group, findings indicated significantly greater mind-
fulness and self-compassion, and significantly less anxiety,
depression, perceived stress, and negative affect post-inter-
vention. Additionally, regression results demonstrated that
self-compassion and mindfulness predicted decreases in anx-
iety, depression, perceived stress, and increases in life satis-
faction post-intervention. MFY shows promise as a program
to increase psychosocial well-being in adolescents through
increasing mindfulness and self-compassion. Further testing
is needed to substantiate the findings.
Keywords Adolescents .Mindfulness .Self-compassion .
Tee ns .Emotional well-being
Introduction
Adolescence is a vulnerable period of growth and challenge,
characterized by rapid cognitive, physiological, and neurolog-
ical changes (Giedd 2008;SusmanandDorn2009).
Adolescents are confronted daily with emotional and interper-
sonal challenges that accompany these developmental chang-
es. A developing self-identity and peer pressure to Bfit in^lead
to elevated stress and negative self-evaluation (Neff and
McGehee 2010). Without appropriate coping skills to manage
these challenges, adolescents are more vulnerable for depres-
sion and other psychological disorders (Horwitz et al. 2011).
These negative events may precipitate further maladaptive
behaviors such as substance abuse, poor school attendance,
and violence against themselves or others, which increase a
risk for a downward life trajectory (Albano et al. 2003;
*Karen Bluth
bluth@med.unc.edu
Susan A. Gaylord
gaylords@med.unc.edu
Rebecca A. Campo
Rebecca_campo@med.unc.edu
Michael C. Mullarkey
michael.mullarkey@utexas.edu
Lorraine Hobbs
jalhobbs@yahoo.com
1
Program on Integrative Medicine, Department of Physical Medicine
and Rehabilitation, CB #7200, School of Medicine, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
2
Department of Clinical Psychology, University of Texas at Austin,
Austin, TX, USA
3
University of California-San Diego Center for Mindfulness,
University of California at San Diego, San Diego, CA, USA
Mindfulness
DOI 10.1007/s12671-015-0476-6
Author's personal copy
Crocetti et al. 2009). Adolescent-appropriate interventions
that provide coping skills may help adolescents to successful-
ly navigate the challenges confronted during adolescence and
set individuals on a healthy path for life.
One such potential intervention is a mindful self-
compassion program, which combines the complementary
benefits of mindfulness and self-compassion. Mindfulness is
the ability to pay attention, on purpose, in the present moment,
with non-judgment and acceptance (Kabat-Zinn 1994). It in-
cludes recognition of thoughts or emotions that are in ones
momentary experience, then subsequently letting go of them,
recognizing them as transitory (Segal et al. 2002). Self-com-
passion, as defined by Neff (2003), includes three compo-
nents: mindfulness, described as being open and present to
ones own suffering; self-kindness, described as responding
with soothing and loving care to oneself at times of suffering;
and common humanity, described as recognizing that suffer-
ing is inherent in the human experience. Research on self-
compassion has provided evidence for its association with
beneficial mental health outcomes and potential for promoting
emotional resilience. For example, a meta-analysis of self-
compassion in adults indicated a large effect size for its asso-
ciation with lower psychopathology (MacBeth and Gumley
2012). Although most of the current research has been limited
to cross-sectional studies, longitudinal research with adults
indicates that self-compassion predicts lower depression
symptomatology over a 5-month period (Raes 2011). In ado-
lescents, greater self-compassion is associated with lower de-
pression, anxiety, and stress and greater well-being and self-
esteem (Barry et al. 2015; Bluth and Blanton 2014a,b;Neff
and McGehee 2010). Additionally, among high-school stu-
dents, self-compassion is associated with a sense of commu-
nity (Akin and Akin 2014) and protects against the negative
effects of low self-esteem when assessed over a 1-year interval
(Marshall et al. 2015). Finally, self-compassion appears to
have a protective effect in adolescent populations that are at
risk for poor mental health outcomes. Among adolescents
who experienced childhood maltreatment, those with lower
self-compassion were more likely to experience greater psy-
chological distress, alcohol abuse, and were more likely to
report a suicide attempt (Tanaka et al. 2011). Among adoles-
cents exposed to a potentially traumatic stressful event (the
Mount Carmel Forest Fire Disaster), self-compassion
exerted a protective effect, beyond dispositional mindful-
ness, with respect to post-traumatic stress, panic, depres-
sive, and suicidality symptoms at 3 and 6 months after the
traumatic event (Zeller et al. 2014). As noted, many of
these findings are based on correlational or cross-
sectional studies. It would be of further importance to de-
velop and test a self-compassion intervention for adoles-
cents that may promote positive mental health outcomes
and emotional resilience to protect against the challenges
of adolescence.
Mindfulness interventions have been developed for adoles-
cents and are associated with decreased stress and increased
life satisfaction, positive affect, happiness, and overall well-
being (e.g., Biegel et al. 2009; Broderick and Metz 2009;
Brown et al. 2011; Schonert-Reichl and Lawlor 2010).
However, these interventions tend to focus on the qualities
of attention, awareness, non-judgment, and acceptance (mind-
fulness),withonlyminorconsideration given to actively
soothing ones suffering or recognition of the universality of
these experiences (self-compassion). Neff and Germer (2013)
have recently developed an 8-week Mindful Self-Compassion
program for adults which focuses on cultivating self-compas-
sion. Clinical trial data from this program have demonstrated a
decreases in anxiety, depression, and stress, and increases in
life satisfaction, social connectedness, compassion for others,
and happiness (Neff and Germer 2013). Additionally, a mod-
ified 3-week version of this program resulted in decreases in
rumination and increases in optimism and self-efficacy among
female college students (Smeets et al. 2014). Although ado-
lescents have the potential to significantly benefit from self-
compassions effects (Neff 2003), there have been no self-
compassion programs designed to fit the emotional and devel-
opmental needs, challenges, and interests of adolescents.
The primary goal of the present study was to test the feasi-
bility and acceptability of a prototype Mindful Self-
compassion program, BMaking Friends with Yourself^
(MFY), which was adapted from the Mindful Self-
compassion program for adults (Neff and Germer 2013).
Our Mindful Self-compassion Program for adolescents
teaches the mindful self-compassion components of mindful-
ness, self-kindness, and awareness of common humanity in an
age-appropriate fashion. Another aim was to identify relevant
psychosocial outcomes associated with the intervention in
young men and women aged 1417. We hypothesized that
the BMaking Friends with Yourself^mindful self-
compassion intervention would be feasible and acceptable to
adolescents. Additionally, compared with a waitlist control,
adolescents assigned to the program would have lower symp-
toms of depression, anxiety, negative affect and perceived
stress, and higher life satisfaction, positive affect, and social
connectedness after completing the program. Finally, we hy-
pothesized that mindfulness and self-compassion would inde-
pendently predict changes in psychosocial outcome measures.
Method
Participants
Enrolled participants included 34 adolescents (ages14 to17)
who responded to flyers posted at their local high schools and
in the community and to e-mails that were sent out via univer-
sity listservs. Seventy-four percent (n= 26) of the participants
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were female, and the distribution for race was: White, 79 %
(n= 27); African American, 9 % (n=3); Asian, 6 % (n=2);
Native Hawaiian/Pacific Islander, 3 % (n=1); and other race,
3%(n= 1). Overall, the adolescents came from well-educated
families; 55 % (n=19) of mothers and 46 % (n=16) of fathers
had masters, doctorate, or professional degrees. In order to be
eligible for the study, participants had to score <13 on a mod-
ified Kutcher Adolescent Depression Scale (KADS; LeBlanc
et al. 2002) and not endorse the item which asked BOver the
last week, how have you been on averageor usuallyre-
garding thoughts, actions, of suicide?^Five adolescents were
excluded from the study for this reason prior to enrollment and
were referred to the study psychologist.
Procedure
Study Design
This study utilized a mixed methods embedded design
(Creswell and Plano Clark 2011). This type of design embeds
qualitative data into an intervention design. The qualitative
data were used to assess whether the program was acceptable
to participants. Therefore, the feasibility and acceptability of
the intervention in an adolescent population is investigated
through both quantitative and qualitative data. The programs
effects on psychosocial outcomes are investigated through
quantitative data.
After the study was approved by the Institutional Review
Board, participants were recruited through the Program on
Integrative Medicines listserv, a university-wide recruitment
e-mail service, and flyers that were posted at local high
schools and in the community. Study screening phone inter-
views were scheduled with both the parent and adolescent.
During this interview, the study coordinator explained the
study, consent procedure, and eligibility requirements to first
the parent and then the adolescent. Next, the adolescent com-
pleted a modified version of the KADS, which separated the
suicide/self-harm item into two separate items for self-harm
and for suicide. The adolescent was considered eligible if he/
she scored below 13 on the KADS and did not endorse the
suicide item. The parent and adolescent were e-mailed the
consent and assent forms. Upon returning the consent forms,
the adolescents were randomized into two groups: a treatment
group (cohort 1) or a waitlist control (cohort 2) but not in-
formed about their group placement until after they completed
the baseline survey. The treatment group (Cohort 1) partici-
pated in the 6-week mindfulness and self-compassion adoles-
cent program, BMaking Friends with Yourself^(MFY), from
February to March 2014 and the waitlist crossover group (co-
hort 2) participated in the program from April to May 2014.
Four days prior to cohort 1s first class (time 1; see Fig. 1), all
study participants were e-mailed a link to the online baseline
survey. The survey was e-mailed a second time to all study
participants the day following cohort 1s final class (time 2).
One week following, cohort 2 began the 6-week MFY pro-
gram. The day following cohort 2s final class, cohort 2 par-
ticipants were again sent the link to the online survey (time 3).
Adolescents received a $25 gift card for completing each of
the three surveys and attending four out of six of the class
sessions, for a maximum total of $75.
Intervention
BMaking Friends with Yourself: a Mindful Self-compassion
Program for Teens^(MFY) was a 6-week course that met
weekly for 90 min. It was led by the first author (Bluth), a
mindfulness practitioner for over 35 years, a mindfulness in-
structor for 3 years, and a certified teacher with 18 years class-
room experience, 10 of which had been with adolescents.
Similar to the adult program (Neff and Germer 2013), each
weekly session of MFY had a specific theme. Session 1 pro-
vided an overview of the program, definition of mindfulness
and self-compassion, and included several hands-on activities
that encouraged participantsself-discovery of mindfulness
and self-compassion. For example, one exercise included a
role-play which elucidated a key understanding of how we
relate to ourselves and set the groundwork for self-
compassion practice. Session 2 focused on mindfulness and
introduced several traditional practices, including mindful
breathing and bringing attention and awareness to physical
sensations. Session 3 centered on the teenage brain, and in-
cluded a didactic presentation of how two brain systems (cog-
nitive control system and incentive processing system) are
developing at different rates during adolescence. The cogni-
tive control system includes the development of the prefrontal
cortex (i.e., logical thinking, decision making) and the incen-
tive processing system includes development of the amygdala
and limbic system (i.e., fight-flight response). Discussion was
encouraged related to the ramifications of these changes in the
individuals temperament, behavior, and family processes.
Session 4 focused on describing how self-compassion is dif-
ferent than self-esteem, and articulated why self-compassion
is a healthier way of relating to oneself. In this session, several
short videos were shown that illustrated the differences be-
tween these two constructs. In session 5, participants were
led through an exercise to find their inner Bcompassionate
voice^and expressed it through their choice of a writing or
art activity. The last session focused on gratitude, adolescents
core values, and discussion of the overall program. In general,
this program differed from the adult program in that classes
were shorter, developmentally appropriate (e.g., more activi-
ty-based, incorporated a mindful movement segment halfway
through each class, shorter guided meditations), and included
a component about the adolescent brain.
In addition to the hands-on activities and exercises that
elucidated the weekly theme, adolescents were introduced to
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specific formal and informal mindfulness and self-compassion
practices. For example, in a formal practice, adolescents were
led through a self-compassion body scan in which they were
invited to bring warmth and affection to each part of their
body while noticing sensations in that area of the body. In an
informal practice called BA Moment for Me,^adolescents
were taught to apply a soothing touch (e.g., stroking ones
arm, holding hands together) while repeating phrases that
reminded them to do three things: (1) acknowledge their suf-
fering in the moment that it is occurring, (2) recognize that
emotional suffering is universal and part of the being human,
and (3) actively soothe themselves precisely in these challeng-
ing moments by repeating kind phrases for themselves. In the
last class, students were asked for feedback about the pro-
gram. Specifically, they were asked about practices or medi-
tations thatthey preferred and ones that they did not like. They
were also asked about any suggestions that they might have
for improving the program.
For homework, participants were assigned at least one for-
mal and one informal mindfulness or self-compassion practice
(e.g., formal guided meditation practice and informal BA
Moment for Me^practice) to do during the week between
classes. To support home practice, students were encouraged
to access a website which had audio and video recordings of
the adult versions of the classs guided meditations, since a
website with adolescent versions of the guided meditations
was not available. These audio and video recordings were
consistent with the practices that had been introduced in class.
Prior to the beginning of class each week, students completed
a questionnaire that assessed the number of days that week
they engaged in any kind (both formal and informal) of mind-
fulness or self-compassion practice.
Measures
Feasibility and Acceptability
Feasibility was assessed through attendance and retention da-
ta. A criteria of 75 % attendance and 80 % retention was
established as a measure of feasibility; this is in accordance
with previous studies (e.g., Sibinga et al. 2008;Mendelsonet
al. 2010). Acceptability was assessed through qualitative data
which elucidated the degree to which participants were en-
gaged in the content of the program, and participantsfeed-
back on the various program activities. Last, since this was a
pilot study to evaluate a new intervention, participants were
asked in the last class fororal feedback regarding the program.
Qualitative Data Collection
All classes were audiotaped and transcribed verbatim. The
purpose of this was to inform our understanding of the
kinds of mindful self-compassion meditations and other
activities that are successful and acceptable to adolescents.
Since this study is the first implementation of a mindful
self-compassion program for adolescents of which we are
aware, hearing the opinions, suggestions, and feedback of
the participants in their own voices provides a rich source
of descriptive data to inform refinement and future imple-
mentation of this program.
The online survey was administered at baseline and post-
intervention within 24 h of completing the last class. The
survey included the following measures:
Mindfulness
The Children and Adolescent Mindfulness Measure (CAMM;
Greco et al. 2011) assesses moment-to-moment attention and
acceptance of internal experiences. Participants indicate their
responses to each item using a 5-point Likert scale ranging
from 0 (never true)to4(always true).The total score is cal-
culated by reverse scoring all items and then summing the
items. The potential range of total scores is 040, with
higher scores indicating greater mindfulness. Examples of
items on this scale include: I get upset with myself for
having certain thoughts and I push away thoughts that I
dontlike. Factor analysis of the construction of this ten-
item scale resulted in a one-factor solution with a reported
Cronbachs alpha of 0.80 (Greco et al. 2011). Reliability
for this study is α=0.76.
Time 1: Assessment 1 Time 2: Assessment 2 Time 3:
Assessment 3
(Cohort 2 only)
Waitlist
Intervention
Intervention
Cohort 1
Cohort 2,
(waitlist
crossovers)
1 week
interval
Fig. 1 Depiction of the study
time frame
Mindfulness
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Positive and Negative Affect
To measure the extent to which individuals experienced posi-
tive and negative affect over the past week, the 20-item Positive
and Negative Affect Schedule was used (PANAS; Watson et al.
1988). The PANAS is composed of two subscales: positive
affect (PA) and negative affect (NA). Participants are asked to
indicate how much he or she has experienced each of the ten
positive emotions (e.g., interested, active, proud)andtheten
negative emotions (e.g., hostile, guilty, distressed) over the past
few days. Participants indicate their responses to each item
using a 4-point scale ranging from 1 (very slightly or not at
all)to4(most of the time). The total scale scores are calculated
by summing the ten PA items for the total PA score and sum-
ming the ten NA items for the total NA scale score. The po-
tential range of values for each total scale score is from 10 to
40. Higher scores for PA indicate higher positive affect, and
higher score for NA indicate higher negative affect. The two
subscales have been shown to have low correlation with each
other (r=0.22), are internally consistent (Cronbachsal-
pha = 0.84 to 0.87 for NA, and 0.86 to 0.90 for PA) and stable
over a 2-month time period (r=0.48 for PA, r=0.42 for NA)
(Watson et al. 1988). Reliability for the current study is
α= 0.84 for positive affect and α= 0.91 for negative affect.
Self-compassion
The Self-compassion scale, short form (SCS-SF; Raes et al.
2011) is composed of 12 items. Example items are: I try to see
my failings as part of the human condition and When Im
going through a very hard time, I give myself the caring and
tenderness I need. Participants indicate their responses to each
item using a 5-point scale ranging from 1 (Almost never) to 5
(Almost always). To compute a total self-compassion score,
negatively worded items are reverse scored, and all 12 items
summed. The potential range in values is from 12 to 60, with
higher score indicating greater self-compassion. A factor anal-
ysis indicated that the shorter version of the scale has the same
factor structure as that of the full 26-item scale, that of a single
first order self-compassion factor with six sub-second-order
factors representing the six facets of self-compassion.
However, due to the brevity of the scale, it is recommended
that only the total score be used, and not subscale scores (Raes
et al. 2011). Reliability for this scale is good; reported
Cronbachs alpha 0.75 (Marshall et al. 2015; Raes et al.
2011). Correlation with the full scale is excellent; r= 0.97
(Raes et al. 2011). Reliability for the sample in this study is
α=0.79.
Life Satisfaction
Life satisfaction was measured using the StudentsLife
Satisfaction Scale (Huebner 1991). A component of
subjective well-being, life satisfaction refers to a judgment
about ones well-being that is beyond that which is linked
directly to well-being in specific contexts. Examples of items
include My life is going well and My life is better than most
kids. Participants indicated their responses to each item using
a 4-point Likert scale ranging from 0 (never)to3(almost
always). The total score was calculated by first reverse scoring
items 3 and 4 and then summing the items and dividing by the
number of items. The potential range of values for the total
score is 03. Higher scores indicate greater life satisfaction.
The seven-item scale has a unidimensional factor structure,
adequate temporal stability over 12 weeks (correlation = 0.74
with student samples from grades 4, 6, and 8), and good in-
ternal consistency (Cronbachs alpha = 0.82 with student sam-
ples from grades 4, 5, 6, and 8) (Huebner 1991). Further val-
idation, internal consistency, and test-retest reliability over
1 year was established in a study with 9th, 10th, 11th, and
12th graders (Huebner et al. 2000). Reliability for the sample
in this study is α=0.84.
Perceived Stress
Perceived stress was measured using the ten-item Perceived
Stress Scale (Cohen et al. 1983). This scale is designed to
assess the degree to which respondents find their lives
Bunpredictable, uncontrollable, and overloading^(Cohen et
al. 1983, p. 387). Examples of items include: In the last month,
how often have you felt that things were going your way? and
In the last month, how often have you felt that you were unable
to control the important things in your life? Participants indi-
cated their responses to each item using a 5-point Likert scale
ranging from 0 (never)to4(very often). Total scale score is
calculated by reverse-scoring positively worded items and
then summing all ten items. The potential range of values
for the total scale score is 040. Reported reliability is 0.91
in college and community samples (Cohen et al. 1983)and
0.88 in a sample with early adolescents (Yarcheski and Mahon
1999). Cronbachs alpha for this study is α=0.75.
Anxiety
The trait portion of the Spielberger State-Trait Anxiety
Inventory (STAI; Spielberger et al. 1983) assessed general
trait anxiety. The trait portion is a 20-item inventory in which
participants are asked how they Bgenerally feel.^Participants
respond to items on a 4-point Likert scale ranging from 1
(almost never)to4(almost always). Examples of items in-
clude I have disturbing thoughts and I am nervous and
restless. To calculate scale scores, positively worded items
are reverse scored and all items are then summed. The poten-
tial score range is 2080, with higher scores indicating greater
anxiety. Reports of Cronbach alphas for the full scale have
ranged from 0.86 to 0.95, and test-retest reliability over two
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months ranges from 0.65 to 0.75 (Spielberger et al. 1983).
Reliability for the current study is α=0.92.
Depression
The Short Mood and Feelings Questionnaire (SMFQ; Angold
et al. 1995) is a self-report 13-item scale that assesses child-
hood and adolescent depression. Participants are asked how
often the items have been true for them over the last two
weeks. Examples of items include: I felt miserable or unhappy
and I felt that it was hard to think properly or concentrate.
Responses are indicated with a 3-point Likert scale ranging
from 0 (not true)to2(true). Potential total score range is 0
26, with higher scores indicating greater depression.
Reliability was reported as 0.85 (Angold et al. 1995).
Reliability for the sample of this study is α=0.89.
Social Connectedness
The Social Connectedness scale is an eight-item scale that
assesses the sense of interpersonal belongingness and
Bsubjective awareness of being in close relationship with the
social world^(Lee and Robbins 1998,p.338).Examplesof
items include I feel disconnected from the world around me
and Even around people I know,I dont feel like I really
belong. Responses are indicated on a 6-point Likert scale
ranging from 1 (agree)to6(disagree).Scale score is comput-
ed by reverse scoring all eight items and then summing all
items. The potential score range is 8 to 48, with higher scores
indicating greater feelings of connectedness. Reported reli-
ability is α=0.91 and test-retest reliability over a 2-week in-
terval was 0.96 (Lee and Robbins 1995). Reliability for the
current study sample is α=0.94.
In addition, we collected data for baseline demographics.
These included information pertaining to age, gender, race/
ethnicity, and level of parentseducation.
Data Analysis
To address outcomes, data were screened for outliers and de-
pendent variables were examined for normality. We investi-
gated whether cohort 1 (n= 16) a nd cohort 2 (n= 18, waitlist
control) differed on baseline demographic and psychosocial
variables at time 1 with independent ttests. Descriptive statis-
tics were calculated for cohort 1 and waitlist control for pre-
and post-intervention for time 1 and time 2. To assess whether
the groups differed on post values (time 2), we conducted
hierarchical regressions controlling for baseline. Next, to in-
crease sample size and statistical power, all data from partic-
ipants who completed the intervention (cohort 1: time 1 to
time 2, cohort 2/waitlist crossovers: time 2 to time 3) were
combined and examined within group changes with paired t
tests. We also calculated Hedgesgscores for effect size as
this complies with current recommendations (Cumming 2014;
Kline 2013; Wilkinson and APA Task Force for Statistical
Inference 1999). Hedgesgis similar to Cohensdbut in-
cludes a correction factor for small samples. Nonsignificant
differences with Hedgesggreater than 0.20 are considered
meaningful and are interpreted according to convention:
0.20 = small, 0.50 = medium, and 0.80 = large (Borenstein et
al. 2009;Cohen1988). Finally, hierarchical regressions were
conducted to examine whether changes in mindfulness and
self-compassion predicted changes in the psychosocial
outcomes.
Results
Feasibility and Acceptability
To determine feasibility of the intervention for an adolescent
population, we investigated attendance and retention. To de-
termine acceptability, we investigated qualitative data via par-
ticipantsin-class discussions.
Cohort 1 had one class (class 3) canceled due to extreme
winter weather conditions, resulting in a total of five classes.
To make up for the missed curriculum, the next class (class 4)
was held for a longer period of time (2.5 h). Cohort 2 was able
to follow the protocol for six total classes. Therefore, class
attendance proportion (no. of classes attended/total no. of clas-
ses) was calculated separately for each group. Additionally,
we report the frequency and percentages of absences separate-
ly for each group.
Attendance was good, with a mean attendance proportion
of M=0.89, SD = 0.14 for cohort 1 and M=0.78, SD =0.12
for cohort 2. No more than two classes were missed in cohort
1 (13 % missed two classes) and cohort 2 (46 % missed two
classes). Youth participants attending 6266 % of classes have
been considered Bcompleters^in other studies (e.g., Britton et
al. 2010; Sibinga et al. 2008). Reasons for a slightly lower
attendance in Cohort 2 may have been due to the time of year
(e.g., school final exams, Advanced Placement exams).
After enrollment, two participants withdrew (one before
the first class, one after the first class) due to schedule con-
flicts. Another participant was withdrawn because she did not
attend any classes, and two other participants were withdrawn
prior to the administration of the final survey because they
missed three or more classes. This resulted in a retention rate
of 86 %.
To assess home practice completion, participants reported
the number of days per week they engaged in home practice.
The participants reported an average of 2.01 days/week of
home practice (SD = 1.46; range 0 to 7 days). The cohorts
did not differ on the total number of home practice days
[t(27) = 0.310, p= 0.76)] or on average days of home practice
per week [t(27)= 0.09, p=0.93].
Mindfulness
Author's personal copy
To analyze qualitative data, transcriptions of audiorecorded
classes were imported into Atlas-ti 7.5 software which was
used to analyze transcriptions based on conventional content
analysis, a process in which codes are derived directly from
data (Hseih and Shannon 2005). Transcriptions were reviewed
to obtain a broad understanding of the class discussions as
they relate to the research questions. Memos were created in
Atlas-ti to describe initial impressions of potential concepts
emerging from the data. Second, inductive coding was con-
ducted; text segments ranging from a few words to a para-
graph (depending on extent of text needed to establish mean-
ing) that related to acceptability of the program were assigned
codes (Strauss and Corbin 1998). After all transcriptions were
provided with initial codes, connections were identified be-
tween the initial codes and these were grouped together by
theme. The node function in Atlas-ti facilitated this process.
Finally, these groupings were linked together with the objec-
tive of discerning overarching categories that emerged from
the in-class discussions and related to the acceptability of the
intervention.
Overall, there were five overarching categories that de-
scribed acceptability of the intervention. These were defined
as: favorite elements of program, suggestions for changes,
enhanced understanding of the concept of self-compassion,
self-compassion implemented in daily lives, and engagement
in class.
Favorite Elements of Program In general, the practices that
participants preferred were those that were more concrete, and
involved noting direct, physical sensations. For example, a
number of participants voiced that they liked the self-
compassionate body scan and found it very relaxing. One
participant stated, BIt felt like a power napHow long was
it, 15 minutes? It felt like hours!^Another agreed, BIfeltreally
tired today because I didnt get much sleep last night. Now I
feel better.^
Several others stated that the tool that was most useful
for them was the here-and-now stone. The here-and-now
stone is a polished stone that the participants were given to
keep with them as a touchpoint to facilitate letting go of
worries about the future or past, and to bring awareness
into the present moment. The fact that it was portable made
it possible to implement the practice in the moment when
participants were experiencing stress. BI really liked the
here-and-now stone. Yeah, especially during AP testing. I
brought that with me and that was like phenomenal. It
really helped.^Another participant recognized that the
stone was simply a tool to bring them into the present
moment, and that this could be extended to any other phys-
ical object.
I misplaced mine; I used other things that I had in my
pocket like my phone. I would just like, fiddle with it,
just kind of rub things, and be like Oh!I think it
would be helpful to emphasize that it doesnthaveto
be the stone.
Another participant expressed that the soothing touch prac-
tice was helpful. In this practice, participants are encouraged
to put a hand on their heart or some other soothing gesture that
involves physical touch. This practice is often used in con-
junction with expressing silent loving-kindness intentions ei-
ther toward oneself or someone else. In the following quote,
the participant expresses that the physical gesture was
comforting and facilitated her feeling more connected with a
loved one.
I felt like having my hands across my chest was very
anchoring. The person who I was imagining isnthere
anymore, so it kind of helped me feel more present,
more connected with the imaginary. I really liked it; it
was something different for me. It was nice. Very
relaxing and comforting.
In addition to the concrete skills that were introduced in the
class, a number of participants voiced that learning about the
componentsof self-compassion was helpful. Specifically, sev-
eral participants articulated that the common humanity com-
ponent of self-compassion was particularly powerful for them.
What I got most out of this class was reinstating the
common humanity. Like whatever youre feeling,
youre not alone in it. Somebody else will feel the same
way, will know where youre coming from, even if you
think that no one understands, there will be somebody
who does.
Another participant elucidated how the practice of repeat-
ing common humanity phrases in the context of BAM
oment
for Me^, another informal practice, allowed the concept of
common humanity itself to emerge, BI got a lot out of the
common humanity which I was originally saying to myself
kind of jokingly, but then it turned more real after a while.^
Another participant articulated that the mindfulness aspect
helped with focus and schoolwork.
Mindfulness has helped me focus because every day. I
have like 20 pages to read in APUSH and APES [AP US
History and AP Environmental Science], and somehow
right now it is hardto get reading, and every day I would
come home and think Idontwanttodothis, and so I
wouldnt, but if I sat down and focused only on this and
nothing else then I got it done and it didnteventakethat
long. So I actually like meditating and focusing on
my breath, because it helped me focus on my
schoolwork.
Mindfulness
Author's personal copy
Suggestions for Changes Although there were fewer com-
ments related to aspects of the program that were less appeal-
ing to participants than those that were appealing, participants
commented about certain aspects of the program that did not
work as well for them, and made suggestions for changes.
Mostly, these were related to the formal home practices.
Participants felt that it was inconvenient and time consuming
to go to a website to listen to guided meditations, as was
suggested, and felt that the meditations on the website were
too long. In contrast, the Bin-the-moment^practices, those that
could be done at the moment when feeling stressed (such as
thehere-and-nowstone)weremoreuseful.
Brush your teeth mindfully, I do that every day, but like I
wouldnt go out of my way to go online, like if you want
people to do them [home practices] really well, like a lot,
then I would suggest it not having it be something like
getting a book and reading about mindfulness or going
online, it would be something you could remember
while you were doing it, like Oh! Im supposed to be
mindful right now!
Another participant agreed with this sentiment, BGoing to
some mindfulness site every day just isntpartofmy
routine.^In addition, participants commented that there
were no consequences for not doing homework, and therefore
attending to it was low priority in the busy lives of these teens.
Yeah, that just wasnt a priority for me. I have a ton of
homework every day. When I get home, I just think
about my homework and what I have to do for the next
day at school. Because this class was once a week for
only six weeks, it wasnt what I was thinking about.
Another participant mentioned, BThere arentasheavycon-
sequences here if you dont do your homework.^Due to these
factors, a number of the participants found it difficult to com-
plete the formal at-home practices. However, at least one par-
ticipant disagreed and was able to make it part of her routine.
For me, it didnt really feel like homework. To me, it
was just like part of my daily routine. Its just like adding
an extra step which would be going online and listening
to something it helped a lot more, it helped. It was
different. It was a change.
Participants suggested that an email be sent halfway
through the week in between classes as a reminder to do the
homework practice. Finally, several participants suggested that
there be more clarification around the concept of mindfulness.
There was a definition [of mindfulness] but I feel like I
missed something, other people explained it to me, and
now I feel like I kind of get it. If I understood more of
what mindfulness was and of its benefits, actual hard-
core benefits, then I would have listened to the medita-
tions more and gotten more out of it than I did.
Enhanced Understanding of the Concept of Self-Compas-
sion Over the course of the 6-week program, participants de-
veloped a greater understanding of the construct of self-com-
passion. One participant commented about how onessenseof
self can be enhanced through implementing this construct,
instead of their self-concept being based on how well they
performed a task. For example, they can perceive themselves
as Bgood^regardless of their performance. BI think what its
basically saying is instead of telling people its ok you did this
good, which they then connect to Ima good person, [youre
saying] its okay you did this poorly, you messed up, but its
ok.^Another participant expressed that understanding self-
compassion helped her change the way she relates to her
schoolwork, thereby decreasing anxiety.
IguessIm thankful for the tools that Ive learned, be-
cause I get a lot of anxiety about school, especially. I feel
like in the last few weeks my anxiety in the moment has
decreased because Im mindful and compassionate to-
ward myself, and I dont know, I feel much better about
a lot of stuff I have to do, because I know itsnottheend
of the world if I dontdoitorwhatever.
Similarly, another participant explained that the program
brought her the ability and awareness to discern which tasks
absolutely had to be attended to immediately versus those that
could wait.
I think mindful self-compassion is about being in tune
with yourself and being able to know what is going on
so that you can judge better OK, this is a thing that I
need to doversus This is something that I can give
myself a rest with.You know, mindfulness is about
really being aware of what is going on emotionally
and physically for you so that you can make that
decision.
Self-compassion Implemented in Daily Lives Throughout
the program, participants related how they were able to imple-
ment the self-compassion tools that they learned in class to
contend with the stressors or difficulties that arose in their
daily lives. In the quote below, one participant demonstrated
her new ability to not ruminate on a mistake she had made.
I forgot my brothers birthday today. I just left the house
and I felt really bad and I emailed him and I emailed my
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Author's personal copy
mom I guess I sort of used the self-compassion thing
because I was like Ok, I cantdoanything,andIdidnt
really dwell on it all day.
Another participant related how she was able to improve
her ability to fall asleep. BI used the mindfulness stuff and
thats pretty cool because the body scan helps me fall asleep
at night.^A third participant demonstrated her ability to main-
tain perspective and hence keep stress at bay, BIve tried the
self-compassion break [BAMomentforMe^] a few times like
when Im really stressed out about something. I just take a
break and put it into perspective and say its not really that
big a deal.^When adolescents experienced heightened emo-
tions that seemed to have no apparent cause, mindful self-
compassion tools were useful, BThere were a couple of times
when I felt anxious for no real reason but I tried to use the
mindfulness stuff and it helped a little bit.^
Engagement in Class In general, students were actively en-
gaged in class throughout the 6-week program. The program
involved hands-on activities, often in small groups, rather than
in a lecture format, and this facilitated student involvement.
Also, the participants seemed able to see the relevance that the
in-class practices had to their daily lives outside of class. For
example, after an activity that used their senses to pay close
attention to a piece of chocolate (i.e., mindful eating), partic-
ipants agreed that they were not worrying or ruminating about
events in their daily lives when engaged in the activity because
they were able to focus on the present experience of tasting or
feeling the texture of the chocolate. When asked what it would
be like if people paid as much attention to aspects in their lives
as they did during the mindful eating activity, one participant
answered, BYou would savor it more.^Another teen elaborat-
ed, BI think people would be closer If you arent really
listening to someone, you cant understand what theyre say-
ing. If neither of you is paying attention to the other, itsalmost
like two separate conversations going on.^
Engagement in class also facilitated participantsunder-
standing of how self-acceptance could be strengthened.
One participant commented, Even if youre a little too
loud or a bit too talkative in groups, or if youre single-
minded about one subject, or if youre kind of selfish, or
bad at problem-solving, or whatever, thats just a part of
who you are and thatsok!
This was affirmed by another participant, BWe all have
flaws because we are human beings and we have to accept
our flaws as flaws.^The essence of the program is that teens
can learn how to be a friend to themselves and this is support-
ed through the compassionate friend meditation, a guided
meditation which facilitates this process. One participant
grasped the essence of the program when she shared, BI
always feel that I have to have someone else to prove that I
can do things. But I have myself, and that is someone!^
In the first step of the analysis of quantitative data, we
determined that cohort 1 and cohort 2 (waitlist control) did
not significantly differ on baseline demographic and psycho-
social variables at time 1 with independent ttests (all pvalues
>0.05). Descriptive statistics for cohort 1 and the waitlist con-
trol group at time 1 and time 2 are displayed in Table 1.Next,
we compared cohort 1 and the waitlist group on their post
psychosocial outcomes (time 2; i.e., before cohort 2 received
the intervention) with hierarchical regressions that controlled
for baseline. The results indicated that cohort 1 had signifi-
cantly greater self-compassion (β=0.24, p= 0.049) and trends
for greater mindfulness (β=0.20, p= 0.08) than the waitlist
group (see Table 2). Additionally, Cohort 1 reported signifi-
cantly greater life satisfaction (β=0.30, p= 0.04), lower de-
pression (β=0.27, p= 0.004), and evidence of trends for
anxiety (β=0.20, p= 0.098) and social connectedness
(β=0.21, p= 0.097) compared with the waitlist group.
Percent change of the psychosocial outcomes from time 1 to
time 2 are depicted in Fig. 2.
There were no significant differences between the two
groups at time 1 (baseline), and the crossover design allowed
us to combine data from the two cohortsintervention periods.
This increased the sample size and statistical power and en-
abled us to examine changes over the intervention periods.
Paired ttests indicated significant changes in self-
compassion (p= 0.005) and mindfulness (p< 0.001).
Additionally, there were significant changes in anxiety
(p= 0.015), depression (p= 0.001), perceived stress
(p=0.032), and negative affect (p= 0.027). Hedgesgresults
demonstrated a small to medium effect size in these variables
(range = 0.37 to 0.58; see Table 3;Fig. 3).
To investigate whether changes in self-compassion and
mindfulness were associated with changes in psychosocial
outcomes, hierarchical regressions were conducted with the
data from the combined cohortsintervention periods. When
controlling for baseline values of self-compassion and the out-
come variables, increases in self-compassion predicted in-
creases in life satisfaction (β= 0.61, p= 0.001), along with
decreases in anxiety (β=0.48, p= 0.01) and perceived stress
(β=0.49, p= 0.02). Increases in self-compassion marginally
predicted increases in social connectedness (β=0.31,
p= 0.09). Changes in self-compassion did not significantly
predict changes in depression, positive affect, or negative af-
fect (pvalues >0.30) (Table 4).
We then examined the predictive ability of changes in
mindfulness on changes in the psychosocial outcome vari-
ables. When controlling for baseline values of mindfulness
and the outcome variables, changes in mindfulness predicted
decreases in depression (β=0.49, p= 0.01) and anxiety
(β=0.59, p=0.01). Mindfulness was not a significant pre-
dictor for the remaining variables (pvalues >0.10) (Table 5).
Mindfulness
Author's personal copy
Because increases in self-compassion and mindfulness pre-
dicted decreases in anxiety independently, we conducted a
hierarchical regression (controlling for baselines) to determine
if they remained significant predictors of decreases in anxiety
when both were included in the model. As a set, changes in
self-compassion and mindfulness explained 30 % of the var-
iance for anxiety (F(1, 23) = 11.39, p= 0.003. Increases in
self-compassion (β=0.45, p= 0.001) and mindfulness
(β=0.55, p= 0.001) had unique predic tive ability on de-
creases in anxiety, when controlling for the other.
As an exploratory analysis, we investigated whether home
practice was related to change in mindfulness or self-compas-
sion. Bivariate correlations indicated that the number of home
practice days per week was not significantly associated with
Tabl e 1 Descriptive statistics of
cohort 1 and waitlist at time 1 and
time 2, and change
Cohort 1 M(SD)
n=16
Waitlist M(SD)
n=18
CAMM
Pre (time 1) 20.19 (5.78) 18.61(6.54)
Post (time 2) 23.56 (5.35) 19.67 (7.30)
Change [95 % CI] 3.37(4.49) [5.77, .99] 1.06 (3.95) [3.02, .91]
SCS
Pre (time 1) 2.79 (0.17) 2.62 (0.67)
Post (time 2) 3.11 (0.43) 2.68 (0.74)
Change [95 % CI] 0.32 (0.63) [0.65, 0.02] 0.06 (0.29) [0.21, 0.08]
PSS
Pre tTime 1) 23.33 (5.11) 26.94 (5.27)
Post (time 2) 21.20 (4.62) 25.94 (6.90)
Change [95 % CI] 2.13 (4.72) [0.48, 4.75] 1.00 (3.82) [0.97, 2.97]
SMFQ
Pre (Time 1) 9.00 (5.97) 9.50 (6.59)
Post (Time 2) 6.75 (5.09) 10.39 (6.63)
Change [95 % CI] 2.25 (3.70) [0.28, 4.22] 0.89 (2.74) [2.25, 0.47]
STAI
Pre (time 1) 47.31 (9.42) 51.22 (12.45)
Post (time 2) 44.75 (8.45) 52.22 (13.22)
Change [95 % CI] 2.56 (10.48) [3.02, 8.15] 1.00 (4.77) [3.37, 1.37]
CONN
Pre (time 1) 33.06 (8.85) 32.61 (13.14)
Post (time 2) 36.50 (8.60) 31.44 (12.89)
Change [95 % CI] 3.44 (10.17) [8.85, 1.98] 1.17 (7.19) [2.41, 4.74]
SLSS
Pre (time 1) 24.75 (3.19) 22.56 (4.85)
Post (time 2) 26.06 (3.43) 22.67 (3.87)
Change [95 % CI] 1.31 (4.33) [3.62, 1.00] .11 (3.18) [2.41, 4.74]
PA
Pre (time 1) 3.01 (0.65) 2.80 (0.56)
Post (time 2) 3.09 (.59) 2.89 (0.66)
Change [95 % CI] 0.08 (0.50) [0.35, 0.18] 0.09 (0.41) [0.30, 0.11]
NA
Pre (time 1) 2.49 (0.76) 2.50 (0.96)
Post (time 2) 2.31 (0.70) 2.47 (1.01)
Change [95 % CI] 0.18 (0.77) [0.22, 0.60] 0.03 (0.43) [0.19, 0.24]
Note.Changeistime2time 1
CAMM Children and Adolescent Mindfulness Measure, SCS Self-compassion Scale, PSS Perceived Stress Scale,
SMFQ Mood and Feelings Questionnaire-short form, STAI Spielberger State-Trait Anxiety Scale (trait subscale),
CONN Social Connectedness Scale, SLSS Student Life Satisfaction Scale, PA Positive Affect subscale of
PANA S, NA Negative Affect subscale of PANAS, CI confidence interval
Mindfulness
Author's personal copy
change in mindfulness or self-compassion (pvalues >0.05).
This may be a result of the low number of days of home
practice overall.
Discussion
The primary aim of this study was to assess the feasibility,
acceptability, and preliminary outcomes of BMaking Friends
with Yourself: A Mindful Self-compassion Program for
Tee ns .^This is a new program for adolescents that introduces
the concepts of both mindfulness and self-compassion, while
providing opportunities for hands-on practice of mindfulness
and self-compassion skills. The program was found to be fea-
sible, as demonstrated by attendance and retention rates.
Attendance rate was good, with students attending 89 %
(cohort 1) and 78 % (cohort 2) of the sessions. Retention rate
was good as well; 86 % of the adolescents completed the
program.
Acceptability of the program was determined by qualitative
data provided through in-class discussions and homework
completion. Qualitative analyses indicated that the program
was generally well-liked by participants. Adolescents found
the concepts of self-compassion and mindfulness to be appli-
cable and useful in their daily lives, felt that they benefited
from coming to class, and indicated that they used the prac-
tices during moments of stress. In particular, the tools that
were most favored by participants were those that involved
noticing direct physical sensations, such as the body scan and
the here-and-now stone. Although adolescents indicated that
the informal practices were useful, they felt that the formal at-
home practices that involved accessing a website and listening
to guided meditations were less helpful. Teens found it
Tab le 2 Hierarchical Regressions of Study group (cohort 1 and
waitlist) predicting post-study outcomes (time 2), controlling for
baseline (N=34)
Outcome BSE BβR
2
ΔR
2
F
CAMM 2.61 1.42 0.20
0.64 0.04 27.84***
SCS 0.31 0.15 0.24* 0.58 0.06 21.13***
SMFQ 3.23 1.05 0.27** 0.77 0.07 51.34***
STAI 4.53 2.66 0.20
0.60 0.04 23.56***
CONN 4.75 2.77 0.21
0.51 0.05 16.42***
SLSS 2.34 1.11 0.30* 0.43 0.08 11.50***
PA 0.04 0.15 0.04 0.54 0.001 18.46***
NA 0.16 0.20 0.09 0.57 0.01 20.69***
PSS 1.79 1.59 0.14 0.58 0.02 20.13***
Note. Cohort 1 = 1, waitlist= 0
ΔR
2
change from the first step that included the baseline, CAMM Chil-
dren and Adolescent Mindfulness Measure, SCS Self-compassion Scale,
PSS Perceived Stress Scale, SMFQ Mood and Feelings Questionnaire-
short form, STAI Spielberger State-Trait Anxiety Scale (trait subscale),
CONN Social Connectedness Scale, SLSS Student Life Satisfaction Scale,
PA Positive Affect subscale of PANAS, NA Negative Affect subscale of
PANA S
p<0.10; *p<0.05; **p< 0.01; ***p<0.001
-25
-20
-15
-10
-5
0
5
10
15
20
Percent Change from Pre to Post-Intervention
Cohort 1 (n=16)
Waitlist Control (n=18)
Fig. 2 Percent change for
outcomes for cohort 1 and waitlist
control from time 1 to time 2
Table 3 Descriptive statistics at pre- and post-intervention for the
combined cohortsintervention period (N=29)
Pre M(SD)PostM(SD)tvalue Hedgesg
CAMM 20.00 (6.50) 23.72 (5.92) 4.64*** 0.58
SCS 2.75 (0.71) 3.11 (0.51) 3.08** 0.55
PSS 25.00 (6.21) 22.23 (4.55) 2.28* 0.49
SMFQ 9.83 (6.22) 6.69 (4.49) 3.93** 0.53
STAI 49.07 (11.51) 44.66 (10.16) 2.59* 0.39
CONN 32.79 (10.17) 35.31(9.64) 1.52 0.25
SLSS 23.97 (3.56) 25.24 (4.25) 1.66 0.32
PA 2.97 (0.59) 3.02 (0.65) 0.49 0.09
NA 2.49 (0.88) 2.18 (0.69) 2.33* 0.37
Note. Cohort 1 intervention period is time 1 to time 2, and cohort 2
intervention period is time 2 to time 3
CAMM Children and Adolescent Mindfulness Measure, SCS Self-
compassion Scale, PSS Perceived Stress Scale, SMFQ Mood and Feel-
ings Questionnaire-short form, STAI Spielberger State-Trait Anxiety
Scale (trait subscale), CONN Social Connectedness Scale, SLSS Student
Life Satisfaction Scale, PA Positive Affect subscale of PANAS, NA Neg-
ative Affect subscale of PANAS
*p<0.05; **p< 0.01; ***p<0.001
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Author's personal copy
troublesome to remember to do the home practice because it
was not part of their daily routine. Additionally, they
expressed that the guided meditations on the website were
too long. This was also reflected in their lack of home practice,
which averaged only two days per week.
Despite the lack of home practice, however, participants in
cohort 1 evidenced significantly greater post-intervention
scores than the waitlist control group in self-compassion and
life satisfaction with trends toward significance in mindful-
ness and social connectedness, and significantly lower depres-
sion scores, with trends towards significance in anxiety. When
data from both cohorts were combined and pre-post measures
were investigated, self-compassion and mindfulness im-
proved significantly pre to post as well as all the negatively
worded psychosocial outcomes (i.e., depression, anxiety, per-
ceived stress, negative affect). Interestingly, none of the pos-
itively worded measures improved significantly pre to post. It
has been suggested that adolescents may more easily relate to
negatively-worded items than those that are positively worded
and therefore respond to negatively-worded items more con-
clusively (Bluth and Blanton 2014a).
Effect sizes for the combined groupsoutcomes during
intervention periods were in the small to medium range for
all variables, with the exception of positive affect, which dem-
onstrated no meaningful effect. In particular, the largest effect
sizes were evidenced with depression, anxiety, and stress.
Similar findings are reported in a meta-analyses on self-
compassion studies with adults, which found a large effect
size when correlating self-compassion with psychopathology,
defined by combining stress, anxiety and depression
(MacBeth and Gumley 2012).
Further, both mindfulness and self-compassion improved
across this 6-week program, demonstrating that these traits
may be modifiable and can be enhanced with practice.
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
Hedges' g (Effect Size)
Changes from Pre-to Post-Intervention (n=29)
Fig. 3 Changes from pre- to
post-intervention in combined
cohorts (includes waitlist
crossovers); Hedgesgsmall
effect = 0.20, medium
effect = 0.50, large effect = 0.80
Tab l e 4 Hierarchical regressions for changes in self-compassion
predicting changes in emotional well-being outcomes (N=29)
Outcome BBSE βR
2
ΔR
2
F
PSS 5.18 1.98 0.49* 0.27 0.20 4.06*
SMFQ 0.68 1.42 0.08 0.48 <0.01 9.58***
STAI 9.61 2.94 0.48** 0.55 0.17 12.48***
CONN 5.85 3.33 0.31
0.36 0.07 6.25**
SLSS 5.10 1.42 0.61** 0.41 0.27 7.54**
PA 0.25 0.26 0.20 0.22 0.03 3.59*
NA 0.16 0.21 0.12 0.48 0.01 9.56***
Note. Data includes both cohortsintervention periods
PSS Perceived Stress Scale, SMFQ Mood and Feelings Questionnaire-
short form, STAI Spielberger State-Trait Anxiety Scale (trait subscale),
CONN Social Connectedness Scale, SLSS Student Life Satisfaction Scale,
PA Positive Affect subscale of PANAS, NA Negative Affect subscale of
PANA S, R
2
Variance accounted for by the full regression model, ΔR
2
Variance accounted for by the addition of Self-compassion Scale to the
model
p<0.10; *p<0.05; **p< 0.01; ***p<0.001
Tabl e 5 Hierarchical regressions for changes in mindfulness predicting
changes in emotional well-being outcomes (N=29)
Outcome BBSE βR
2
ΔR
2
F
PSS 0.11 0.23 0.13 0.03 0.01 1.29
SMFQ 0.37 0.14 0.49* 0.63 .09 16.70***
STAI 1.01 0.34 0.59** 0.55 0.14 12.26***
CONN 0.43 0.40 0.27 0.31 0.03 5.23**
SLSS 0.28 0.19 0.39 0.18 0.06 3.07*
PA 0.03 0.03 0.27 0.23 0.03 3.82*
NA 0.05 0.03 0.40 0.38 0.06 6.76**
Note. Data includes both cohortsintervention periods
PSS Perceived Stress Scale, SMFQ Mood and Feelings Questionnaire-
short form, STAI Spielberger State-Trait Anxiety Scale (trait subscale),
CONN Social Connectedness Scale, SLSS Student Life Satisfaction Scale,
PA Positive Affect subscale of PANAS, NA Negative Affect subscale of
PANA S, R
2
Variance accounted for by the full regression model, ΔR
2
Variance accounted for by the addition of Children and Adolescent Mind-
fulness Measure to the model
*p<0.05; **p< 0.01; ***p<0.001
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Results from regression analyses indicated that increases in
mindfulness predict decreases in depression and anxiety.
Further, increases in self-compassion predict decreases in per-
ceived stress and anxiety, and increases in life satisfaction;
both mindfulness and self-compassion uniquely predict de-
creases in anxiety. This evidence supports the hypothesis that
BMaking Friends with Yourself,^a program which incorpo-
rates mindfulness and self-compassion practices, can be effec-
tive in reducing depression, stress, and anxiety and improving
overall emotional health in adolescents.
Interestingly, results indicated that at-home practice was
not correlated with increases in mindfulness or self-compas-
sion. In other words, self-compassion and mindfulness im-
proved significantly from pre- to post-intervention despite
the lack of at-home practice. Attending the weekly class and
possibly reflecting on them during the week appeared to be
sufficient to improve mindfulness and self-compassion as
these changes were not evident in the waitlist control. As there
is a lacuna in research on home practice in mindfulness-based
interventions among adolescents, further research is necessary
to definitively support these findings.
A number of modifications will be made in future iterations
of this program in response to the feedback of the participants
in this study. For example, recognizing that the guided medi-
tations on the website were created for adults, plans are un-
derway to create a website with shorter, developmentally ap-
propriate guided meditations for teens. As some teens found
accessing a website to be time-consuming, a phone app with
short guided meditations and practice reminders will be creat-
ed. Additionally, halfway through each week, participants will
be emailed reminders to do their home practice. As broader
literature on interventions among adolescents (i.e., cognitive
behavioral therapy) indicates that homework adherence is im-
proved by providing a clear rationale for the homework,
spending more time explaining the homework, and trouble-
shooting obstacles to homework practice, these factors will be
emphasized in future iterations of MFY (Jungbluth and Shirk
2013). Further, as in-the-moment practices (i.e., A Moment
for Me) were more acceptable to teens, these practices will
be emphasized in the next iteration of this program. Finally,
the program will be expanded from 6 to 8 weeks to include
greater mindfulness discussion and practice, as several partic-
ipants indicated that this concept could have been more clearly
explained.
This study has a number of limitations that are common in
pilot studies. First, the sample size was small, and the demo-
graphics indicated that these adolescents were mostly female
and came largely from well-educated families, limiting gener-
alizability. Further, it would have been helpful to ask partici-
pants weekly which of the informal and formal practices they
used each week. In addition, future studies should include
follow-up measures to determine if changes that were evi-
denced post-intervention would be stable over time. There
are also limitations inherent in a waitlist control; that is, there
may be an overestimate of effects on the treatment group. It is
recommended that future studies utilize an active control.
Overall, these preliminary findings indicate that BMaking
Friends with Yourself: A Mindful Self-compassion Program
for Teens^is feasible and acceptable to adolescents, and pro-
motes increases in mindfulness and self-compassion that can be
instrumental in improving psychological outcomes. An addi-
tional strength of our study is that we have contributed longi-
tudinal evidence of these changes to a literature that has mainly
consisted of cross-sectional studies. Providing teens with skills
to develop and strengthen self-compassion may protect against
depression and anxiety disorders in this critical developmental
stage. Future research should investigate more long-term out-
comes and potential mechanisms for these findings.
Compliance with Ethical Standards This study was funded by the
University of North Carolina University Research Council and in part
by grant number T32AT003378-04 from the National Center on Comple-
mentary and Alternative Medicine (NCCAM). Analyses and conclusions
are the responsibility of the authors rather than the funders. All procedures
performed in studies involving human participants were in accordance
with the ethical standards of the institutional and/or national research
committee and with the 1964 Helsinki declaration and its later amend-
ments or comparable ethical standards.
Conflicts of Interest No authors have any conflicts of interest.
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... Neff and Germer (2013) developed an 8-week Mindful Self-Compassion training program based on the MBSR structural model that includes mindfulness, lovingkindness, and compassion meditation practice and emphasizes compassionate listening, meeting difficult emotions, exploring challenging relationships, and embracing life with savoring, gratitude, and self-appreciation. Research shows Mindful Self-Compassion training can increase self-compassion, compassion for others, mindfulness, personal self-efficacy, and life satisfaction and can decrease stress, anxiety, depression, negative self-directed thinking, and diabetic distress (Bluth et al., 2016;Dundas, et al., 2017;Friis et al., 2016;Neff & Germer, 2013). These studies, which are described and summarized more fully in Appendix 14.S1, suggest that self-compassion is a teachable skill that can substantially enhance people's well-being. ...
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Mindful Self-Compassion (MSC) program has been considered as one of the usefull psychological interventions in improving individual well-being. Although the use of the MSC has been suggested, its effectiveness needs to be evaluated because the variety of implementation contexts. This review was conducted on 10 journal articles based on inclusion criteria such as experimental research with or without a control group, participants without age restrictions, interventions using MSC, classified as peer-reviewed journals and written in English and fully accessible. While the exclusion criteria are the article is a literature study and the article is a meta-analysis. The results showed that MSC was effective in non-clinical and clinical cases as well as in the student, adult, and elderly age categories. Both complete and modified MSC can improve self-compassion, mindfulness, and other psychological well-being outcomes and can reduce psychological stressors such as rumination, depression, anxiety, stress, fatigue symptoms, and the negative effects of illness. ABSTRAK Program Mindful Self-Compassion (MSC) telah dipandang sebagai salah satu intervensi psikologi yang berguna dalam meningkatkan kesejahteraan individu. Meskipun penggunaan MSC telah disarankan, evaluasi keefektifannya perlu dilakukan karena pengunaan MSC dilakukan pada berbagai macam konteks yang berbeda. Review ini dilakukan pada 10 artikel jurnal berdasarkan kriteria inklusi seperti penelitian eksperimen dengan atau tanpa kelompok kontrol, partisipan tidak ada batasan usia, intervensi menggunakan MSC, tergolong jurnal peer-reviewed dan ditulis dalam Bahasa Inggris serta dapat diakses full text. Sedangkan kriteria eksklusi yaitu: artikel merupakan studi literatur dan artikel merupakan meta-analysis. Hasilnya menunjukkan bahwa MSC efektif digunakan baik pada kasus non klinis maupun klinis dan pada kategori usia pelajar, dewasa maupun lansia. Pemberian MSC secara lengkap maupun modifikasi sama-sama efektif dalam meningkatkan self-compassion, mindfulness dan output kesejahteraan psikologis lainnya serta dapat menurunkan tekanan psikologis seperti ruminasi, depresi, kecemasan, stres, gejala kelelahan dan dampak negatif dari penyakit.
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Adolescents today are confronted with the compounded stressors of life in our high-pressured society and the cognitive, physiological, and emotional changes characteristic of this stage of development. To explore ways to promote well-being in this population, mindfulness, defined as paying attention in the moment in an intentional and purposeful way, was examined in terms of its associations with aspects of emotional well being. It has been reported to have positive effects on emotional well-being in adults, and shows promise for similar results in research with youth. Moreover, the mechanisms through which being mindful may influence positive outcomes have only recently been explored, and have not been investigated with adolescents. Self-compassion, defined by the three components of self-kindness, sensing oneself as part of a common humanity, and maintaining perspective in challenging circumstances, was examined as a potential mediator of the relationship of mindfulness to various outcome measures. Measures assessing mindfulness, self-compassion, and aspects of emotional well-being comprised an online survey that was administered to 67 adolescents in an urban high school. Path analysis was utilized to explore relationships among the variables. An alternate model with self-compassion as the predictor and mindfulness as the mediator was also investigated. Results suggested that both mindfulness and self-compassion functioned as mediators in the pathway to emotional well-being. A theorized model is presented which depicts a reciprocal relationship between mindfulness and self-compassion and describes an iterative process that takes place between these two constructs, promoting emotional well-being. Implications for research and practice include conducting longitudinal studies, which assess constructs at three time points to definitively establish mediation, and developing a self-compassion program tailored for adolescents to facilitate improvements in emotional well-being.
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