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Given the potentially demanding nature of teaching, efforts are underway to develop practices that can improve the wellbeing of educators, including interventions based on mindfulness meditation. We performed a systematic review of empirical studies featuring analyses of mindfulness in teaching contexts. Databases were reviewed from the start of records to January 2016. Eligibility criteria included empirical analyses of mindfulness, mental health, wellbeing, and performance outcomes acquired in relation to practice. A total of 19 papers met the eligibility criteria and were included in the systematic review, consisting of a total 1981 participants. Studies were principally examined for outcomes such as burnout, anxiety, depression and stress, as well as more positive wellbeing measures (e.g., life satisfaction). The systematic review revealed that mindfulness was generally associated with positive outcomes in relation to most measures. However, the quality of the studies was inconsistent, and so further research is needed, particularly involving high-quality randomised control trials.
Content may be subject to copyright.
Cite as: Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., & Eiroa-Orosa, F. J. (2017). The impact of mindfulness
on the wellbeing and performance of educators: A systematic review of the empirical literature. Teaching
and Teacher Education, 61, 132141. http://doi.org/10.1016/j.tate.2016.10.008
Page 1 of 30
The impact of mindfulness on the wellbeing and performance of educators: A
systematic review of the empirical literature.
Authors
Tim Lomas1†, Juan Carlos Medina2, Itai Ivtzan1, Silke Rupprecht3, Francisco Eiroa-Orosa1
1 School of Psychology, University of East London, Arthur Edwards Building, Water Lane,
London, E15 4LZ, United Kingdom
2 Faculty of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 08035 Barcelona,
Spain
3 Leuphana University, Scharnhorststraße 1, 21335 Lüneburg, Germany
Author responsible for correspondence:
Email: t.lomas@uel.ac.uk
Note: This article may not exactly replicate the final version published in Teaching and Teacher
Education. It is not the copy of recor
Page 2 of 30
Abstract
Given the potentially demanding nature of teaching, efforts are underway to develop practices
that can improve the wellbeing of educators, including interventions based on mindfulness
meditation. We performed systematic review of empirical studies featuring analyses of
mindfulness in teaching contexts. Databases were reviewed from the start of records to January
2016. Eligibility criteria included empirical analyses of mindfulness and wellbeing outcomes
acquired in relation to practice.
A total of 19 papers met the eligibility criteria and were included in the systematic review,
consisting of a total 1,981 participants. Studies were principally examined for outcomes such
as burnout, anxiety, depression and stress, as well as more positive wellbeing measures (e.g.,
life satisfaction).
The systematic review revealed that mindfulness was generally associated with positive
outcomes in relation to most measures. However, the quality of the studies was inconsistent,
and so further research is needed, particularly involving high-quality randomised control trials.
Keywords: mindfulness; meditation; education professionals; wellbeing; systematic review
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Introduction
There are widespread concerns about the increasingly stressful nature of many
professions. This claim is based upon the observation that although the prevalence of mental
illness in the general United Kingdom (UK) population has not significantly increased in the
last twenty years (Office for National Statistics [ONS], 2014), since 2009 the number of sick
days lost to stress, depression and anxiety has increased by 24%, while the number lost to
serious mental illness has doubled (Davies, 2014). As the annual report by Sally Davies
(2014), the UKs Chief Medical Officer elucidates, mental ill health is the leading cause of
sickness absence in the UK, accounting for 70 million sick days (more than half of the 130
million total every year); indeed, each year between 2010 and 2014, a million workers in the
UK took sick leave for longer than four weeks. Stress and mental disorders connected to
work are a serious problem obviously for the sufferers themselves, but also for their
employers and the wider economy. Davies reports that the indirect costs to the UK of mental
ill health in unemployment, absenteeism and presenteeism (leading to loss of productivity)
are estimated at between £70 and £100 billion, with £9 billion being paid by employers in
terms of sick pay and related costs.
Some jobs are often regarded as particularly stressful. Teaching is widely-regarded
as one such profession. Even in countries where it is a well-respected and remunerated
occupation, such as Finland (Tirri, 2011), it can still often be a demanding and challenging
endeavour, physically, emotionally, cognitively and socially (Blomberg & Knight, 2015).
Moreover, these inherentchallenges are frequently exacerbated by externalfactors, such
as politically-driven structural changes and pressures. In the UK, for instance, a recent
survey of 3,500 members of the NASUWT (National Association of Schoolmasters Union
of Women Teachers) union a large UK union for teachers and head teachers, comprising
over 300,000 members found that over two-thirds of respondents had considered leaving
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the profession in the last 12 months (Precey, 2015). The findings revealed the extent to which
respondents felt their wellbeing had been adversely affected by work: 83% reported
experiencing workplace stress, while 67% stated that their job had adversely affected their
mental or physical health (with 5% actually being hospitalised as a result). Arguably, much
of this pressures relates specifically to the current context of teaching in the UK (e.g.,
systemic pressures in the UK education system). The top concerns cited by respondents as
being responsible for their work-related stress was workload (flagged up by 89% of
respondents), followed by pay (45%), inspections (44%), and curriculum reform (42%).
Given the burdens of work-related stress both in teaching, and more generally
there is an increasing recognition of the need to take preventative action to mitigate or
ameliorate work-related mental health issues (George, Dellasega, Whitehead, & Bordon,
2013). Some efforts are structural, such as initiatives to provide more flexible working
arrangements (Joyce, Pabayo, Critchley, & Bambra, 2010). Other remedial actions focus
more on offering clinical and psychotherapeutic help to staff who may be in need; however,
workers may be somewhat reluctant to avail themselves of such services, wary lest it appear
on their record or prove detrimental career-wise in some way (Chew-Graham, Rogers, &
Yassin, 2003). Arguably less problematic are interventions and programmes aimed at
alleviating or protecting against issues such as stress. (There may be less of a stigma about
attending these kind of programmes, since they are often targeted at staff more “generally,”
rather than specific individuals.) Such initiatives can still prove difficult to implement of
course; e.g., staff may be reluctant to engage in these due to perceived lack of time (Bearse,
McMinn, Seegobin, & Free, 2013). However, they are nevertheless increasingly common.
In recent years, among the most prominent of these types of initiatives are programmes
based around mindfulness meditation mindfulness-based interventions (MBIs) which is
the focus of this review.
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Before introducing mindfulness, it is worth noting that many such interventions are
not only aimed at ameliorating mental health issues, such as anxiety, but promoting
wellbeing in a broader sense. Of course, wellbeing is a contested term, used in different ways
in various contexts (de Chavez, Backett-Milburn, Parry, & Platt, 2005). For instance, Cooke,
Melchert, and Connor (2016) identified four prominent conceptualisations of wellbeing: (1)
hedonic wellbeing, also known as ‘subjective wellbeing’ (Diener, 2000), which encompasses
constructs like positive affect and life satisfaction; (2) eudaimonic wellbeing, also known as
‘psychological wellbeing’ (Ryff, 1989), which includes considerations such as meaning in
life; (3), quality of life (Frisch, Cornell, Villanueva, & Retzlaff, 1992), which often
encompasses both hedonic and eudaimonic processes; and (4) ‘wellness,’ which tends to be
used interchangeably with quality of life.
In addition, other conceptualisations of wellbeing emphasise its multidimensional
nature. For instance, Pollard and Davidson (2001, p.10) define wellbeing as ‘a state of
successful performance across the life course integrating physical, cognitive and social-
emotional function.’ (In constructing wellbeing as being multidimensional in this way, such
definitions align with influential multidimensional conceptualisations of health, such as
Engel’s (1977) biopsychosocial model, and the World Health Organization’s (1948)
inclusive definition of health as ‘a state of complete physical, mental and social well-being,
and not merely the absence of disease and infirmity’.) As such, in the current review, we are
not only interested in the amelioration of mental health issues, but also in the promotion of
‘positive’ wellbeing. Thus, our analysis will consider outcomes pertaining to all four
conceptualisations identified by Cooke et al. (2016), including hedonic constructs (e.g.,
positive affect) and eudaimonic constructs (e.g., meaning in life). We shall also look to
appraise wellbeing in a multidimensional way, e.g., encompassing health and relationships.
With that in mind, let’s consider what mindfulness is.
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Mindfulness
The past few decades have seen a burgeoning interest in mindfulness in the West,
spanning clinical practice, academia, and society more broadly. Mindfulness is generally
regarded as having originated in the context of Buddhism around the 5th millennium B.C.,
though its roots stretch back at least as far as the third millennium B.C. as part of the
Brahmanic traditions in India, from which Buddhism subsequently emerged (Cousins,
1996). However, it came to prominence in the West particularly through the work of Kabat-
Zinn (1982), who harnessed it for an innovative mindfulness-based stress reduction
(MBSR) programme (discussed further below) which was successfully used to treat chronic
pain. Somewhat confusingly, the term mindfulnessis frequently used to refer to both: (1)
a state or quality of mind; and (2) a form of meditation that enables one to cultivate this
particular state/quality. Both uses will be deployed in this review, though the context will
make clear which particular usage is being used.
In terms of (1), the most prominent and influential operationalisation of mindfulness
as a state/quality of mind is Kabat-Zinns (2003, p.145) widely-cited definition, which
constructs mindfulness as the awareness that arises through paying attention on purpose, in
the present moment, and nonjudgmentally to the unfolding of experience moment by
moment.Expanding on this idea, Shapiro, Carlson, Astin, and Freedman (2006) formulated
a theoretical elucidation of Kabat-Zinns (2003) definition, deconstructing it into three key
axiomsor components: intention (i.e., a teleological motivation for paying attention in this
way, e.g., a commitment to psychological development); attention (i.e., the cognitive
processes and mechanisms through which said attention is enacted); and attitude (i.e., the
emotional qualities with which one imbues ones attentive focus, like compassion).
The second main usage of the term mindfulness is for the forms of meditation practice
which may facilitate this mindfulstate/quality of mind. Mindfulness meditation, and
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meditation more broadly, refer to a diverse spectrum of mental activities, which share a
common focus on training the self-regulation of attention and awareness (Author et al.,
2015a), with the goal of enhancing voluntary control of mental processes, thereby increasing
wellbeing (Walsh & Shapiro, 2006). Lutz, Slagter, Dunne, and Davidson (2008) offer a
useful way of differentiating between types of meditation, suggesting that most common
forms can be identified as featuring either focused attentionor open- monitoring
processes. Focused attention can be operationalised in terms of the co-ordination of various
attention networks (Mirsky, Anthony, Duncan, Ahearn, & Kellam, 1991; Posner & Petersen,
1990), including sustained attention (e.g. towards a selected target, like the breath), executive
attention (e.g., preventing ones focus from wandering), attention switching (e.g.,
disengaging from distractions), selective attention and attention re-orienting (e.g. redirecting
focus back to the target), and working memory (Lutz et al., 2008; Vago & Silbersweig, 2012).
In contrast, open-monitoring refers to a broader receptive capacity to detect events within an
unrestricted fieldof awareness, without a specific focus (Raffone & Srinivasan, 2010); this
capacity can include processes of meta- awareness(i.e., in which practitioners are able to
reflect on the process of consciousness itself).
Mindfulness both as a meditation practice, and as a state/quality of mind is
commonly presented as an example of open-monitoring (Kabat-Zinn, 2003). However, in
practice, mindfulness meditation usually involves a combination of focused attention and
open-monitoring, since it usually begins with a period of focused attention on a target, such
as the breath, in order to focus awareness, followed by the more receptive state of open-
monitoring (Chiesa, Calati, & Serretti, 2011).
According to Shapiro et al. (2006), the main significance of mindfulness as a
quality/state of mind, and as a meditation practice that can facilitate this is that it involves
a meta-mechanism known as reperceiving.The three components of mindfulness
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(intention, attention and attitude) combine to generate what is described as a fundamental
shift in perspective,in which rather than being immersed in the personal drama or narrative
of our life story, we are able to stand back and witness it(p.377). Thus, in practising
mindfulness, people are seen as learning how to enter into a different relationship with their
subjectivity: being able to stand backand dispassionately view subjective qualia as
phenomena passing though their internal world, rather than identifying with and attaching to
or becoming averse to such qualia (Bishop et al., 2004). This standing back referred to
by Shapiro et al. as reperceiving is also known as decentring,defined as the ability to
observe ones thoughts and feelings as temporary, objective events in the mind, as opposed
to reflections of the self that are necessarily true(Fresco et al., 2007, p.234).
Crucially, Shapiro et al. (2006) theorise that reperceiving/decentring has a positive
impact upon wellbeing. In MBIs, the aim is not to change participantsthoughts/feelings per
se, as cognitive therapy might seek to, but to help people become more aware of, and relate
differently to this content (Shapiro, Astin, Bishop, & Cordova, 2005, p.165). For example,
Mindfulness-Based Cognitive Therapy (MBCT) is an adaptation of MBSR, designed to
prevent depressive relapse (Segal, Williams, & Teasdale, 2002). In MBCT, people are taught
to decentre from their cognitions, thus helping prevent a downward spiral of negative
thoughts and worsening negative affect which could otherwise trigger a depressive relapse.
Thus MBCT, and mindfulness interventions generally, involve retraining awareness so
that people have greater choice in how they relate and respond to their subjective experience,
rather than habitually responding in maladaptive ways (Chambers, Gullone, & Allen, 2009,
p.659). The positive impact of retraining awareness in this way is not limited to depression,
but extends to mental health generally. For instance, the development of decentring
capabilities can help people tolerate otherwise distressing qualia, which is important given
that the inability to tolerate such qualia is a transdiagnostic factor underlying diverse
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psychopathologies (Aldao, Nolen-Hoeksema, & Schweizer, 2010), from depression (Borton,
Markowitz, & Dieterich, 2005) to substance abuse (Garland, Gaylord, Boettiger, & Howard,
2010).
Mindfulness interventions were initially limited to clinical settings. The first such
intervention was Kabat-Zinns (1982) MBSR program, which was initially used to treat
chronic pain, then was subsequently applied in the treatment of various other conditions,
from cancer (Ledesma & Kumano, 2009) to migraine (Schmidt et al., 2010). Kabat-Zinn’s
(1982) work was also followed by other clinical interventions which adapted the MBSR
protocol for the treatment of specific mental health problems, including MBCT for the
treatment of depression (Segal et al., 2002), and Mindfulness- Oriented Recovery
Enhancement for the treatment of substance abuse (Garland et al., 2014).
However, since the late 1990s, there has been increasing interest in the use of mindfulness
interventions in occupational contexts, not only for staff who may be suffering with stress
and mental health issues, but for workers in general(e.g., as a protective measure against
future issues). For instance, in one such early study, Shapiro, Schwartz, and Bonner (1998)
reported that MBSR was effective at reducing stress among medical and pre-medical
students.
Indeed, such interventions may be particularly valuable for educators, given their
vulnerability to stress and other adverse work-related mental health outcomes (as discussed
above). However, there have currently been no reviews assessing the impact of MBIs on the
health and wellbeing of educators specifically. This is not to say that there are no summaries
on the value of mindfulness in educational contexts: there have been numerous reviews into
the burgeoning literature on the value of MBIs for students (e.g., Waters, Barsky, Ridd, &
Allen, 2015; Kallapiran, Koo, Kirubakaran, & Hancock, 2015), which generally show
mindfulness to be efficacious in promoting health and wellbeing, as well as outcomes such
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as academic performance. However, only two such reviews have been conducted on the use
of MBIs with educators per se: one was by Albrecht, Albrecht, and Cohen (2012), which
only featured three studies that had been published at that time, while a more recent report
by Weare (2014) featured 13 studies. As such, to provide an updated assessment of this area,
a systematic review was conducted, featuring empirical studies of the impact of mindfulness
on the mental health and wellbeing of educators.
Methods
The literature search was conducted using the MEDLINE and Scopus electronic
databases. The search was conducted as part of a broader systematic review on mindfulness
in all spheres of occupation (which is still ongoing). The criteria for the broader review were:
mindfulness AND work OR occupation OR profession OR staff (in all fields in MEDLINE
and limited to article title, abstract, and keywords in Scopus). The dates selected were from
the start of the database records to 10th January 2016. For this current review into educators,
in terms of PICOS (participants, interventions, comparisons, outcomes and study design) the
key criteria were: participants currently employed in an educational context; outcomes
any pertaining to mindfulness, mental health and wellbeing; and study design any empirical
study featuring data collection. Although we were principally interested in studies of MBIs
in educational workplaces, as a secondary concern we were also interested in non-
intervention studies on mindfulness in the workplace (e.g., regression analyses of the
association between trait mindfulness and health and wellbeing outcomes). Studies were
required to be published (or in press) in a peer-reviewed academic journal, and to be in
English. The review was conducted according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher, Liberati, Tetzlaff, &
Altman, 2009). The review protocol for the broader systematic review was registered with
the International Prospective Register of Systematic Reviews (PROSPERO) database on 5th
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January 2016. Registration number: CRD42016032899
(http://www.crd.york.ac.uk/PROSPERO).
The inclusion criteria for the broader systematic review were: 1) participants
currently employed by a company or organisation; 2) empirical assessment undertaken in
the context of
participantsengagement with a company or organisation; 3) empirical assessment of
mindfulness, mental health and wellbeing outcomes; 4) quantitative or qualitative analysis,
supported by appropriate methodology; 5) published (or in press) in a peer-reviewed
academic journal; and 6) written in English. Exclusion criteria were theoretical articles or
commentaries without statistical or qualitative analyses. In addition to these criteria, the
review in the current paper had an additional inclusion criterion namely participants
currently employed in an educational context.
Papers were divided into intervention studies and non-intervention studies. For
intervention studies, the following variables were extracted from each paper: type of design
(e.g., RCT versus convenience sample); occupation of participants; number of experimental
participants, and number of control participants (if applicable); type of MBI; length of MBI;
nature of control; principal mental health and wellbeing outcomes; and the significance level
of principal outcomes (for statistical analyses). For non-intervention studies, the following
variables were extracted from each paper: type of analysis (e.g., regression versus
qualitative); occupation of participants; number of experimental participants; principal
mental health and wellbeing outcomes; and the significance level of principal outcomes (for
statistical analyses).
The primary summary measures were mindfulness, mental health and wellbeing
outcomes. These were principally psychometric scales pertaining to mindfulness, mental
health (e.g., anger, anxiety, burnout, depression, distress, stress), wellbeing (engagement,
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satisfaction), and physical health (e.g., illness, diet, exercise, and sleep). Secondary
summary measures of interest were outcomes that pertain to mental health and wellbeing
(e.g., compassion, empathy, emotional intelligence and regulation, resilience, and
spirituality). Finally, tertiary summary measures of interest were outcomes relating to job
performance.
The Quality Assessment Tool for Quantitative Studies (QATQS; National
Collaborating Centre for Methods and Tools, 2008) was used to assess the quality of the
studies. QATQS assesses methodological rigor in six areas: (a) selection bias; (b) design; (c)
confounders; (d) blinding; (e) data collection method; and (f) withdrawals and drop-outs.
Each area is assessed on a quality score of one to three (one = strong; two = moderate; three
= weak). Scores for each area were collated, and a global score was assigned to each study.
If there are no weak ratings, the study is given a score of one (judged as strong); one weak
rating leads to a score of two (moderate); and two or more weak ratings generates a score of
three (weak) (Supplementary Materials). QATQS scoring was conducted (II) and checked
independently (TL). Any discrepancies were resolved by discussion with agreement reached
in all cases.
Results
Search Results.
For the broader systematic review (i.e., mindfulness across all occupations), following
removal of duplicate citations, 722 potentially relevant papers were identified. In the current
specific systematic review (focusing specifically on educators), from reviewing the abstract,
606 papers were excluded.
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Table 1. Overview of Intervention Studies.
Authors
Occupation
Design
Expt.
group
Intervention
Length
Control
Primary outcome(s)
Baccarani et al.
(2013)
University
administrators
RCT
10
Mindfulness program
(specific to study)
4 weeks
NR
PI > general wellbeing (p = .002) & selective attention (p =
.011)
Beshai et al.
(2015)
Teachers
Convenienc
e sample
49
.b Foundations course
9
session
Wait-list
PI < stress (p < .01). PI > compassion (p < .01),
mindfulness (p < .01), & wellbeing (p < .01).
Flook et al.
(2013)
Teachers
RCT
9
MBSR adaptation
8 weeks
Wait-list
PI < burnout (p < .05) & distress (p < .001). PI > attention
(p < .05) & mindfulness (p < .05).
Franco et al.
(2010)
Teachers
RCT
34
Mindfulness program
(specific to study)
10
weeks
Music
listening
PI < anxiety (p = .008), depression (p = .001), & distress (p
= .001).
Frank, Riebel, et
al. (2015)
Teachers
RCT
18
MBSR
8 weeks
Wait-list
PI > self-regulation (p = .003), calmness (p = .002),
mindfulness (p = .01), self-compassion (p = .003), sleep
duration (p = .01) & sleep quality (p = .001). PI >< anxiety,
burnout, depression.
Gold et al. (2010)
Teachers (9)
and assistants
(2)
Convenienc
e sample
11
MBSR
8 weeks
N/A
PI < depression (p < .02), stress (p < .05). PI >< anxiety &
mindfulness.
Harris et al.
(2015)
Teachers
RCT
34
CALM
16
weeks
Wait-list
PI > distress tolerance (p < .01), health (p < .05),
mindfulness (p < .05) & positive affect (p < .01). PI ><
burnout or sleep quality.
Hue and Lau
(2015)
Trainee teachers
Convenienc
e sample
35 (78)
Mindfulness program
(specific to study)
6 weeks
Nothing
PI > mindfulness (p = .023) & wellbeing (p = .022). PI ><
anxiety, depression & stress.
Jennings et al.
(2011)
Teachers
Convenienc
e sample
31 (1) &
43 (2)
Cultivating awareness
& resilience in
education **
1 month
(2
w’end)
N/A
PI >< depression, mindfulness, negative affect, positive
affect, self-efficacy, & time pressure.
Jennings et al.
(2013)
Teachers
RCT
25
Cultivating awareness
& resilience in
education **
1 month
(2
w’end)
Wait-list
PI < time pressure (p = .025). PI > health (p = .004),
mindfulness (p = .003), & self-efficacy (p = .002). PI ><
negative affect, positive affect.
Klatt et al. (2009)
University
employees
RCT
22
MBSR adaptation
PI < stress (p = .002). PI > mindfulness (p = .014), sleep
quality (p = .016).
Malarkey et al.
(2013)
University
employees
RCT
93
Mindfulness program
(specific to study)
8 weeks
Lifestyle
education
programm
e
PI > mindfulness (p = .003). PI >< depression, sleep quality
& stress.
Poulin et
al. (2008)
Teachers
RCT
28
Mindfulness-based
wellbeing
education
8 weeks
Nothing
PI > mindfulness (p < .001), satisfaction with life (p < .05),
self-efficacy (p < .05)., & self-rated health (p < .05). PI ><
distress
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Ramsey and
Jones
(2015)
Teachers
RCT
13 (22)
Mindfulness
workshop (specific to
study)
1 day
NR
PI > relationships [perceived instigated ostracism] (p =
.014).
Roeser et
al. (2013)
Teachers
RCT
54
Mindfulness Training
8 weeks
Wait-list
PI < anxiety (p < .01), burnout (p < .01), depression (p <
.01), stress (p < .01). PI > self-compassion (p < .01)
& mindfulness (p < .01). PI >< blood pressure.
Schussler et
al. (2015)
Teachers
Conven
ienc e
sample
50
CARE
8 weeks
N/A
Qualitative focus groups. PI > self-regulation
Taylor et al.
(2015)
Teachers
RCT
26
SMART
8 weeks
Wait-list
PI < stress (p < .001). PI >< compassion.
Note. < = decreases in; > = increases in; >< = no change in; ! = mindfulness associated with worsened outcome; expt = experimental group; cnt = control group; PI = post-intervention;
NR
= not-reported; MBCT = mindfulness-based cognitive therapy; MBSR = mindfulness-based stress reduction; MBST = mindfulness-based stress reduction therapy. CALM = community
approach to learning mindfully. CARE = cultivating awareness and resilience in education. SMART = stress management and relaxation training. MM = mindfulness meditation; NCC =
neural correlates of consciousness; NR = not recorded; N/A = not applicable; NA = not available; RCT = randomized controlled trial;.* = number in parenthesis is the initial sample size (if
different from sample size featured in analysis); ** = mindfulness just one component of broader intervention
Table 2. Overview of non-intervention studies
Authors
Workplace
Meditator
s
Non-
meditators
Analysis
Primary result
Frank, Jennings et
al. (2015)
Teachers
-
918 (263, 263,
392)
Regression
Mindfulness correlation: < burnout (p < .01). > behaviour management
efficacy (p < .01).
Jennings (2015)
Early childhood
teachers
-
35
Mindfulness correlation: > emotional support (p < .001). >< classroom
organisation & instructional support.
Note. < = negative correlation with; > = positive correlation with; >< = no correlation;
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Relationship between Mindfulness and Key Outcomes
An overview of the findings is shown in table 3 below. This shows whether outcomes were
either: (a) increased in relation to an MBI; (b) did not change in relation to an MBI (or in exceptional
cases, changed in a negativedirection); or (c) were found in non-intervention studies to be
associated with mindfulness (i.e., through regression analyses). A more detailed presentation of the
results is then shown in table 4 below; this lists all the specific assessment tools used for each measure,
together with the specific studies deploying that tool.
Table 3. Summary of common outcomes across all studies
Outcome
Number of
studies
assessing
Improvement related to
mindfulness intervention
No change in relation to
mindfulness
intervention
Association
(benign) with
mindfulness
Anxiety
3
2
1
0
Burnout &
resilience
7
4
2
1
Compassion &
empathy
4
3
1
0
Depression
4
3
1
0
Distress & anger
5
3
2
0
Emotional
regulation
3
3
0
0
Health
8
5
5
0
Job performance
4
2
0
3
Mindfulness &
awareness
14
12
2
0
Stress & strain
6
4
2
0
Wellbeing &
satisfaction
6
5
2
0
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Table 4. Common outcomes across all studies
Outcome
Measure
Improvement (positive change) related to
mindfulness intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Anxiety
State trait anxiety inventory
Johnson et al. (2015), Roeser et al. (2013)
Symptom checklist-90-R [anxiety]
Franco et al. (2010)
Burnout
Connor David resiliency scale
Klatt et al. (2015)
Maslach burnout inventory
Flook et al. (2013), Roeser et al. (2013)
Frank, Riebel. et al. (2015),
Frank, Jennings, et al. (2015)
Harris et al. (2015)
Utrecht work engagement scale
Klatt et al. (2015)
[vigour]
Empathy &
compassion
Santa Clara brief compassion scale
Self-compassion scale
Beshai et al. (2015), Frank, Riebel. et al. (2015)
Taylor et al. (2015)
Roeser et al. (2013)
Depression
Beck depression inventory
Roeser et al. (2013))
Brief symptom inventory
Frank, Riebel. et al. (2015)
Symptom checklist-90-R
Franco et al. (2010)
[depression]
Distress &
anger
Brief symptom inventory
Distress tolerance scale
Harris et al. (2015)
Frank, Riebel. et al. (2015)
Kessler 10 psychological distress
scale
Poulin et al. (2008)
Symptom checklist-90-R
Flook et al. (2013), Franco et al. (2010)
Emotional
intelligence &
Affective self-regulatory efficacy
scale
Frank, Riebel. et al. (2015)
regulation
Emotion regulation questionnaire
Jennings et al. (2013)
Qualitative interviews
Schussler et al. (2015)
Health
Blood pressure
Roeser et al. (2013)
Daily physical symptoms scale
Harris et al. (2015), Jennings et al. (2013)
Jennings et al. (2011)
Interleukin 6
Malarkey et al.( 2013) !
Perceived stress scale [sleep
duration]
Klatt et al. (2009)
Perceived stress scale [sleep
quality]
Klatt et al. (2009)
Pittsburgh sleep quality index
Frank, Riebel. et al. (2015)
Self-rated health
Poulin et al. (2008)
Sleep-related impairment scale
Harris et al. (2015)
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Job
performance
Behaviour management efficacy
scale
Frank, Jennings, et al. (2015)
Classroom assessment scoring
system [organization &
instructional support]
Jennings (2015)!
Classroom assessment scoring
system [emotional support]
Jennings (2015)
Teachers’ self-efficacy scale
Jennings et al. (2013)
Teachers’ sense of efficacy scale
Poulin et al. (2008)
Mindfulness &
awareness
Five facets of mindfulness
questionnaire
Beshai et al. (2015), Flook et al. (2013), Frank,
Riebel. et al. (2015), Harris et al. (2015),
Jennings et al. (2013), Manotas et al. (2014)
Roeser et al. (2013)
Jennings et al. (2011)!
Kentucky inventory of mindfulness
skills
Poulin et al. (2008)
Mindful attention and awareness
scale
Klatt et al. (2009)
Selective attention (not specified)
Baccarani et al. (2013)
Sustained attention
Flook et al. (2013)
Toronto mindfulness scale
Malarkey et al. (2013)
Stress & strain
Occupational stress survey
Taylor et al. (2015)
Perceived stress scale
Klatt et al. (2009)
Malarkey et al. (2013)
Salivary cortisol
Roeser et al. (2013)
Self-reported job stress
Roeser et al. (2013)
Time urgency scale
Jennings et al. (2011)
Wellbeing &
satisfaction
Positive & negative affect scale
Harris et al. (2015)
Jennings et al. (2011), Jennings
et al. (2013)
Psychological general wellbeing
Baccarani et al. (2013)
Satisfaction with life scale
Poulin et al. (2008)
Smith relaxation disposition
inventory
Poulin et al. (2008)
Warwick-Edinburgh mental
wellbeing scale
Beshai et al. (2015)
Note. RCT studies are highlighted in bold.
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Discussion
The main finding to emerge from the systematic review is that MBIs overwhelmingly had a
positive impact upon all outcome measures, with the exception of burnout (where the findings were
more equivocal). Thus, overall, the review corroborated the positive appraisal of the value of
mindfulness for educators provided by Albrecht et al. (2012) and Weare (2014). Before dealing with
the various outcomes in turn, we can begin by observing that the MBIs certainly appeared effective
at facilitating the development of mindfulness, which was assessed by 14 intervention studies: of
these, the vast majority found increased mindfulness in relation to the MBI (n = 12), with only two
finding no increase. It is interesting to note that a range of different psychometric scales (n = 10)
were deployed across the studies, which is perhaps both a weakness and a strength. It is a weakness
inasmuch as the lack of a dominant standardised scale makes it difficult to draw comparisons across
studies, and to aggregate the findings through meta-analyses. The latter is particularly important in
terms of trying to draw any more substantive conclusions around the value of mindfulness. This
inconsistency in the use of scales across different studies was a common theme in this review, and is
something that mindfulness scholars may wish to address going forward (as discussed further below).
That said, the diversity of measures does allow us to discern nuances in the development
of mindfulness. The most popular tool, used in eight studies, was Baer, Smith, Hopkins,
Krietemeyer, and Toneys (2006) 39-item Five Facets of Mindfulness Scale. This widely used
tool (with 2,171 citations as of January 2016) features five different dimensions/skills: describing,
acting with awareness, non-judging of inner experience, and non-reactivity to inner experience. In
contrast, Brown and Ryans (2003) Mindful Attention and Awareness Scale is arguably more
prevalent in the literature (with 4,127 citations as of January 2016), but featured in only one study
here. This assesses dispositional mindfulness, gauging individual differences in the frequency of
mindful states over time(p.824). It focuses on a single, core characteristic of mindfulness, namely
open and receptive awareness, which essentially aligns with Kabat-Zinns (2003) definition cited
above. Clearly, this complements the multidimensionality of Brown and Ryans (2003) scale, and
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in future we would recommend that studies use both tools.
Turning to the specific outcomes, on balance mindfulness appears to have a beneficial impact
upon most metrics of mental health, although the results were by no means unequivocal. For instance,
with burnout, while three studies found that this was reduced in relation to an MBI (Flook, Goldberg,
Pinger, Bonus, & Davidson, 2013; Klatt, Steinberg, & Duchemin, 2015; Roeser et al., 2013), two
found no significant changes (Frank, Reibel, Broderick, Cantrell, & Metz, 2015; Harris, Jennings,
Katz, Abenavoli, & Greenberg, 2015), although in the latter two studies the results were certainly
close to significance in the expected direction. Similarly, with depression, while three studies found
that an MBI significantly reduced this (Franco, Mañas, Cangas, Moreno, & Gallego, 2010; Gold et
al., 2010; Roeser et al., 2013), Frank et al. (2015) found no significant change (although the results
were again approaching significance). With stress, four studies observed a reduction in connection
with an MBI (Gold et al., 2010; Klatt et al., 2015; Roeser et al., 2013; Taylor et al., 2015), while two
found no significant change (Jennings, Snowberg, Coccia, & Greenberg, 2011; Malarkey, Jarjoura,
& Klatt, 2013).
Away from mental health per se, mindfulness was also associated with wellbeing generally,
with four studies finding MBIs significantly increasing wellbeing/satisfaction (Baccarani,
Mascherpa, & Minozzo, 2013; Beshai, McAlpine, Weare, & Kuyken, 2015; Harris et al., 2015;
Poulin, Mackenzie, Soloway, & Karayolas, 2008), while two found no significant changes (Jennings
et al., 2011; Jennings, Frank, Snowberg, Coccia, & Greenberg, 2013). The positive impact of MBIs
spanned outcomes including positive affect (Harris et al., 2015), relaxation (Poulin et al., 2008),
satisfaction with life (Poulin et al., 2008), and psychological wellbeing satisfaction (Baccarani et al.,
2013; Beshai et al., 2015). The findings for health were rather more equivocal, with five studies
finding significant improvements in health relating to an MBI (Frank et al., 2015; Klatt, Buckworth,
& Malarkey, 2009; Harris et al., 2015; Jennings et al., 2013; Poulin et al., 2008), but a further five
finding no significant changes (Klatt et al., 2009; Harris et al., 2015; Jennings et al., 2011; Roeser et
al., 2013; Malarkey et al., 2013). With health, the positive changes included reduced daily physical
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symptoms (Harris et al., 2015; Jennings et al., 2011) and improved sleep (Klatt et al., 2009).
However, no changes were observed in relation to blood pressure (Roeser et al., 2013), while
Malarkey et al. (2013) found that inflammation as indexed by Interleukin 6, an endogenous
chemical active in inflammation actually worsened in relation to an MBI.
In addition to these primary wellbeing outcomes, mindfulness was also linked to various
skills and qualities that are associated with wellbeing, and which may help to provide an explanation
for the generally positive outcomes adumbrated above. For instance, three studies examined the
relationship between mindfulness and emotional regulation, with all three suggesting that MBIs
significantly increased emotional regulation (Frank et al., 2015; Jennings et al., 2013; Schussler,
Jennings, Sharp, & Frank, 2015). As outlined above, according to Shapiro et al. (2006), the key
mechanism through which mindfulness exerts its positive effects is that of reperceiving, also
known as decentring (Fresco et al., 2007). This ability means that people are better able to detach
themselves from distressing qualia that might otherwise precipitate feelings of stress etc. More
generally, reperceiving could be regarded as an aspect of a more general capacity of emotion
regulation. For instance, Walsh and Shapiro (2006) define meditation as “a family of self-regulation
practices that focus on training attention and awareness in order to bring mental processes under
greater voluntary control and thereby foster general mental well-being” (pp.228-229). Thus, the
suggestion is that mindfulness might positively impact on wellbeing in the following way: (a)
mindfulness involves introspective practices that facilitate the development of attention and
awareness skills; (b) the development of these skills leads to enhanced emotional regulation and
intelligence (including abilities such as reperceiving); and (c) emotional regulation and intelligence
are meta-skills that subserve multiple health and wellbeing outcomes (while, conversely, poor
emotion regulation skills are a transdiagnostic factor underlying diverse psychopathologies; Aldao
et al., 2010). Future work may help to elucidate these hypothesised causal chains further, e.g.,
through longitudinal studies deploying regression analyses.
Finally, the impact of mindfulness was not limited to the mental health and wellbeing of
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employees but also was associated with enhanced job performance, although this was only assessed
by a handful of studies. Both Jennings et al. (2013) and Poulin et al. (2008) found that MBIs enhanced
teachers sense of self-efficacy, while non-interventions studies found that mindfulness was
associated with outcomes such as behaviour and classroom management (Frank, Jennings, &
Greenberg, 2015; Jennings, 2015).
Conclusions and Recommendations
On the whole, the results are relatively encouraging. MBIs did appear to have a largely
positive impact on the mental health and wellbeing of educators. With respect to all outcomes, the
majority of studies reported statistically-significant improvements. In terms of mental health
outcomes, the findings included positive results for anxiety (two out of three studies finding an
improvement), burnout and resilience (four out of seven), depression (three out of four), distress
and anger (three out of five), and stress and strain (four out of six). With respect to wellbeing
outcomes more broadly, the findings included positive results for mindfulness (12 out of 14),
compassion and empathy (three out of four), emotional regulation (three out of three), wellbeing
and satisfaction (five out of six), health (five out of eight), and job performance (three out of four).
These positive conclusions must be tempered by a number of caveats. Firstly, the quality of
the studies was relatively poor. According to the QATQS scoring protocol, the majority of the
studies only achieved a global rating of “weak”, due to factors such as poor monitoring of attrition
and insufficient attention to confounders. Obviously, future research will hopefully remedy these
flaws, enabling a stronger and more reliable research base to be built. Secondly, the research is
currently largely biased towards interventions that were developed for use in clinical settings, and
relatedly, the assessments tend to mostly use metrics pertaining to mental health. While such
interventions and metrics are of course valuable, it would be good in future to see interventions and
outcomes that are also geared towards more ‘positive’ wellbeing constructs, such as work
engagement (Schaufeli & Bakker, 2003). As a final point, it is also important not to regard MBIs as
any kind of panacea for stress, nor as a sustainable remedy for an education system that imposes
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such stressors to begin with. It is encouraging that MBIs are helpful to educators, but the
encouragement and implementation of such interventions must not come at the expense of trying to
create a system that is less inherently stressful. Indeed, this is a broader concern regarding the use
of mindfulness in occupational contexts, where some scholars are raising concerns about MBIs
being used to help workers “adapt” to a toxic work environment, as opposed to employers striving
to reduce the toxicity of the work itself (Van Gordon, Shonin, Zangeneh, & Griffiths, 2014).
Nevertheless, all that being said, while educators are subjected to these kinds of work-related
burdens, then it would appear that MBIs can be of assistance in enabling them to cope.
To conclude, based on the above considerations, we have a number of recommendations
regarding the future implementation and assessment of MBIs in the context of teaching and teacher
training. Let’s take implementation first. To begin with, given the largely promising results above,
it would be ideal to see MBIs being offered in all teacher training courses and in all educational
environments. That is, ideally all educators would be given the opportunity to attend at least one
MBI, e.g., lasting eight weeks. If resources permit, courses and educational settings could also
include provisions for on-going practice (e.g., weekly drop-in sessions). However, if resources did
not allow that, the introductory MBI would at least introduce mindfulness to educators, who would
then have the opportunity to pursue this on their own time (e.g., in the community). Of course, the
caveat above still holds about such interventions not being used to mask a toxic work environment,
nor placing the onus on staff to simply be ‘resilient’ to these. In addition, it is vital that participation
not be compulsory. While many participants may well benefit, mindfulness may not be to everyone’s
taste, or within their ‘comfort zone’ (see e.g., Author et al., 2015b). More seriously, it may be even
harmful to people with certain pre-existing or current mental health conditions (see e.g., Dobkin,
Irving, & Amar, 2012). As such, a degree of sensitivity will be necessary in terms of encouraging
and facilitating participation.
As to which MBIs might be offered, this is an interesting question. On the one hand, there
are good arguments for using MBIs that have been well-tested and validated, such as MBCT and
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MBSR. At the same time though, such MBIs were created primarily for clinical populations. There
is thus also an argument for the development of new programmes suited specifically to certain
contexts, as we have seen with the creation of bespoke MBIs suited to schoolchildren (Waters et al.,
2015). As such, there is certainly room for the development of MBIs particularly suited to educators,
as indeed Malarkey et al. (2013) have done. Similarly, such programmes may not only want to focus
on a ‘deficit model’ of mental health (e.g., reducing outcomes like anxiety), but may also be able to
aim towards more positive wellbeing outcomes, such as work engagement (Schaufeli & Bakker,
2003).
Of course, introducing new initiatives carries its own issues, most notably a lack of empirical
validation. As such, the future implementation of MBIs in educational contexts including the
careful development and introduction of new MBIs will ideally be accompanied by a concomitant
program of empirical assessment. With such assessment, researchers should obviously aim for best
practice in this regard, like the use of randomised controlled trials (RCTs) with adequate sample
sizes. (In fact, the existing literature is already quite good in this respect, with 12 of the 17
intervention trials analysed here employing an RCT design.) In addition, researchers might also
consider broadening their assessment repertoire, not only analysing deficit-based mental health
outcomes (e.g., anxiety, stress), but also more positive wellbeing-related outcomes, such as
engagement (Schaufeli & Bakker, 2003). In this way, over time, we may be able to build up an even
clearer understanding of the potential value of mindfulness for educators.
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Supplementary table 1
QATQS scoring assessment of intervention studies
Authors
Selection bias
Design
Cofounders
blinding
Data collection
Attrition
Global
Baccarani et al.
(2013)
3
2
3
3
2
1
3
Beshai et al. (2015)
1
1
1
2
1
1
1
Flook et al. (2013)
1
1
1
3
1
1
1
Franco et al. (2010)
2
2
2
2
1
3
2
Frank, Riebel, et al.
(2015)
3
2
2
3
1
3
3
Gold et al. (2010)
3
2
3
3
2
2
3
Harris et al. (2015)
2
2
2
2
1
1
2
Hue and Lau (2015)
3
3
3
3
1
3
3
Jennings et al.
(2011)
3
3
3
3
1
2
3
Jennings et al.
(2013)
1
2
2
2
1
2
2
Klatt et al. (2009)
2
2
3
3
1
1
2
Malarkey et al.
(2013)
2
2
3
2
1
1
2
Poulin et al. (2008)
1
2
1
1
1
3
2
Ramsey and Jones
(2015)
2
2
1
2
1
1
2
Roeser et al. (2013)
1
1
2
2
1
2
2
Schussler et al.
(2015)
Q
Q
Q
Q
Q
Q
Q
Taylor et al. (2015)
1
1
2
2
1
2
2
Note. Q = qualitative study
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