Program Profile: Mindfulness in Schools Project’s “.b” Curriculum

This is a school-based program that works to improve emotional awareness and regulation in adolescents to improve their mental health outcomes. The program is rated Ineffective. There were no statistically significant differences between students who received the intervention and students in the control group who did not receive the intervention in measures of resilience, anxiety, depression, socioemotional functioning, well-being, drug use, self-harm, suicidal ideation, and mindfulness.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals

The .b curriculum (which stands for “stop and be”) is a 9-week mindfulness training program for youths ages 11–18 in secondary school, developed by the England-based charity the Mindfulness in Schools Project, in partnership with hundreds of teachers and thousands of youths. The .b curriculum includes weekly 45-minute group sessions in schools and short, at-home practices (the recommended amount of practice being five or six times a week, 3 to 15 minutes at a time). It is designed to improve emotional awareness, sustained attention, and attentional and emotional regulation. The goal of the program is to strengthen children’s and adolescents’ internal resources that promote mental well-being, cognitive functions, psycho-physiological responses, and academic achievement.

Program Components/Target Population

The main intention of mindfulness training is to teach students to attend, observe, and accept what is happening in the here and now. It involves continuous attention to both outer events and inner experiences in a purposeful way without judgment or criticism (Meiklejohn et al., 2012). Each .b curriculum lesson is between 40 to 60 minutes in length and is crafted for use in the classroom to teach a distinct mindfulness skill. The nine lessons are

1. Playing Attention: Introduces students to our “attention” which, like a puppy, needs to be trained.
2. Taming the Animal Mind: Explores different mind states and teaches students that “anchoring” attention in the body, while nurturing curiosity and kindness, can be calming and nourishing.
3. Recognizing Worry: Explains the tricks the mind plays that lead to stress and anxiety and provides techniques to deal with them.
4. Being Here Now: Comes to the heart of mindfulness and teaches students how to respond, rather than react, to whatever happens in their lives.
5. Moving Mindfully: Shows students that mindfulness is not just something we do sitting or lying down. It also looks at high performance in sport.
6. Stepping Back: Offers students a new way of relating to their thoughts.
7. Befriending the Difficult: Addresses the challenge of dealing with difficult emotions.
8. Taking in the Good: Focuses on gratitude and the “heartfulness” of savoring the good in life.
9. Pulling it All Together: Consolidates the key techniques from .b and inspires students to use what they have learned in the future.

Students are also provided materials to engage in guided mindfulness practices at home (Mindfulness in Schools Project, 2022).

The .b curriculum is an intervention that includes elements applicable to young people who are stressed and experiencing mental health difficulties, are in the normal range of mental health, or who are flourishing. By teaching mindfulness as a way of working with everyday stressors and experiences, participants across the full range of the normal distribution of well-being can potentially benefit (Kuyken et al., 2013).

Program Theory

The .b curriculum draws on positive psychology, neuroscience, and cognitive–behavioral therapy to teach students about their thoughts, emotions, and behaviors (Hailwood, 2020) to improve their mental health outcomes. Specifically, mindfulness practices are congruent with much of the theory and practice in positive psychology (Huppert and Johnson, 2010), a branch of psychology that attempts to understand and enhance positive mental states (Seligman, 2002). This informs the .b curriculum’s emphasis on teaching techniques of mindfulness meditation, which involves directing attention toward one’s present experience, and also includes imagining, remembering, and cultivating positive emotion (Hailwood, 2020).

Study

Kuyken and colleagues (2022) conducted a cluster randomized controlled trial to examine the effectiveness of school-based mindfulness training “.b” on adolescents’ mental health and well-being outcomes at a 1-year follow-up.

All mainstream secondary schools, including private schools, in the United Kingdom were eligible for participation if they had a substantive appointed headteacher, had not been judged inadequate in their most recent official inspection, and had a strategy and structure in place for delivery of adequate social–emotional learning curricula. Recruitment was conducted in two cohorts (Cohort 1 was the academic year 2016–17; Cohort 2 was the academic year 2017–18), and first involved schools agreeing to participate, then providing parents an option to opt their children out, and then obtaining assent from the young people. Following collection of baseline data, 85 schools were randomized one-to-one to either school-based mindfulness training .b (the intervention group, n = 43 schools and 4,232 students) or treatment as usual (the control group, n = 42 schools and 4,144 students). Allocation of schools was balanced on school size (large, with 1,000 or more children, versus small, fewer than 1,000 children); school quality (“outstanding/good” versus “requires improvement”); and level of deprivation (below or above the median 29.4 percent of United Kingdom school children eligible for free school meals). In addition, for Cohort 2, allocation was balanced by type of school (boys, girls, and mixed) and country (England, Scotland, Wales, and Northern Ireland). A constrained randomization approach was used, where the allocation sequence was selected to achieve a high level of balance on these factors between the intervention and control groups.

The school-based mindfulness training .b was delivered by intervention school teachers over 10 lessons. The treatment-as-usual control group involved standard social–emotional teaching that typically covered relationships, sex education, and physical and mental health education.

Outcomes were measured at the individual student level at baseline (before randomization), at preintervention, at postintervention (or equivalent time in the treatment-as-usual control arm), and at the 1-year follow-up (1 year after preintervention measures). Outcomes included self-reported risk for depression (measured by the Center for Epidemiologic Studies for Depression Scale); three subscales of self-reported social–emotional behavioral functioning: conduct problems, peer relationship problems, and prosocial behavior (measured by the Strengths and Difficulties Questionnaire, Youth Self-Report Version); self-reported well-being (measured by the Warwick–Edinburgh Mental Well-Being Scale); self-reported drug and alcohol use (with a measure designed specifically for this study); self-reported anxiety (measured by anxiety subscales from the Revised Child Anxiety and Depression Scale); self-reported self-harm and suicidal ideation (with a measure designed specifically for this study); and self-reported mindfulness skills (measured by the Child and Adolescent Mindfulness Measure).

At baseline, students in the school-based mindfulness training .b intervention group were 56.5 percent female, 78.1 percent white, and an average of 12.2 years old. Intervention group students scored an average of 13.6 on the risk of depression measure, 11.8 on the social–emotional and behavioral functioning (total difficulties) measure, and 49.7 on well-being at baseline. Students in the treatment-as-usual control group were 53.1 percent female, 73.2 percent white, and an average of 12.2 years old. Control group students scored an average of 13.3 on the risk of depression measure, 11.7 on the social–emotional and behavioral functioning (total difficulties) measure, and 49.6 on well-being at baseline. The study authors did not indicate whether there were any statistically significant differences between intervention and control group students at baseline.

Forty-three schools and 3,678 students were in the intervention group and 41 schools and 3,572 students were in the control group included in the analysis at the 1-year follow-up. The intention-to-treat principle was used to compare outcomes between students in the intervention and control groups. Outcomes were analyzed using mixed-effects linear regression models that allowed for an intermediate level of clustering at the class level. The outcomes were adjusted for the factors used to balance randomization, cohort, student gender, and baseline score on the outcome. No subgroup analysis was conducted.

Study

Johnson and colleagues (2017) used a cluster (class based) randomized controlled design to assess the effectiveness of the mindfulness-based .b curriculum on depression, anxiety, well-being, and mindfulness for a sample of secondary students in Australia at a 12-month follow-up.

Four urban coeducational secondary schools (one private, three public) participated. Clustering at the class level within schools allowed for matching of demographic variables. Classes were assigned to one of three conditions: 1) the mindfulness intervention .b (without parental involvement), 2) the mindfulness intervention .b with parental involvement, or 3) a control group that undertook normal lessons (i.e., pastoral care, community projects, English, science, or history). The CrimeSolutions review of this study focused on the outcomes for students in the .b intervention without parental involvement, compared with the control group.

Students in the .b intervention group received the curriculum as described in the Program Description, with some modifications to strengthen the program. Specifically, there was a greater focus on motivation in the introductory lesson; the .b practice was added at the start of every formal mindfulness lesson; quizzes were added at the start of each lesson to review the previous lesson's key points; more pages were added to the homework manual so that each week’s activity could be easily recorded; each classroom was given colorful posters summarizing the four steps of the .b practice and illustrating a series of key mindfulness ideas; and at the final lesson, students received a laminated color copy of key ideas, and teachers received a handout describing how to reinforce mindfulness with their class into the future.

Self-report outcome measures were administered on four occasions: 1) 3-4 weeks pre-intervention, 2) post-intervention, 3) 6-month follow-up, and 4) 12-month follow-up. The Depression Anxiety Stress Scale–Short Form included two seven-item anxiety and depression factors, each scored on a four-point scale from 0 (“never”) to 3 (“almost always”), with higher scores reflecting higher depression or anxiety over the past week. The Warwick-Edinburgh Mental Well-Being Scale was a 14-item scale that surveyed the past 2 weeks; items were rated on a five-point scale from 1 (“none of the time”) to 5 (“all of the time”), with higher scores indicating higher well-being. Mindfulness was measured with the Comprehensive Inventory of Mindfulness Experiences–Adolescents, a 25-item scale of eight individual factors (awareness of internal experiences; awareness of external experiences; acting with awareness; acceptance and nonjudgment; decentering and non-reactivity; openness; relativity; and insight) that used a five-point rating scale ranging from 1 (“never true”) to 5 (“always true”) to survey the past 2 weeks. For each factor, a higher score indicated greater mindfulness. This scale did not provide an overall total score.

The study authors did not indicate whether there were any statistically significant differences between the .b intervention group (n = 169) and control group students (n = 151) at baseline.

Logistic regressions were conducted for the postintervention, 6-month, and 12-month follow-up data to test whether any baseline variable predicted missing data. Data were not adjusted for the effect of clustering, given that the same instructor delivered all mindfulness classes. Primary outcome analyses (depression, anxiety, well-being, and the eight factors of mindfulness) were conducted using linear mixed modeling, enabling inclusion of cases with missing data by maximum likelihood estimation, with baseline measures entered as covariates. Linear mixed modeling was also used to investigate the following moderators: sex, depression, anxiety, weight/shape concerns, socioeconomic status, and age. No subgroup analyses were conducted.

Study

Volanen and colleagues (2020) conducted a randomized controlled trial with three study arms to assess the effects of the mindfulness-based intervention, Stop and Breath/Be or “.b,” on adolescent mental health (specifically resilience, depression, and socioemotional functioning) in a school setting in Finland. The effects of the .b intervention were compared with both a standard relaxation program (an active control group) and teaching as usual (the inactive control group). Students in the intervention condition received the .b curriculum as described in the Program Description. In the inactive control group, students followed the usual school curriculum without any interventions. Both active and inactive control groups completed the same questionnaires as the intervention group at baseline, at completion of the program (at 9 weeks), and at follow-up 6 months after the program (26 weeks from the baseline). The CrimeSolutions review of this study compared the results of the .b intervention group with the inactive control group at the 26-week follow-up.

All 247 schools in a southern part of Finland were contacted, and 59 of those schools from 14 cities/municipalities participated in the study. A random allocation sequence was used to assign schools to either the intervention, active control, or inactive control groups. To achieve a balanced sample, the randomization procedure accounted for socioeconomic differences in terms of school location and the average apartment price per square meter. After randomization, the 25 intervention schools included 94 classes, and the 7 inactive control schools included 31 classes. Participants were sixth, seventh, and eighth graders (ages 12–15).

Students completed numerous self-report questionnaires. The Resilience scale measured resilience, with 14 self-report-items measured on a seven-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). A higher score on the resilience scale indicated greater resilience. A Finnish version of the Beck Depression Inventory was used to measure level of depressive symptoms. For ethical reasons, the item about suicidal ideation was removed and a 12-item version of the inventory was used. Each item was scored 0–3 according to the severity of the symptom, and the level of depressive symptoms was calculated as the sum score of the 12 items (range 0–36). The Strengths and Difficulties Questionnaire was used to measure socioemotional functioning. This questionnaire included 25 items scored 0 (not true), 1 (somewhat true), and 2 (certainly true). The symptom part consisted of 10 positive and 15 negative statements forming five subscales: emotional problems, conduct problems, hyperactivity, peer problems, and prosociality. The scores of all subscales, except the prosociality scale, were summed to calculate a total socioemotional functioning score (range 0–40), with a lower total score indicating better socioemotional functioning.

Students in the intervention group (n = 1,334) and inactive control group (n = 371) had no statistically significant differences in the main outcomes of resilience, depression, and socio-emotional functioning at baseline. The analysis included 658 girls and 675 boys in the intervention group and 188 girls and 182 boys in the inactive control group. The study did not indicate the equivalency of any other group characteristics at baseline.

All analyses were based on the intention-to-treat principle. The effect of the .b intervention on resilience, depression, and socioemotional functioning was analyzed with multilevel models to account for the clustered nature of the data. A three-level model with time at level 1, student at level 2, and classroom at level 3 was used. Multilevel linear models included the main effects of group, time, gender, and grade (age). The intervention effect was examined by interaction terms between group (intervention versus inactive control) and time (26 weeks versus baseline). Subgroup analysis was conducted by gender.

Kuyken and colleagues (2022) assessed the cost effectiveness of the school-based mindfulness training .b in terms of quality-adjusted life years derived from the Child Health Utility 9D Index. Joint effects of costs and outcomes (quality-adjusted life years or the risk of depression, social–emotional behavioral functioning, and well-being outcomes, as relevant) were estimated using mixed-effects linear regression. Kuyken and colleagues (2022) found that the mean cost of the school-based mindfulness training .b intervention was £70.73 per student. School-based mindfulness training had a higher probability (83 percent) of being cost effective than treatment-as-usual social–emotional teaching in terms of quality-adjusted life years at the £20,000 willingness-to-pay thresholds used by the National Institute for Health and Care Excellence. However, these results were generated by small differences in costs and quality-adjusted life years, and there was no evidence to support the cost effectiveness of the intervention when considering the outcomes.

Teachers who want to bring the .b curriculum to their schools must first complete an 8-week group session online mindfulness course led by a Mindfulness in Schools Project instructor, and then a 4-day training course (or 5-day if delivered online) [Mindfulness in Schools Project, 2021].

Detailed information and a sample lesson are available on the Mindfulness in Schools website: https://mindfulnessinschools.org/teach-dot-b/dot-b-curriculum/.

Subgroup Analysis

Volanen and colleagues (2020) conducted subgroup analysis by gender and found no statistically significant differences in resilience, depression, or socioemotional functioning between girls who received the mindfulness-based .b intervention and girls in the inactive control group at the 26-week follow-up. Similarly, there were no statistically significant differences on any of the outcomes between boys in the .b intervention group and boys in the inactive control group at the 26-week follow-up.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Blackledge, John T. 2003. “An Introduction to Relational Frame Theory: Basics and Applications.” Behavior Analyst Today 3(4):421–33.

Hailwood, Elena. 2020. Mind, Body, Discipline: A Multisited Ethnography of a Secondary School Mindfulness Programme, ‘.b’. Doctoral Thesis. Cardiff, Wales: Cardiff University.

Huppert, Felicia A., and Daniel M. Johnson. 2010. “A Controlled Trial of Mindfulness Training in Schools; The Importance of Practice for an Impact on Well-Being.” Journal of Positive Psychology 5(4):264—74.

Johnson, Catherine, Christine Burke, Sally Brinkman, and Tracey Wade. 2016. “Effectiveness of a School-Based Mindfulness Program for Transdiagnostic Prevention in Young Adolescents.” Behaviour Research and Therapy 81:1–11. (This study was reviewed but did not meet Crime Solutions’ criteria for inclusion in the overall program rating.)

Kuyken, Willem, Katherine Weare, Obioha C. Ukoumunne, Rachael Vicary, Nicola Motton, Richard Burnett, Chris Cullen, Sarah Hennelly, and Felicia Huppert. 2013. “Effectiveness of the Mindfulness in Schools Programme: Nonrandomised Controlled Feasibility Study.” British Journal of Psychiatry 203:126–31.

Meiklejohn, John, Catherine Phillips, M. Lee Freedman, Mary Lee Griffin, Gina Biegel, Andy Roach, Jenny Frank, Christine Burke, Laura Pinger, Geoff Soloway, Roberta Isberg, Erica Sibinga, Laurie Grossman, and Amy Saltzman. 2012. “Integrating Mindfulness Training Into K–12 Education: Fostering the Resilience of Teachers and Students.” Mindfulness 3:291–307.

Mindfulness in Schools Project. 2021. Bring Mindfulness to Your School. Tonbridge, Kent, England.

https://mindfulnessinschools.org/wp-content/uploads/2021/02/MiSP-Info-Booklet-FEB-2021.pdf

Mindfulness in Schools Project. 2022. .b Curriculum (Ages 11–18). Tonbridge, Kent, England.

https://mindfulnessinschools.org/teach-dot-b/dot-b-curriculum/

Seligman, Martin E.P. 2002. Authentic Happiness. New York, N.Y.: Free Press.

Volanen, Salla–Maarit, Maarit Lassander, Nelli Hankonen, Päivi Santalahti, Mirka Hintsanen, Nina Simonsen–Rehn, Anu Raevuori, Sari Mullola, Tero Vahlberg, Anna But, and Sakari Suominen. 2016. “Healthy Learning Mind—A School-Based Mindfulness and Relaxation Program: A Study Protocol for a Cluster Randomized Controlled Trial.” BMC Psychology 4(1):1–10.

Following are CrimeSolutions-rated programs that are related to this practice:

Early Self-Control Improvement Programs for Children

This practice consists of programs designed to increase self-control and reduce child behavior problems (e.g., conduct problems, antisocial behavior, and delinquency) with children up to age 10. Program types include social skills development, cognitive coping strategies, training/role playing, and relaxation training. This practice is rated Effective for improving self-control and reducing delinquency.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Juvenile Problem & At-Risk Behaviors - Self-Control

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?