Mindfulness-Based Cognitive Therapy for Children (MBCT-C) for Prevention of Internalizing Difficulties: a Small Randomized Controlled Trial with Australian Primary School Children

Objectives: The use of mindfulness-based programs (MBP) with children is rapidly growing, but calls for well-designed randomized controlled trials (RCTs) of existing programs. Mindfulness-Based Cognitive Therapy for Children (MBCT-C) has preliminary evidence for targeting internalizing symptoms in children. Within MBCT-C (and MBPs more broadly), attention is thought to be a key component of change, but mediation has been relatively unexplored. The overall aim of this small RCT was to compare MBCT-C to cognitive behavior therapy (CBT), as a preventive program for children experiencing internalizing difficulties. Methods: A mixed factorial design was used, with 2 (program group) by 2 (pre- and post-intervention) conditions. Children from 3 primary schools were randomized to MBCT-C (n = 45) or CBT (n = 44) using random permuted blocks, with stratification by school, gender, and age. Main analyses were multi-level mixed models. Results: Contrary to the hypotheses, only limited differences were found between programs. Both programs had small effects on symptoms of anxiety and depression, quality of life, attention control, and parent- and teacher-SDQ Total Difficulties, as well as moderate-large effects on shifting attention. There were no statistically significant changes in mindfulness or sustained attention. Conclusions: This RCT provides a robust test of MBCT-C in a “real life” setting, demonstrating that it may be used as a clinically oriented preventive program in schools to reduce internalizing symptoms. The results challenge whether attention (as measured in this study) is a unique component of change for MBCT-C.