Vol.:(0123456789)1 3

Child and Adolescent Social Work Journal https://doi.org/10.1007/s10560-020-00657-5

A Scoping Review of Arts‑Based Mindfulness Interventions for Children and Youth

Diana Coholic1 · Nicholas Schwabe1 · Kenneth Lander1

© The Author(s) 2020

AbstractMindfulness-Based Interventions (MBIs) hold promise for building resilience in children/youth. We were interested in understanding why some MBIs incorporate arts-based methods, and what key findings were identified from the study of these MBIs. We used a scoping review to address our research questions. Scoping reviews can help us better understand how different types of evidence can inform practice, policy, and research. Steps include identifying research questions and relevant studies, selecting studies for analysis, charting data, and summarizing results. We identified 27 research articles for analysis. MBIs included the use of drawing, painting, sculpting, drama, music, poetry, and karate. Rationales included both the characteristics of children/youth, and the benefits of the methods. Arts-based MBIs may be more relevant and engaging especially for youth with serious challenges. Specific focus should be paid to better understanding the development and benefits of these MBIs.

Keywords Mindfulness · Arts-based · Youth · Scoping review

Mindfulness is a holistic philosophy and way of being in the world, and it can be both a state (an experience) and a trait (a personality characteristic or disposition) (Kabat-Zinn, 2003). Mindfulness-Based Interventions (MBIs) can help people learn to focus their attention, and with regular practice, they can learn to be aware of their present thoughts, feelings, and bodily sensations without negative judgements (Kabat-Zinn, 1990). With this nonjudgmental awareness, an individual can develop the ability to choose a response to distressing situations and emotions instead of reacting with unhealthy behaviors and interpretations (Horesh & Gordon, 2018). Indeed, emotion regulation is an important component in treating a variety of complex mental health challenges including anxiety (Chambers, Gullone, & Allen, 2009). As a way of being in the world, mindfulness represents an inner-resource that contributes to resilience, which is the ability to recover from tumultuous circumstances (Bajaj & Pande, 2016). Thus, youth facing a variety of psychosocial stressors may find mindfulness a helpful strategy for mitigating chal-lenges and building resilience.

MBIs have been developed for a range of conditions in both clinical and healthy adult populations. Well established MBIs include Mindfulness Based Stress Reduction (MBSR) (Kabat-Zinn, 1990), Mindfulness Based Cognitive Therapy (MBCT) (Segal, Williams, & Teasdale, 2002), and Accept-ance and Commitment Therapy (ACT) (Hayes, Strosahl, & Wilson, 1999). There is evidence that MBSR improves mental health and reduces symptoms of stress, anxiety and depression, and MBCT prevents depressive relapse (Fjor-back, Arendt, Ornbol, Fink, & Walach, 2011). MBIs have also been found to be helpful in reducing symptoms of anxi-ety (Vollestad, Birkeland Nielsen, & Hostmark Nielsen, 2012). ACT combines mindfulness and cognitive therapy with an emphasis on treating anxiety and depression but is typically delivered in a traditional one-on-one counselling setting. Most other MBIs are facilitated via group delivery making them cost-effective, and providing the additional benefit of developing social competencies (Klatt, Buck-worth, & Malarkey, 2009).

A wide variety of MBIs, often adapted from programs developed for adults, have also been investigated for use with children and youth in clinical settings and in schools with promising results. It appears that MBIs in schools may improve resilience (Zenner, Herrnleben-Kurz, & Walach, 2014). Others have found that youth with serious

* Diana Coholic dcoholic@laurentian.ca

1 School of Social Work, Laurentian University, Sudbury, ON P3E 2C6, Canada

D. Coholic et al.

1 3

mental health challenges who participated in MBSR developed improved attention and mood, self-concept, and interpersonal relationships (Van Vliet et al., 2017). A review of the evidence for MBCT for improving self-regulation in teenagers indicated that youths reported bet-ter self-regulation and coping (Perry-Parrish, Copeland-Linder, Webb, Shields, & Sibinga, 2016). Similarly, a review of MBIs for youth with anxiety reported that MBIs are effective for the treatment of anxiety disorders in youth (Borquist-Conlon, Maynard, Esposito Brendel, & Farina, 2017).

Tan and Martin (2013) summarized the mechanisms that are thought to contribute to the effectiveness of practicing mindfulness. These include improved atten-tional capacity, which is important in learning processes; increased self-awareness and the ability to notice thoughts as transitory experiences that are not necessarily true (flexible thinking); and reduced distress and/or distress tolerance through the process of accepting thoughts and feelings rather than repressing or trying to control them. These mechanisms of change and consequent benefits can build on each other. For example, with improved attention and focus, self-awareness can be developed so that a youth can understand and express their feelings. With improved emotion regulation, they can cope better with challenges, which can affect overall mood and self-esteem (Coholic et al., 2019). However, this is a developing field and some have argued that findings should be considered tentatively promising (Zenner et al., 2014), while others argued that we need more research that examines the mechanisms of change that participants experience and/or self-report (Alsubaie et al., 2017; Chiesa, Fazia, Bernardinelli, & Morandi, 2017), that is, learning mindfulness may not be the only factor implicated in change.

When MBIs are adapted from adult programs for use with children and youth, modifications are often made to make the programs more relevant for young people, for example, shortened meditation exercises and the addi-tion of experiential activities, but typically, the structure of the program adheres to the original adult program. Some researchers have argued that there is a need to bet-ter understand the factors contributing to changes in chil-dren’s behaviours, feelings, and thoughts as a result of having participated in an MBI (Harnett & Dawe, 2012). In our own work, we have found that the enjoyment cre-ated through the use of arts-based methods engages our target population and is consistently reported as one of the most favorite aspects of our arts-based MBI (Coholic & Eys, 2016). Thus, we were interested in better understand-ing what research exploring arts-based MBIs has been completed and why arts-based approaches were used by researchers and facilitators. With this information, future areas for research and practice can be identified.

Scoping Reviews

Scoping reviews have been successfully used to aid in the design of research, inform best policies/practices, and locate research gaps in the literature (Pham et al., 2014). Various definitions have been proposed to describe scoping reviews including to identify key concepts and sources of available evidence (Arksey & O’Malley, 2005); to synthesize and analyze diverse research and non-research material (Davis, Drey, & Gould, 2009); and to map the literature on a spe-cific topic so that we can better understand how different types of evidence can inform practice, policy making, and research (Pham et al., 2014). Scoping reviews are most com-monly used to rapidly develop a description and analysis of available literature in a specific area (Grant & Booth, 2009). Study quality is not assessed, thus, more studies tend to be included compared to systematic reviews/meta-analyses. Therefore, the scoping review was selected as a methodol-ogy well suited to quickly, and with limited resources, map the emerging literature with regards to the use of arts-based group MBIs with children and youth. In a scoping review of scoping reviews, Pham et al. (2014) indicated that Arksey and O’Malley’s (2005) framework was the most common methodological framework employed. We also used their five-stage framework to guide our work with the following steps: (1) identifying research questions, (2) identifying rel-evant studies, (3) study selection, (4) charting the data, and (5) collating and summarizing. Consultation is listed as an optional component (Arksey & O’Malley, 2005).

Method

Research Questions

We were interested in exploring the existent research per-taining to arts-based group MBIs with children and youth aged 8–18 years old. The research questions were: (1) What are the MBIs that primarily use arts-based methods to facili-tate mindfulness with children and youth? (2) Why do these MBIs focus on using arts-based methods? and (3) What are the key findings from these programs?

Selection Criteria

We focused on research published from 2000–2017 because studying MBIs with children and youth is an emergent area of research, and beginning with the year 2000 ensured a comprehensive search. Literature published in English was the focus as we did not have the resources to translate papers written in other languages. Criteria was also related

A Scoping Review of Arts-Based Mindfulness Interventions for Children and Youth

1 3

to type of intervention including MBIs with children and youth aged 8–18 years old including all types of challenges and rationales for participation in the MBI; group delivery; and any group size and mix of genders. Importantly, for the purposes of our review, the MBI had to have a major focus on arts-based methods. We understood arts-based methods to include a variety of creative and experiential approaches such as drawing, painting, sculpting, games, movement such as karate or tai chi, drama, music, and poetry/journaling. We agreed that the MBIs had to be primarily focused around teaching mindfulness-based practices and concepts by way of arts-based activities so that arts-based activities were facilitated in every session serving as the context for the delivery of the mindfulness-based practices. We included all cultures, practitioner-types, and geographical/physical locations.

Identifying Relevant Studies

As academic journals are increasingly web-based we decided to conserve our limited resources by solely searching elec-tronic databases. Our search was limited to English language articles published between January 2000 and March 2017. To identify relevant studies a number of search terms were selected in consultation with one of our university’s librar-ians and based on the research questions. For instance, an article’s abstract or title would require the term mindfulness and synonyms for children/youth, groups, and arts-based/creative interventions. These terms were separated by

Boolean operator ‘AND,’ whilst synonyms were separated by ‘OR.’ Terms with varying suffixes were truncated with the asterisk symbol to yield more studies. The terms were then used to search the abstracts and titles of articles in their respective databases (see Table 1 for list of keyword search terms). The second and third authors, who were senior social work students training in the first author’s research program, independently searched 22 databases which were expected to yield the most relevant results using the same set of search terms (see Table 2 for a list of the databases searched).

Study Selection

The initial search yielded 4363 articles. This number was reduced when 2116 duplicates were removed. The second and third authors then independently reviewed the titles and abstracts to identify articles that did not meet the inclusion criteria; this eliminated an additional 1365 articles. Another 674 articles were eliminated following the abstract review leaving 208 articles. The description of interventions in the remaining articles were then independently reviewed by the second and third authors to assess whether the interventions met the inclusion criteria. When there was a lack of consen-sus between these two authors, discussions were held with the first author regarding the inclusion of an article in order to resolve the discrepancies. The flow chart in Fig. 1 depicts the process of searching and screening the articles. Addition-ally, we found that our search yielded several dissertations but they were eliminated during the intervention description

Table 1 Database keyword search terms

Search terms and Boolean operators

(mindfulness) AND (youth* OR teen* OR child* OR laten* OR adolescen* OR kid* OR boy* OR girl* OR juvenile* OR minor* OR young* OR preteen* OR pubescent* OR prepubescent* OR junior* OR student* OR immature*) AND (program* OR creativ* OR art* OR activit* OR non-traditional* OR recreation* OR experiential* OR expressi* OR adventur* OR outdoor* OR play*) AND (group* OR class* OR club* OR circle* OR team* OR program* OR company* OR cast* OR gang* OR band* OR squad* OR crew* OR clan* OR collectiv* OR troop*)

Table 2 Databases searched Databases

Academic OneFile PsycINFOCINAHL PubMedDirectory of Open Access Journals REHABDATA JSTOR Sage JournalsLiterature Resource Center Scholars PortalMedline (Ovid) ScienceDirectNative Health Database Social Work AbstractsOVID Nursing Journals Sociological AbstractsPublished International Literature on Traumatic Stress Springer LINKProject MUSE Taylor & Francis OnlineProQuest Nursing & Allied Health Source Wiley Online Library

D. Coholic et al.

1 3

review due to time and resource constraints. Ultimately, 27 studies were selected for inclusion and analysis.

Charting the Data

The second and third authors charted the 27 articles accord-ing to the following extraction fields: publication year, authors, title, country, purpose/research questions, popula-tion characteristics, sample size, study design, intervention duration and description, facilitator qualifications, compara-tor description, outcome measures, outcomes, and research-ers’ rationales for the use of arts-based MBIs (see Table 3 for a list of included articles and relevant extraction data).

Results

The analysis phase of a scoping review should include three steps: analyzing the data, reporting results, and applying meaning to the results. Analysis typically involves a descriptive numerical summary and a thematic analysis (Levac, Colquhoun, & O’Brien, 2010).

Characteristics of Arts‑Based MBIs

Of the 27 studies, 10 were based in Canada, eight were based in the United States of America, and five were based in Australia. One study was from South Korea, Norway, and Kosovo respectively. One article reported on two stud-ies, one from Australia and another from Sweden evalu-ating the same MBI. Studies included children/youth between the ages of 7–27 years, with the highest minimum age requirement being 16 years. Twenty-one of the MBIs were offered to boys and girls. Most of the studies targeted specific populations that included youth with chronic pain and illness, low income, placement in foster care, incarcer-ation, learning disabilities, anxiety, eating disorders, post-traumatic stress disorder, depression, disruptive behaviors, and other mental health challenges. Six studies recruited youth from schools or the general population.

Eight studies employed solely qualitative designs. Nine of the remaining studies had primarily quantitative designs whilst also featuring qualitative methods. Six studies iden-tified themselves as randomized controlled trials (RCTs) compared to 14 intervention trials that were non-RCTs. Eight of the non-RCT designs included control groups. Twenty-three of the studies had total sample sizes of less than 100, but one RCT included 347 participants. New programs usually require preliminary evidence of benefits before being studied more widely. Thus, many of the stud-ies were pilot projects (Jee et al., 2015), feasibility studies (Klatt, Harpster, Browne, White, & Case-Smith, 2013) or exploratory studies (Milligan, Badali, & Spiroiu, 2015). Research investigating arts-based MBIs is emergent, which may account in part for the heterogeneity of the MBIs and the study designs.

Integra Mindfulness Mixed Martial Arts (MMA) (Milli-gan et al., 2015, 2016), Taming the Adolescent Mind (Tan & Martin, 2013, 2015), and the Holistic Arts-Based Pro-gram (Coholic & Eys, 2016; Coholic, Eys, & Lougheed, 2012) were the only MBIs reported in multiple studies. Briefly, MMA aims to decrease challenging behaviors, increase self-awareness, control, and adaptability, and improve social and self-defence skills. The 20-week pro-gram consists of weekly 1.5-h sessions that include mind-fulness, cognitive behavioral therapy (CBT), and mixed

Database search(n=4363)

Articles after duplicates removed(n=2247)

Articles after title review (n=882)

Articles after abstract review

(n=208)

Articles included in review(n=27)

Articles excluded based on intervention description

(n=181)

Articles excluded based on abstracts(n=674)

Articles excluded based on title

(n=1365)

Duplicates removed

(n=2116)

Fig. 1 Article search flowchart

A Scoping Review of Arts-Based Mindfulness Interventions for Children and Youth

1 3

Tabl

e 3

List

of i

nclu

ded

artic

les a

nd e

xtra

cted

dat

a

Aut

hors

(Yea

r)C

ount

ryA

geG

ende

rPo

pula

tion

Cre

ativ

e in

terv

entio

n co

mpo

nent

sSa

mpl

e si

zeSt

udy

desi

gnQ

uant

itativ

e m

easu

res

Find

ings

Atk

inso

n an

d W

ade

(201

5)A

ustra

lia14

–18

Girl

sYo

uths

at r

isk

of

deve

lopi

ng a

n ea

ting

diso

rder

Feat

ured

vid

eos,

mirr

or

exer

cise

s, ro

le-p

layi

ng,

and

disc

ussi

on to

con

vey

non-

judg

emen

tal p

rese

nt

mom

ent a

war

enes

s fo

cuse

d on

bod

y re

late

d se

nsat

ions

and

thou

ghts

- opt

iona

l hom

ewor

k w

as

prov

ided

to p

ract

ice

skill

s le

arne

d in

-ses

sion

n = 34

7C

luste

r ran

d-om

ized

con

trol

trial

with

follo

w

up a

nd p

ost-

inte

rven

tion

writ

ten

prog

ram

fe

edba

ck

EDE-

Q, P

AN

AS-

X, D

EBQ

-R,

SATA

Q-3

, C

IA, a

nd

prog

ram

ac

cept

abili

ty

Like

rt sc

ales

The

inte

rven

tion

prod

uced

impr

oved

scor

es o

n w

eigh

t/sha

pe c

once

rns,

nega

tive

affec

t, di

etar

y re

strai

nt, t

hin-

idea

lizat

ion,

soci

o-cu

ltura

l pre

s-su

res,

eatin

g di

sord

er sy

mpt

oms,

and

psyc

ho-

soci

al im

pairm

ents

thro

ugh

follo

w u

p bu

t no

stat

istic

ally

sign

ifica

nt e

ffect

was

foun

d fo

r stu

dy

cond

ition

or c

ondi

tion

x tim

e in

tera

ctio

n. M

BI

parti

cipa

nts r

epor

ted

the

low

est i

nter

vent

ion

acce

ptab

ility

scor

es w

ith st

atist

ical

ly si

gnifi

cant

di

ffere

nces

for t

he u

nder

stan

ding

of c

once

pts a

nd

likel

ihoo

d to

con

tinue

the

use

of sk

ills

Bur

ckha

rdt e

t al.

(201

7)A

ustra

lia14

–16

Mix

edPr

ivat

e sc

hool

stu

dent

sIn

clud

ed th

e us

e of

vid

eos,

liste

ning

min

dful

ly

to a

udio

tape

s, m

ock

deba

tes,

and

actin

g in

a

play

abo

ut th

ough

ts

n = 48

Clu

ster r

and-

omiz

ed c

ontro

l tri

al w

ith fo

llow

up

DA

SS-2

1, F

S,

and

custo

m

prog

ram

eva

lu-

atio

n qu

estio

n-na

ire w

ith

Like

rt sc

ales

The

inte

rven

tion

impr

oved

scor

es o

n bo

th th

e D

ASS

-21

(dep

ress

ion,

anx

iety

, and

stre

ss) a

nd

FS (fl

ouris

hing

) but

thes

e w

ere

not s

igni

fican

tly

diffe

rent

from

the

cont

rol g

roup

, tho

ugh

the

pre

to fo

llow

-up

effec

t siz

es w

ere

mod

erat

e to

larg

e.

On

the

prog

ram

eva

luat

ion

scal

es, p

artic

ipan

ts

belie

ved

they

wer

e m

ore

confi

dent

, im

pact

ed

less

by

nega

tive

thou

ghts

, hap

pier

, fou

nd th

e w

orks

hop

help

ful,

mor

e co

mfo

rtabl

e w

ith

nega

tive

emot

ions

and

anx

iety

, und

ersto

od th

eir

valu

es, h

ad b

ette

r rel

atio

nshi

ps, a

nd a

pplie

d th

e w

orks

hop

to d

aily

life

Coh

olic

(201

1)C

anad

a8–

15M

ixed

—si

ngle

ge

nder

gro

ups

Chi

ldre

n re

ceiv

-in

g m

enta

l he

alth

or c

hild

w

elfa

re se

rvic

es

Mul

timod

al (p

aint

, pas

tels

, sa

nd, e

tc.)

arts

-bas

ed

min

dful

ness

exe

rcis

es

that

requ

ire th

e pr

actic

e of

pre

sent

mom

ent a

war

e-ne

ss a

nd n

onju

dgem

ent

with

par

ticul

ar a

ttent

ion

to e

mot

iona

l aw

aren

ess

n = 31

Qua

litat

ive

post-

inte

rven

tion

inte

rvie

ws

N/A

Yout

h fo

und

the

inte

rven

tion

fun

and

this

aid

ed in

th

e de

velo

pmen

t of s

elf-

awar

enes

s, em

otio

nal

regu

latio

n, h

ealth

y em

otio

nal e

xpre

ssio

n, c

opin

g sk

ills,

and

self-

este

em

Coh

olic

and

Eys

(2

016)

Can

ada

Ran

ge n

ot

repo

rted

( x =

10.34

± 1.

71)

Mix

ed—

sing

le

gend

er g

roup

sC

hild

ren

rece

iv-

ing

men

tal

heal

th o

r chi

ld

wel

fare

serv

ices

See

Coh

olic

(201

1)n =

77N

on-e

quiv

alen

t gr

oups

qua

si-

expe

rimen

tal

trial

with

pos

t-in

terv

entio

n in

terv

iew

s

PHC

SCS

and

RSC

AYo

uth

foun

d th

e gr

oup

enjo

yabl

e an

d re

ques

ted

it be

leng

then

ed. T

hey

also

foun

d th

e M

BI f

un a

nd

enjo

yed

mak

ing

frie

nds a

nd d

oing

art.

Per

ceiv

ed

bene

fits i

nclu

ded

emot

iona

l reg

ulat

ion,

moo

d,

soci

al/c

opin

g sk

ills,

confi

denc

e/se

lf-es

teem

, em

path

y, a

nd im

prov

ed a

ttent

ion.

Sta

tistic

ally

si

gnifi

cant

impr

ovem

ents

wer

e fo

und

for s

elf-

conc

ept

Coh

olic

et a

l. (2

012)

Can

ada

8–14

Mix

ed—

sing

le

gend

er g

roup

sC

hild

ren

rece

iv-

ing

men

tal

heal

th o

r chi

ld

wel

fare

serv

ices

See

Coh

olic

(201

1)n =

21N

on-e

quiv

alen

t gr

oups

qua

si-

expe

rimen

tal

trial

PHC

SCS

and

RSC

ASt

atist

ical

ly si

gnifi

cant

impr

ovem

ents

wer

e fo

und

for e

mot

iona

l rea

ctiv

ity fo

llow

ing

the

MB

I

D. Coholic et al.

1 3

Tabl

e 3

(con

tinue

d)

Aut

hors

(Yea

r)C

ount

ryA

geG

ende

rPo

pula

tion

Cre

ativ

e in

terv

entio

n co

mpo

nent

sSa

mpl

e si

zeSt

udy

desi

gnQ

uant

itativ

e m

easu

res

Find

ings

Coh

olic

, Lo

ughe

ed, a

nd

Cad

ell (

2009

)

Can

ada

8–15

Mix

ed—

sing

le

gend

er g

roup

sC

hild

ren

rece

iv-

ing

men

tal

heal

th o

r chi

ld

wel

fare

serv

ices

See

Coh

olic

(201

1)n =

38Q

ualit

ativ

e po

st-in

terv

entio

n in

terv

iew

s and

se

ssio

n ob

serv

a-tio

ns

N/A

Youn

g pe

ople

enj

oyed

the

grou

p, w

ould

like

to

cont

inue

atte

ndin

g be

yond

the

initi

al p

rogr

am,

and

coul

d no

t ide

ntify

any

are

as fo

r im

prov

emen

t. Pa

rtici

pant

s des

crib

ed th

e gr

oup

as fu

n an

d pl

ace

to d

evel

op se

lf-es

teem

. Gua

rdia

ns w

ere

sup-

porti

ve o

f the

pro

gram

and

wer

e gl

ad to

see

the

child

ren

expr

essi

ng e

xcite

men

t, se

lf-aw

aren

ess,

and

impr

oved

scho

ol o

utco

mes

. The

you

ths f

ound

th

ey u

sed

thei

r im

agin

atio

n m

ore

and

min

dful

ness

ex

erci

ses t

o re

lax

and

regu

late

em

otio

nC

ohol

ic,

Loug

heed

, an

d Le

Bre

ton

(200

9)

Can

ada

8–12

Mix

ed—

sing

le

gend

er g

roup

sC

hild

ren

rece

iv-

ing

child

w

elfa

re se

rvic

es

See

Coh

olic

(201

1)n =

35N

on-c

ontro

lled

pre-

post

trial

w

ith p

ost-

inte

rven

tion

inte

rvie

ws

PHC

SCS

Qua

ntita

tive

resu

lts w

ere

not r

epor

ted.

For

qua

lita-

tive

resu

lts se

e C

ohol

ic, L

ough

eed,

and

Cad

ell

(200

9)

Dia

z et

 al.

(201

2)U

SA7–

12N

/ASu

mm

er st

uden

ts

with

em

otio

nal

reac

tivity

cha

l-le

nges

The

use

of th

e ga

me

head

s-up

/sev

en-u

p to

teac

h m

indf

ulne

ss

N/A

Qua

litat

ive

jour

n-al

ing

durin

g se

ssio

ns a

nd

focu

s gro

ups

N/A

Parti

cipa

nts n

oted

that

min

dful

ness

was

abo

ut

quie

tnes

s, de

coru

m, a

nd k

indn

ess.

The

child

ren

enjo

yed

play

ing

the

gam

e an

d in

tegr

atin

g m

indf

ulne

ss. F

ocus

gro

ups a

t firs

t hel

ped

deve

lop

the

gam

e ru

les.

They

als

o re

veal

ed th

at th

e ga

me

help

ed th

e yo

uths

lear

n ab

out m

indf

ulne

ss in

w

ays t

hey

coul

dn’t

in c

lass

Gor

don

et a

l. (2

008)

Kos

ovo

14–1

8M

ixed

Stud

ents

with

PT

SDEx

pres

sive

arts

incl

ud-

ing

writ

ing,

dra

win

g,

imag

ery,

gen

ogra

ms,

spok

en w

ord,

and

dan

ce

n = 82

Ran

dom

ized

wai

t-lis

t con

trol t

rial

with

follo

w u

p

HTQ

Trau

ma

sym

ptom

s wer

e si

gnifi

cant

ly re

duce

d af

ter t

he in

terv

entio

n w

hen

com

pare

d w

ith th

e w

aitli

st co

ntro

l and

at f

ollo

w-u

p. A

void

ance

and

re

expe

rienc

ing

sym

ptom

s wer

e si

gnifi

cant

ly

redu

ced

imm

edia

tely

afte

r the

inte

rven

tion

whe

n co

mpa

red

with

the

wai

tlist

cont

rol,

how

ever

, hy

pera

rous

al sy

mpt

oms w

ere

not

Hay

dick

y et

 al.

(201

2)C

anad

a12

–18

Boy

sYo

uths

with

le

arni

ng d

is-

abili

ties

Mix

ed m

artia

l arts

incl

ud-

ing

the

Bus

hido

Way

of

the

War

rior a

nd a

bel

t sy

stem

rew

ardi

ng m

artia

l ar

ts p

rofic

ienc

y, h

ome

prac

tice,

and

pro

soci

al

beha

vior

n = 60

Non

-ran

dom

ized

w

aitli

st co

ntro

l tri

al

WA

SI, W

J-II

I, C

PRS,

BR

IEF,

C

BC

L, a

nd

CB

CL-

YSR

With

in th

e A

DH

D/L

earn

ing

disa

bilit

y su

b-gr

oup,

si

gnifi

cant

tim

e x

grou

p (in

terv

entio

n v.

con

trol)

effec

ts w

ere

foun

d fo

r opp

ositi

onal

defi

ant a

nd

cond

uct p

robl

ems o

n th

e C

BC

L. W

ithin

the

hype

ract

ive/

impu

lsiv

e su

b-gr

oup

sign

ifica

nt

time

x gr

oup

(inte

rven

tion

v. c

ontro

l) eff

ects

w

ere

foun

d fo

r met

acog

nitiv

e m

onito

ring

on th

e B

RIE

F. W

ithin

the

inat

tent

ive

sub-

grou

p, si

gnifi

-ca

nt ti

me

x gr

oup

(inte

rven

tion

v. c

ontro

l) eff

ects

w

ere

foun

d fo

r soc

ial p

robl

ems o

n th

e C

BC

L.

With

in th

e an

xiet

y su

b-gr

oup,

sign

ifica

nt ti

me

x gr

oup

(inte

rven

tion

v. c

ontro

l) eff

ects

wer

e fo

und

for D

SM a

nxie

ty o

n th

e C

BC

L-Y

SRH

imel

stein

et a

l. (2

012)

USA

14–1

8B

oys

Yout

hs in

carc

er-

ated

in a

ju

veni

le h

all

Expe

rient

ial e

xerc

ises

(e.g

., ic

eber

g ac

tivity

, bag

of

rese

ntm

ents

, and

be

a m

an b

ox),

story

telli

ng,

and

visu

aliz

atio

n

n = 23

Post-

inte

rven

tion

qual

itativ

e in

terv

iew

s with

pa

rtici

pant

s

N/A

Parti

cipa

nts r

epor

ted

incr

ease

d re

laxa

tion,

self-

este

em, s

elf-

cont

empl

atio

n, e

mot

iona

l and

ph

ysic

al aw

aren

ess,

pres

ent—

mom

ent a

war

enes

s, em

otio

nal r

egul

atio

n, c

ogni

tive

regu

latio

n, a

nd

beha

vior

al re

gula

tion.

The

y al

so re

porte

d re

duce

d str

ess,

impr

oved

slee

p, in

terv

entio

n ac

cept

ance

, an

d po

sitiv

e gr

oup

expe

rienc

es

A Scoping Review of Arts-Based Mindfulness Interventions for Children and Youth

1 3

Tabl

e 3

(con

tinue

d)

Aut

hors

(Yea

r)C

ount

ryA

geG

ende

rPo

pula

tion

Cre

ativ

e in

terv

entio

n co

mpo

nent

sSa

mpl

e si

zeSt

udy

desi

gnQ

uant

itativ

e m

easu

res

Find

ings

Jee

et a

l. (2

015)

USA

14–2

1M

ixed

Yout

h in

foste

r or

kins

hip

care

Arts

and

cra

fts a

ctiv

ities

an

d pl

ayin

g m

usic

n = 42

Ran

dom

ized

co

ntro

l tria

l w

ith p

artic

ipan

t fo

cus g

roup

s at

the

seco

nd

last

sess

ion

and

follo

w u

p in

terv

iew

s with

gu

ardi

ans/

case

-w

orke

rs

PSC

-17,

CA

MM

, ST

AIT

/STA

IS,

and

HRV

Two

adve

rse

even

ts (fi

ghts

bet

wee

n pa

rtici

pant

s)

wer

e re

porte

d. N

o st

atist

ical

ly si

gnifi

cant

im

prov

emen

ts w

ere

foun

d fo

r ext

erna

lizin

g sy

mpt

oms,

inte

rnal

izat

ion,

atte

ntio

n pr

oble

ms,

min

dful

ness

, or a

nxie

ty. E

CG

resu

lts in

dica

ted

stat

istic

ally

sign

ifica

nt h

ighe

r hea

rt ra

tes p

ost-

inte

rven

tion

for a

ctiv

e gr

oup

parti

cipa

nts

Kla

ssen

(201

7)U

SA10

–13

Girl

sSi

xth-

grad

e stu

dent

sJo

urna

ling,

min

dful

m

ovem

ent,

and

phot

o el

icita

tion

N/A

Qua

litat

ive

desc

riptiv

e ca

se

study

N/A

The

case

stud

y re

ports

the

impe

tus f

or th

e cr

eatio

n of

the

prog

ram

(i.e

., an

incr

ease

in c

once

rn th

at

fem

ale

stude

nts w

ere

self-

criti

cal a

nd h

ighl

y co

m-

petit

ive)

and

a n

arra

tive

acco

unt o

f the

inte

rven

-tio

n im

plem

enta

tion

but q

ualit

ativ

e in

terv

entio

n or

pro

cess

out

com

es w

ere

not r

epor

ted

Kla

tt et

 al.

(201

3)U

SA ~

9M

ixed

Yout

hs li

ving

in

low

-inco

me

fam

ilies

Gui

ded

visu

aliz

atio

n,

colo

ring

and

draw

ing,

ex

pres

sive

writ

ing,

and

co

llage

mak

ing

n = 49

Non

-ran

dom

ized

co

ntro

lled

trial

w

ith fo

llow

up

and

post-

inte

r-ve

ntio

n te

ache

r in

terv

iew

s

CTR

S-R

:SQ

ualit

ativ

ely,

teac

hers

repo

rted

stude

nts l

earn

ed to

re

lax,

shor

t ses

sion

s wer

e us

eful

for i

nteg

ratio

n in

the

scho

ol d

ay, t

he in

terv

entio

n im

prov

ed

clas

s atte

ndan

ce, i

ncre

ased

ale

rtnes

s dur

ing

clas

ses a

fter t

he in

terv

entio

n, th

e in

corp

orat

ion

of m

usic

was

hel

pful

, and

that

the

inte

rven

tion

was

acc

epta

ble

and

feas

ible

. AD

HD

, hyp

erac

tiv-

ity, a

nd c

ogni

tive

atte

ntio

n w

ere

all s

tatis

tical

ly

sign

ifica

ntly

impr

oved

afte

r the

inte

rven

tion

and

thes

e im

prov

emen

ts w

ere

mai

ntai

ned

at fo

llow

up

and

the

effec

t siz

es w

ere

mod

erat

e. O

ppos

ition

al

beha

vior

scor

es w

ere

not s

igni

fican

tly im

prov

edLa

gor e

t al.

(201

3)U

SA8–

12M

ixed

Stud

ents

with

a

chro

nic

illne

ssV

isua

l im

ager

y, m

indf

ul

touc

hing

gam

es, u

sing

op

tical

illu

sion

s, lis

teni

ng

to m

usic

, dra

win

g, a

nd

assi

gnin

g co

lour

and

so

und

to e

mot

ions

n = 15

Non

-con

trolle

d pr

e-po

st tri

al

with

pos

t-in

terv

entio

n in

terv

iew

s

CAM

M, P

edsQ

L,

and

BYI-

IIA

maj

ority

of s

tude

nts l

iked

the

inte

rven

tion,

43%

of

stud

ents

pre

ferr

ed e

xper

ient

ial a

ctiv

ities

, on

e ev

en b

roug

ht in

terv

entio

n el

emen

ts to

thei

r fa

mily

, but

mul

tiple

stud

ents

foun

d th

e ac

tiviti

es

diffi

cult

or b

orin

g an

d on

e w

as fr

ustra

ted

that

m

indf

ulne

ss d

oes n

ot re

duce

em

otio

n in

tens

ity.

Hal

f of t

he st

uden

ts re

porte

d m

indf

ulne

ss a

s a

tool

for b

ehav

iora

l reg

ulat

ion

and

21%

repo

rted

that

min

dful

ness

is m

eant

to in

crea

se aw

aren

ess.

Stud

ents

wou

ld h

ave

pref

erre

d gr

oups

bas

ed o

n ag

e. A

mon

g tre

atm

ent c

ompl

eter

s, an

xiet

y w

as

stat

istic

ally

sign

ifica

ntly

redu

ced.

No

sign

ifica

nt

resu

lts w

ere

foun

d fo

r sel

f-co

ncep

t, de

pres

sion

, an

ger,

disr

uptiv

e be

havi

ors,

qual

ity o

f life

, or

min

dful

ness

D. Coholic et al.

1 3

Tabl

e 3

(con

tinue

d)

Aut

hors

(Yea

r)C

ount

ryA

geG

ende

rPo

pula

tion

Cre

ativ

e in

terv

entio

n co

mpo

nent

sSa

mpl

e si

zeSt

udy

desi

gnQ

uant

itativ

e m

easu

res

Find

ings

Livh

eim

et a

l. (2

015)

Aus

tralia

and

Sw

eden

12–1

8/14

–15

Mix

ed—

sing

le

gend

er g

roup

sSt

uden

ts

expe

rienc

ing

sym

ptom

s of

depr

essi

on/

Stud

ents

with

m

enta

l hea

lth

chal

leng

es

Pain

ting,

role

-pla

ys, fi

nger

-tra

ps, c

harc

oal c

olou

ring,

cl

ay sc

ulpt

ing,

poe

m

writ

ing,

and

map

dra

win

g

n = 66

/ n =

32R

ando

miz

ed c

on-

trol t

rial w

ith a

po

st-in

terv

en-

tion

feed

back

qu

estio

nnai

re/

Ran

dom

ized

co

ntro

l tria

l w

ith fo

llow

up

and

pos

t-in

terv

entio

n fe

edba

ck

ques

tionn

aire

RA

DS-

2, A

FQ-

Y8,

and

SD

QIn

the

Aus

tralia

n stu

dy, t

here

wer

e m

oder

ate

to

larg

e st

atist

ical

ly si

gnifi

cant

tim

e x

grou

p eff

ects

fo

r the

RA

DS-

2 ov

eral

l (in

clud

ing

dysp

horia

, ne

gativ

e aff

ect,

and

nega

tive

self-

eval

uatio

n su

bsca

les b

ut n

ot so

mat

ic c

ompl

aint

s) a

nd th

e A

FQ-Y

8 (a

void

ance

and

fusi

on).

In th

e Sw

edis

h stu

dy, t

here

wer

e la

rge

to m

ediu

m si

gnifi

cant

and

m

argi

nally

stat

istic

ally

sign

ifica

nt ti

me

x gr

oup

effec

ts fo

r per

ceiv

ed st

ress

, min

dful

ness

, and

an

xiet

y. A

dditi

onal

ly, s

tress

, dep

ress

ion,

anx

iety

, an

d qu

ality

of l

ife w

ere

sign

ifica

ntly

cor

rela

ted

amon

g in

terv

entio

n pa

rtici

pant

s with

the

num

ber

of se

ssio

ns a

ttend

edPa

rtici

pant

s in

the

Aus

tralia

n stu

dy re

porte

d le

arni

ng a

bout

feel

ings

, lea

rnin

g ‘e

very

one

was

th

e sa

me’

, had

fun,

nor

mal

ized

feel

ings

, and

le

arni

ng th

at ‘t

houg

hts a

nd fe

elin

gs d

o no

t nee

d to

rule

my

life’

. Par

ticip

ants

als

o co

mm

ente

d th

at

ther

e w

as n

othi

ng th

ey w

ould

cha

nge

abou

t the

pr

ogra

m, b

ut it

was

too

shor

t and

was

occ

asio

n-al

ly c

onfu

sing

. Sw

edis

h pa

rtici

pant

s rep

orte

d th

at

the

prog

ram

was

val

uabl

e an

d ov

er 9

1% p

rovi

ded

posi

tive

feed

back

Loug

heed

and

C

ohol

ic (2

016)

Can

ada

15–1

7M

ixed

—si

ngle

ge

nder

gro

ups

Yout

h ag

ing

out

of fo

ster c

are

See

Coh

olic

(201

1)n =

8D

escr

iptio

n of

the

grou

p pr

ogra

m

and

prel

imin

ary

qual

itativ

e re

sults

N/A

Yout

hs re

port

impr

oved

em

otio

nal r

egul

atio

n, o

pti-

mis

m, a

nd sl

eep

hygi

ene.

The

y al

so re

port

feel

ing

acce

pted

by

peer

s. Re

sear

cher

s bel

ieve

that

the

crea

tive

inte

rven

tions

are

eng

agin

g, p

rovi

de

flexi

bilit

y, a

nd o

ffer t

he o

ppor

tuni

ty to

wor

k w

ith

a ra

nge

of st

reng

ths.

Add

ition

ally

, the

rese

arch

ers

iden

tify

norm

aliz

ing

expe

rienc

es, c

olla

bora

tion,

an

d m

utua

l aid

as k

ey b

enefi

ts to

the

grou

p fo

rmat

Mea

gher

et a

l. (2

018)

Aus

tralia

7–11

Mix

edSt

uden

ts e

xper

i-en

cing

anx

iety

A m

ultis

enso

ry le

arni

ng a

id

that

pro

vide

s a ta

ctile

and

vi

sual

repr

esen

tatio

n of

m

indf

ulne

ss

n = 14

Ran

dom

ized

ac

tive

and

inac

-tiv

e co

ntro

l tria

l w

ith p

ost-i

nter

-ve

ntio

n w

ritte

n fe

edba

ck

ques

tionn

aire

PSW

Q-C

, SC

AS,

AFQ

-Y,

CAM

M, S

DQ

, an

d PE

Q

Sam

ple

size

s wer

e to

o sm

all t

o an

alyz

e in

activ

e co

ntro

l gro

up d

iffer

ence

s. St

atist

ical

ly si

gnifi

cant

la

rge

pre-

post

effec

ts w

ere

foun

d fo

r chi

ld

repo

rted

wor

ry a

nd p

aren

t-rep

orte

d an

xiet

y w

ithin

the

inte

rven

tion

grou

p. N

o si

gnifi

cant

eff

ects

wer

e fo

und

for t

he a

ctiv

e co

ntro

l. N

o si

g-ni

fican

t res

ult w

ere

foun

d fo

r avo

idan

ce, f

usio

n,

acce

ptan

ce, a

nd m

indf

ulne

ssM

illig

an e

t al.

(201

6)C

anad

a13

–17

Mix

edRu

ral h

igh

scho

ol

stude

nts w

ith

self-

regu

latio

n ch

alle

nges

Mix

ed m

artia

l arts

, phy

sica

l ch

alle

nges

, sto

ryte

lling

, an

d po

ints

-bas

ed sy

stem

fo

r pro

soci

al b

ehav

ior

and

hom

e pr

actic

e

n = 35

Non

-ran

dom

ized

w

aitli

st co

ntro

l tri

al

PCS-

C, S

CS-

C,

and

CN

CEQ

Posi

tive

smal

l-mod

erat

e st

atist

ical

ly si

gnifi

cant

tim

e x

grou

p eff

ect s

izes

(in

favo

r of t

he in

terv

entio

n)

wer

e fo

und

for p

artic

ipan

ts’ se

cond

ary

cont

rol

and

cogn

itive

err

or sc

ores

but

not

prim

ary

cont

rol

A Scoping Review of Arts-Based Mindfulness Interventions for Children and Youth

1 3

Tabl

e 3

(con

tinue

d)

Aut

hors

(Yea

r)C

ount

ryA

geG

ende

rPo

pula

tion

Cre

ativ

e in

terv

entio

n co

mpo

nent

sSa

mpl

e si

zeSt

udy

desi

gnQ

uant

itativ

e m

easu

res

Find

ings

Mill

igan

et a

l. (2

015)

Can

ada

12–1

7M

ixed

Yout

hs w

ith a

le

arni

ng d

is-

abili

ty

See

Mill

igan

et a

l. (2

015)

n = 29

Post-

inte

rven

tion

qual

itativ

e fe

edba

ck q

ues-

tionn

aire

and

in

terv

iew

s

N/A

Yout

h re

porte

d at

tend

ing

to im

prov

e re

latio

n-sh

ips,

fitne

ss/m

artia

l arts

skill

s, an

d em

otio

nal

regu

latio

n. M

ost y

outh

s rep

orte

d ac

hiev

ing

thei

r go

als.

Like

wis

e, p

aren

ts re

porte

d go

als t

hat t

he

parti

cipa

nts w

ould

impr

ove

emot

iona

l reg

ulat

ion,

be

havi

oral

con

trol,

fitne

ss, a

nd sc

hool

per

for-

man

ce. T

he m

ost f

avor

ed c

ompo

nent

s of t

he

inte

rven

tion

wer

e th

e gr

oup

form

at a

nd m

artia

l ar

ts fo

llow

ed b

y m

edita

tion

and

min

dful

self-

talk

. G

ener

ally

, stu

dent

s enj

oyed

the

use

of st

orie

s, cl

ass s

umm

arie

s, th

e po

ints

syste

m, a

nd th

e in

clu-

sion

of p

aren

ts. H

owev

er, t

he u

se o

f wor

kshe

ets

rece

ived

less

supp

ort.

The

clas

s tim

ing,

leng

th,

and

freq

uenc

y w

ere

repo

rted

as a

ppro

pria

te b

y pa

rtici

pant

s. Pa

rent

s app

reci

ated

the

parti

cipa

nts’

m

edita

tion

prac

tice

and

mee

tings

with

par

ents

but

so

me

foun

d w

orks

heet

s the

leas

t hel

pful

Parti

cipa

nt-r

epor

ted

bene

fits i

nclu

ded

incr

ease

d ca

lmne

ss, m

aste

ry a

nd p

ride,

em

otio

nal w

ell

bein

g, p

eer r

elat

ions

hips

, ‘th

inki

ng b

efor

e ac

t-in

g’, t

oler

ance

of d

isco

mfo

rt, c

omm

unic

atio

n,

self-

unde

rsta

ndin

g, a

nd b

ehav

iora

l reg

ulat

ion.

Pa

rent

s and

you

ths r

epor

ted

prog

ram

del

iver

y fo

rmat

ben

efits

incl

uded

the

expe

rient

ial f

eatu

res

of in

tegr

ated

mar

tial a

rts a

nd th

erap

y, le

arni

ng

acco

mm

odat

ions

, and

a sa

fe a

nd su

ppor

tive

envi

-ro

nmen

t. N

egat

ive

feat

ures

as r

epor

ted

by p

aren

ts

wer

e tim

ing,

dist

ance

, and

cos

ts. T

wo

yout

hs

repo

rted

the

med

itatio

n an

d yo

ga a

s bor

ing

and

pain

ful r

espe

ctiv

ely

Rusk

in e

t al.

(201

7)C

anad

a12

–18

Mix

edYo

uth

with

ch

roni

c pa

inFi

nger

trap

s, ic

e-cu

be

med

itatio

n, a

nd o

ther

ex

perie

ntia

l act

iviti

es

n = 21

Non

-con

trolle

d pr

e-po

st tri

al

with

follo

w u

p,

acce

ptab

ility

as

sess

men

t, an

d po

st-in

ter-

vent

ion

focu

s gr

oups

with

pa

rtici

pant

s

AH

IF, P

CQ

, FD

I, M

ASC

, CD

S,

PCS,

CA

MM

, C

PAQ

-R,

MSP

SS, a

nd

custo

m p

ost-

sess

ion

and

satis

fact

ion

ques

tionn

aire

s

Ave

rage

satis

fact

ion

with

the

inte

rven

tion

was

ra

ted ~

8/10

. Tw

o of

the

twen

ty-o

ne p

artic

ipan

ts

wer

e no

n-co

mpl

eter

s. Pa

rtici

pant

s’ d

isab

ility

in

dex

and

pain

acc

epta

nce

stat

istic

ally

sig-

nific

antly

incr

ease

d. N

o si

gnifi

cant

resu

lts w

ere

foun

d fo

r anx

iety

, pai

n ca

tastr

ophi

zing

, soc

ial

supp

ort,

pain

, min

dful

ness

, or d

epre

ssio

n

Tan

and

Mar

tin

(201

5)A

ustra

lia13

–18

Mix

edYo

uths

with

m

enta

l hea

lth

chal

leng

es

Min

dful

scul

ptin

g, v

isu-

aliz

atio

n, d

raw

ing,

and

m

indf

ul m

usic

liste

ning

n = 91

Ran

dom

ized

con

-tro

l tria

l with

fo

llow

up

DA

SS-2

1, R

SES,

R

SCA

, AFQ

-Y

8, C

AM

M,

CB

CL

Sign

ifica

nt ti

me

x gr

oup

effec

ts w

ere

foun

d fo

r ov

eral

l men

tal h

ealth

(DA

SS-2

1), m

indf

ulne

ss,

psyc

holo

gica

l infl

exib

ility

, sel

f-es

teem

, and

tota

l be

havi

oral

out

com

es (C

BC

L) in

favo

r of t

he

min

dful

ness

inte

rven

tion.

Bet

wee

n-gr

oup

men

tal

heal

th o

utco

me

diffe

renc

es w

ere

med

iate

d by

ch

ange

s in

min

dful

ness

D. Coholic et al.

1 3

Tabl

e 3

(con

tinue

d)

Aut

hors

(Yea

r)C

ount

ryA

geG

ende

rPo

pula

tion

Cre

ativ

e in

terv

entio

n co

mpo

nent

sSa

mpl

e si

zeSt

udy

desi

gnQ

uant

itativ

e m

easu

res

Find

ings

Tan

and

Mar

tin

(201

3)A

ustra

lia13

–17

Mix

edYo

uths

dia

gnos

ed

with

a m

enta

l ill

ness

See

Tan

and

Mar

tin (2

015)

n = 10

Pre-

post

trial

with

fo

llow

up

and

open

resp

onse

po

st-in

terv

en-

tion

feed

back

qu

estio

nnai

re

DA

SS-2

1, R

SES,

CA

MM

, AFQ

-Y

8, C

BC

L,

and

custo

m

post-

inte

rven

-tio

n pr

ogra

m

satis

fact

ion

scal

e

Smal

l sta

tistic

ally

sign

ifica

nt e

ffect

s wer

e fo

und

for s

tress

, anx

iety

, dep

ress

ion,

self-

este

em,

psyc

holo

gica

l infl

exib

ility

, beh

avio

ral o

utco

mes

(C

BC

L), a

nd a

larg

e eff

ect f

or m

indf

ulne

ss. B

ene-

fits i

nclu

ded

bette

r sle

epin

g, le

ss a

nger

, inc

reas

ed

rela

xatio

n, b

ette

r em

otio

nal r

egul

atio

n, re

duce

d str

ess a

nd te

nsio

n, le

arni

ng to

be

mor

e aw

are,

th

ink

mor

e cl

early

, inc

reas

ed a

ccep

tanc

e, a

nd

lear

ning

to d

o on

e th

ing

at a

tim

e. P

artic

ipan

ts

foun

d th

e pr

ogra

m u

sefu

l, he

lpfu

l, an

d re

laxi

ng.

They

als

o re

porte

d th

at th

ey w

ould

reco

mm

end

the

grou

p to

frie

nds a

nd w

ante

d m

ore

sess

ions

or

wou

ld c

hang

e no

thin

g. E

ight

y-ni

ne p

erce

nt w

ere

high

ly sa

tisfie

d w

ith th

e pr

ogra

mTh

aral

dsen

(2

012)

Nor

way

16–2

7M

ixed

Hig

h sc

hool

stu

dent

sRo

le-p

layi

ng, s

tory

telli

ng,

visu

aliz

atio

n, a

nd c

omic

str

ips

n = 81

Non

-ran

dom

ized

co

ntro

l pre

-pos

t tri

al w

ith fo

llow

up

and

pos

t-in

terv

entio

n in

terv

iew

s

MC

S, S

CL-

90-R

, an

d SW

LSSt

atist

ical

ly si

gnifi

cant

diff

eren

ces e

xiste

d in

th

e pr

e-fo

llow

-up

chan

ges i

n lif

e sa

tisfa

ctio

n w

ith d

eter

iora

ting

life

satis

fact

ion

with

in th

e in

terv

entio

n gr

oup.

The

re w

as a

lso

a st

atist

ical

ly

sign

ifica

nt p

re-p

ost r

educ

tion

in aw

aren

ess i

n th

e co

ntro

l gro

up. P

artic

ipan

ts re

porte

d th

at m

indf

ul

brea

thin

g sk

ills w

ere

usef

ul a

s wer

e in

crea

sed

awar

enes

s, as

serti

vene

ss, a

nd se

lf-di

strac

tion.

Fe

w p

artic

ipan

ts re

porte

d th

e be

nefit

s of p

re-

vent

ing

nega

tive

emot

ions

. Som

e pa

rtici

pant

s re

porte

d di

fficu

lty le

arni

ng se

lf-di

strac

tion

and

awar

enes

s but

mos

t had

thei

r exp

ecta

tions

of t

he

prog

ram

met

Wal

l (20

05)

USA

11–1

3M

ixed

—si

ngle

ge

nder

gro

ups

Mid

dle

scho

ol

stude

nts

Tai-c

hiN

/AQ

ualit

ativ

e st

ate-

men

ts c

olle

cted

th

roug

hout

the

proc

ess

N/A

Ane

cdot

al re

ports

sugg

est p

artic

ipan

ts fe

lt m

ore

calm

, les

s rea

ctiv

e, m

ore

self-

awar

e, im

prov

ed

slee

p, m

ore

rela

xed,

incr

ease

d fe

elin

gs o

f int

er-

conn

ecte

dnes

s, m

ore

peac

eful

, and

exp

erie

nced

in

crea

sed

wel

l bei

ng a

fter e

ach

sess

ion.

Som

e pa

rtici

pant

s stru

ggle

d w

ith th

e ph

ysic

al d

eman

ds.

Fem

ale

parti

cipa

nts r

eque

sted

the

grou

p co

ntin

ue

but m

ale

parti

cipa

nts w

ere

less

inte

reste

d. T

here

w

as in

tere

st in

the

use

of n

ovel

aid

s suc

h as

m

edita

tion

cush

ions

Wal

tman

et a

l. (2

012)

USA

14–1

7B

oys

Yout

h w

ith d

is-

rupt

ive

beha

v-io

r dis

orde

rs

and

expo

sure

to

min

dful

ness

Stor

ytel

ling

and

read

ing,

w

ritin

g ex

erci

ses,

and

Stan

ford

mar

shm

allo

w

expe

rimen

t rep

licat

ion

n = 7

Non

-con

trolle

d pr

e-po

st tri

al

with

follo

w u

p

MQ

and

PC

ITh

ere

was

a sm

all p

ost-t

est e

ffect

of t

he in

terv

en-

tion

on m

indf

ulne

ss a

nd a

larg

e eff

ect a

t fol

low

-up

—st

atist

ical

sign

ifica

nce

was

not

repo

rted.

A

larg

e th

en m

oder

ate

effec

t was

repo

rted

at

post-

test

then

follo

w-u

p fo

r fac

ility

pro

gram

co

mpl

ianc

e. O

nly

four

of t

he se

ven

parti

cipa

nts

finis

hed

the

inte

rven

tion

and

wer

e in

clud

ed in

th

e an

alys

is

A Scoping Review of Arts-Based Mindfulness Interventions for Children and Youth

1 3

martial arts. Key mindfulness concepts emphasized are impermanence, nonjudgment, acceptance, letting go, and focusing on the moment (Haydicky, Wiener, Badali, Mil-ligan, & Ducharme, 2012). Taming the Adolescent Mind (Tan & Martin, 2013) is based on the adult MBSR but delivered over 5-weeks in 1-h group sessions. Modifica-tions to the adult MBSR include shorter meditations and a variety of activities such as mindful drawing, eating, listening to music, and sculpting given youths’ need for movement and familiar activities. Program goals include mastering attention regulation, improving internal and external awareness, nonjudgmental acceptance, and learn-ing how to be mindful. Finally, the Holistic Arts-Based Program (HAP) is a strengths-based group intervention with the following goals: teaching mindfulness in acces-sible and relevant ways; improving self-awareness and expression of feelings and thoughts; developing self-compassion and empathy; and recognizing and shoring up strengths. It was developed and refined through research with marginalized children and youth, and is traditionally offered over 12 weeks in weekly 2-h sessions (Coholic & Eys, 2016).

Rationales for an Arts‑Based Approach

While the rationales for the use of arts-based methods were not always well articulated, some rationales were connected with characteristics of the participants including that activi-ties had to be age appropriate, and the need to engage young people who can be noncompliant, have short attention capac-ities and a variety of interests, possess limited verbal fluency, and struggle with abstract reasoning. Himelstein, Hastings, Shapiro, and Heery (2012) noted the ability of their MBI to engage and retain incarcerated adolescents who are a par-ticularly difficult group to engage in helping processes. Also, Coholic (2011) argued that some marginalized youth may not have the capacities for, or interests in, learning mindful-ness by way of traditional practices such as sitting medi-tations. Another study noted that young people reported a desire to play during MBIs (Diaz, Liehr, Curnan, Brown, & Wall, 2012). Creative methods involving play were adopted in Diaz et al.’s (2012) work to improve retention. Similarly, Tan and Martin (2013) noted that MBIs for youths should incorporate a range of activities that involve physical activ-ity and pastimes already familiar to adolescents (drawing, listening to music, art, etc.). Yook, Kang, and Park (2017) reported physical activity was utilized because of its many benefits for psychological health in general. Thus, mindful-ness needs to be facilitated in a manner that engages youth in a strengths-based helping process that promotes success.

Other rationales were connected with the ability of arts-based methods to teach mindfulness-based practices and concepts including the processes of self-expression, Ta

ble

3 (c

ontin

ued)

Aut

hors

(Yea

r)C

ount

ryA

geG

ende

rPo

pula

tion

Cre

ativ

e in

terv

entio

n co

mpo

nent

sSa

mpl

e si

zeSt

udy

desi

gnQ

uant

itativ

e m

easu

res

Find

ings

Yook

et a

l. (2

017)

Sout

h K

orea

~ 11

Mix

edPr

imar

y sc

hool

stu

dent

sN

ovel

spor

t ‘K

inba

ll’n =

46C

ontro

lled

pre-

post

trial

RSE

S-K

, ER

89-K

, and

th

e K

orea

n Ps

ycho

logi

cal

Wel

l-bei

ng

Scal

e

Ther

e w

ere

stat

istic

ally

sign

ifica

nt ti

me

x gr

oup

effec

ts fo

r sel

f-es

teem

, res

ilien

ce, a

nd h

appi

ness

USA

Uni

ted

Stat

es o

f Am

eric

a, A

HIF

Ado

lesc

ent H

ealth

Info

rmat

ion

Form

, PC

Q P

ain

Cha

ract

erist

ics

Que

stion

naire

, FD

I Fun

ctio

nal D

isab

ility

Inde

x, M

ASC

Mul

tidim

ensi

onal

Anx

iety

Sca

le

for C

hild

ren,

CSD

Col

umbi

a D

epre

ssio

n Sc

ale,

PC

S Pa

in C

atas

troph

izin

g Sc

ale,

CAM

M C

hild

and

Ado

lesc

ent M

indf

ulne

ss M

easu

re, C

PAQ

-R C

hron

ic P

ain

Acc

epta

nce

Que

stion

naire

-Rev

ised

, M

SPSS

Mul

tidim

ensi

onal

Sca

le o

f Per

ceiv

ed S

ocia

l Sup

port,

PSC

-17

Pedi

atric

Sym

ptom

Che

cklis

t—17

, STA

IT/S

TAIS

Sta

te-T

rait

Anx

iety

Inve

ntor

y fo

r Chi

ldre

n, H

RV H

eart

Rat

e Va

riabi

lity,

D

ASS-

21 D

epre

ssio

n A

nxie

ty a

nd S

tress

Sca

le—

Shor

t For

m, F

S Fl

ouris

hing

Sca

le, M

Q M

indf

ulne

ss Q

uesti

onna

ire, P

CI P

erfo

rman

ce C

ompl

ianc

e In

dex,

RSE

-K R

osen

berg

Sel

f-Es

teem

Sca

le

Kor

ean

Vers

ion,

ER8

9-K

Ego

-Res

ilien

ce S

cale

Kor

ean

Vers

ion,

WAS

I Wec

hsle

r Abb

revi

ated

Sca

le o

f Int

ellig

ence

, WJ-

III W

oodc

ock-

John

son

Tests

of A

chie

vem

ent—

3rd

Ed.,

CPR

S C

onne

rs’

Pare

nt R

atin

g Sc

ale,

BRI

EF B

ehav

ior

Rat

ing

Inve

ntor

y of

Exe

cutiv

e Fu

nctio

n—Pa

rent

For

m, C

BCL-

YSR

Chi

ld B

ehav

ior

Che

cklis

t—Yo

uth

Self

Repo

rt, C

TRS-

R:S

Con

ner’s

Tea

cher

Rat

ing

Scal

e—Re

vise

d Sh

ort F

orm

, Ped

sQL

Pedi

atric

Qua

lity

of L

ife I

nven

tory

, BYI

-II

Bec

k Yo

uth

Inve

ntor

ies—

2nd

Ed.,

MC

S M

indf

ul C

opin

g Sc

ale,

SC

L-90

-R S

ympt

om C

heck

list-9

0-Re

vise

d,

SWLS

Sat

isfa

ctio

n W

ith L

ife S

cale

, PC

S-C

Per

ceiv

ed C

ontro

l Sca

le fo

r Chi

ldre

n, S

CS-

C S

econ

dary

Con

trol S

cale

for C

hild

ren,

CN

CEQ

Chi

ldre

n’s

Neg

ativ

e C

ogni

tive

Erro

rs Q

uesti

onna

ire,

EDE-

Q E

atin

g D

isor

der E

xam

inat

ion—

Que

stion

naire

, PAN

AS-X

Pos

itive

and

Neg

ativ

e A

ffect

Sch

edul

e Ex

pand

ed, D

EBQ

-R D

utch

Eat

ing

Beh

avio

ur Q

uesti

onna

ire—

Restr

aint

, SAT

AQ-3

Soc

io-

cultu

ral A

ttitu

des

Tow

ards

App

eara

nce

Scal

e, C

IA C

linic

al Im

pairm

ent A

sses

smen

t, RS

CA R

esili

ency

Sca

les

for C

hild

ren

and

Ado

lesc

ents

, AFQ

-Y8

Avo

idan

ce a

nd F

usio

n Q

uesti

onna

ire fo

r Yo

uth,

RAD

S-2

Reyn

olds

Ado

lesc

ent D

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improved understanding of feelings and thoughts, and self-compassion and non-judgement. Arts-based methods included martial arts, tai chi, theatre/drama, drawing, sculpt-ing, painting, music, creative writing and more. For exam-ple, Klassen (2017) stated that journaling could improve participants’ self-awareness, and Milligan et al. (2016) com-mented that interventions utilizing movement can improve a youth’s ability to observe and accept distressing sensations and emotions. In our own MBI program, painting to different types of music helped participants to explore and express feelings and thoughts, and drawing oneself as a tree helped the participants to share about themselves and develop self-awareness (Coholic & Eys, 2016). Other experiential examples included Burckhardt, Manicavasagar, Batterham, Hadzi-Pavlovic, and Shand’s (2017) use of theatre to help participants practice thought diffusion, and Gordon, Staples, Blyta, Bytyqi, and Wilson’s (2008) use of dance to reduce physical tension and explore emotions. Creative interven-tions were also used in a didactic manner such as when Rus-kin et al. (2017) used finger traps to illustrate the concepts of acceptance and resistance. Meagher, Chessor, and Fogliati (2018) used a multi-sensory teaching aid to explain the tran-sient nature of thoughts.

Key Findings from the Arts‑Based MBIs

Diverse benefits were reported and included improved responses to stress and depressive symptoms (Livheim et al., 2015), increased comfort with challenging emotions (Burckhardt et al., 2017), and being able to think before act-ing and other metacognitive skills. For example, Haydicky et al. (2012) reported that boys with ADHD had significant improvements in parent-rated oppositional defiant problems and conduct problems. Improved self-concept (Coholic & Eys, 2016) and feelings of confidence and happiness (Yook et al., 2017) were noted as were feelings of general well-being and interconnectedness (Wall, 2005).

Most of the studies were focused on specific populations and findings were related to the goals of the MBIs and char-acteristics of these populations. For instance, Atkinson and Wade’s (2015) MBI was focused on the prevention of eat-ing disorders. They concluded that the MBI had a positive impact on weight and shape concerns, which are relevant in eating disorder prevention. They also concluded that the girls in their study indicated a strong preference for the increased use of visual and interactive activities. Lagor, Williams, Lerner, and McClure (2013) found that their MBI reduced anxiety in chronically ill youth, and Ruskin et al. (2017) found that youth with chronic pain reported learning mind-fulness helped them to cope better with their pain. Waltman, Hetrick, and Tasker (2012) studied adolescent males living in residential treatment with poor behavior control and noted that the largest self-reported change was in the ability to

notice feelings without having to react to them, which is a skill particularly important for these youth. Also, there were improvements noted in trauma symptoms in youth diagnosed with Post-Traumatic Stress Disorder (Gordon et al., 2008).

Several of the studies found mixed or unexpected results. For example, one study found participants’ heart rates, a measure of physiological stress, increased following the intervention (Jee et al., 2015). This was attributed in part to the population’s (traumatized youth-in-care) possible desen-sitization to stress, and the reality that practicing mindful-ness can raise awareness of difficult emotions. Tharaldsen (2012) explained that contradictory findings are valuable as they encourage re-examination of conceptual frameworks. They also pointed out that an increased awareness of diffi-cult feelings could lead to participants feeling worse than at the beginning of an intervention. Thus, they concluded that mixed methods research is most helpful as different types of data can help us understand research results in a more thorough manner.

Consultation with Youth

An optional step in a scoping review is consultation with appropriate stakeholders (Levac et al., 2010). We decided to invite youth (aged 11–17 years) who had recently par-ticipated in HAP groups to take part in a group discussion regarding our preliminary findings from the scoping review. Given these youths’ recent experiences in an arts-based mindfulness program, we thought it would be interesting to elicit their viewpoints regarding what we found in the literature regarding rationales for using arts-based methods. This also reflected our commitment to including youth in our research processes in meaningful ways. Six youth from three different HAP groups attended an hour-long meeting where we provided pizza and an opportunity to engage in some arts-based activities as incentives. At the beginning of the discussion, we asked the youth to think about their recent experiences in HAP and to compare these with the following rationales for using arts-based methods in MBIs, which were written on a white board: (1) engaging and inter-esting, (2) promote the development of self-awareness, (3) help participants pay attention, (4) help participants to stay with uncomfortable feelings, (5) address retention, (6) aid self-expression, and (7) address youth’s need for movement. Through our group discussion, we encouraged the youth to identify which of these seven rationales most resonated with them. They identified three factors that were most reflective of their own experiences in HAP: (1) arts-based methods were engaging/interesting and “not boring” (2) arts-based methods helped them pay attention and focus, and address their “wandering minds” and, (3) arts-based methods helped them express themselves. They added that the arts-based methods were “fun and different” and that they have been

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able to carry on with some of the activities at home. They also appreciated the arts-based approaches to breathing, which helped them learn how to focus on their breath and meditate.

Discussion

This scoping review examined why and how arts-based methods were used in MBIs. A variety of approaches were studied with diverse youth populations with a variety of challenges. Because arts-based MBIs were often developed for a specific population, a good number of the studies were pilot projects investigating the suitability and benefits of the MBIs. Rationales for the use of arts-based methods included both the characteristics of children and youth, and benefits of the methods themselves. In our consultation with a small group of youth, they confirmed that arts-based methods were engaging, interesting, fun, and helpful. Participating in the MBIs helped the youth develop capacities such as self-awareness and non-judgment, and abilities to cope with challenges such as poor mood and emotion regulation.

There are sound rationales for using arts-based methods based both on participant characteristics and the benefits of creative approaches. One of the main reasons identified for the use of arts-based approaches was the ability of these methods to engage hard to reach youth and/or youth with challenging problems such as chronic pain or eating disor-ders. Thus, many of the creative MBIs were developed for specific youth populations including marginalized youth, youth with chronic pain, incarcerated youth, and youth with learning disabilities. The benefits reported in the studies indicated that mindfulness-based practices and concepts can be taught by way of arts-based methods, and can have benefits for youth who may not engage in a more traditional MBI such as MBSR. When working with youth, it is impor-tant to enable them to engage with methods that they find enjoyable, meaningful, and helpful for self-expression and learning. We should not diminish the importance of creativ-ity, fun, and play for children and youth learning new skills and concepts.

In fact, arts-based group modalities have a long history within helping practices with children and youth (Kelly & Doherty, 2017). In particular, they have been used exten-sively in non-deliberative social group work practice. Non-deliberative practice recognizes that there are multiple avenues for self-expression that do not rely on verbaliza-tion. Instead, the arts and creative processes act as analogs for situations and challenges that youths face outside of the group (Lang, 2016). Others have found that arts-based methods help people express their thoughts and feelings that would otherwise remain unidentified (Sinding, War-ren, & Paton, 2014). Indeed, youths with communication

challenges may find arts-based modalities more accessible and feasible than the high level of verbalization and cogni-tion required for more traditional talk-based interventions. Furthermore, group-based arts and crafts have been identi-fied as a source of enjoyment for marginalized youth who live in unstable environments (Punch, 2002). Thus, they are highly engaging and can become a refuge for children and youth. Moreover, they can be culturally competent practices. For example, crafting has been recognized as a holistic inter-vention appropriate for use with Indigenous peoples living in Canada (Archibald & Dewar, 2010).

Given the promising benefits of MBIs and arts-based interventions with youths, a combined approach may make more sense especially for children and youth dealing with serious problems. The practices may work synergistically, for instance, the art-making process provides children an in vivo opportunity to not only explore analogous situa-tions but to additionally practice mindful awareness and acceptance. Mindfulness is a complicated concept to teach didactically; it may require experiential activities such as those found in arts-based social work groups (Thompson & Gauntlett-Gilbert, 2008). Arts also provide youths a unique method of practicing and embodying mindfulness that does not rely on sitting meditation. The frontal lobe of young peo-ple is generally in the process of developing and their execu-tive functioning skills are limited (Greenberg, 2006). A lack of attention regulation may intensify the difficulty of sitting meditation especially for marginalized youths who are also dealing with challenging life situations. Creative arts-based meditation involving audio tracks and sculpting, actively engage multiple sensory inputs including visual, auditory, and tactile systems. Importantly, by engaging youths in enjoyable and successful activities, they can learn about and practice mindfulness-based practices and concepts.

Research Directions and Implications for Practitioners

Based on reported results and the needs/developmental stages of children and youth, practitioners and researchers should be encouraged to facilitate and study MBIs that focus on arts-based approaches. The study of arts-based MBIs is emergent, which may account in part for their lack of promi-nence in this field and the diversity of approaches being developed and studied. We agree that there is a need for MBIs that are youth-centered in their design and shaped by feedback from youth as opposed to adaptations predeter-mined to be appropriate for use with young people (Diaz et al., 2012). Also, authors writing about arts-based MBIs should more thoroughly describe the synthesis of practice wisdom, research, and feedback used in the design and deliv-ery of their MBI. Generating a sufficient evidence base is

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vital for the dissemination and study of MBIs. Thus, we encourage researchers and practitioners to draw on existent arts-based MBIs that show promising benefits for children and youth rather than develop new programs.

It may be more complex and challenging to offer crea-tive MBIs as researchers and facilitators require training not just in mindfulness but in arts-based approaches as well. For instance, one could not facilitate the MMA program without having gained advanced belts in various forms of martial arts (Milligan et al., 2015). However, there are ways to address the need for specific facilitator qualifica-tions. As Haydicky et al. (2012) explained, volunteers with martial arts expertise and advanced students of MMA could assist qualified facilitators. We have previously encouraged helping practitioners without specialized degrees in crea-tive therapies to offer arts-based methods as part of their practices because arts-based methods are used as tools for engagement and self-expression, and teaching concepts and practices (Coholic, Lougheed, & Cadell, 2009; Coholic, Lougheed, & LeBreton, 2009). Helping practitioners can access the plethora of resources in arts-based approaches in order to gain confidence in incorporating these practices into their interventions (Carey, 2006; Malchiodi, 2007).

In line with other researchers, we have found that feed-back from youth indicated that the arts-based nature of our MBI was a key component in their engagement and appre-ciation of the program (Coholic & Eys, 2016). Thus, learn-ing and practicing mindfulness, in and of itself, is likely not the only mechanism of change. It is quite possible that the effectiveness of a program might be due to a combination of factors including group work, mindfulness practice, and other factors such as specific cultural practices and/or an arts-based approach to learning mindfulness. As research in this field develops, it might become more evident that some arts-based methods work more effectively for specific issues or youth populations. For instance, we have often struggled with engaging male youth over the age of 15 years in HAP. Perhaps for these young men, learning mindfulness via movement such as karate or outdoor activities would be more appealing and relevant. In general, we need to better understand what methods work for whom, and all of the fac-tors contributing to change as a result of having participated in an MBI.

Limitations

The literature in the area of arts-based MBIs with children and youth includes a wide diversity of programs of varying lengths facilitated with diverse groups of youth. In future reviews, researchers should focus on specific populations and challenges, which could develop our understanding of effective approaches for particular groups of youth. This would also make the review process more manageable and

in-depth. For example, Simpson, Mercer, Simpson, Law-rence, and Wyke (2018) conducted a scoping review that explores MBIs for young offenders. Also, we lacked the time and resources to include a review of dissertations, which may be where some novel approaches are first described and studied. We note that a scoping review is very time consum-ing and additional human resources would have helped us finalize the results in a timely manner. Also, in our review, it was sometimes challenging for us to understand if an MBI could be considered arts-based, especially since many of these MBIs were not described with enough detail. Thus, there is a chance that we eliminated some MBIs because the program was not described in sufficient detail for us to assess how arts-based approaches were used.

Finally, our consultation occurred with a small group of youth. We would have liked to recruit more youth to par-ticipate in multiple group discussions but time constraints and the time of year (it was summer when many youth were unavailable) limited the depth and scope of our process. In the future, we would also like to consult with practitioners/researchers facilitating and studying arts-based MBIs. We would have to conduct this consultation using an on-line video/audio platform given our physical location in a smaller city far from larger urban centres, and the lack of similarly engaged professionals in our community. In conclusion, we note that the attention paid to testing arts-based MBIs has not been robust. Given the known benefits of arts-based methods for children and youth, we believe that more focus should be paid to these practices and how mindfulness-based concepts and skills can be taught using these methods. In this manner, more youth may have the chance to benefit from participating in MBIs.

Acknowledgement We acknowledge the assistance of Mr. Ashley Thomson, Librarian at Laurentian University. The research described in this paper was supported in part by funding from the Social Sciences and Humanities Research Council of Canada.

Compliance with Ethical Standards

Conflict of interest The authors declare that they have no conflict of interest.

Open Access This article is licensed under a Creative Commons Attri-bution 4.0 International License, which permits use, sharing, adapta-tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/.

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References

Alsubaie, M., Abbott, R., Dunn, B., Dickens, C., Frieda Keil, T., Hen-ley, W., et al. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55, 74–91. https ://doi.org/10.1016/j.cpr.2017.04.008.

Archibald, L., & Dewar, J. (2010). Creative arts, culture, and healing: Building an evidence base. Pimatisiwin, 8(3), 1–25.

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a meth-odological framework. International Journal of Social Research Methodology, 8, 19–32. https ://doi.org/10.1080/13645 57032 00011 9616.

Atkinson, M. J., & Wade, T. D. (2015). Mindfulness-based preven-tion for eating disorders: A school-based cluster randomized controlled study: Mindfulness-based eating disorder prevention. International Journal of Eating Disorders, 48, 1024–1037. https ://doi.org/10.1002/eat.22416 .

Bajaj, B., & Pande, N. (2016). Mediating role of resilience in the impact of mindfulness on life satisfaction and affect as indices of subjective well-being. Personality and Individual Differ-ences, 93, 63–67. https ://doi.org/10.1016/j.paid.2015.09.005.

Borquist-Conlon, D., Maynard, B., Esposito Brendel, K., & Farina, A. (2017). Mindfulness-based interventions for youth with anxi-ety: A systematic review and meta-analysis. Research on Social Work Practice, 29(2), 1–11. https ://doi.org/10.1177/10497 31516 68496 1.

Burckhardt, R., Manicavasagar, V., Batterham, P., Hadzi-Pavlovic, D., & Shand, F. (2017). Acceptance and commitment therapy universal prevention program for adolescents: A feasibility study. Child and Adolescent Psychiatry and Mental Health, 11, 27. https ://doi.org/10.1186/s1303 4-017-0164-5.

Carey, L. (Ed.). (2006). Expressive and creative arts methods for trauma survivors. London, UK: Jessica Kingsley Publishers.

Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29, 560–572. https ://doi.org/10.1016/j.cpr.2009.06.005.

Chiesa, A., Fazia, T., Bernardinelli, L., & Morandi, G. (2017). Cita-tion patterns and trends of systematic reviews about mindful-ness. Complementary Therapies in Clinical Practice, 28, 26–37. https ://doi.org/10.1016/j.ctcp.2017.04.006.

Coholic, D. (2011). Exploring the feasibility and benefits of arts-based mindfulness-based practices with young people in need: Aiming to improve aspects of self-awareness and resil-ience. Child and Youth Care Forum, 40, 303–317. https ://doi.org/10.1007/s1056 6-010-9139-x.

Coholic, D., & Eys, M. (2016). Benefits of an arts-based mindfulness group intervention for vulnerable children. Child & Adolescent Social Work Journal, 33, 1–13. https ://doi.org/10.1007/s1056 0-015-0431-3.

Coholic, D., Eys, M., & Lougheed, S. (2012). Investigating the effec-tiveness of an arts-based and mindfulness-based group program for the improvement of resilience in children in need. Journal of Child and Family Studies, 21, 833–844. https ://doi.org/10.1007/s1082 6-011-9544-2.

Coholic, D., Lougheed, S., & Cadell, S. (2009a). Exploring the help-fulness of arts-based methods with children living in foster care. Traumatology, 15, 64–71. https ://doi.org/10.1177/15347 65609 34159 0.

Coholic, D., Lougheed, S., & LeBreton, J. (2009b). The helpful-ness of holistic arts-based group work with children living in foster care. Social Work with Groups, 32, 29–46. https ://doi.org/10.1080/01609 51080 22909 66.

Coholic, D., Schinke, R., Oghene, O., Dano, K., Jago, M., McAl-ister, H., et al. (2019). Arts-based interventions for youth with mental health challenges. Journal of Social Work. https ://doi.org/10.1177/14680 17319 82886 4.

Davis, K., Drey, N., & Gould, D. (2009). What are scoping stud-ies? A review of the nursing literature. International Journal of Nursing Studies, 46, 1386–1400. https ://doi.org/10.1016/j.ijnur stu.2009.02.010.

Diaz, N., Liehr, P., Curnan, L., Brown, J. L. A., & Wall, K. (2012). Playing games: Listening to the voices of children to tailor a mindfulness intervention. Children, Youth and Environments, 22, 273–285. https ://doi.org/10.7721/chily outen vi.22.2.0273.

Fjorback, L., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cog-nitive therapy: A systematic review of randomized controlled trials. Acta Psychiatrica Scand., 124, 102–119. https ://doi.org/10.1111/j.1600-0447.2011.01704 .x.

Gordon, J. S., Staples, J. K., Blyta, A., Bytyqi, M., & Wilson, A. T. (2008). Treatment of posttraumatic stress disorder in postwar Kos-ovar adolescents using mind-body skills groups: A randomized controlled trial. Journal of Clinical Psychiatry, 69, 1469–1476. https ://doi.org/10.4088/jcp.v69n0 915.

Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Infor-mation and Libraries Journal, 26, 91–108. https ://doi.org/10.1111/j.1471-1842.2009.00848 .x.

Greenberg, M. T. (2006). Promoting resilience in children and youth. Annals of the New York Academy of Sciences, 1094, 139–150. https ://doi.org/10.1196/annal s.1376.01.

Harnett, P. H., & Dawe, S. (2012). Review: The contribution of mind-fulness-based therapies for children and families and proposed conceptual integration. Child and Adolescent Mental Health, 17, 195–208. https ://doi.org/10.1111/j.1475-3588.2011.00643 .x.

Haydicky, J., Wiener, J., Badali, P., Milligan, K., & Ducharme, J. (2012). Evaluation of a mindfulness-based intervention for ado-lescents with learning disabilities and co-occurring ADHD and anxiety. Mindfulness, 3, 151–164. https ://doi.org/10.1007/s1267 1-012-0089-2.

Hayes, S., Strosahl, K., & Wilson, K. (1999). Acceptance and com-mitment therapy: An experiential approach to behavior change. New York: Guilford.

Himelstein, S., Hastings, A., Shapiro, S., & Heery, M. (2012). A qualitative investigation of the experience of a mindulness-based intervention with incarcerated adolescents. Child and Adolescent Mental Health, 17, 231–237. https ://doi.org/10.1111/j.1475-3588.2011.00647 .x.

Horesh, D., & Gordon, I. (2018). Mindfulness-based therapy for traumatized adolescents: An underutilized, understudied inter-vention. Journal of Loss and Trauma, 23, 627–638. https ://doi.org/10.1080/15325 024.2018.14380 47.

Jee, S. H., Couderc, J., Swanson, D., Gallegos, A., Hilliard, C., Blum-kin, A., … Heinert, S. (2015). A pilot randomized trial teach-ing mindfulness-based stress reduction to traumatized youth in foster care. Complementary Therapies in Clinical Practice, 21, 201–209. https ://doi.org/10.1016/j.ctcp.2015.06.007

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delta.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Prac-tice, 10, 144–156. https ://doi.org/10.1093/clips y.bpg01 6.

Kelly, B. L., & Doherty, L. (2017). A historical overview of art and music-based activities in social work with groups: Nondelib-erative practice and engaging young people’s strengths. Social Work with Groups, 40, 187–201. https ://doi.org/10.1080/01609 513.2015.10917 00.

D. Coholic et al.

1 3

Klassen, S. (2017). Free to be: Developing a mindfulness-based eating disorder prevention program for preteens. Journal of Child and Adolescent Counseling, 3, 75–87. https ://doi.org/10.1080/23727 810.2017.12949 18.

Klatt, M., Buckworth, J., & Malarkey, W. (2009). Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Education & Behavior, 36, 601–614. https ://doi.org/10.1177/10901 98108 31762 7.

Klatt, M., Harpster, K., Browne, E., White, S., & Case-Smith, J. (2013). Feasibility and preliminary outcomes for move-into-learning: An arts-based mindfulness classroom intervention. The Journal of Positive Psychology, 8, 233–241. https ://doi.org/10.1080/17439 760.2013.77901 1.

Lagor, A., Williams, D. J., Lerner, J., & McClure, K. (2013). Lessons learned from a mindfulness-based intervention with chronically ill youth. Clinical Practice in Pediatric Psychology, 1, 146–158. https ://doi.org/10.1037/cpp00 00015 .

Lang, N. (2016). Nondeliberative forms of practice in social work: Artful, actional, analogic. Social Work with Groups, 39, 97–117. https ://doi.org/10.1080/01609 513.2015.10477 01.

Levac, D., Colquhoun, H., & O’Brien, K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, 1–9. https ://doi.org/10.11186 /1748-5908-5-69.

Livheim, F., Hayes, L., Ghaderi, A., Magnusdottir, T., Hogfeldt, A., Rowse, J., … Tengstrom, A. (2015). The effectiveness of accept-ance and commitment therapy for adolescent mental health: Swedish and Australian pilot outcomes. Journal of Child and Family Studies, 24, 1016–1030. https ://doi.org/10.1007/s1082 6-014-9912-9.

Lougheed, S., & Coholic, D. (2016). Arts-based mindfulness group work with youth aging out of foster care. Social Work with Groups, 41, 165–178. https ://doi.org/10.1080/01609 513.2016.12586 26.

Malchiodi, C. (2007). The art therapy sourcebook (2nd ed.). New York, NY: McGraw-Hill.

Meagher, R., Chessor, D., & Fogliati, V. (2018). Treatment of pathological worry in children with acceptance-based behav-ioral therapy and a multisensory learning aide: A pilot study: Acceptance-based anxiety treatment for children. Australian Psychologist, 53, 134–143. https ://doi.org/10.1111/ap.12288 .

Milligan, K., Badali, P., & Spiroiu, F. (2015). Using integra mindful-ness martial arts to address self-regulation challenges in youth with learning disabilities: A qualitative exploration. Journal of Child and Family Studies, 24, 562–575. https ://doi.org/10.1007/s1082 6-013-9868-1.

Milligan, K., Irwin, A., Wolfe-Miscio, M., Hamilton, L., Mintz, L., Cox, M., …Phillips, M., (2016) Mindfulness enhances use of secondary control strategies in high school students at risk for mental health challenges. Mindfulness, 7, 219–227 https ://doi.org/10.1007/s1267 1-015-0466-8

Perry-Parrish, C., Copeland-Linder, N., Webb, L., Shields, A. H., & Sibinga, E. (2016). Improving self-regulation in adolescents: Current evidence for the role of mindfulness-based cognitive therapy. Adolescent Health, Medicine and Therapeutics, 7, 101–108. https ://doi.org/10.2147/AHMT.S6582 0.

Pham, M., Rajic, A., Greig, J., Sargeant, J., Papadopoulos, A., & McEwen, S. (2014). A scoping review of scoping reviews: Advancing the approach and enhancing the consist-ency. Research Synthesis Methods, 5, 371–385. https ://doi.org/10.1002/jrsm.1123.

Punch, S. (2002). Research with children: The same or different from research with adults? Childhood, 9, 321–341. https ://doi.org/10.1177/09075 68202 00900 3005.

Ruskin, D., Gagnon, M., Kohut, S., Stinson, J., & Walker, K. (2017). A mindfulness program adapted for adolescents with chronic pain:

Feasibility, acceptability, and initial outcomes. The Clinical Jour-nal of Pain, 33, 1019–1029. https ://doi.org/10.1097/AJP.00000 00000 00049 0.

Segal, Z., Williams, J., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.

Simpson, S., Mercer, S., Simpson, R., Lawrence, M., & Wyke, S. (2018). Mindfulness-based interventions for young offend-ers: A scoping review. Mindfulness, 9, 1330–1343. https ://doi.org/10.1007/s1267 1-018-0892-5.

Sinding, C., Warren, R., & Paton, C. (2014). Social work and the arts: Images at the intersection. Qualitative Social Work, 13, 187–202. https ://doi.org/10.1177/14733 25012 46438 4.

Tan, L., & Martin, G. (2013). Taming the adolescent mind: Prelimi-nary report of a mindfulness-based psychological intervention for adolescents with clinical heterogeneous mental health diagnoses. Clinical Child Psychology and Psychiatry, 18, 300–312. https ://doi.org/10.1177/13591 04512 45518 2.

Tan, L., & Martin, G. (2015). Taming the adolescent mind: A ran-domised controlled trial examining clinical efficacy of an adoles-cent mindfulness-based group programme. Child and Adolescent Mental Health, 20, 49–55. https ://doi.org/10.1111/camh.12057 .

Tharaldsen, K. (2012). Mindful coping for adolescents: Beneficial or confusing. Advances in School Mental Health Promotion, 5, 105–124. https ://doi.org/10.1080/17547 30X.2012.69181 4.

Thompson, M., & Gauntlett-Gilbert, J. (2008). Mindfulness with children and adolescents: Effective clinical application. Clini-cal Child Psychology & Psychiatry, 13, 396–408. https ://doi.org/10.1177/13591 04508 09060 3.

Van Vliet, K. J., Foskett, A., Williams, J., Singhal, A., Dolcos, F., & Vohra, S. (2017). Impact of a mindfulness-based stress reduction program from the perspective of adolescents with serious mental health concerns. Child and Adolescent Mental Health, 22, 16–22. https ://doi.org/10.1111/camh.12170 .

Vollestad, J., Birkeland Nielsen, M., & Hostmark Nielsen, G. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta-analysis. British Jour-nal of Clinical Psychology, 51, 239–260. https ://doi.org/10.1111/j.2044-8260.2011.02024 .x.

Wall, R. B. (2005). Tai chi and mindfulness-based stress reduction in a Boston public middle school. Journal of Pediatric Health Care, 19, 230–237. https ://doi.org/10.1016/j.pedhc .2005.02.006.

Waltman, S., Hetrick, H., & Tasker, T. (2012). Designing, implement-ing, and evaluating a group therapy for underserved populations. Residential Treatment for Children & Youth, 29, 305–323. https ://doi.org/10.1080/08865 71x.2012.72537 4.

Yook, Y. S., Kang, S. J., & Park, I. (2017). Effects of physical activ-ity intervention combining a new sport and mindfulness yoga on psychological characteristics in adolescents. International Jour-nal of Sport and Exercise Psychology, 15, 109–117. https ://doi.org/10.1080/16121 97X.2015.10698 78.

Zenner, C., Herrnleben-Kurz, S., & Walach, H. (2014). Mindfulness-based interventions in schools: A systematic review and meta-analysis. Frontiers in Psychology. https ://doi.org/10.3389/fpsyg .2014.00603 .

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