Teachers "Finding Peace in a Frantic World": An Experimental Study of Self-Taught and Instructor-Led Mindfulness Program Formats on Acceptability, Effectiveness, and Mechanisms.

Instructor-Led and Self-Taught MT for Enhancing Teacher Well-Being

There is a growing body of research investigating whether or not MT might be helpful for teachers in school settings. A recent meta-analysis of 29 studies of MT for teachers (including 1,493 participants between prekindergarten and 12th grade) suggests that MT has a medium effect size on a range of well-being and mental health outcomes ( Klingbeil & Renshaw, 2018 ). Mindfulness is a natural, trainable, human capacity to bring awareness to all aspects of experience, with attitudes of curiosity, friendliness, and care ( Bishop et al., 2004 ; Feldman & Kuyken, 2019 ). MT develops these foundational skills and enables people to apply them in their daily lives to support well-being and general functioning. MT combines regular mindfulness exercises with psycho-educational content, designed to provide a rationale for the program, and an enhanced understanding of psychological processes that are relevant to the specific population receiving the program ( Crane et al., 2017 ; Jennings & DeMauro, 2017 ). The practice of mindfulness meditation is a core component of MT that seems to be related to mental health outcomes such as decreased rumination, depressive symptom alleviation, and lower hazard of relapse to major depression ( Crain et al., 2017 ; Crane et al., 2014 ; Hawley et al., 2014 ; Segal et al., 2013 ). The meta-analysis carried out by Parsons et al. (2017) observed small but significant associations between the amount of mindfulness practice and reductions on stress, anxiety and depressive symptomatology.

A commonly used format for MT for teachers is an instructor-led eight-session group delivery ( Lomas et al., 2017 ), possibly derived from the original structure of major mindfulness-based programs, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy. Over the course of the program, participating teachers engage in a range of mindfulness practices and psycho-educational exercises. These are intended to develop their ability to attend to present moment experiences in a nonreactive and nonjudgmental way in order to become aware of, and relate differently to, unhelpful mental habits ( Crain et al., 2017 ). Mindfulness instructors encourage and support participants’ to engage in mindfulness practices that can translate to their everyday lives, both professionally and personally. However, a major barrier for many people is accessing instructor-led MT programs. Among school teachers, lack of time and financial resources have been identified as the most important barriers ( Bazzano et al., 2018 ; Wilde et al., 2019 ).

An important challenge for the field is therefore finding accessible and scalable ways for people to learn how to use MT to support their well-being ( Lim et al., 2015 ). In this sense, mobile apps, web-based programs, and bibliotherapy are potential ways to enhance access to MT ( Cavanagh et al., 2014 ). Preliminary findings suggest that these formats might have some benefits for well-being in college students and people with a history of depression ( Hazlett-Stevens & Oren, 2017 ; Lever-Taylor et al., 2014 ; Levin et al., 2020 ; Segal et al., 2020 ). Such self-taught MTs could increase accessibility for teachers, enabling them to choose when and how to engage with mindfulness practice. However, greater accessibility can come at the cost of lower engagement, which is a relevant consideration given that research suggests that engagement with mindfulness practice is a key element of possibility for change ( Roeser et al., 2013 ; Webb et al., 2017 ).

The mindfulness training manual, Mindfulness: A Practical Guide to Finding Peace in a Frantic World (M-FP; Williams & Penman, 2011 ), was first written as a “self-guided” book intended to be a highly accessible, low-intensity introduction to mindfulness meditation practice suitable for the general population. Using a sample of undergraduate students versus waitlist controls, a study by Lever-Taylor et al. (2014) suggested that the M-FP self-taught program was associated with large effect sizes for mindfulness and moderate effect sizes for self-compassion as well as perceived stress, depression, and anxiety. An instructor-supported program based on the book has also been developed and is being taught widely, including to school teachers. A previous controlled study of secondary school teachers used a very similar instructor-supported group program led by qualified mindfulness instructors and observed large effect sizes for mindfulness, self-compassion, well-being, and perceived stress ( Beshai et al., 2016 ). However, we do not know the comparable effectiveness of self-taught and instructor-led formats of teacher MT.

Acceptability and Engagement With Self-Taught and Instructor Led MT

Research is needed to compare self-taught and instructor-led methods of MT delivery with regard to not just effectiveness (e.g., impact on mechanisms and outcomes) but also to implementation factors such as acceptability and engagement with the MT, which could facilitate teacher skills development ( Roeser et al., 2012 ). Acceptability is the degree to which individuals perceive an intervention as reasonable and appropriate to their needs, and this can be based on anticipated responses to the MT, for example, expectancy for positive outcomes previous to having experiences with the program, or based on experienced responses, for example, credibility of the program after having completed it ( Sekhon et al., 2017 ). Acceptability is considered essential for influencing usage and results of a given intervention, because programs that are expected to be acceptable are more likely to be used with a greater degree of integrity ( Witt & Elliott, 1984 ). In this sense, engagement with meditation exercises, for example, frequency of mindfulness meditation practice, is a core integrity aspect of mindfulness-based programs, as adherence to meditation practice underlies its theoretical model of psychological change ( Crane et al., 2017 ). Other important characteristic of engagement is the dose or amount of program that participants receive ( Durlak & DuPre, 2008 ). In the case of instructor-led MT, dose can be operationalized as the number of group sessions that participants receive. However, in the case of self-taught MT, we need to consider the specific format through which the MT was accessed (e.g., if the MT was in the form of a workbook, such as the M-FP program, how much of the book the participants read is the dose variable).

In summary, we need to know more about the comparable effectiveness of self-taught and instructor-led formats of teacher MT, but also to explore possible differences in acceptability (e.g., expectancy for positive outcomes, and credibility after carrying out the program), and engagement (e.g., frequency of mindfulness meditation practice, and amount of the program that has been received). In this study, we examine possible differences in those perceptions, experiences, and outcomes related to each type of MT delivery in teachers. We would expect more positive values in the instructor-led MT, as it has the support of an expert who drives the motivation of participants toward the aims of the program.

Mindfulness and Self-Compassion Skills as Psychological Mechanisms of MT

If an adequate MT implementation brings about positive change in well-being and mental health for secondary school teachers, this raises the question of how and why these effects are produced and what the importance of such changes are for a teachers’ professional role. A comprehensive theoretical framework hypothesizes that an adequate implementation of MT could enable teachers to develop skills such as mindfulness and self-compassion, which if applied in daily life through practice, lead teachers to improved occupational health and well-being ( Roeser et al., 2012 ; Roeser et al., 2013 ). Specifically, MT seems to promote mindfulness and self-compassion by improving the ability to intentionally focus attention on the here and now, instead of ruminating about the past or worrying about the future ( Kabat-Zinn, 1994 ), and also, cultivating a certain attitude of curiosity toward the present moment that suspends self-criticism and facilitates coping with challenges with kind acceptance ( Cullen, 2011 ). All of this in turn would reinforce teachers’ resilience, favoring adequate coping processes ( Taylor et al., 2016 ), and supporting a “prosocial classroom” that starts with the teachers’ well-being ( Jennings & Greenberg, 2009 ).

There is growing evidence that enhancements in mindfulness and self-compassion skills could play an important role in promoting mental health and well-being ( Gu et al., 2015 ; Van der Velden et al., 2015 ). Self-compassion is defined as “being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness” ( Neff, 2003 ). In general, mindfulness skills enable people to recognize their distress without judgment, be open to it, and learn to self-soothe through a range of strategies, whereas self-compassion skills might specifically increase the ability to regulate intense negative emotions in response to stressors ( Emerson et al., 2017 ; Hölzel et al., 2011 ; Kirschner et al., 2019 ; Neff & Dahm, 2017 ).

These skills are helpful to teachers because teaching can be a stressful occupation, and teachers need abilities to manage their own negative emotional responses ( Carson et al., 2006 ). In fact, failure to do so can lead to a “burnout cascade,” impairing physical and mental health and producing anxiety and depressive symptoms ( McEwen, 2008 ). This is particularly problematic in a classroom context because increased teacher irritability and distress has the potential to produce a similar reactivity in the pupils ( Jennings & Greenberg, 2009 ). A previous study observed that teachers randomized to instructor-led MT showed greater mindfulness, self-compassion, focused attention, and working memory as well as lower levels of stress and burnout than waitlist controls; with mindfulness and self-compassion skills mediating reductions in stress, burnout, anxiety, and depression ( Roeser et al., 2013 ). Thus, these foundational skills of mindfulness and self-compassion may increase teachers’ ability to cope with their everyday job and could be thus relevant across the spectrum of wellness in teachers, with the potential to move teachers toward improved states of mental health and well-being ( Crain et al., 2017 ; Klingbeil & Renshaw, 2018 ; Roeser et al., 2013 ; Schussler et al., 2018 ; Schussler et al., 2019 ; Taylor et al., 2016 ).

It has also been observed that mindfulness meditation practice facilitates staying well after depression ( Crane et al., 2014 ), and that indirect effects on depressive symptoms may occur through reductions in rumination ( Hawley et al., 2014 ). MT might facilitate the identification of ruminative patterns, understanding the consequences of these kinds of thoughts and taking constructive steps to reduce mental distress ( Smart et al., 2016 ). Exploratory studies have observed that MT aimed at reducing ruminative thinking in depressive patients also improves mediators such as mindfulness and self-compassion, although more research to establish the specific causal links between these two groups of variables is needed ( Foroughi et al., 2020 ; Frostadottir & Dorjee, 2019 ). These indirect effects of mindfulness practice have been observed in clinical samples using instructor-led MT, but they have not been studied in secondary teachers using self-taught MT. Therefore, we do not know the relative importance of the mindfulness practice when using these different delivery formats. We also do not know whether mindfulness and self-compassion might differently mediate gains in outcomes according to these two modes of delivery.

We would expect different patterns of mediation because those receiving the instructor-led course are potentially exposed to greater modeling of mindfulness and self-compassion by the class instructor as he or she responds to participants’ sharing of personal experiences. The fact that the class participants are all listening to and learning from each other’s experiences, and at the same time are supported and guided by an expert who holds and befriends the group, might enhance opportunities to learn mindfulness and self-compassion skills, increase participants’ sense of common humanity, and also reduce stigma associated with mental health difficulties ( Allen et al., 2009 ; Griffith et al., 2019 ; Tickell et al., 2020 ). Thus, we proposed that the mindfulness and self-compassion skills might be acquired and mediate outcomes in different ways across the two MT formats.

Study Aims

The first aim of this study was to explore possible differences in the levels of acceptability (e.g., expectancy for positive outcomes, and credibility of program content after completing the program) and engagement with the program (e.g., frequency of mindfulness meditation practice, and amount the book read) of two MT delivery formats (e.g., self-taught and instructor-led) of the popular mainstream manual, M-FP ( Williams & Penman, 2011 ), as well as their effectiveness on the well-being and mental health of secondary school teachers. The second aim was to explore possible mechanisms of change, specifically whether foundational skills such as mindfulness and self-compassion mediate improvements in well-being and mental health in secondary teachers, and whether frequency of mindfulness practice might produce indirect effects on outcomes, using self-taught and instructor-led ways of delivering the MT (we only examined frequency of practice because we do not have enough evidence to consider other implementation variables as potentially amplifying indirect effects in MT). We recognize that a third arm receiving no intervention (which would allow us to know the usual course of development across the time) would have strengthened the study design used. Nonetheless, our study enables us to answer important questions about the expectancy, credibility, engagement, effectiveness, and mechanisms of change of two modes of MT in secondary school teachers, and we are able to benchmark our findings in terms of mental health, perceived stress, anxiety, depression, and burnout, as well as mindfulness and self-compassion, using previous studies which have compared teacher MT to no intervention control groups ( Beshai et al., 2016 ; Lever-Taylor et al., 2014 ; Roeser et al., 2013 ).

Method

The study was registered at the ISRCTN trials registry on November 24, 2015, prior to obtaining participant consent to randomization (ISRCTN18013311). The data reported in this article form part of a larger experimental study using a four-arm cluster randomized feasibility design to examine the implementation processes and competency reached by different training pathways for secondary school teachers wishing to deliver a MT program to their students ( Crane et al., 2020 ) English secondary schools (clusters) were randomized and outcomes were measured on participating teachers within these schools. The first phase in training to deliver MT to students was to follow a personal MT program that was intended to support participant teachers learning mindfulness for their own well-being. The aim was to encourage participant teachers to have experience with, and an understanding of, mindfulness (Phase 1) prior to teaching it to students (Phase 2). The data reported here correspond to the first phase of the protocol and indicate prepost changes of MT on the participants’ psychological mental health and well-being via self-taught and instructor-led formats of the M-FP program.

We recruited secondary schools that were representative of mainstream English schools in terms of the proportion that were state funded, large, selective, and with above average levels of pupil deprivation (e.g., percentage of pupils that were receiving free school meals). The characteristics of participating teachers in relation to the national age and gender of the secondary school teacher workforce were also monitored. Recruitment was conducted through emails sent directly to all secondary school head-teachers and local education authorities in England, identified through a freedom of information request. Potential participant teachers and headteachers were also approached through professional events (such as local headteacher meetings). Interested individuals (whether headteachers or teaching staff) were invited to contact the research team. Initially, contacts were received from 185 schools, and following screening, this resulted in 254 eligible and interested teachers from 75 schools. After exclusion of schools with fewer than three participating members of staff and schools located in a geographical region too logistically difficult to be reached by a mindfulness instructor, 206 participating teachers from 43 schools were ultimately included in the study. Schools were then randomized. School and participating teacher inclusion/exclusion criteria are reported in the Supplementary Material S1 . The baseline characteristics of those schools and participating teachers who started the study are shown in the Supplementary Material S2 .

Procedure

Following receipt of the study information, interested teachers were screened for eligibility and provided written informed consent. In order for a participating teacher to be included in the study, consent was initially required from the head-teacher of the school. Consenting participating teachers were sent a link to an online questionnaire containing the baseline measures, which were completed in Autumn 2015. Once at least three participating teachers within each school had completed this baseline preintervention assessment (T0), the school was then eligible to be included in both Phase 1 (teacher mindfulness) and Phase 2 (teacher training for student mindfulness program), being randomized to one of four training routes. Two of the training routes commenced with self-taught MT (Phase 1: self-taught teacher mindfulness + Phase 2: 1-day syllabus training for student mindfulness program; and Phase 1: self-taught teacher mindfulness + Phase 2: 4-day syllabus training for student mindfulness program), and two commenced with instructor-led MT (Phase 1: instructor-led teacher mindfulness + Phase 2: 1-day syllabus training for student mindfulness program; and Phase 1: instructor-led teacher mindfulness + Phase 2: 4-day syllabus training for student mindfulness program). Schools were randomized using a simple randomization procedure, with equal probability of allocation for each cluster (school) within strata (schools that recruited five or more teachers or less than five teachers). We anticipated that having more teachers in a school might influence training through greater opportunities for peer learning, support, and positive group experience, and therefore, we stratified the randomization of schools (clusters) based on the number of participating teachers per school. The cut was the median. Randomization was conducted by Exeter Clinical Trials Unit (ExeCTU), which was not otherwise involved in the study. MT commenced in February 2016 and was delivered free of charge. Following completion of the instructor-led course, or the end of a comparable time frame allotted to completion of the self-taught course, participating teachers were sent a second link to complete the postintervention assessment (T1). Participating teachers were compensated £25 in Amazon vouchers for completion of each set of study questionnaires. Schools were also given £250 to spend on school resources at the end of the study. Completion of the post intervention (T1) assessment marked the end of study Phase 1, which corresponded to the personal-training intended to support participating teachers learning mindfulness skills for themselves. Participating teachers then continued to Phase 2, which focused on the training required to deliver a MT curriculum to pupils. The corresponding second phase training route was not communicated until after they had commenced Phase 1 training (details of Phase 2 training routes and outcomes can be seen in Crane et al., 2020 ).

Mindfulness Trainings

The two different forms of MT examined in this study were both based on the M-FP manualized curriculum ( Williams & Penman, 2011 ). This curriculum is an introductory skills-based training designed to be applicable for use in everyday life. It builds on the core elements of mindfulness-based cognitive therapy ( Segal et al., 2013 ) and was developed specifically for improving well-being in the general population. It develops the following understandings and skills: (a) recognizing the tendency to be on autopilot and begin to practice bringing mindfulness to aspects of everyday present-moment experience; (b) recognizing thoughts, emotions, sensations, and impulses, stabilizing attention and returning with appreciation to the here and now; (c) recognizing unhelpful patterns of thinking, feeling, and acting; and (d) learning skills for keeping balanced through life’s ups and downs, responding skillfully when difficulties arise, engaging with what is most important, and opening up to moments of joy, contentment, and gratitude. The curriculum has eight sessions that work sequentially through these four main themes. Participants are encouraged to engage in a range of home practices that support learning, including a daily 20-minute mindfulness practices.

Participating teachers allocated to self-taught training were provided with the M-FP course book ( Williams & Penman, 2011 ). Each participating teacher was contacted prior to commencing the course and the importance of reading the whole course book and completing the associated activities and mindfulness practices was emphasized. Participating teachers were asked to read the introductory chapters of the M-FP book to ensure that a minimum preliminary knowledge had been reached before they were able to commence the 8-week program outlined in the course book on a set date (usually the week after mailing out the books and as far as possible contemporaneous with instructor-led MT groups). Participating teachers were also given access to a publicly-available app which accompanies the course and a CD or MP3 of the course material. A general overview and some details of the 8-week program timeline, themes, and specific mindfulness practices, so that one can see the distribution and nature of the contents and activities carried out and how they train mindfulness and self-compassion through meditation exercises, is included in the Supplementary Material S3 .

Instructor-Led Mindfulness Training

The instructor-led delivery was based on the same M-FP manual ( Williams & Penman, 2011 ), and was taught face-to-face (in person) in groups of between three and nine participating secondary teachers at their corresponding school facilities. Participating teachers also read the book by Williams and Penman (2011) alongside their group sessions.

The course was delivered by trained and experienced mindfulness instructors over eight 90-min group sessions, occurring once per week. We trained 47 qualified mindfulness instructors that (a) had taught at least five classes since their MT qualification (preferably mindfulness-based cognitive therapy); (b) had a desire to work with secondary school teachers in a school setting; and (c) were registered on the United Kingdom listing of mindfulness trainers and adhered to the Good Practice guidelines for mindfulness instructors ( Supplementary Material S4 ). A 2-day training course was provided to the pool of 47 potential trainers, which consisted of presenting project and school information and going through the M-FP teacher handbook with experienced supervisors and program developers. A general overview of the research project and the course was given and allowed the trainers to become familiar with all the materials and practices to be used. In the end, 15 mindfulness instructors that agreed with the responsibilities of the study ( Supplementary Material S4 ) were chosen following a process of matching the location and dates for each school with the nearest mindfulness instructor (once the schools had been randomized then the trainers were matched, first by geographic location, i.e., nearest to the school, and then on availability on the days that the school had specified). Biweekly supervisions, regular telephone support and emails throughout the course were conducted with experienced supervisors in the M-FP course, with mindfulness instructors encouraged to get in touch if they need any kind of help.

Mindfulness instructors were asked to record one session of their classes to bring it to their experienced supervisor for discussion and to ensure the quality of the course and standardization control. Members of the research team were in contact with the mindfulness instructors, introducing them to schools and providing a box which contained everything they would need practically for the course. If a mindfulness instructor was involved, they were paid £1,300. An overview of the course is shown in the Supplementary Material S3 .