Garber, J., Chavira, D. A., Adam, E. K., Craske, M. G., McMahon, T., Williams, A., Abitante, G., Lanser, I., Pashtunyar, D. S., Chen, S., & Zinbarg, R. (2025). A randomized controlled trial of an online mindfulness program for adolescents at risk for internalizing problems. Journal of Consulting and Clinical Psychology, 93(4), 226–237. https://doi.org/10.1037/ccp0000921
Key Takeaways
- Focus: The study explored the effectiveness of an online, coached mindfulness intervention in reducing negative affect among adolescents at high risk for internalizing problems.
- Aims: The research aimed to evaluate whether the mindfulness intervention reduced momentary negative affect (mNA) and to examine if these reductions correlated with decreased internalizing symptoms.
- Findings: The mindfulness intervention specifically reduced stressor-reactive momentary negative affect, indicating targeted effectiveness in managing stress-related emotional responses.
- Implications: Findings suggest digital mindfulness interventions could be beneficial in reducing emotional distress in high-risk youth, potentially informing preventative strategies in adolescent mental health.
Rationale
Increasing rates of anxiety and depression among youth highlight the urgent need for effective preventative interventions (Twenge et al., 2019).
Negative affectivity (NA), a heritable propensity for negative emotional responses, significantly predicts internalizing disorders (Zinbarg et al., 2016).
Mindfulness-based interventions have demonstrated efficacy in reducing NA and internalizing symptoms in youth (Dunning et al., 2019), but few studies have focused on momentary negative affect using digital platforms (Grist et al., 2017).
Identifying effective digital interventions that target mNA could substantially enhance mental health services accessibility (Webb et al., 2021).
The next step is to test if reductions in mNA translate into clinical symptom improvement in larger, diverse samples.
Method
A randomized controlled trial using ecological momentary assessment (EMA) measured emotional responses before and after an online mindfulness intervention.
Procedure:
- Initial screening for eligibility based on NA scores and diagnostic criteria.
- Random assignment to mindfulness intervention or control.
- Completion of EMA surveys four times daily for five days at two time points (baseline and post-intervention).
- Weekly coaching sessions via digital platform.
Sample:
- 111 adolescents aged 12-17 years (M = 14.17, 68% female).
- 54.55% White, 31.82% Hispanic/Latinx.
Measures:
- Negative Affectivity (NA-15)
- Patient Health Questionnaire–8 (PHQ-8)
- Generalized Anxiety Disorder–7 (GAD-7)
- Screen for Child Anxiety Related Disorders (SCARED)
- Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL)
- Ecological Momentary Assessment (EMA) to assess momentary negative affect
Statistical measures:
- Latent variable analyses, regression analysis for regressed changes, Cohen’s d for effect size, principal components analysis (PCA) for internalizing symptom changes.
Results
- Hypothesis 1: Mindfulness intervention would reduce overall mNA – Not supported.
- Hypothesis 2: Mindfulness intervention would reduce stressor-independent mNA – Not supported.
- Hypothesis 3: Mindfulness intervention would reduce stressor-reactive mNA – Supported.
- Changes in stressor-reactive negative affect correlated significantly with changes in internalizing symptoms.
Insight
The study highlights the particular effectiveness of mindfulness in reducing adolescents’ negative emotional responses specifically related to stressors rather than impacting overall negative mood or trait-level negative affectivity.
This specificity suggests mindfulness practices might help adolescents manage acute emotional responses triggered by stressful events through strategies like focused breathing, acceptance, and attentional control.
These findings build on prior research demonstrating the role of mindfulness in improving emotional regulation, particularly under stress.
The present study provides clear evidence supporting the use of digital mindfulness interventions as a viable method to help adolescents better cope with stressors, potentially decreasing their vulnerability to developing internalizing disorders over time.
Future research could benefit from identifying precisely which mindfulness techniques adolescents utilize most effectively in real-time scenarios and how these skills influence long-term emotional health.
Clinical Implications
Practitioners and policymakers should consider integrating digital mindfulness interventions into mental health prevention programs, especially targeting adolescents who demonstrate heightened negative affectivity.
The affordability, accessibility, and scalability of digital interventions could significantly expand reach and effectiveness, particularly for populations with limited access to traditional in-person mental health services.
Incorporating mindfulness programs into school curricula or community health initiatives could proactively equip adolescents with practical skills to manage stress effectively.
However, successful implementation may require addressing potential challenges, such as ensuring consistent participation and providing adequate support through trained coaches.
Policymakers and mental health practitioners may need to explore creative solutions, including peer mentoring, automated coaching systems, or training educators to facilitate mindfulness activities, to optimize scalability and effectiveness in various contexts.
Strengths
- Digital and accessible intervention format.
- Use of rigorous EMA data collection.
- Targeted high-risk adolescent population.
- Clear theoretical foundation and structured intervention.
Limitations
- Lack of active control group.
- Limited generalizability due to selective sample.
- Coaching requirement could limit scalability.
- Short duration might not affect stable emotional traits.
Socratic Questions
- How might the results differ if an active control group had been included?
- What alternative explanations could account for reductions in stressor-reactive negative affect?
- In what ways might these findings apply to broader adolescent populations or different age groups?
- What specific mindfulness techniques might most effectively reduce stable negative affectivity over time?
- How could implementation barriers (e.g., coach training and costs) be overcome to scale this intervention broadly?
References
Garber, J., Chavira, D. A., Adam, E. K., Craske, M. G., McMahon, T., Williams, A., Abitante, G., Lanser, I., Pashtunyar, D. S., Chen, S., & Zinbarg, R. (2025). A randomized controlled trial of an online mindfulness program for adolescents at risk for internalizing problems. Journal of Consulting and Clinical Psychology, 93(4), 226–237. https://doi.org/10.1037/ccp0000921
Cuijpers, P., Pineda, B. S., Quero, S., Karyotaki, E., Struijs, S. Y., Figueroa, C. A., Llamas, J. A., Furukawa, T. A., & Muñoz, R. F. (2021). Psychological interventions to prevent the onset of depressive disorders: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 83, 101955.
Dunning, D. L., Griffiths, K., Kuyken, W., Crane, C., Foulkes, L., Parker, J., & Dalgleish, T. (2019). Research review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents—A meta-analysis of randomized controlled trials. Journal of Child Psychology and Psychiatry, 60(3), 244–258.
Grist, R., Porter, J., & Stallard, P. (2017). Mental health mobile apps for preadolescents and adolescents: A systematic review. Journal of Medical Internet Research, 19(5), e176.
Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology, 128(3), 185–199.
Webb, C. A., Swords, C. M., Murray, L., & Hilt, L. M. (2021). App-based mindfulness training for adolescent rumination: Predictors of immediate and cumulative benefit. Mindfulness, 12(10), 2498–2509.
Zinbarg, R. E., Mineka, S., Bobova, L., Craske, M. G., Vrshek-Schallhorn, S., Griffith, J. W., Wolitzky-Taylor, K., Waters, A. M., Sumner, J. A., & Anand, D. (2016). Testing a hierarchical model of neuroticism and its cognitive facets: Latent structure and prospective prediction of first onsets of anxiety and unipolar mood disorders during 3 years in late adolescence. Clinical Psychological Science, 4(5), 805–824.
