The active intervention, MBSR-T, was provided in a group format [51, 65]. Relative to MBSR [66], MBSR-T has been slightly modified for use with adolescents ages 13–18 and takes into account the attentional capabilities of youth and the impact of technology on interpersonal interactions. Adaptations include shortened formal mindfulness practice (10–20 min, rather than 40 for adults), On-Your-Own-Practices (rather than homework), and no day-long retreat [51, 65]. Sessions were conducted twice a week for four weeks to further examine feasibility and reduce participant burden. Other brief mindfulness interventions (e.g., 2–5-week programs) have been successfully implemented [6769] with similar gains in buffering stress reactivity [70].

Topics of focus included intention (direction of effort toward mindfulness practice), attention (experiencing what is taking place in the present moment), and attitude (nonjudgmental attributions of cognitive, emotional, and somatic experiences), with each session having specific foci. Session 1 centered on examining and defining the foundations of stress and providing an introduction to mindfulness (mindfulness practice: mindful eating; dropping-in mindfulness). Session 2 explored the effect of stress on the mind and body, as well as beginning a personal mindfulness practice (mindfulness practice: body scan mindfulness). Session 3 focused on developing and strengthening mindfulness practice, including learning how to increase present-moment awareness (mindfulness practice: mindful breathing; sitting mindfulness). Session 4 centered on cultivating self-care and facilitating awareness of positive experiences and pleasant moments (mindfulness practice: mindful walking and movement; heartfulness mindfulness). In Session 5, mindfulness exercises were used to notice, be, and work with thoughts, as well as to facilitate awareness of negative experiences and unpleasant moments (mindfulness practice: yoga and mindful movement; mindful stopping). Session 6 further focused on improving awareness through mindfulness and use of positive coping strategies and behaviors to manage life’s events (mindfulness practice: sitting mindfulness; mindful homework and test taking). Session 7 cultivated mindfulness resilience and building mindful relationships (mindfulness practice: mindful gratitude taking; body scan mindfulness). Finally, Session 8 focused on reviewing the MBSR-T program and making mindfulness a continuing part of daily life (mindfulness practice: dropping in mindfulness; gratitude practice).

Adolescents assigned to MBSR-T were given a workbook to use for On-Your-Own-Practice assignments. The study investigator and a doctoral student in clinical psychology supervised by the study investigator delivered the intervention. The study investigator, a licensed health service psychologist, completed a 12-session trainers’ training on MBSR-T prior to study commencement. Sessions were video recorded. A board-certified child and adolescent psychiatrist trained in mindfulness (SC) listened to the tapes and provided weekly supervision to promote treatment fidelity and a developmentally appropriate intervention, while also assessing for potential bias introduced by intervention facilitators.

Adolescents in the CTRL group were followed for the duration of the study with self-report measures administered at the same time intervals as the MBSR-T groups. Participants were not asked to stop any treatments or activities they were already undergoing, including psychotherapy, pharmacotherapy, or other services during the duration of the study. All participants were provided with a list of community-based referrals upon randomization.

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