Mindfulness-Enhanced Coping Power: Adaptation and Feasibility Testing

Introduction: Children who are aggressive and emotionally reactive are at high risk for substance abuse. However, existing preventive interventions have not been as effective with children with reactive aggression (RA).  One illustration is Coping Power (CP), an indicated preventive intervention for high-risk children and their parents implemented before the transition to adolescence. Eight randomized controlled trials (RCT) find CP effective in reducing externalizing behavior, proactive aggression, and substance use. However, CP has not produced significant reductions in RA. Unlike proactive aggression (PA), which is unprovoked, goal-directed, and instrumental, RA is characterized by impulsivity, low frustration tolerance, and emotional dysregulation.

The aim of our study is to adapt the evidence-based CP program by integrating it with mindfulness strategies, and then testing its feasibility and acceptability with children who have high levels of RA. Studies with adults find mindfulness effective in reducing depression and anxiety, and improving health conditions. A growing literature also shows similar effects on youth. Of particular salience to this study, studies show that mindfulness strategies impact the active mechanisms of reactive aggression: improved attention; increased emotional self-regulation, and greater cognitive self-control. Because mindfulness impacts the active mechanisms of RA, mindfulness strategies are an ideal enhancement to increase CP’s effects on RA.

Methods: We will report on two sets of findings: (1) our formative process (input from research experts, mindfulness and CP practitioners, and parents and children participating in a pre-test of the Mindful Coping Power [MCP] program); and (2) multi-rater implementation data (feasibility; fidelity; satisfaction and acceptability) from the first cohort of a feasibility RCT (48 children and families).  Our adaptation included integration of mindfulness in CP in three ways: mindfulness-only sessions, mindfulness in every session, and infusion of mindfulness principles into existing CP sessions.

Results: Pre-test results indicate that children with high levels of RA and their parents liked MCP very well. On a Likert scale (1 – low to 5 - high), the mean child rating was 5.0 (SD = 0) and the mean parent rating was 4.8 (SD = 0.4).  Children’s and parents’ most-favored mindfulness activities included:  pausing to observe thoughts, feelings, and breathing in high emotional-arousal situations, yoga, and compassion-building practices.   

Conclusions: Integration of mindfulness into CP bridges the conceptual and programmatic strengths of a cognitive behavioral intervention with mindfulness. This integration is expected to enhance outcomes of the CP prevention program that targets children at high risk for substance use and their parents.