Understanding how adolescents engage in mindfulness-based intervention: a mixed methods study of engagement processes

Mindfulness-based intervention (MBI) improves mental health outcomes in adolescents; however, effects tend to be small, and findings have been inconsistent. Engagement (i.e., productive involvement) has been positively associated with outcomes in other types of mental health interventions, suggesting it may play a role in MBI. However, it is unclear how engagement functions in the context of MBI for adolescents. The purpose of this mixed methods study was to examine adolescent engagement in MBI, including identifying. reasons they do or do not engage. In n = 73 adolescents who received a community-delivered MBI, we described self-reported engagement and tested differences between engagement dimensions. Based on quantitative scores, we purposively sampled n = 25 adolescents for interviews and used reflexive thematic analysis to develop themes that reflected adolescents' perspectives on engaging in MBI. Through merging integration, we examined patterns of thematic results across engagement levels. Engagement scores were high, and cognitive-behavioral engagement was significantly higher than affective engagement. Qualitative and mixed methods analyses resulted in four themes that showed variation by engagement level. Adolescents' perspectives on engagement in MBI aligned somewhat with prior conceptualizations of engagement, and highlighted distinctive characteristics of engagement in the MBI context. There are opportunities before, during, and outside of MBI sessions to support adolescent engagement, which may increase efficacy of MBI for promoting mental health in this age group.