Bernadette Lensen Mindfulness-Based Stress Reduction for Elementary School Teachers Exploring feasibility and effectiveness
Mindfulness-Based Stress Reduction for Elementary School Teachers Exploring feasibility and effectiveness Johanna Huiberdina Lensen
This PhD research was made possible with the support of the Rotterdamse Vereniging voor Katholiek Onderwijs. ISBN: 978-94-6506-298-3 Copyright 2024 © Bernadette Lensen All rights reserved. No parts of this thesis may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the author. Provided by thesis specialist Ridderprint, ridderprint.nl Printing: Ridderprint Layout and design: Britt de Kroon, persoonlijkproefschrift.nl
Mindfulness-Based Stress Reduction for Elementary School Teachers EƩűlorinğ feasiýility and eDžectiƣeness roefschrift ter ƣerĽriĺğinğ ƣan de ğraad ƣan doctor aan de Radýoud §niƣersiteit fiĺmeğen oű ğeƳağ ƣan de rector mağniLjcus űrofȵ drȵ YȵMȵ Sanders, ƣolğens ýesluit ƣan het colleğe ƣoor űromoties in het oűenýaar te ƣerdediğen oű maandağ ǓǓ noƣemýer ǔǒǔǖ om ǓǔȷǕǒ űrecies door Yohanna Euiýerdina ]ensen ğeýoren oű Ǔǖ seűtemýer ǓǛǘǚ te Schoonhoƣen
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Mindfulness-Based Stress Reduction for Elementary School Teachers EƩplorinğ feasiýility and eDžectiƣeness Dissertation to obtain the degree of doctor from Radboud §niƣersity fiĺmegen on the authority of the Rector MagniLjcus profȵ drȵ YȵMȵ Sanders, according to the decision of the Doctorate Board to be defended in public on Monday, foƣember 11, ǔǒǔǖ at 1ǔȵǕǒ pm by Yohanna Euiberdina ]ensen born on September 1ǖ, 1Ǜǘǚ in Schoonhoƣen ɉthe fetherlandsɊ
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TABLE OF CONTENTS Chapter 1 General Introduction 9 Chapter 2 Mindfulness-Based Stress Reduction intervention for elementary school teachers: A pilot study Orthopedagogiek: Onderzoek en Praktijk, 2022 61, 36-48 21 Chapter 3 Mindfulness-Based Stress Reduction intervention for elementary school teachers: a mixed method study Trials 2021, 22(1), 1-10 35 Chapter 4 Mindfulness-Based Stress Reduction for elementary school teachers: a randomized controlled trial Frontiers in Education 2024, Vol. 9, p. 1385375 51 Chapter 5 Potential mediators in a Mindfulness-Based Stress Reduction program for elementary school teachers to reduce perceived stress and improve well-being and classroom climate: A multiple mediation model Submitted 79 Chapter 6 Mindfulness-Based Stress Reduction for Elementary School Teachers: A Qualitative study Under review 97 Chapter 7 Summary and general discussion 119 Chapter 8 Miscellaneous 135 References 136 Nederlandse samenvatting 152 Research Data Management and Privacy 160 Dankwoord 162 About the author 168
In some ways the mind is much like a garden, it needs your care, attention and effort. Left to its own devices it will soon become overrun with weeds. And where there are too many weeds flowers can not grow. ― James Norbury, Big Panda & Tiny Dragon
Chapter 1 General Introduction
10 Chapter 1 GENERAL INTRODUCTION In the first part of this introduction, I describe a series of observations that raised questions, followed by a theoretical and empirical underpinning of the questions discussed. With over three decades of experience in primary education, primarily in disadvantaged areas, of which 15 years as principal of an elementary school serving 700 pupils with a dedicated team of 80, I have witnessed a wide array of societal and educational developments that may increase teachers’ stress. An observation which has motivated me to study this topic further. The evolving landscape of a complex society has firmly entrenched itself in all aspects of primary education. An example of this is the rapid succession of digital advancements. Another is the noticeable rise in complex social themes such as diversity and inclusion, equal opportunities, environmental consciousness, and media education—each now integral to the elementary school curriculum. Moreover, educators must navigate shifting government and municipality regulations, such as the increased attention given to the consequences of growing poverty in families and the introduction of acts like the Appropriate Education Act (Primary Education Act, n.d.). This act aims to guarantee that all children, regardless of disabilities or learning and behavioral challenges, have access to education alongside their peers in regular schools. This necessitates increased differentiation in teaching methods and heightened specialization among teachers (Van Den Berg, 2020). In addition, society places greater emphasis on results and performance, heightening expectations of pupils and parents. Furthermore, the perception of the elementary school teaching profession has deteriorated, leading to a decline in social esteem for these educators (Algemene Onderwijsbond, 2020). This trend coincides with a growing teacher shortage, further straining those working in the field. Among other things, these developments have contributed to the stress that can be experienced in schools (Peeters et al., 2022). In addition to above mentioned societal pressures, I have also noted aspects that are more specific to the teachers themselves that may contribute to their stress levels. For instance, combining intensive days with pupils with non-lesson hours dedicated to preparation and meetings presents a significant challenge, especially since there has been a marked increase in administrative tasks as well (De Weerd et al., 2017). Additionally, I’ve noticed an increase in the range of challenges that pupils present, including the nuances of their behavior and a more intricate interplay of various issues they face. For instance, pupils today might exhibit a wider range of behaviors stemming from diverse backgrounds, experiences, and individual circumstances, such as socioeconomic factors, mental health concerns, or learning disabilities. These complexities
11 General Introduction not only pose challenges for pupils themselves but also present significant hurdles for teachers in effectively addressing their diverse needs and providing appropriate support, which is also confirmed by the Algemene Onderwijsbond (2020). I have personally witnessed the impact the above mentioned developments had on the well-being of teachers in primary education, confirmed by a notable increase in teacher absenteeism (Statistics Netherlands, 2022). This has led me to ponder: ‘How can we take care of pupils while also ensuring the welfare of our teachers?’. Acknowledging that I cannot transform the education system, I have sought insights from scientific research that could initially contribute to reducing stress and enhancing teacher well-being in primary education which might indirectly also improve the caretaking of pupils. In my view, effective education begins with teachers who feel comfortable and possess the necessary skills to navigate the daily demands of teaching in a healthy manner. I came across promising research on mindfulness-based interventions in schools, primarily from the US and the UK (Abenavoli et al, 2013; Jennings et al., 2011; Roeser et al., 2012). These interventions generally target pupils or a mixed teacher population across primary, secondary, and higher education. Surprisingly, there has not yet been any research in this domain in the Netherlands. Therefore, I sought training in MindfulnessBased Stress Reduction (MBSR), and earned my certification as an MBSR and Mindfulness-based Cognitive Therapy mindfulness-teacher at the Radboud University Medical Center. This positively impacted both my professional and personal life and prompted me to explore the potential for implementing a standard MBSR intervention for education professionals. The board of the Rotterdam Association for Catholic Education (RVKO), overseeing 67 elementary schools (n= 21.000 pupils, n= 2400 professionals) supported my plans , so I started to teach the MBSR training to professionals in primary education. The overwhelmingly positive feedback led us to ponder how we might objectively demonstrate and understand the specific benefits of these practices, which inspired a pilot-study (Lensen et al., 2022) in collaboration with Radboud University -Behavioral science Institute, the Radboud University Medical Center- Center for Mindfulness, and the Trimbos Institute. And this subsequently paved the way for a largerscale randomized controlled trial. Stress among teachers a growing concern Teaching is acknowledged as one of the most demanding professions, often accompanied by significant work-related stress (Lomas et al., 2017; Agyapong et al., 2022; OECD, 2020). This stress is concerning for multiple reasons. First, it can undermine teachers’ well-being, encompassing their mental, emotional, and physical health, potentially leading to burnout, fatigue, and other health issues (Travers, 2017; de Carvalho, 2021). Second, stress can impede teachers’ performance and self-efficacy, negatively affecting the quality of the classroom climate, instructional strategies, and the provision of quality education, which may, in turn, influence student outcomes (Chong & Kong, 2012; Meristo 1
12 Chapter 1 & Eisenschmidt, 2014; Robertson & Dunsmuir, 2013). Also, teachers model social skills for young children, thus stress can negatively affect their role-modeling capabilities (Jennings & Greenberg, 2009). Third, excessive stress contributes to burnout and may be a factor in the high turnover rates within the teaching profession (Tsouloupas et al., 2010). This holds particularly true for elementary school teachers in The Netherlands, who report higher levels of burnout symptoms and increasing absenteeism compared to other professions (Statistics Netherlands, 2022). When teachers experience chronic stress without adequate support, they may choose to leave the profession, resulting in a loss of experienced educators. In the Netherlands, one in five elementary school teachers exits the educational system within five years (Ministry of Education, Culture and Science, 2022), with one in eight leaving due to sickness, disability, or (early) retirement (Statistics Netherlands, 2018). Additionally, high levels of teacher stress have far-reaching implications within the broader educational system. Schools often grapple with absenteeism and encounter challenges in fostering a positive and engaging learning environment (Ter Weel et al., 2020). The relationship between teacher stress and well-being, self-efficacy, pupil-teacher relationships, and classroom climate quality, as investigated in several studies, underscores the need for strategic interventions to alleviate perceived stress in elementary school teachers (de Carvalho, 2021; Chong & Kong, 2012; Meristo & Eisenschmidt, 2014; Robertson & Dunsmuir, 2013; Travers, 2017) Reducing teacher stress The stress levels experienced by individual teachers are likely to depend on the interaction between specific work stressors, teachers’ appraisal of these stressors, and their perceived coping ability (Engelbrecht & Eloff, 2001). Lazarus (1991) suggests that stress originates from one’s interpretation of stressors and the ability to regulate emotions. This suggests that interventions aimed at reducing stress should prioritize enhancing teachers’ emotion regulation, which involves establishing goals that can positively impact the way they experience and express their feelings (Gross et al.,2011). Research indicates that mindfulness increases emotional self-regulation (Hölzel et al., 2011; Vago & Silbersweig, 2012; Tang et al., 2015) which has also been supported by research in neuroscience (Hölzel et al., 2011; Tang et al., 2015). Mindfulness-Based Stress Reduction Mindfulness has a rich history rooted in both religious and secular traditions (Psychologist, 2023). In the 1980s, Kabat-Zinn, connected to the University of Massachusetts Medical School, adapted mindfulness from its Buddhist roots to a clinically applicable practice, i.e. Mindfulness-Based Stress Reduction (MBSR) (Kabat-Zinn, 2005). Informed by Eastern teachings, Kabat-Zinn integrated mindfulness in Western health care settings. MBSR gained widespread acceptance in clinical practice and science (Dryden & Still, 2006; Psychologist, 2023). Kabat-Zinn not only started to build the evidence base of MBSR in health care settings, but also explored its possible value in non-clinical settings, highlighting lasting benefits in personal, social, and political realms (Kabat-Zinn, 2005).
13 General Introduction This shifted the perspective from a Buddhist moral system to an ethically secularized mindfulness accessible to all (Hanley et al., 2016). Post-2000, mindfulness research evolved into the evaluation of a psychological intervention for enhanced well-being (Hanley et al., 2016). This era also witnessed the increase of Randomized Controlled Trials (RCTs) in the mindfulness research community (Lee et al., 2021). Mindfulness is characterized as “the awareness that arises through purposeful, nonjudgmental attention to the unfolding of experience moment by moment” (KabatZinn, 2003, p.145). The original MBSR-program, developed by Kabat-Zinn (2013) is a group-based intervention consisting of eight weekly sessions of two hours and one day of silent practice. The program consists of three primary components: (1) formal and informal meditation exercises, such as sitting meditation and yoga; (2) dialogue and (3) psychoeducation about stress and stress responses. Participants are encouraged to practice mindfulness at home for at least 35 minutes each day during the entire course of MBSR. The core of MBSR involves cultivating mindfulness skills, allowing participants to direct their attention to the present moment through the development of an observing stance towards their thoughts, feelings, and behaviors. This practice improves the capacity to identify habitual reaction patterns, empowering individuals to make conscious choices. Participants develop the ability to respond with reduced reactivity to negative thoughts and emotions (Fanning et al., 2018; Rad et al., 2023, Gilbert & Waltz, 2010). While MBSR initially focused on stress and pain management, it has evolved over time and is now applied in a much broader context. Today, MBSR is used not only for stress reduction but also to prevent well-being. MBSR is based in science and contemporary approaches managing mental and physical health and supporting well-being; it is suitable for delivery in mainstream public institutions across a range of settings and cultures; and is maximally accessible to people with diverse values and religious affiliations (Crane et al., 2017). Mindfulness-Based Interventions for teachers Research on Mindfulness-Based Interventions (MBIs) for teachers has expanded over the last two decades (Jennings, 2017). However, a significant research gap exists in studies specifically addressing elementary school teachers (Jennings, 2017). A limited number of RCTs, infrequent preregistration of study protocols, and rare follow-up assessments characterize the current state of research in this context. Elementary school teachers, who engage daily with their pupils, cultivate stronger pupil-teacher relationships and experience a stronger emotional involvement in teaching compared to teachers in secondary or higher education (Statistics Netherlands, 2020). Therefore, elementary school teachers may experience more profound effects from MBIs. For example in the experienced quality of pupil-teacher relationship and the quality of the classroom climate, which in turn is related to the teachers’ experienced stress (Collie et al., 2017; Corbin et al., 2019; Jennings et al., 2017; Lomas et al., 2017). Furthermore, while most studies on MBIs in education were conducted in the United States, European educational systems, where 1
14 Chapter 1 elementary school teachers primarily teach children aged 4 to 12, remain comparatively understudied. Standard MBSR versus tailored Mindfulness-Based Interventions (MBIs) Most studies on mindfulness for teachers examine MBIs that are adapted to the educational field and, therefore, differ in terms of content and duration from the standard MBSR program as described earlier. According to Crane and colleagues (2016), MBIs emphasize systematic and sustained training in formal and informal mindfulness meditation practices for both mindfulness-teachers and participants. These interventions are rooted in mindfulness, integrating core curriculum elements with adapted ones, tailored to specific contexts and populations. Program variations in structure, length, and delivery can be adjusted to suit the population and context. The meta-analysis of 29 studies by Klingbeil and Renshaw (2018) evaluated teacher interventions in which training mindfulness skills was the primary therapeutic component. There was a large variety in duration (from 2 to 36 weeks) and dosage (from 2 to 75 hours) of the MBIs and the interventions could also differ in content. In addition to mindfulness skills, an intervention could also place more emphasis on, for example, self-compassion or emotion-regulating skills (Jennings et al., 2017; Roeser et al, 2013). Furthermore, working with and researching adapted MBIs prompts an exploration into how the effects of these tailored interventions in educational settings differ from standard MBSR programs. The current evidence presents a mixed picture. For example, the Cultivating Awareness Resilience in Eduction (CARE) intervention, despite being highly tailored, did not consistently enhance teacher self-efficacy across multiple studies (Jennings et al., 2011, 2013). In contrast, Mindfulness-Based Wellness Education (MBWE), with only minor adjustments for teachers, demonstrated significant improvements in self-efficacy (Poulin et al., 2008). These discrepancies in outcomes highlight the importance of considering the nuances in the design of mindfulness programs, as variations in customization may impact their effectiveness and reported outcomes. As the evidence base continues to expand, it becomes imperative to pinpoint the specific components of MBIs that are most efficacious for teachers. Thus, while MBIs are often tailored to the educational field, the inconsistency in results raises questions about the necessity of such adjustments. This is particularly relevant given evidence from the medical context suggesting that standard programs like Mindfulness-Based Cognitive Therapy or MBSR may outperform tailored MBIs (Cillessen et al., 2019). In addition, a standard program is easier to implement. In search of evidence Numerous studies collectively support the positive effects of Mindfulness-Based Interventions (MBIs) in teachers. Klingbeil and Renshaw’s (2018) meta-analysis of 29 studies, encompassing various MBIs such as MBSR, Stress Management and Relaxation Techniques-in-education (SMART), CARE and Cultivating Emotional Balance Training, revealed positive impacts on teachers’ occupational stress and burnout, mindfulness
15 General Introduction skills (i.e. observing, describing, acting with awareness, non-judgement and nonreactivity) and psychological well-being. Also, small effects were found on pupil-teacher relationship and modest effects on classroom climate quality. The duration and dosage of MBIs varied widely, with effects ranging from small to medium. Another systematic review by Hwang and colleagues (2017), which included only 9 out of 19 studies that overlapped with those reviewed by Klingbeil and Renshaw (2018) and also incorporated qualitative research, found large effects on perceived stress and mindfulness skills, moderate effects on self-compassion, and small effects on teacher self-efficacy. A meta‐analysis of mindfulness training on teacher well‐being by Zarate et al. (2019), which included 18 control‐trial studies, 16 of which were from the meta‐analysis by Klingbeil and Renshaw (2018) involved a total of 1,001 in‐service teachers using mindfulness as a primary intervention. The analysis suggests that mindfulness has statistically significant positive outcomes, including increases in teacher mindfulness and decreases in stress. The small to moderate overall effects of mindfulness practices for teachers are consistent with the findings of Klingbeil and Renshaw (2018). While these overview studies show promising effects, it is noteworthy that they primarily include studies from the USA, involving a mixed teacher population. The recent study of De Carvalho and colleagues (2021) stands out as one of the few European RCTs, focusing specifically on elementary school teachers in Portugal. This study reported increased well-being, mindfulness skills, emotional regulation, and self-efficacy in the intervention group. However, only short-term benefits for the classroom climate were observed. Mechanisms of Change To understand why an intervention generates effects, it is not enough to only focus on direct outcomes. Only a few studies report the mechanisms of change in MBI program outcomes (Emerson et al., 2017). Understanding the working mechanisms and essential elements of mindfulness interventions is crucial for comprehending the effectiveness of MBSR programs. This knowledge will facilitate the development of more effective MBSR programs for teachers in the future. Both Schlusser and colleagues (2016) and Taylor and colleagues (2016) suggested that increased emotion regulation efficacy may serve as a potential mediator in stress reduction as a consequence of MBSR. A systematic review and narrative synthesis by Emerson and colleagues (2017) was conducted on 13 samples of quantitative and qualitative studies that reported the effects of MBIs on symptoms of stress, emotion regulation, and self-efficacy in teachers of children aged 5–18 years. They concluded that MBIs, including SMART, CARE, and adapted MBSR, improved mindfulness skills, emotion regulation, and self-compassion. Regarding intermediate effects on stress reduction, they concluded that MBIs showed the strongest promise for enhancing teacher emotion regulation. According to Emerson and colleagues (2017), research on MBIs often includes the measurement of trait mindfulness and selfcompassion as indicators of cognitive changes that may lead to broader changes, such as decreased stress. 1
16 Chapter 1 Theoretical Framework The MBSR intervention is expected to enhance teachers’ mindfulness skills (Jennings et al., 2017) and foster self-compassion (Roeser et al., 2022). This, in turn, is expected to promote improved emotion regulation by teachers (Jennings et al, 2017; Roeser et al., 2022; Tang et al., 2015), leading to a reduction in perceived stress and an increase in emotional, psychological, and social well-being (Querstret et al., 2020; Jennings et al., 2017; Roeser et al., 2022). However, these concepts partly overlap, suggesting that the changes are likely to occur not sequentially but rather simultaneously. Past MBSR interventions among teachers have demonstrated an increase in teachers’ self-efficacy (Emmerson et al., 2017). This enhanced self-efficacy, is anticipated to contribute to improved pupil-teacher relationships and a higher classroom climate quality (Robertson & Dunsmuir, 2013; Meristo & Eisenschmidt, 2014; Chong & Kong, 2012). For a visual representation of the proposed theory of change, please refer to Figure 1. Qualitative Research on the effects of Mindfulness-Based Interventions Although quantitative studies on the effectiveness of MBIs in education provide important insights, none of these studies tell us about how elementary school teachers experience participating in standard MBSR and the possible relation between participating in MBSR and their personal functioning, their professional functioning and their classroom climate quality. In contrast, qualitative methods provide rich descriptions, enhancing understanding of both events and their context. These methods broaden perspectives, helping to identify patterns and distinctions among variables. It raises the question “Can we test the above model using qualitative research?”. Qualitative research goes beyond description, moving inquiry toward more meaningful explanations (Sofaer,1999). Therefore, by using a qualitative design we can examine how teachers in elementary schools experience the effects of standard MBSR on their personal and professional functioning and on the classroom climate quality . As an emerging area, there are only a handful of qualitative studies available for review. Information presented in the review of Hwang and colleagues (2017) containing quantitative and qualitative research therefore, contains the context and effects of mindfulness-based interventions generated by studies that did not meet all quality indicators as stated in their study. Of the five qualitative studies, two provided an account of trustworthiness in their findings. Hwang et al. (2017) conducted a secondary analysis of qualitative studies exploring in-service teachers’ experiences with mindfulness. This analysis offered potential explanations for the effects of mindfulness interventions observed in primary quantitative studies. Mindfulness practices strategically helped teachers cope with stress, fostering improved awareness over time. This heightened awareness was linked to reduced stress levels, enabling skillful and reflective responses in challenging situations. Positive impacts were noted in emotion regulation and the use of positive language, resulting in enhanced teacher performance. Teachers’ improved coping with stress was associated with increased attunement to students’ needs and
17 General Introduction the development of compassion and kindness towards themselves and others. The cultivation of self-awareness, social awareness, self-management, and compassion were identified as instrumental factors in improving relationships and teaching practices. A subset of three qualitative studies from the systematic review and narrative synthesis by Emerson and colleagues (2017) generally yield results similar to the research of Hwang and colleagues (2017). They further contribute to these findings by emphasizing that teachers consistently integrate mindfulness into their personal lives, resulting in improved self-care. Figure 1. Theory of change Conclusion In conclusion, numerous studies on MBIs for teachers have shown promising effects on teachers’ perceived stress. Additionally, there are encouraging indications of improvements in teachers’ well-being, self-efficacy, perceived pupil-teacher relationships, and classroom climate quality. However, the current state of research is characterized by limited RCTs, infrequent preregistration of study protocols, small sample sizes, and rare follow-up assessments (Hwang et al., 2017; Klingbeil and Renshaw, 2018; Zarate et al., 2019). Moreover, the majority of studies investigating mindfulness for teachers focus on MBIs specifically tailored to the educational context. Consequently, these interventions often differ in terms of content and duration from the standard MBSR program. It is essential to note that the majority of these studies were conducted in the USA or outside Europe and encompassed a mixed teacher population. Considering the concerning trend of increased perceived stress levels among Dutch elementary school teachers and the associated negative consequences, there is a need for stress-reducing interventions within Dutch primary education. The already existing and readily accessible standard MBSR could potentially contribute positively to this. Furthermore, gaining a clearer understanding of 1
18 Chapter 1 the working mechanisms of MBSR and teacher experiences could add value to future interventions. This thesis Aim The primary aim of this thesis was to investigate the effectiveness of a standard MBSR program in reducing perceived stress among teachers in Dutch primary education. The secondary aim was to examine the effects of MBSR on teachers’ mental health, teacher skills, the pupil-teacher relationship and the perceived quality of the classroom climate. The third aim was to gain deeper insights into the demographic or individual characteristics that are most conducive to the optimal effectiveness of the MBSR program. Additionally, we aimed to investigate possible mediators that influence treatment outcomes, encompassing mindfulness skills, self-compassion, and emotion regulation skills. Due to the absence of similar research in the Netherlands, we conducted a preliminary uncontrolled pilot study on the effects of standard MBSR on elementary school teachers in Rotterdam establishing a solid foundation for a well-conducted RCT. The subsequent superiority RCT, comparing MBSR to a waiting list control condition with a 3-month follow-up, was conducted with elementary school teachers in a large urban area. Additionally, in-depth qualitative interviews were conducted to explore the personal experiences of teachers, further revealing underlying mechanisms. Outline Chapter 2 describes an uncontrolled pilot study comprising 71 elementary school teachers. The research questions in this chapter are: Does the MBSR-training reduce the perceived stress of teachers in primary schools? Does the MBSR-training improve mindfulness skills, self-compassion and mental health of the teachers? Is standard MBSR feasible to offer in this setting, and what is its provisional effectiveness? Chapter 3 describes the design and protocol of Mindfulness-Based Stress Reduction as an intervention for elementary school teachers. This chapter provides a comprehensive overview of both the randomized controlled trial and qualitative study. It furnishes detailed information on various methodological aspects of the trial, encompassing its design, eligibility criteria, study procedure, sample size calculation, research questions, outcome measures, and statistical analyses. Answering important questions it elucidates the study’s objectives and the anticipated impact of its findings, particularly concerning the effects of MBSR training on elementary school teachers’ perceived stress, mental health, mindfulness skills, self-compassion, emotion regulation, self-efficacy, as well as their perceived pupil-teacher relationship and classroom climate quality. Chapter 4 presents the results of the main RCT (n = 146 teachers) and answers the following research questions: Does participation in a standard MBSR training lead to a decrease in perceived stress and an enhancement in well-being among elementary school teachers? To what degree do mindfulness skills, emotion regulation, and self-compassion serve
19 General Introduction as secondary proximal outcomes in the context of MBSR training? To what degree do teacher self-efficacy and their perceived pupil-teacher relationship and classroom climate quality serve as secondary distal outcomes in the context of MBSR training? Are the effects of the MBSR training moderated by factors such as past or present psychological problems, school weight, years of teaching experience, and age? Chapter 5 describes the possible mediating processes underlying the effectiveness of the standard MBSR program on elementary school teachers. The research question in this chapter is: To what extent do mindfulness skills, self-compassion, emotion regulation, and teacher self-efficacy serve as possible mediators that explain the effects of the MBSR program on perceived outcomes? Chapter 6 describes an explorative qualitative study (n = 46). The research question in this chapter is: How do elementary school teachers perceive the impact of a standard eight-week MBSR program on their personal functioning, professional functioning, pupil-teacher relationship and classroom climate quality? Chapter 7 provides a summary of the main findings, followed by a general discussion of the results in the context of the current literature. It addresses the strengths and limitations of the research project, providing directions and implications for future research. 1
“Can’t stop” said Tiny Dragon “so much to do!” “If you slow down and pay attention’’ said Big Panda, “you will find hidden within the most mundane tasks the peace that you are seeking.” ― James Norbury, Big Panda & Tiny Dragon
Chapter 2 Mindfulness-Based Stress Reduction intervention for elementary school teachers: a pilot study This chapter is based on Lensen, J. H., Stoltz, S. E. M. J., Scholte, R. H. J., Speckens, A. E. M., and Kleinjan, M. (2022). Mindfulness-Based Stress Reductie interventie voor leerkrachten in het basisonderwijs: Een pilotstudie. Orthopedagogiek: Onderzoek en Praktijk, (SintNiklaas: Gompel & Svacina), 36–48.
ABSTRACT In primary education, more than half of all teachers experience a heavy workload which is often accompanied by detrimental health consequences. Compared to other professions, both the rate of sick leave and the chance of developing mental health problems are overrepresented among elementary school teachers. Despite the strong need to reduce the experience of stress among elementary school teachers, research on stress reduction in this particular population is relatively scarce. Previous studies in the general population have shown that practicing mindfulness significantly reduces stress. The present pilot study examined whether completing an 8-week Mindfulness-Based Stress Reduction (MBSR) training by elementary school teachers was associated with decreased levels of perceived stress, and improvements in mental health, mindfulness skills and self-compassion. It was also examined for whom the MBSR training could be most effective. The total research sample consisted of 71 elementary school teachers. Questionnaires were administered immediately before and after the training. Analyses revealed a significant reduction of perceived stress as well as significant increases in mental, emotional and social well-being, and in mindfulness skills and self-compassion, after completing the MBSR training. We also found indications that the training might exert a larger effect on a) teachers who have had, or currently have, symptoms of mental health problems, and/or, b) teachers who worked in schools with more complex pupil populations. The results of this pilot study provide the first indications that elementary school teachers do benefit from MBSR training. Additional research with a larger sample size and a stronger design with a control group included is needed to obtain more clarity about the potential of MBSR training as an intervention to reduce levels of stress and to ameliorate mental health problems among elementary school teachers.
23 Mindfulness-Based Stress Reduction intervention for elementary school teachers: a pilot study INTRODUCTION In recent years, the profession of elementary school teaching has come under increasing pressure. According to Grinsven et al. (2016), 56% of teachers indicate that they are experiencing an unacceptably high workload. This pressure encompasses not only the substantial number of tasks but also the emotional demands inherent in the work (Jennings, 2017). The ability of a teacher to manage this emotional burden is directly linked to the level of stress they experience. Roeser et al. (2013) conducted research involving 113 elementary and secondary school teachers in Canada and the United States, revealing that the capacity of teachers to cope with stress and regulate their emotions significantly impacts their mental health. The study established a correlation between these factors and feelings of anxiety, depression, exhaustion, and burnout. According to the Transactional Model of Stress and Coping proposed by Lazarus (1991), the intensity of an emotion is determined by how one interprets a stressor along with their ability to regulate emotions. Consequently, prolonged exposure to negative emotions triggered by external stressors contributes to feelings of stress (Roffey, 2012). The stress experienced by teachers can result in failure or premature departure from the profession. This is evidenced by a significant percentage of absenteeism and burnout symptoms among elementary school teachers (Algemene Onderwijsbond, 2020). Additionally, statistics show that one in five of the starting teachers leave the education sector within five years, while one in eight teachers actively seek employment outside of education. The primary reasons cited for this trend are workload and the associated stress levels (TNO/Statistics Netherlands, 2015; TNO, 2019). Furthermore, the World Health Organization (WHO, 2011) has made a concerning prediction that stress will become the number one health hazard by 2030. Consequently, there is an urgent need to explore sustainable interventions aimed at reducing stress in the education sector. Consequences of stress Persistent stress among teachers has negative consequences for their mental health and overall well-being (Roeser et al., 2013). Additionally, stress can adversely affect cognitive and social functioning, such as reduced (working) memory function, impaired planning abilities, and quicker loss of self-control (Arnsten, 2009). Since these effects can manifest in stressful educational settings, they can detrimentally impact the skills required for effective teaching and classroom management (Meiklejohn et al., 2012). Furthermore, stress not only affects teachers’ well-being and skills but also their relationships with pupils. A review study by Spilt et al. (2011), which summarized the findings of 99 studies from international literature across primary and secondary education, indicates that teacher stress negatively influences the pupil-teacher relationship, and vice versa. A poor pupil-teacher relationship indirectly affects the mental health and well-being of the teacher as well (Collie et al., 2017). It leads to undesirable pupil behaviors, lack of motivation, and decreasing academic performance (Roffey, 2012; Spilt et al., 2011), which 2
24 Chapter 2 in turn can increase the stress experienced by teachers (Jennings et al., 2017). Given the advisory and supportive role played by internal and external educational psychologists in assisting elementary school teachers, it is crucial to disseminate newly acquired insights into stress prevention. This is especially important as it not only positively impacts teacher functioning but can also have ripple effects on the pupil-teacher relationship and pupil performance. Reducing stress Although there is a significant need in the workplace to mitigate the stress experienced by teachers, there has been minimal worldwide research conducted on ways to reduce stress specifically among elementary school teachers. A meta-analysis of 65 independent studies on teacher stress experience, of which only 17 pertained to elementary school teachers, suggests that improved emotion regulation can be key to stress reduction (Jennings et al., 2017). Skills such as insight into one’s own emotions and thoughts, and the ability to effectively regulate these emotions and thoughts during teaching, contribute to reducing experienced stress. Teachers who possess these skills are better equipped to develop supportive relationships with their pupils, experience more positive emotions, exhibit greater mental resilience, and achieve higher levels of job satisfaction. Mindfulness-Based Stress Reduction (MBSR) A promising method to improve emotion regulation and reduce experienced stress is Mindfulness-Based Stress Reduction (MBSR), developed by Jon Kabat-Zinn (2013). He defines mindfulness as “being attentive in a special way: being consciously present in the here and now, without judgment.” Mindfulness can contribute to stress reduction by enhancing insight into thought patterns, fostering emotional awareness, and facilitating emotion regulation (Meiklejohn et al., 2012). A meta-analysis of 29 studies involving healthy adults demonstrates that participation in a mindfulness intervention significantly decreases stress perception and has a moderate effect on reducing depressive and anxiety symptoms, as well as improving quality of life (Khoury et al., 2015). The results of a meta-analysis involving more than 12,000 individuals with disorder-specific symptoms in psychiatry, such as depression, support the notion that mindfulness-based interventions are as effective as other evidence-based psychological and psychiatric treatments (Goldberg et al., 2018). Additionally, other studies have shown promising effects on worrying, attention, emotion regulation, personal performance, and empathy (Meiklejohn et al., 2012). An overview article by Tang et al. (2015) further confirms the positive effect on emotion regulation. Specifically, participants in an eight-week MBSR training exhibited an increase in gray matter density in the hippocampus compared to the control group, an area associated with emotion regulation. Furthermore, participants reported reduced emotional reactivity to unpleasant situations, decreased psychological reactivity, and quicker recovery to emotional stability following a stress response.
25 Mindfulness-Based Stress Reduction intervention for elementary school teachers: a pilot study Mindfulness among elementary school teachers To date, hardly any international research has been conducted into the effectiveness of mindfulness among elementary school teachers. Research in this field in the Netherlands is completely lacking. The research by Jennings et al. (2017) among 224 American k-5 teachers (similar to primary education) is the largest research to date. The research shows promising results. Compared to the control group, the intervention group shows significant reduction in experienced stress, perceived time pressure and an improvement in mindfulness and emotion regulation through self-reporting. In addition, the teachers in the intervention group indicate that they experience more self-awareness (96%), an improvement in mental health and well-being (88%) and less work stress (66%). They also report coping more effectively and compassionately with the behavior of their pupils (86%). Previous studies, in which a mix of teachers from various forms of education participated, reveal similar findings (Roeser, 2016; Roeser et al., 2012; Skinner & Beers 2016). For example, it appears that when teachers can use mindfulness skills, they are better able to estimate and respond to emotionally provocative situations in the classroom. This reduces the stress experienced and improves mental well-being. Investing in sustainable stress reduction for elementary school teachers is necessary, particularly due to the negative consequences of persistent stress. In the absence of such research in the Netherlands, we conducted an initial pilot study to investigate the effects of an MBSR training aimed at reducing stress experienced by 71 elementary school teachers. Following the training, it was anticipated that teachers would experience reduced stress levels and improvements in mindfulness skills, self-compassion, and mental health. Since elementary school teachers comprise a diverse group, some teachers may derive greater benefits from the MBSR intervention than others. For instance, teachers at urban schools often encounter more stress due to working with complex pupil populations compared to teachers in rural areas (Ouellette et al., 2018). Therefore, teachers working with more complex pupil populations might derive greater benefits from the intervention. Additionally, it’s possible that teachers who have experienced psychological issues or currently experience psychological complaints may also benefit more from the MBSR training (Goldberg et al., 2018). 2
26 Chapter 2 METHODS Procedure Teachers who were interested and met the following criteria were able to register via an online system at a teacher training college (Pabo) in Rotterdam: a) teaching at least two days in the same group between the start of the school year and the end of MBSR training. b) not have previously completed mindfulness-based training totaling more than 4 hours. An intake interview was conducted with all teachers by the MBSR trainer. The pilot was divided into four starting periods spread across two school years, allowing teachers to begin training in September 2017 and 2018, as well as March 2018 and 2019. During the online registration process, teachers were asked to provide the name of their school, enabling linkage to the school’s socioeconomic status (SES) weight. This weight percentage is publicly available and can be obtained free of charge. Subsequently, it was found that 73% of teachers taught at schools with less than 17% pupils with low SES weight, while 27% taught at schools with more than 17% pupils with a low SES weight. During the telephone intake interview, participants were asked about their current psychological well-being and whether they had experienced psychological complaints in the preceding period. Participants As depicted in Table 1, 71 teachers from 23 different schools in Rotterdam and the surrounding area participated in the study (M age = 40.7 years; SD = 11.4). They were enrolled between September 2017 and March 2019. The participants’ teaching experience in primary education ranged from 1 to 40 years (M work experience = 14.9 years; SD = 10.5). For this study, we examined the average percentage of school weight1 among elementary schools in the municipality of Rotterdam, which remained at 17% throughout the study period.
27 Mindfulness-Based Stress Reduction intervention for elementary school teachers: a pilot study Table 1. Characteristics of the total research group Percentage (n =71) Male 4 Female 96 Psychological complaints Not have (had) psychological complaints 48 Current and/or past psychological complaints 52 Work place/weighted pupils 2 < 17% weighted pupils in school 73 ≥ 17% weighted pupils in school 27 Teachers’ work experience ranges from 1 year to 40 years (M = 14.9; SD = 10.5). Intervention The intervention involves MBSR based on the program developed by Kabat-Zinn (2013). It consists of a group training with 6-15 participants, comprising eight weekly two-hour sessions and a silent day. The training includes psychoeducation, interactive exercises, as well as various forms of meditation and yoga (see Table 2). The trainer was a certified category-1 trainer, trained at the Radboudumc Center for Mindfulness and affiliated with the Association Mindfulness-based Trainers Netherlands and Flanders. The following outcome measures were addressed: Measurements Perceived Stress: Perceived Stress Scale (PSS, Cronbach’s α = .83-.90; 10 items; 5-point Likert scale ranging from 1 “never” to 5 “very common”) (Cohen et al., 1983). This questionnaire assesses the overall stress level experienced in the past month, capturing perceptions of unpredictability, uncontrollability, and overload in life. Sample questions include: “In the last month, how often have you felt upset by something happening unexpectedly? and “Have you felt nervous and stressed?”. Mindfulness skills: Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF, Cronbach’s α = .85-.86; 24 items; 5-point Likert scale ranging from 1 “never or very rarely true” to 5 “very often or always true”) (Baer et al., 2008). This questionnaire assesses five mindfulness skills associated with mental health: observing, describing, acting with awareness, non-judging, and non-reactivity. It consists of statements such as: “ It’s hard for me to find the words to describe what I’m thinking “ and “I find it difficult to stay focused on what’s happening in the present moment “. Self-compassion: Self-Compassion Scale-Short Form (SCS-SF, Cronbach’s α = .82- .84; 12 items; 7-point Likert scale ranging from 1 “almost never” to 7 “almost always”) 2
28 Chapter 2 (Neff & Vonk, 2009). This questionnaire assesses the level of self-compassion, which is associated with mental health. Respondents rate each statement on a scale, with items including: “If I fail at something important to me, I become consumed by feelings of inadequacy” and “I try to be understanding and patient toward aspects of my personality I don’t like.” Mental Health: Mental Health Continuum-Short Form (MHC-SF, Cronbach’s α = .88- .89; 14 items; 6-point Likert scale ranging from 1 “never” to 6 “every day”) (Lamers et al., 2011). This questionnaire assesses the emotional well-being, social well-being, and psychological well-being of the teacher. Sample questions include: “In the past month, how often did you feel that your life has a sense of direction or meaning to it?” and “In the past month, how often did you feel that you had warm and trusting relationships with others?”. Analysis strategy For the analysis, descriptive statistics were first calculated for the research group. Additionally, correlations were computed between all descriptive data and outcome measures to provide insight into the univariate relationships between variables. Paired t-tests were conducted to assess differences in perceived stress, mindfulness skills, self-compassion, and mental health between pre- and post-measurements. To compare elementary school teachers with and without psychological complaints, as well as those working in schools with pupil-weights below 17% or above-average pupil weights, repeated measures ANOVA was employed. This analysis included one betweenparticipants factor (subgroup) and one within-participants factor (time; pre-post), aiming to determine whether the intervention yielded more favorable outcomes for certain groups of teachers. Of the 71 teachers, 3 did not complete the questionnaire after the intervention due to absence from the final meeting, where the last data collection occurred. Although this dropout rate was very low, chi-square tests and t-tests were conducted to examine whether there was selective dropout. Results indicated selective dropout occurred. All analyses were performed using SPSS (version 27). RESULTS Descriptive Data Firstly, the descriptive characteristics of the teachers were examined (see Table 1). The majority of the teachers were women, with just over half reporting current and/or past psychological complaints. Additionally, about a quarter of elementary school teachers taught at schools with a pupil weight of 17% or more. Nearly half of the teachers (47%) reported no current or past mental health issues. Furthermore, it was found that 4% of teachers experienced mental health problems for the first time at the time of intake, while 22% had experienced psychological problems both at intake and in the past.
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