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Effect of mindfulness training on attention, emotion-regulation and risk-taking in adolescence

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DISSERTATION

Effect of mindfulness training on attention, emotion-regulation and risk-taking in
adolescence

Vitaliya Droutman

SUBMITTED TO THE FACULTY OF THE USC GRADUATE SCHOOL in partial
fulfillment of the requirements for the degree DOCTOR OF PHILOSPHY
(PSYCHOLOGY)

Stephen Read, Ph.D., Committee Chair

Antoine Bechara, Ph.D., Committee Member

John Monterosso, Ph.D., Committee Member

Giorgio Coricelli, Ph.D., Committee Member

University of Southern California
December 2015
2

Copyright 2015, Vitaliya Droutman

This document is copyrighted material. Under copyright law, no parts of this
document may be reproduced without the expressed permission of the author

3
Table of Contents
Abstract ......................................................................................................................................................... 5
Acknowledgments ..................................................................................................................................... 7
Effect of mindfulness training on attention, emotion-regulation and risk-taking in
adolescence ............................................................................................................................................. 8
What is Mindfulness? .......................................................................................................................... 9
Change producing mechanisms and neural substrates of mindfulness practice .... 10
Mindfulness training and risk-taking in adolescence ......................................................... 15
Role of mindfulness in reducing health risk behaviors – evidence from smoking
cessation programs for adults .................................................................................................. 16
Existing work on mindfulness effects for youth ................................................................... 17
STUDY 1 ....................................................................................................................................................... 19
Method .................................................................................................................................................... 19
Overview ........................................................................................................................................... 19
Participants ...................................................................................................................................... 20
Procedures ........................................................................................................................................ 20
Materials and Dependent Measures ...................................................................................... 21
Analysis .............................................................................................................................................. 27
Results ..................................................................................................................................................... 28
Time 1 ................................................................................................................................................. 28
Time 2 ................................................................................................................................................. 28
Time 3 ................................................................................................................................................. 29
Summary ................................................................................................................................................ 31
STUDY 2 ....................................................................................................................................................... 32
Method .................................................................................................................................................... 32
Overview ........................................................................................................................................... 32
Participants ...................................................................................................................................... 32
Materials, Procedure, Dependent Measures and Analysis ........................................... 32
Results ..................................................................................................................................................... 33
Time 1 ................................................................................................................................................. 33
Time 2 ................................................................................................................................................. 33
Time 3 ................................................................................................................................................. 33
Summary ................................................................................................................................................ 34
STUDY 3 ....................................................................................................................................................... 34
Method .................................................................................................................................................... 34
Overview ........................................................................................................................................... 34
Analysis .............................................................................................................................................. 35
Results ..................................................................................................................................................... 35
Time 1 ................................................................................................................................................. 35
Time 2 ................................................................................................................................................. 36
Time 3 ................................................................................................................................................. 37
Summary ................................................................................................................................................ 39
STUDY 4 ....................................................................................................................................................... 39
Method .................................................................................................................................................... 39
Overview ........................................................................................................................................... 39
4
Participants ...................................................................................................................................... 40
Material, procedure and analysis ........................................................................................... 40
Results ..................................................................................................................................................... 42
Summary ................................................................................................................................................ 43
DISCUSSION ............................................................................................................................................... 44
Reference .................................................................................................................................................... 48
Appendix A1. Difficulties in Emotion Regulation Scale (DERS) .......................................... 58
Appendix A2. Self-Compassion Scale .............................................................................................. 59
Appendix A3. Mindfulness Scale for Preteens, Teens and Adults (MSPTA) ................... 60
Appendix 4. Adolescent Risk-taking Questionnaire (ARQ) ................................................... 61

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Abstract
Mindfulness training has the potential for improving attention and emotion-
regulation, as well as reducing risk taking - all areas of critical importance during
adolescence. Although significant evidence exists for the above effects and their
neural underpinning in adults, work with adolescents is critically lacking. The
goal of this project is to help fill this gap by examining the effect of mindfulness
training for adolescents on attention, emotion-regulation and risk-taking and their
neural correlates.
The research program consists of four studies. Studies 1 and 2 evaluate
adolescents’ performance on attention, emotion-regulation and risk taking tasks
prior to and immediately following an 8-weeks mindfulness training, and after a
follow up period of eight to ten weeks. Several self-report measures that assess
differences in emotion regulation, risk-taking and the trait of mindfulness are also
administered. Study 1 evaluates a ‘community sample’, children ages 11 through
18, attending conventional middle or high schools, with half participating in
mindfulness training as an after school program offered in the community. Study
2 evaluates teens ‘at risk for negative consequences’, children who did not
succeed at a conventional school and are attending a continuation high school.
This is a randomized controlled study of a mindfulness program offered as part of
the school curriculum. Study 3 combines subjects from Study 1 and Study 2 to
evaluate whether the findings can be generalized while controlling for participant
source and to examine whether there is a difference in the effects on high school
aged participants of Study 1 and Study 2. Study 4 is an imaging pilot study that
6
begins evaluation of the neural substrates that underlie the effect of mindfulness
training on attention, self-regulation and risk taking during adolescence.

7
Acknowledgments
I would like to thank my advisor, Dr. Stephen Read, who has been
tremendously supportive in every possible way throughout my graduate career.
He guided me, but also gave me great freedom in exploring the topics that I am
interested in. I am very grateful for his recognition of my potential and abilities
and how he has helped me in becoming an independent social neuroscientist.
I thank my dissertation committee members, Drs. Antoine Bechara, John
Monterosso, Giorgio Coricelli and Wendy Wood, for their invaluable inputs and
discussions on my dissertation, and for being great role models. I am grateful to
mentorship of Dr. Antoine Bechara who inspired my interest in neuroscience of
decision-making and Dr. Randye Semple who guided my mindfulness research.
I greatly appreciate the support of Drs Stefanie and Elisha Goldstein
whose devotion to mindfulness education for youth was imperative for this
project.
I have been very lucky to have the support of my enthusiastic lab-mate Dr.
Emily Barkley-Levinson and dedicated research assistants Ken Hei Yeung Lam,
Amanda Cheng, Ryan Pham, Ilana Golub and Peter Wong.
I am very grateful to Phoenix school teachers, Anne Scatolini and Kate
Mitchel, and principal, Nancy Huerta, for their dedication to their students and
efforts to improve their students well-being by introducing them to mindfulness.

8
Effect of mindfulness training on attention, emotion-regulation and risk-
taking in adolescence
Demands for attention and executive function (EF) increase dramatically
in middle and high school but no established methods are available to improve
them. This adds to the already high stress levels at this age and leaves many
unprepared and failing in life and in school. Further, adolescence is a period of
heightened emotional reactivity, which has been implicated in the increased risk-
taking that is characteristic of this period (Casey & Caudle, 2013). It seems clear
that children and teens would benefit dramatically from a program that would
help reduce stress and improve attention and self-regulation at the same time. In
the past decade Mindfulness Meditation has been identified as a promising
program to fulfill this role. Mindfulness programs have been implemented in
many schools around the US: Baltimore, MD (Holmes, 2013), Richmond, CA
(Schwartz, 2014), Los Angeles South Bay cities (Kuznia, 2013), just to name a
few.
According to a recent review of mindfulness interventions for youth
‘enthusiasm for promoting such practices, however, outweighs the current
evidence supporting them’ (Greenberg & Harris, 2012, p. 165). It is evident from
the rest of this review that this criticism is not due to the authors’ skepticism
about the potential benefits of mindfulness practice, but rather results from the
complete lack of research that would confirm or refute such benefits for this
population. The goal of this project is to start filling this gap by evaluating the
9
effects of mindfulness training in adolescence on increasing attentional control,
EF, and emotion-regulation, as well as on decreasing risk taking.
What is Mindfulness?
Mindfulness has been described as a non-elaborative nonjudgmental
awareness of the present moment, in which thoughts, feelings and sensations
that arise are acknowledged and accepted as they are (Bishop, 2004). It is
considered to be comprised of two main components,
where the first component is the regulation of attention in order to
maintain it on the immediate experience, and the second component
involves approaching one’s experiences with an orientation of curiosity,
openness, and acceptance, regardless of their valence and desirability
(Holzel et al., 2011, p538).
Although mindfulness originated in the Buddhist tradition, in the last several
decades it became widely accepted in the West as a secular practice. One of
the first and most fundamental clinical applications was the Mindfulness-Based
Stress Reduction Program (MBSR) developed by Jon Kabat-Zinn in 1982 to deal
with chronic pain, and later extended to alleviate the psychological hardship of
chronic illnesses and to help treat emotional disorders (Kabat-Zinn, 1984). Rising
interest in the technique inspired an increase in research on the effects of the
practice in adults, and the literature covers a wide spectrum of outcomes
including changes in physiological and immune systems (Davidson, 2003), better
response to medical treatment (Kabat-Zinn, 1998), and improvements in
attention (Jha et al., 2007). These findings even prompted the initiation of a pilot
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mindfulness program for the US Marine Corps to reduce stress and improve
attention and EF (Associated Press, 2013).
Change producing mechanisms and neural substrates of mindfulness
practice
In a recent review, Holzel and colleagues (2011) suggest that the
beneficial effects of mindfulness practice are due to a combination of several
closely interacting mechanisms and conceptualize four factors that describe most
of these mechanisms and together ‘constitute a process of enhanced self-
regulation’ (p. 539): attention regulation, body awareness, emotion regulation and
change in perspective on the self. For the purpose of this paper we focus mostly
on attention and emotion regulation mechanisms, since those skills are still
developing throughout adolescence and demand for them is very great during
that time.
Attention Regulation.
The most obvious and well-studied component of mindfulness is the
attention regulation mechanism, due to the practice of focused attention that is
often cultivated early in the training. The attention system has been
conceptualized as a combination of three networks: alerting, focused on
producing and maintaining an optimal state of vigilance; orienting, focused on
prioritizing and limiting sensory input; and executive control
1
, focused on target
detection and identifying conflict (Posner & Peterson, 1990). During mindfulness
practice a participant focuses on a single object, most commonly the breath, and

1
Executive control network is also often called conflict-monitoring network. These terms used
interchangeably in the literature
11
is instructed to non-judgmentally bring the attention back to this object when it
wanders off. This practice of maintaining attention on a goal-object while
disregarding distractions requires the recruitment of conflict monitoring or
executive control attention network. Not surprisingly, improved performance of
this network, measured by computerized behavioral tasks, was evident in long-
term meditators (Jha et al., 2007), following MBSR training in adults (Baijal et al.,,
2011) and in children (Goldin et al.,, 2008), after a five day Integrative Mind-Body
training (IMBT, Tang et al, 2007), and even in novices after a 20-minute lab
practice of focused attention (Wenk-Sormaz, 2005).
On the neural level, the anterior cingulate cortex (ACC) is implicated in
conflict monitoring (van Veen & Carter, 2002). Also, the insular cortex (IC)
together with ACC are considered to form a salience network that coordinates
activity in other brain networks and thus is responsible for facilitating cognitive
control (Menon & Uddin, 2010; Sridharan, Levitin, & Menon, 2008). Structural
imaging studies show greater cortical thickness in right anterior insula (Lazar et
al., 2005) and dorsal ACC (Grant et al., 2010), and higher gray matter
concentration in right anterior insula (Holzel et al., 2008) in experienced
meditators compared to novice controls. Moreover, only 11 hours of IMBT
increased the structural connectivity of the ACC with striatum and other
structures (Tang et al., 2010). Functional imaging studies provide evidence of
increased recruitment dorsal anterior IC (Farb et al., 2013) during mindfulness
practice compared with controls.
12
In addition to the executive attention network described above,
improvement in the orienting attentional network (limiting attention to a subset of
inputs) was evident following 8-week MBSR training (Jha et al., 2007). Also,
alerting network (achieving and sustaining an alert state of preparedness)
proficiency was greater in experienced meditators after retreat (MacLean et al.,
2010, Jha et al., 2007).
Emotion Regulation.
The impact of mindfulness training on emotion regulation seems to spring
from being non-judgmental and focused on accepting our feelings, emotions and
thoughts. Also, due to the strengthening of emotional awareness, affective stimuli
or rising feelings can be detected earlier, which allows for earlier engagement of
emotion regulation before intense emotional responses occur (Taper et al.,
2013). Taper and colleagues suggest that mindfulness “focuses on changing a
person’s relationship to his or her emotions rather than the nature of the
emotions themselves” (p. 450). It teaches practitioners to experience emotions
differently by maintaining a non-judgmental focus on somatic sensations
representing emotions, rather than on the ‘story’ connected with the emotion;
hence, it reduces habitual cognitive reactions like rumination and thus improves
emotion regulation.
A growing body of research provides evidence for the improvement of
emotion regulation as a result of mindfulness training. For example, Ortner and
colleagues (2007) examined the effect of a 7-week mindfulness training program
on emotional interference, assessed as a delay in response time (RT) on a
13
cognitive task after being presented with affective images. They found a
reduction in RT delay (consistent with improved emotion regulation) for the
mindfulness group in comparison with relaxation meditation and wait list control
groups.
In their review of emotion regulation research, Ochsner and Gross (2008)
reviewed 16 studies focused on down-regulation, up-regulation and maintenance
of emotion evoked by visual stimuli. The evidence presented suggests increased
activation in lateral and medial prefrontal cortex (PFC), and anterior cingulate
cortex (ACC) independent of the direction of the regulatory focus. However,
activation in emotion systems (consistently amygdala, in a few instances insula)
was sensitive to the direction of regulatory focus and was modulated according to
appraisal goals (reduced in down-regulation conditions and increased in up-
regulation and maintenance conditions). We will now examine the evidence
suggesting that PFC, ACC, amygdala and insula, the components identified
above as key for emotion regulation, play a role in mindfulness practice.
The effect of mindfulness on ACC has been discussed earlier in connection
with attention regulation; it is likely that its conflict-monitoring role extends to
identifying incongruity between current affective state and the cognitive goal.
Holzel et al. (2007) found greater activation in dorso-medial PFC and rostral ACC
while comparing long-term meditators with non-meditators during mindfulness
exercise. Also, increased activity in ventro-lateral PFC was evident following an
8-weeks MBSR course (Farb et al., 2007).
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Several studies examined the mediating role of dispositional mindfulness
(as measured by a self-report scale) on neural activation. Specifically, Creswell
et al. (2007) found that during affect labeling, dispositional mindfulness predicted
increased activation in lateral PFC and reduced activation in amygdala. Similarly,
Modina et al. (2010) found that during cognitive emotion regulation, an increased
tendency to be mindful correlated positively with activation in dorso-medial PFC.
Fascinating insights come from Taylor and colleagues (2011), who
examined the impact of mindfulness on neural responses to emotional pictures in
experienced and beginning meditators. The experienced meditators had at least
1000 hours of practice, and novices were asked to perform guided mindfulness
meditation on their own for seven days prior to the imaging evaluation. During the
experiment the participants viewed images in a baseline state (without attempting
to modulate attention) and in a mindful state (instructed to mindfully attend to the
stimuli). No between groups differences in neural activity were observed in the
baseline state. Further, for both groups emotion regulation was improved in the
mindfulness state compared to the baseline; however, neural mechanisms for
this effect differed between the groups. For experienced meditators attenuation in
emotional response was achieved due to deactivation of the default mode
network (DMN), specifically in medial PFC and posterior cingulate cortex (PCC),
and for beginners due to down-regulation of the amygdala. In addition,
‘behavioral response data revealed that mindfulness attenuated emotional
intensity perceived from all valence categories of pictures across the entire
sample of participants’ (p. 1530).
15

Mindfulness training and risk-taking in adolescence
Until very recently the heightened risk-taking in adolescence was
explained by different timetables of development of the neural components
critical to reward-processing, impulsivity and self-control (Steinberg, 2010; van
Leijenhorst, et al., 2010). Results of neuroimaging studies suggest that the
Impulsive system, engaged during reward processing, is fully developed by
adolescence, but that the Reflective system responsible for self-control is not
fully developed until the mid twenties (Steinberg, 2007; Galvan et al., 2006).
However, a recent review of neuroimaging work on self-control in adolescence by
Casey and Caudle (2013) provided a further explanation of the neural
mechanisms that result in increased adolescent risk-taking. A set of studies
conducted by their lab utilized an emotional Go-NoGo task (described in detail
further in this paper) to examine the ‘neural correlates of self-control in the face
of emotional and non-emotional cues’ (p.85). They ‘found that the ability to
suppress a habitual response, regardless of emotional content, relied on the
ventrolateral prefrontal cortex’ (p. 85). Both activity in this region and behavioral
performance linearly increased with age (children, teens and adults were
evaluated in the study) and were positively correlated. Moreover, other studies of
self-control show that many adolescents perform as well as adults, and some
perform even better when no emotional information is present (Hare et al., 2008;
National Research Council, 2011). However, when faced with emotional stimuli
adolescents show a deficit in inhibiting an approach reaction to a positive
16
emotional cue in comparison with both children and adults (Somerville et al.,
2011). Casey and Caudle conclude that the prefrontal control system, although
not fully developed, is already quite capable of performing the necessary role, as
evidenced in adolescent’s performance in non-emotional contexts. However,
they suggest that increased emotional reactivity in adolescence may overwhelm
this still less mature system, which results in increased risk-taking in adolescence
when in emotional contexts.
Considering the previously discussed effects of mindfulness on emotion
regulation, we suggest mindfulness may reduce risk-taking behavior in
adolescents by reducing emotional reactivity and facilitating suppression of
approach behaviors in the face of emotional stimuli.
Role of mindfulness in reducing health risk behaviors – evidence from
smoking cessation programs for adults
Further evidence connecting mindfulness and reduced risk-taking stems
from research on effects of mindfulness practice on behaviors associated with
health risk such as smoking. Half-dozen nonrandomized pilot studies of
mindfulness-based smoking cessation programs (Altner, 2002; Witkiewitz et al.,
2005, 2010; Davis et al., 2007; Bowen and Marlatt 2009) showed promising
results. This was followed by a randomized controlled study (Brewer et al., 2011)
that confirmed their findings that ‘mindfulness training was associated with
reduction in smoking and improvements in biochemically validated abstinence,
both immediately after treatment and at 17-week follow-up, in comparison to a
standard behavioral cessation paradigm’ (Westbrook et al., 2013, p. 73). They
17
suggest that mindfulness facilitates smoking cessation through reducing craving
in response to smoking cues. Most recently a neuroimaging study (Westbrook et
al., 2013) provided evidence for the possible neural mechanism that underlies
the effect. Their findings are particularly intriguing because the participants were
not familiar with mindfulness, not having participated in mindfulness training
before the imaging evaluation. Their findings resulted from comparing neural
responses to smoking related images viewed in two conditions: a baseline
condition in which participants are instructed to relax and view the pictures
naturally, and a mindful attention condition in which ‘participants were instructed
to actively focus on their responses to the picture, including thoughts, feelings,
memories and bodily sensations, while maintaining a nonjudgmental attitude
toward those responses’ (p. 76). They found reduced self-reported craving in the
mindful attention condition compared to baseline, and, when contrasting BOLD
activity in mindful vs. baseline conditions, deactivation of subgenual ACC/ventro-
medial PFC was evident. Most importantly, they found reduced functional
connectivity between the ACC seed region and other craving related areas
(posterior IC, premotor cortex and ventral striatum) ‘suggesting that mindfulness
may decouple craving neurocircuitry when viewing smoking cues’ (p. 73).
Existing work on mindfulness effects for youth
A recent meta-analysis of mindfulness interventions with youth

(Zoogman
et al., 2014) found mindfulness interventions to be helpful and superior to active
control. However out of more than 20 studies examined in that paper, only two
18
assessed attention and one emotion-regulation improvements; the rest focused
on physiological changes, reduction of clinical symptoms and overall wellbeing.
In their recent review of Mindfulness interventions for school aged children
Greenberg and Harris (2012) conclude:
Although these models hold promise, they are pilot studies that are
inconclusive and point to the need for larger, well-designed trials. In all
cases, findings were reported only at post-test (no follow-up), and most
used self-report measures or the reports of adults aware of student
participation (p. 4).
They further recommend ‘developing more rigorous scientific base’ by designing
studies that can provide high-quality evidence. We couldn’t agree more; the
present proposal is partially a response to Greenberg and Harris’ as well as to
the paucity of the research on mindfulness’ effects for youth. The current
research program consists of four studies. Studies 1 and 2 evaluated
adolescents’ performance on attention, emotion-regulation and risk taking tasks
prior to and immediately following 8-weeks mindfulness training, and after follow
up period of eight to ten weeks. Several self-report measures that assess
differences in emotion regulation, risk-taking and the trait of mindfulness are also
administered. Study 1 evaluated a ‘community sample’, children ages 11 through
18, attending conventional middle or high schools, with half participating in
mindfulness training as an after school program offered in the community. This
was a nonrandomized study; the experimental group was recruited from
participants of the after-school mindfulness class, and the control group from
19
non-participating children in the same community. Study 2 evaluated teens ‘at
risk for negative consequences’, children that did not succeed at a conventional
school and are attending a continuation high school. This was a randomized
controlled study of mindfulness program offered as part of the school curriculum.
Study 3 examined whether there was a difference in the effects on high school
aged participants of Study 1 and Study 2. Study 4 was an imaging pilot study that
begins evaluation of the neural substrates that underlie the effect of mindfulness
training on attention and self-regulation during adolescence.
STUDY 1

Method
Overview
The present study examined effects of mindfulness training on attention,
EF, emotion-regulation and risk-taking in adolescents, ages 11 through 18.
CALM (Connecting Adolescents to Learning Mindfulness) program, developed
specifically for this age group and based on the well-researched Mindfulness
Based Stress Reduction (MBSR, Kabat-Zinn, 1994) program, served as the
mindfulness intervention. We emploed a 2 (treatment: CALM training vs. no-
treatment control) X 3 (time: pre-training, immediately post-training, 8-10 weeks
post-training follow up) design to ensure that improvements in performance are
not due to learning and prior experience with tasks, nor due to growth and
maturation. This design also allows for assessing whether the changes persist
past training. We evaluated changes in attention and EF with the Attention
Network Task (ANT, Fan et al., 2002) that was successfully used in the past with
20
children (Goldin, Saltzman, & Gross, 2006) and adults (Jha, Krompinger, &
Baime, 2007) to detect mindfulness training related changes in attentional
networks. Improvement in emotion regulation assessed by the Emotional Go-
NoGo task (Hare et al., 2005) and the Difficulty in Emotion Regulation scale
(DERS, Gratz et al., 2004). We examined potential change in risk-taking by
performance in the Stoplight task (Chein, Albert, O’Brien, Uckert, & Steinberg,
2011) and responses to The Adolescent Risk-Taking questionnaire (ARQ,
Gullone, Moore, Moss, & Boyd, 2000). To assess differences in trait mindfulness
we used the Self-Compassion Scale (SCS, Raes, Griffith, Gucht, & Williams,
2014) and the Mindfulness Scale for Teens and Adults (MSPTA, Droutman &
Read, in prep).
Participants
CALM is currently offered at InsightLA (ILA) in Santa Monica as an after
school activity. Classes are taught separately for middle school children, ages 11
to 13, and high school students, ages 14 to 18. We have recruited 53
participants (38 from high school classes and 15 from middle school classes).
Forty-two participants have completed the 8-week program and at least two
evaluations (21% attrition rate). We have also recruited 32 adolescents from the
community to serve as a no-treatment control group, 30 completed at least 2
assessments.
Procedures
CALM program participants were evaluated three times: prior to the 1
st

CALM session, after the last CALM session and eight to ten weeks after the last
21
CALM session. The participants from the control group will be evaluated on a
matching schedule.
For each of the evaluation sessions, participants completed the
questionnaire packets at home prior to the testing session. Packets included
measures to evaluate emotion regulation (DERS) and risk preference (ARQ

), as
well as evaluation of the trait of mindfulness (SCS, MSPTA). The initial testing
was performed prior to training on the 1
st
training day. Second testing was
performed on the last training day, after the end of class. The 3d session was
performed 8-10 weeks after the end of the training. During the evaluation
participants performed ANT, the Emotional Go-NoGo task and the Stoplight task.
At the end of each evaluation participants received a monetary reward for their
efforts that includes a performance-based bonus for their performance on the
Stoplight task.
Materials and Dependent Measures
Mindfulness Training – CALM Program. CALM was developed by Drs.
Stefanie and Elisha Goldstein, mindfulness trained teachers and licensed clinical
psychologists who adjusted the original adult program age-appropriately. The
program consists of eight weekly 90-minute sessions and a daylong retreat. It
provides audio recordings of mindfulness meditations and strongly encourages
daily practice, both formal and informal. The curriculum closely mirrors the
Mindfulness Based Stress Reduction (MSBR, the industry standard for
mindfulness research) program (Kabat-Zinn, 1994) and is accessible and
engaging for children ages 11 through 18.
22
Attention Network Task (ANT). This task identifies three attentional
components: alerting, orienting and conflict monitoring (aka executive control).
‘Alerting is defined as achieving and maintaining an alert state; orienting is the
selection of information from sensory input; and executive control is defined as
resolving conflict among responses’ (Fan et al., 2002, p. 340). The nature of
mindfulness training should solicit improvements in at least two of these systems.
Specifically, mindfulness improves awareness of all sensory inputs and thus
should improve the performance of the orienting component. During the
mindfulness practice participants are instructed to focus on physical sensations
such as breathing and when attention wanders to bring it back to the object of
meditation. In essence, such practice is a conflict detection and resolution
exercise (conflict in this case can be defined as sustaining attention on the object
of meditation vs. being distracted). Due to people’s natural tendency of mind
wandering, practitioners (especially those less experienced) usually go through
hundreds of instances of this process during even a short meditation exercise,
thus training their conflict monitoring system. Therefore we expect an
improvement in this component as well. Existing
literature corroborates these expectations;
improvement in orienting component in adults (Jha et
al., 2007) and conflict monitoring component in
children (Goldin et al., 2006) were found in previous
studies.
Figure 1
23
During this task participants are required to identify the direction of the
central arrow in a set of five arrows, while the surrounding arrows either point in
the same (congruent condition) or the opposite (incongruent condition) direction.
Conflict monitoring is assessed as a difference in response time (RT) between
incongruent and congruent conditions, lesser RT difference indicating better
performance. Appearance of the arrows is preceded by one of four cues (spatial
cue, center cue, double cue and no cue, Figure 1). The orienting network is
assessed as difference in RT between trials with center cue and spatial cue,
larger RT difference indicating better performance. The alerting component is
assessed as RT difference between no cue and double cue condition, with larger
RT difference indicating better performance. The task consists of 96 trials
randomized but balanced evenly across conditions as follows: 2 positions (upper
or lower part of the screen) X 2 central arrows directions X 3 flanker conditions
(congruent, incongruent, none) x 4 cues. Each trial is timed as follows. First
subject is presented with fixation cross for 400-1700ms (original fixation time,
randomly selected), followed by a cue condition for 100ms, followed by fixation
cross for 400ms. Next, the arrows are displayed either on upper or lower part of
the screen. The participant is expected to press an arrow corresponding to the
center arrow of the stimulus. The response is awaited for no longer than 1700ms.
As soon as the response is provided the image is cleared and a fixation cross is
displayed for 3500ms-response time - original fixation time.
Emotional Go-No-Go Task. This is a version of the Go-
NoGo task with emotional faces as stimuli, based on Hare et
24
al. (2008). During this task the participant sees a word identifying an emotion
(happy, fear or calm), followed by a set of faces, and is asked to press a button
when the facial expression matches the emotion identified by the word preceding
the set (Go) and to do nothing for any other emotion (NoGo) (Figure 2). This task
evaluates impulse control and response inhibition both in ‘cold’ and ‘hot’
contexts. By contrasting the performance in neutral vs. emotional contexts it
provides a measure of emotion regulation. Specifically, trials that require
participants to press the ‘go’ button when confronted with negative emotional
stimulus entail overcoming a natural avoidance response. Prior work shows that
participants take more time on such trials (Hare et al., 2005), thus, decreasing
RT difference between trials where the go-emotion is fear and trials where the
go-emotion is calm will serve as a measure of improvement in emotion
regulation. Likewise, trials that require withholding a button press in response to
a happy face demand suppressing an approach reaction to a positive stimulus; it
has been shown that participants have more false alarms when inhibiting
responses to happy faces (Hare et al, 2005). Therefore decreasing the difference
between the false alarms rate (FAR) in trials with happy as the NoGo-emotion
will serve as the 2nd measure of improvement in emotion regulation. The task
consists of four blocks of 48 trials each, with 75% of the trials being ‘Go-trials’ for
all subjects in each block (see Table 1 for condition details). The order of blocks
was pseudo-randomized (each participant was randomly assigned one of the
four possible order combinations). The image set consists of six female faces (2-
Caucaisan, 2-African American and 2 Asian) and six male faces (4 Caucasian, 2-
25
African American)
2
. Models 6, 8, 11, 14, 15,16, 23, 28, 36, 37, 39 and 43 from
the NimStim set were used (Tottenham et al., 2009). Faces were presented for a
maximum of 500ms with inter-trial interval of 1.5s.
Table 1
Go Emotion NoGo Emotion
Block A Calm Fear
Block B Fear Calm
Block C Calm Happy
Block D Happy Calm

Stoplight task, a driving simulation task used in the adolescent risk-taking
literature. During this task participants need to drive through 20 stoplight
intersections while trying to complete the driving route as soon as possible for
maximum reward. At each intersection they face a yellow stoplight and must
decide to stop or continue through. If they stop they lose a set amount of time,
whereas if they run the yellow light they risk getting into a crash that delays them
even more than stopping does. Participants are told that unlike real life they are
not encouraged to stop on every yellow light and can decide how many times
they want to stop and how many times to run through. Risk-taking will be
assessed by the number of risks taken (driving on a yellow light).
Difficulties in Emotion Regulation Scale (DERS) was developed as a
comprehensive measure to evaluate emotion regulation ‘involving not just the
modulation of emotional arousal, but also the awareness, understanding, and
acceptance of emotions, and the ability to act in desired ways regardless of
emotional state’ (Gratz and Roemer, 2004, p. 41). It consists of 36 items in six

2
The data set did not include an Asian male model with required facial expressions
26
subscales: non-acceptance of emotional responses (NONACCEPTANCE), lack
of emotional awareness (AWARENESS), lack of emotional clarity (CLARITY),
impulse control difficulties (IMPULSE), limited access to emotion regulation
strategies (STRATEGIES) and difficulties engaging in goal-directed behavior
(GOALS). With the first two subscales mirroring the two facets of mindfulness,
awareness and acceptance of the present moment (including emotional
awareness and acceptance), this scale fits perfectly to the goal of this project –
evaluating potential improvements in self-regulation as a consequence of
mindfulness practice. Not surprisingly, use of this scale in previous studies
evaluating the effect of mindfulness provided evidence of improvement in
emotion regulation both in adults (Leahey et al., 2008) and children (Broderick
and Metz, 2009). For each item participants are asked to indicate how often the
statement is true for them on a 5-point Likert scale from ‘almost never’ to ‘almost
always’. Higher scores indicate more difficulty in regulating emotions. For ease of
reading and interpretation we reverse-scored this scale and its components and
transformed it to emotion regulation ability scale (ER).
The Adolescent Risk-taking Questionnaire (ARQ) consists of 22 behavior
items that fall into four sub-scales: thrill-seeking behaviors, rebellious behaviors,
reckless behaviors and antisocial behaviors. For each of the behaviors
participants answer two questions: ‘how likely is it for you to engage in the
behavior’ and ‘how risky do you think this behavior is’ on a 5-point Likert scale
(from ‘quite unlikely’ to ‘very likely’, and from ‘not risky at all’ to ‘very risky’
27
respectively). Thus, it measures both risk perception and the likelihood of risk
taking.
Self-Compassion Scale – Short Form (SCS-SF) will be used to assess the 2nd
main component of mindfulness, being non-judgmental. The 12-item scale
consists of six factors: self-kindness, self-judgment, common-humanity,
mindfulness (or balance) and over identification with negativity and failure. For
each item participants are asked to indicate how often the statement is true for
them on a 5-point Likert scale from ‘almost never’ to ‘almost always’.
Mindfulness Scale for Preteens, Teens and Adults (MSPTA). We have
designed this scale to measure four main facets of mindfulness with one
instrument that would be applicable to both teen and adult populations
(Droutman & Read, in prep). The 24-items scale asks participants to indicate how
true each statement is for them on a 5-point Likert scale from ‘never true ’ to
‘always true’. It is the only scale available that is validated for the full age
spectrum (for ages ten and up) and assesses the main facets of mindfulness:
attention and awareness, being non-reactive, being non self-critical and being
non-evaluative.
Analysis
Time 1 (prior to CALM training) analysis evaluated whether any between
group differences are evident prior to the intervention, either in demographic or
dependent measures using simple t-tests.
At Time 2 (after CALM training) we fitted a series of repeated measures
mixed effect models, utilizing the nlme package in R, to evaluate the difference in
28
performance change between experimental and control groups from before to
after completion of the CALM training.
Similarly, at Time 3 (8-10 weeks after the end of CALM training) we fitted
a series of repeated measures mixed effect models, using the nlme package in
R, to evaluate the difference in performance change between experimental and
control groups between all three time points.
Results
Time 1
We found significant differences in ratings on the emotion regulation scale
(t= -2.13 p= .036), with control group participants rating higher than experimental
group participants (Mc= 3.47, Me= 3.19). There was also a significant difference
in age (t= -2.63, p= .01) with younger participants in the experimental group (Mc=
15.58, Me= 14.5). Performance on the Go-NoGo task meas ured by overall hit
rate was marginally higher in the control group (Mc= .79) than in the
experimental group (Me = .73, t= -1.89, p= .064).
Time 2
We found a significant time by group interaction for clarity (t=2.02, p=
.048) and awareness (t=2.75, p= .008) components of the ER scale and of the
SCS (t= 2.18, p= .033), indicating improvements for subjects in the experimental
group (see Table 2 for means and SD). Because age was significantly different
between the groups we controlled for age in all models. We found that age had a
significant effect only on SCS score (p= .045). No significant findings were
evident for the ANT and the Stoplight tasks.
29

Table 2. Means (SD) for Aware and Clarity components of the Emotion
Regulation Scale and the Self Compassion Scale.

Aware Clarity Self Compassion
Mindfulness Control Mindfulness Control Mindfulness Control
Time 1 3.36 (.79) 3.46 3.38 (.81) 3.52 (.76) 2.88 (.69) 3.06 (.59)
Time 2 3.70 (.8) 3.33 3.66 (.83) 3.50 (.79) 3.05 (.7) 3.05 (.69)
Time 3 3.85 (.78) 3.41 3.86 (.71) 3.51 (.91) 3.33 (.72) 3.04 (.66)

Examining Go-Nogo results we found a marginal
(p=.06) time by group interaction for false alarm rate
(FAR) difference between happy and fear conditions
(comparing blocks where the NoGo emotion is either
happy or fear). This parameter is a proxy for ability to
down regulate positive emotions in order to suppress
approach reaction to a happy face (see Figure 3 for
regression lines by condition). The effect is due to a slight decrease
(characteristic of improvement) for the experimental group and an increase for
the control group participants.
Time 3
We found a significant time by group interaction for the Self Compassion
(p=. 005), the MSPTA (p= .043) and the ER (p= .049) scales, the AA (p= .002)
component of MSPTA, the aware (p= .017), clarity (p= .009) and strategy (p=
.015) components of ER, indicative of improvement in the experimental group
between time 1 and time 3. Because age was significantly different between the
Figure 3. FAR difference
between Happy and Fear
1 2
time
CALM
Control
30
groups we controlled for age in all models. We found that age had a significant
effect only on SCS score (p= .039).
Table 3. Study 1. Insight LA. Time X group interaction significant at Time 3
MSPTA AA
Strateg
y ER
Mindfulness Control Mindfulness Control Mindfulness Control Mindfulness Control
Time 1 12.52 (2.03) 13.10 (1.7) 3.50 (.71) 3.47 (.49) 3.18 (1.05) 3.63 (.85) 3.19 (.71) 3.47 (.52)
Time 2 12.56 (2.2) 13.65 (.2.26) 3.65 (.61) 3.52 (.5) 3.31 (1.08) 3.59 (.75) 3.38 (.74) 3.52 (.45)
Time 3 13.65(2.22) 13.29 (1.95) 3.89 (.67) 3.28 (.49) 3.52 (.91) 3.49 (.84) 3.57 (.58) 3.52 (.55)

Figure 4. A Significant effect at Time 2 & Time 3. B Significant effect at Time 3

Examining the Go-NoGo results we found a
marginal (p= .094) time by group interaction for a false
alarm rate difference between happy and fear
conditions. Similar to our findings at Time 2, the gap
Figure 5. FAR difference
between Happy and Fear

MSPTA& A'en*on&&&Awareness&(AA)& Strategy&
Self&Compassion&Scale&(SCS)&
Emo*on&Regula*on&(ER)&
Clarity& Aware&
A
B
CALM&training&
group&
Control&group&
1 &&&&&&&&&&&&&&&2&&&&&&&&&&&&&&&3&
&&&&&&&&&&&&&&&&&&*me&
1 &&&&&&&&&&&&&&&2&&&&&&&&&&&&&&&&&3&
&&&&&&&&&&&&&&&&&&*me&
1 &&&&&&&&&&&&2&&&&&&&&&&&&&&&&&3&
&&&&&&&&&&&&&&&*me&
1 &&&&&&&&&&&&&&&2&&&&&&&&&&&&&&&&&3&
&&&&&&&&&&&&&&&&&&*me&
1 & & &&&&&&&&&2&&&&&&&&&&&&&&&&&&3&
&&&&&&&&&&&&&&&&&&*me&
1 & & &&&&&&&&&2&&&&&&&&&&&&&&&&&&&3&
&&&&&&&&&&&&&&&&&&*me&
1 & & &&&&&&&&&&2&&&&&&&&&&&&&&&&&3&
&&&&&&&&&&&&&&&&&&*me&
1 2 3
time

31
between FAR Happy and FAR Fear decreased for experimental group
participants and increased for control group participants (see Figure 5 for
regression lines by condition).
We also found a significant (p= .005) time by
group interaction for hit rate when Go-
emotion was happy (Figure 6), such that
participants in the experimental group
improved their performance in the block
where the Go emotion was happy, unlike control
group participants that showed no change.
No significant findings for ANT and Stoplight task at
Time 3.
Summary
Study 1 findings suggest the improvement in clarity and awareness
components of emotion regulation and in self-compassion after mindfulness
training. These improvements were sustained after the follow up period.
Improvement in mindfulness and especially in its awareness component, as well
as in emotion regulation and its strategy component were evident over the
course of the study for the experimental group. The Go-NoGo task results
provide additional evidence that mindfulness training improves emotion
regulation and decision-making in a ‘hot’ context.

Figure 6. Hit Rate for Happy block
32
STUDY 2
Method
Overview
Study 2 evaluated the effect of mindfulness training for an at risk
population of adolescents that did not succeed in a traditional high school
environment because of substance abuse, behavioral or emotional problems or
family circumstances.
Participants
Phoenix (PHX) is a continuation high school in Venice, CA for children
who did not succeed in a traditional high school environment. The school has an
interest in mindfulness and added CALM to their curriculum as an elective class
for two semesters. We have recruited 57 Phoenix high school students and
randomly assigned 34 to the CALM program (maximum program capacity) and
23 to the waitlist control group. The attrition was 20% and 26% in experimental
and control group respectively, with 44 participants completing at least 2
evaluation sessions (27 in experimental and 17 in control group). The attrition
rate was lower than anticipated 30% and mostly resulted from students leaving
the school (5 graduated, 4 dropped out).
Materials, Procedure, Dependent Measures and Analysis
All materials, procedure, dependent measures and analysis were identical
to the Study 1 with one exception. Unlike InsightLA CALM participants who had
time 1 and time 2 evaluations on the 1
st
and the last day of the CALM program,
the Phoenix students had their time 1 evaluation a week before their 1
st
class and
33
time 2 evaluation a week after the last class; thus, the time between these
evaluations will be 10 rather than 8 weeks. This change was necessary strictly
for logistical purposes. It was impractical to expect Phoenix students to fill out the
questionnaire packets at home prior to the evaluation session; hence we had to
allow time during the session for filling out questionnaires. Therefore we could
not conduct the evaluation session and a CALM class on the same day within the
allocated class time.
Results
Time 1
We found no significant differences on any measure between experimental and
control groups.
Time 2
We found no time by run interactions on any measure at time 2.
Time 3
Examining Go-NoGo results we found a
marginal (p= .066) time by group interaction for RT
difference between trials where the go-emotion is
fear and trials where the go-emotion is calm, indicative
of improvement (decrease) for participants in the
experimental group (see Figure 7 for regression lines
by condition). Examining within group differences in
this parameter between all 3 runs by fitting repeated
measures ANOVAs separately for experimental and
Figure 7. Hit RT difference
Fear and Calm blocks
time
34
control group we found a significant effect of time (F=4.2, p= .045) in the
experimental group and no significant effect of time in the control group (F=.71,
p= .405).
No significant effects were evident in any of the scales, nor in ANT and
Stoplight tasks.
Summary
Study 2 supports the hypothesis that mindfulness training improves
emotion regulation as evident from decreased difference in RT between
response to fearful and calm faces. It is not clear why this set of participants did
not show any effects on the self-report questionnaires. It is possible that
participants of this study did not put the necessary effort into earnestly filling out
the questionnaire packets and/or have much lower reading levels and lower
reading comprehension than participants of Study 1. This suggestion is
supported by significantly lower inter-item correlations for SCS (t= -5.95 p<.0001,
Mp=.37 Mi=.68) and ER (t=-2.47, p= 0.018 Mp=.69, Mi=.8) scales when
comparing with ILA values.
STUDY 3
Method
Overview
The goal of Study 3 was to assess if the effects of mindfulness training
differ between the general population and adolescents at risk for negative
consequence. We used the data collected in studies 1 and 2 for this evaluation.
Data from all Phoenix students was used for this study. From Study 1 we only
35
used data from the older children (ages 14-18); the participants of the CALM
class for the older age group and their age and gender matched control group.
Analysis
Time 1 (prior to CALM training) analysis evaluated whether any
differences between Phoenix and InsightLA participants were evident prior to the
intervention, either in demographic or dependent measures using the aov
function from the stat package in R.
At Time 2 (after CALM training) we fitted a series of repeated measures
mixed effect models, utilizing the nlme package in R, to evaluate whether the
difference in performance change between experimental and control groups from
before to after completion of the CALM training varies due to the subjects’ source
(Phoenix, continuation HS students vs. InsightLA, traditional HS students).
Similarly, at Time 3 (8-10 weeks after the end of CALM training) we fitted a
series of repeated measures mixed effect models, using the nlme package in R,
to evaluate whether the difference in performance change between experimental
and control groups between all three time points varies across participants’
source (PHX or ILA).
Results
Time 1
We found significant difference between Phoenix and ILA participants in
SCS (F=15.89, p= .0001, Mi=2.946, Mp=3.337), ER (F=12.999, p= .0004,
Mi=3.299, Mp=3.669), impulsivity (F=6.06, p=0.015, Mi=3.433, Mp=3.802),
strategy (F=17.529, p< .0001, Mi=3.351, Mp=4.019), goals (F=28.25, p< .0001,
36
Mi=2.608, Mp=3.352), acceptance (F=16.319, p<.0001, Mi=3.568, Mp=4.151)
and awareness (F=7.93, p= .006, Mi=3.401, Mp=3.018) components of ER and
in the non-reactivity component (F=10.36 p= .002 Mi=3.003 Mp=3.549) of
MSPTA. Phoenix participants’ self-ratings were higher on all these scales than
InsightLA participants’. There was a significant main effect of experimental group
for age (F=6.39, p= .013), ER (F=4.70, p= .032) and its impulsivity (F=8.7,4
p= .004) and strategy (F=5.71, p= .018) components. We also found significant
interaction between experimental group and participant source for age (F= 7.86,
p= .006). This finding is due to difference in age
between experimental groups in ILA but
not PHX participants.
Time 2

Since there was a significant difference in age we
included age as covariate in all models. We found a
significant 3-way interaction of time, experimental
group and source for
ER (t= -2.47,p= .016), and it’s clarity (t= -
2.22, p= .03) component (Figures 8 & 9).
For clarity component of ER we found a
1 2
TIME
Figure 8. ER
Figure 9. Clarity
1 2
TIME
Table 4. Age by group/condition
37
significant effect in the ILA group at time 2 (Study 1), and a null effect in the PHX
(Study 2), thus the finding above is likely driven by ILA improvement. ER
increases for ILA participants in both groups, but for PHX there is increase in
control group and decrease in experimental group.
We have also found significant 2-
way interactions between time and
experimental group for the SCS
(t=2.44, p= .017) and aware
(t=2.27, p= .025) component of ER
(Figures 10 & 11). In both cases
we observe improvement in the experimental group and no
change in the control group.
No significant findings were evident for ANT and Stoplight tasks.
Time 3
Since there was a significant difference in age we included age as a
covariate in all models.

Figure 10. SCS
Figure 11. Aware
1 2
TIME
Figure 12. ER, SCS and MSPTA 3 way
interaction
38
We found a significant 3-way interaction of time, experimental group, and
source for SCS (t= -2.81, p= 0.006), ER (t= -3.83, p=.0002) and it’s accept (t= -
2.48, p= .01), aware (t= -2.15,p= .03), clarity (t= -2.41, p= .017), strategy
(t= -3.29, p= .001) and impulse (t= -2.79, p= .006) components, MSPTA (t= -2.6,
p= .01) and its AA (t= -3.27, p= .001) component.

The finding for SCS, MSPTA and it’s AA component, and ER and it’s aware,
clarity and strategy components are driven by significant
improvements in the experimental group of the
ILA arm of the study, as has been shown in
Study 1. Examining regression plots by
group/condition we suggest that the effect for
accept component is due to a decrease in the
experimental group of PHX and for impulse component it is due to an
AA Aware
Clarity
Figure 13. Strategy, Aware and Clarity components of ER, AA component of MSPTA
Strategy
1 2 3
TIME
1 2 3
TIME
1 2 3
TIME
1 2 3
TIME
Figure 14. Impulse
1 2 3
TIME
1 2 3
TIME
Figure 15. Accept
39
increase in the experimental group of ILA. No significant findings were evident for
the ANT and Stoplight tasks.
Summary
Time 1 results show that participants from PHX group self-reported superior
self-compassion and emotion regulation skills compare with participants from ILA
group. This finding is puzzling since it is unlikely that students that failed
traditional high school, often due to experienced adversity, would have better
emotion regulation than children who succeed in traditional school. We suggest
that Phoenix students were unaware of their shortcomings in this area and gave
unrealistically high self-assessments at time 1. Interestingly, our findings at time
2 and time 3 show a decrease in self-reports on emotion regulation measures for
Phoenix participants from the experimental group. Perhaps this is an indication of
improved self-awareness due to the training.
STUDY 4

Method
Overview
Studies 1-3 provide initial evidence that mindfulness training may improve
emotion regulation in adolescents. The goal of Study 4 is to start investigation
into neural substrates responsible for these improvements. As the first step in
this process, we examined neural processing changes during meditation,
acquired as a result of mindfulness training. We anticipated differentiated
activation in the Default Mode Network (DMN) since prior work with adults has
shown robust changes in DMN function as a result of mindfulness training and
40
practice (Brewer et al., 2011; Prakash, De Leon, Klatt, Malarkey, & Patterson,
2013; Taylor et al., 2013) . This serves as a measure of the training success, and
evaluates whether the changes are consistent with findings from prior
neuroimaging work on mindfulness in adults. This is a pilot study constrained by
limited funding and a small potential subject pool that aimed to generate
preliminary data to obtain funding for a full-scale evaluation.
Participants
We have recruited eight participants from the Study 1 subject pool (two
from the InsightLA CALM class and six from the control group) to be evaluated a
week after CALM program completion.
Material, procedure and analysis
All participants’ parents/ guardians completed an fMRI safety screening
form a week prior to the scanning session to ensure participants eligibility.
Participants and their parents/guardians completed all the consent forms
appropriate for the age group prior to arriving for their imaging sessions. After
arriving at the imaging center participants were taken to the mock scanner room
where they were familiarized with the process and safety rules, and acclimated to
the various sounds heard during the scan. In the scanner participants underwent
a structural scan first, followed by a control task and the mindfulness meditation
task. After completion of the scanning session participants were paid $50.
Materials
The mindfulness task was a five-minute guided meditation. We used one
of the CALM audio recordings, which are offered as part of the program. The
41
control task was designed to parallel the meditation task in terms of auditory
processing by matching the balance of sound and quiet periods. During the task
a female experimenter (same gender as the leader of the meditation task) read a
modified excerpt from the participant assent form, where overall number of
words, length of each sentence and pauses between sentences were matched
with the meditation audio script.
MRI methods: A Siemens 3T scanner was used for blood-oxygen level
dependent (BOLD) acquisition to determine brain responses during the tasks.
During the scan, subjects lay supine inside the bore of the magnet and a
conventional T2*-weighted echo planar imaging sequence (EPI) was used for the
functional scan (150 images; 39 slices; slice thickness, 3mm; TR, 2000ms; TE,
25). The slices were tilted about 30 degrees clockwise from the AC–PC plane to
obtain better signals in the orbitofrontal cortex. A high-resolution T1 structural
brain image was also acquired (MPRAGE; 176 sagittal slices; slice thickness,
1 mm; TR, 2300 ms; TE, 2.3 ms).
fMRI analysis. Image preprocessing and analysis were carried out using tools
from the FMRIB software library (www.fmrib.ox.ac.uk/fsl). The first four volumes
before the task were automatically discarded by the scanner to allow for T1
equilibrium. The remaining images were realigned using interleaved slice timing
correction, motion-corrected using MCFLIRT and de-noised using MELODIC
independent components analysis (Jenkinson & Smith, 2001). The data were
filtered in the temporal domain using a non-linear high pass filter with a 100 s cut-
off, and spatially smoothed using a 5 mm full-width-half-maximum (FWHM)
42
Gaussian kernel. A two-step registration procedure was used whereby EPI
images were first registered to the MPRAGE structural images, and then into
standard (MNI) space, using affine transformations (Jenkinson & Smith, 2001).
Registration from MPRAGE structural images to standard space was further
refined using FNIRT nonlinear registration (Anderson et al., 2007). Statistical
analyses were performed in the native image space, with the statistical maps
normalized to the standard space prior to higher-level analysis.
A three-level statistical analysis approach was employed. The general
linear model (FSL’s FEAT module, Friston, 1995) was used on the first level to
model activation separately during each session (mindfulness mediation and
control tasks), convolving two regressors of interest (sound and quiet periods)
with a canonical hemodynamic response function. Statistical parametric maps
were computed for each contrast of interest, and the contrast effect maps from
these analyses were entered into a second-level model, using Fixed Effects to
evaluate between-sessions difference for Mindfulness and Control tasks for each
participant. The results of these analyses were then entered into an
OLS mixed effects model to evaluate group level difference between the
conditions. Group images were thresholded with a height threshold of z > 2.3 and
a cluster probability of p < 0.05, corrected for whole-brain multiple comparisons
using the Gaussian Random Field Theory (GRFT).
Results
We found a two way group-task interaction indicative of higher activation
in two DMN components: precuneus (PC:2,-60,50) and posterior cingulate cortex
43
(PCC:14,-48,32), as well as in anterior cingulate cortex (ACC:4,34,18) and frontal
pole (FP:22,38-,20) during the Control task as compared to the Meditation task
for the experimental group.

Summary
Our finding suggest a deactivation (or lesser activation) of DMN, as
represented by PC and PCC, during Mindfulness compared with the Control task.
This finding is consistent with prior work that shows deactivation of DMN during
meditation in trained meditators (Brewer et al., 2011; Hasenkamp, Wilson-
Mendenhall, Duncan, & Barsalou, 2012; Taylor et al., 2011). Increased activation
in FP may be explained by its critical role in cognitive tasks and relational
integration (Koechlin, 2011). Thus, it was more active during the Control task
when subjects were processing the information read to them by the
Figure 16. Group –Task interaction: CTL – Meditation Task
difference greater for CALM participants
44
experimenter. . Activity in FP has also has been shown to be synchronized with
DMN (Schacter et al., 2007). We suggest that increased activation in ACC during
the control task was due to greater need for salience network activity, since
participants were paying attention to the meaning of the information read to them;
in comparison, during the Mindfulness block the words were simple reminders to
stay focused on breath and bodily sensations.
DISCUSSION
This project examined the effects of mindfulness training on attention,
emotion regulation and risk-taking during adolescence. With mindfulness
becoming more and more popular, and many schools attempting to bring this
practice onto their campuses (Kuznia, 2013), it is necessary to understand what
it can and cannot offer us. Up until now no comprehensive evaluation of
mindfulness effect for teens has been published. With few exceptions (Goldin et
al., 2006; Broderick & Metz, 2009) the body of literature covering mindfulness
interventions with this age group includes a dozen or so papers focused on
physiological changes or reduction in clinical symptoms. The current work
provides preliminary evidence that an 8-week mindfulness training program
improves emotion regulation in adolescents and that this effect persists for at
least 8 weeks after the program completion.
Study 1 examined the impact of a mindfulness program taught as an after-
school extracurricular activity. Participants in this study show self-reported
improvements in emotion-regulation, self-compassion and mindfulness, both at
the program completion and at the 8-10 weeks follow up assessment. Moreover,
45
improvements in emotion regulation, specifically, the ability to down-regulate
approach reaction to positive emotional stimuli, was evident from the Go-NoGo
task results, both at the end of the training and at the follow up. Finally, we have
found evidence of gradual improvement in attention and decision-making in ‘hot’
context over the length of the project as represented by hit-rate improvement
during the ‘Happy-Go’ block of the Go-NoGo task. The limitation of Study 1 was
that the assignment into experimental and control groups was not randomized.
Participants in the experimental group were self (or parent) -selected by signing
up for CALM training, and participants of the control group where recruited from
the community. Perhaps this circumstance explains the experimental group
participants’ lower ratings on emotion regulation questionnaire and overall task
performance on the Go-NoGo task. It is possible that CALM class participants
had weakness in emotion regulation and/or attention that either they or their
parents were aware of, and thus chose to participate in the training. Never the
less, in spite of lower scores prior to the training, the experimental group
participants’ performance was better than control group participants’ at follow up
time, thus supporting the effectiveness of the CALM program in improving
emotion regulation.
An important aspect of this project was to examine the impact of
mindfulness training on an ethnically diverse population of adolescents who
exhibited behavioral and/or emotional problems. The goal of Study 2 was to
evaluate CALM’s potential to improve their cognitive and social-emotional
competencies and enhance school success and wellbeing. We have found
46
evidence that participation in the CALM program improved emotion regulation in
experimental group participants, specifically, the ability to down regulate the
avoidance reaction to negative stimuli, as evident from the Go-NoGo task results
at the follow up time.
We were initially surprised by no significant findings from the self-report
questionnaires for Study 2 participants. However, after a more detailed look at
the data we offer two possible explanations. First, participants in this study may
not have put the necessary effort into filling out the questionnaire packet. It is
possible that for students in the continuation high school reading and filling out a
9-page packet was somewhat overwhelming and perceived to not be worth the
effort, especially since their reading comprehension skills may be weaker than
participants’ from Study 1. This suggestion is supported by significantly lower
inter-item correlations for both the Emotion Regulation and Self-Compassion
scales for Study 2 participants compared with Study 1 participants. Second,
according to their self-reports, participants in Study 2 were significantly higher on
emotion regulation than participants of Study 1, which is highly unlikely. This
result may be due to overall inaccuracy on the behalf of Study 2 participants. It is
also possible that Study 2 participants had unrealistic assessments of their
emotion regulation ability and were unaware of their weaknesses in this area.
Examination of time 2 and time 3 results shows decreased ratings on emotion
regulation measures for Study 2 CALM participants. This may suggest improved
awareness of their shortcomings for the program participants.
47
We believe that null findings on the ANT task in both Study 1 and Study 2
were due to a celling effect, since all participants demonstrated high performance
on the task at time 1 that left no room for improvement. We also reason that
neither ARQ nor Stoplight task were sensitive enough to capture potential
changes in risk tendencies in our sample. It is also possible that potential
improvements in risk tendencies may be secondary effect of mindfulness and
require longer time period to develop.
Understanding the influence of mindfulness training on the adolescent
brain will allow developing optimal interventions targeting groups most at need,
thus promoting healthy decision-making and reduced risk-taking during this
sensitive developmental period. Study 4 is the first investigation in this area, to
the best of our knowledge. It provides initial evidence that for adolescents an 8-
week mindfulness training results in similar neuro-processing changes that have
been consistently shown with adults – specifically, deactivation of DMN during
meditation. In adults the change in DMN activity, as a result of mindfulness
training, was implicated in an improvement in attention, emotion regulation and a
decrease in social anxiety (Marchand, 2014).

48

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58
Appendix A1. Difficulties in Emotion Regulation Scale (DERS)
1. I am clear about my feelings
2. I pay attention to how I feel
3. I experience my emotions as overwhelming and out of control
4. I have no idea how I am feeling
5. I have difficulty making sense out of my feelings
6. I am attentive to my feelings
7. I know exactly how I am feeling
8. I care about what I am feeling
9. I am confused about how I feel
10. When I’m upset, I acknowledge my emotions
11. When I’m upset, I become angry with myself for feeling that way
12. When I’m upset, I become embarrassed for feeling that way
13. When I’m upset, I have difficulty getting work done
14. When I’m upset, I become out of control
15. When I'm upset, I believe that I will remain that way for a long time
16. When I'm upset, I believe that I'll end up feeling very depressed
17. When I'm upset, I believe that my feelings are valid and important
18. When I'm upset, I have difficulty focusing on other things
19. When I'm upset, I feel out of control
20. When I'm upset, I can still get things done
22. When I'm upset, I know that I can find a way to eventually feel better
23. When I'm upset, I feel like I am weak
24. When I'm upset, I feel like I can remain in control of my behaviors
25. When I'm upset, I feel guilty for feeling that way
26. When I'm upset, I have difficulty concentrating
27. When I'm upset, I have difficulty controlling my behaviors
28. When I'm upset, I believe there is nothing I can do to make myself feel
better
29. When I'm upset, I become irritated with myself for feeling that way
30. When I'm upset, I start to feel very bad about myself
31. When I'm upset, I believe that wallowing in it is all I can do
32. When I'm upset, I lose control over my behaviors
33. When I'm upset, I have difficulty thinking about anything else
34. When I'm upset, I take time to figure out what I'm really feeling
35. When I'm upset, it takes me a long time to feel better
36. When I'm upset, my emotions feel overwhelming

59
Appendix A2. Self-Compassion Scale

1. When I fail at something important to me I become consumed by feelings
of inadequacy.
2. I try to be understanding and patient towards those aspects of my
personality I don’t like.
3. When something painful happens I try to take a balanced view of the
situation.
4. When I’m feeling down, I tend to feel like most other people are probably
happier than I am.
5. I try to see my failings as part of the human condition.
6. When I’m going through a very hard time, I give myself the caring and
tenderness I need.
7. When something upsets me I try to keep my emotions in balance.
8. When I fail at something that’s important to me, I tend to feel alone in my
failure
9. When I’m feeling down I tend to obsess and fixate on everything that’s
wrong.
10. When I feel inadequate in some way, I try to remind myself that feelings
of inadequacy are shared by most people.
11. I’m disapproving and judgmental about my own flaws and
inadequacies.
12. I’m intolerant and impatient towards those aspects of my personality I
don’t like.

60
Appendix A3. Mindfulness Scale for Preteens, Teens and Adults (MSPTA)

1
I tell myself that I shouldn’t be feeling the way I'm feeling. -How true
is it for you?
2 I notice when my moods begin to change. -How true is it for you?
3
I pay attention to whether my muscles are tense or relaxed. -How
true is it for you?
4
When I take a shower or a bath, I notice sensations of water on my
body-How true is it for you?
5 I intentionally stay aware of my feelings. -How true is it for you?
6
I tend to evaluate if the emotions I feel are appropriate. -How true
is it for you?
7
I pay attention to sensations, such as the wind in my hair or sun on
my face. -How true is it for you?
8
I notice changes in my body, such as whether my breathing (or
heartbeat) slows down or speeds up. -How true is it for you?
9
How often do you notice detail of architecture or landscape around
you? -Select your answer
10
I tend to evaluate if my experiences are good and valuable or not -
How true is it for you?
11 The emotions I sometime feel seem wrong. -How true is it for you?
12
I make judgments about whether my thoughts are good or bad. -
How true is it for you?
13
I pay attention to sounds, such as clocks ticking, birds chirping, or
cars passing.-How true is it for you?
14
I recognize art elements in nature, such as colors, shapes, textures,
or patterns of light and shad...-How true is it for you?
15
I pay attention to how the mood I am in affects my thoughts and
behavior. -How true is it for you?
16
When I get upset about something I usually keep thinking about it .
-How true is it for you?
17
I tell myself that I shouldn’t be thinking the way I m thinking. -
How true is it for you?
18 I notice the smells and aromas of things. -How true is it for you?
19
When I play music or sports and make a mistake I usually get really
upset and angry with self
20
I like to judge whether my ideas and opinions are right or wrong -
How true is it for you?

When I realize that I missed something important in a class or
during a lecture …
21
- I make a mental or physical note to follow up on the
missed info and bring my focus back on the topic.
22 - I worry about not being able to find missed info.
23 - I think about consequences of missing the info.
24 - I get angry with myself
61
Appendix 4. Adolescent Risk-taking Questionnaire (ARQ)

For each item participants will answer 2 questions:
1. Please estimate estimated the frequency with which you engage in this
behavior from 0 (never) to 4 (very often).
2. Please evaluate the level of risk associated with this behavior ranging
from 0 (not at all risky) to 4 (extremely risky).

Factor 1: thrill-seeking behaviors
1. Snow Skiing
2. Tao Kwon Do fighting
3. Inline skating
4. Parachuting
5. Entering a competition
6. Flying a plane
7. Leaving school
Factor 2: rebellious behaviors
1. Underage drinking
2. Smoking
3. Getting drunk
4. Taking drugs
5. Staying out late
Factor 3: reckless behaviors
1. Drinking and driving
2. Stealing cars and going for joy rides
3. Having unprotected sex
4. Speeding
5. Driving without a license
Factor 4: antisocial behaviors
1 Overeating
2. Teasing and picking on people
3. Cheating
4. Talking to strangers
5. Sniffing gas or glue

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Core Title Effect of mindfulness training on attention, emotion-regulation and risk-taking in adolescence

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Publication Date 11/24/2015

Defense Date 08/10/2015

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