Introduction

Mindfulness has been defined as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (p.4) [1]. The benefits of mindfulness in children have been examined through the study of trait mindfulness and mindfulness training. Trait mindfulness refers to one’s disposition or tendency to attend to experiences with an open and nonjudgmental attitude [2] and can be measured by self-report questionnaires [3–5]. Mindfulness training aims to cultivate trait mindfulness through instruction and practice. Studies of both trait mindfulness and mindfulness instruction have documented benefits to child mental health [4, 6, 7]. An important aspect of mental health in children is emotional resilience, the capacity to overcome emotional challenges. Greater trait mindfulness in children has been associated with more resilience in response to bullying [8]. Here we asked whether greater trait mindfulness was a source of emotional resilience in response to stressful changes in education and home-life during the COVID-19 pandemic in the United States.

The COVID-19 pandemic severely and suddenly altered the educational, social, and home experiences of children. These changes presented serious challenges to mental health, including fear of health risks, social isolation, and more. Soon after the outbreak of COVID-19 in February and March 2020, studies reported increased loneliness, anxiety, depression, and sleep disturbances in adults complying with strict social distancing protocols in China [9]. As the pandemic unfolded, increased rates of mental health symptoms were observed in other countries around the world [10]. Some findings suggested increased prevalence of psychiatric symptoms like depression in older children [11, 12] and in girls [13]. Other studies reported that some children experienced improvements in mental health outcomes during social distancing [14–16]. Further research is needed to understand why some children may be more resilient than others to the mental health challenges of the pandemic.

In this study, we operationalized emotional resilience as positive mental health outcomes in the context of adverse situations [17]. We did not measure resilience as a trait, but instead measured trait mindfulness as one of the cognitive and self-regulatory skills that contributes to resilience [18]. Researchers have highlighted mindfulness as a type of cognitive regulation of emotions [19], leading to a less self-critical or judgmental attitude towards one’s experiences [20, 21] and greater attention to body sensations involved in emotion [22]. Mindfulness may decrease rumination, stopping repetitive cycles of depressive thoughts, e.g., “I’m worthless”; or anxious thoughts, e.g., “What if I never get it right?”, “Everything is going to fall apart” [23, 24]. Most of these studies have examined adults, but there is also some evidence that greater trait mindfulness in children is associated with less rumination and healthier patterns of emotion regulation [25]. Trait mindfulness may support emotional resilience in children.

In this study, we examined children’s mental health outcomes during the COVID-19 pandemic. The 163 eight-to-ten-year-old children were from families that volunteered to participate in a randomized controlled trial (RCT) examining the potential benefits of an audiobook intervention on reading outcomes. Data were collected remotely during the height of pandemic distancing restrictions, from July 2020 to February 2021. We assessed mental health using standardized self-report measures of anxiety, depression, and stress, and asked questions about negative affect. We also measured how strongly children felt they have been impacted by COVID-19. We assessed trait mindfulness with the Child and Adolescent Mindfulness Measure (CAMM), which emphasizes nonjudgmental, accepting attention to emotions [4].

We hypothesized that trait mindfulness would negatively correlate with self-report measures of anxiety, depression, stress and negative affect as has been reported before in children [4, 25]. Critically, we hypothesized that greater trait mindfulness would provide greater resilience to the changes of the COVID-19 pandemic by specifically moderating the relationship between self-reported COVID-19 impact and negative mental health outcomes.

Materials and methods

Results

Mental health variables

Descriptive statistics for the main variables of interest are shown in Table 1, including means and standard deviations of negative affect, RCADS anxiety and depression subscales, PSS-C, CAMM and COVID-Impact. T-scores for RCADS were relatively low. On the anxiety scale all children fell in the low severity range (0–65) and on the depression scale only two children fell in the moderate range (65–70), with one falling in the severe range (>70).

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Table 1. Bivariate correlations and descriptive statistics for main variables of interest.

https://doi.org/10.1371/journal.pone.0278501.t001

Moderation analyses

Mindfulness significantly moderated the relationship between COVID-Impact and negative affect in the children (Table 2). We further investigated this relationship using simple slopes analysis. High mindfulness (+1SD) children showed no relationship between COVID- Impact scores and Negative Affect scores (β = -.11, SE = 0.11, p = .31), whereas low mindfulness (-1SD) children had a positive relationship between COVID-Impact scores and Negative Affect scores (β = 0.27, SE = 0.11, p = .018). This is also depicted in a median split (Fig 1). Gender was the only control variable to reach significance, where female children showed higher negative affect than males. We probed this gender vs. negative affect relationship without the other variables, and it was trend-level in the full sample (t(161) = -1.8, p = .07). No other main moderation analyses (with depression, anxiety or stress) were significant (see S1-S3 Tables in S1 File).

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Fig 1. Relationship between child COVID-Impact and negative affect, median split by mindfulness.

A) Low mindfulness children show positive correlation between COVID Impact and Negative Affect. B) High mindfulness children show no relationship between COVID Impact and Negative Affect. In black are linear regression fits with gray confidence bar, and regression slope and p-values are listed in bold.

https://doi.org/10.1371/journal.pone.0278501.g001

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Table 2. Mindfulness is a moderator of the relationship between COVID Impact and negative affect.

https://doi.org/10.1371/journal.pone.0278501.t002

Discussion

In this study, we found evidence that mindfulness was related to emotional resilience in children. We specifically investigated whether trait mindfulness was associated with more positive mental health outcomes in response to the severe life changes of the COVID-19 pandemic. We obtained self-report data from US children during the height of pandemic distancing restrictions, from July 2020 to February 2021. Greater trait mindfulness was associated with less stress, anxiety, depression, and negative affect. Greater mindfulness was also associated with lower children’s ratings on the impact of COVID-19 on their lives. Critically, trait mindfulness moderated the relationship between COVID-19 child impact and negative affect. Children scoring high on mindfulness showed no correlation between rated COVID-19 impact and negative affect, whereas those who scored low on mindfulness showed a positive correlation between child COVID-19 impact and negative affect. Overall, higher levels of trait mindfulness may have helped children to better cope with a wide range of COVID-19 stressors.

To assess COVID-19 impact, we asked children questions like ‘how much harder has it been to see friends during the pandemic?” During pandemic-related lockdowns, children may find it harder to see friends and understandably experience negative emotions like frustration and loneliness about such isolation. However, the degree to which they blame themselves for these emotions, try to avoid feeling them, and generally get caught up in their emotions as opposed to having a healthy distance from them, may play a role in overall mental health outcomes. In our study, trait mindfulness was associated with more positive mental health outcomes, as in prior work [4, 5, 25], and lower COVID-19 stress. Perhaps higher trait mindfulness means less self-blame and judgment, which in turn supports emotional resilience to pandemic related stressors.

Two theoretical foundations of mindfulness are attention to the present and non-judgement [20]. Some trait mindfulness scales like the Mindful Awareness Attention Scale (MAAS) focus on the attentional construct [36, 37], whereas the Child and Adolescent Mindfulness Measure (CAMM), administered in this study, focuses on the construct of non-judgement. The CAMM aims to capture propensities to self-blame and judge one’s feelings (e.g., “I get upset with myself for having certain thoughts”). Lower scores on the CAMM correlate with less adaptive strategies to cope with one’s emotions, such as rumination, catastrophizing, and suppression [4, 25]. Consistent with these prior studies, our study showed that mindfulness moderated the relationship between pandemic stress and negative affect. Mindfulness may support emotional resilience through the mechanisms of non-judgement and acceptance of emotions.

This study connects mindfulness to positive mental health outcomes in children during the pandemic. This finding is consistent with studies showing that self-reported mindfulness correlated with lower psychological distress in adults during the pandemic [38–41], as well as an RCT study showing that a four-week mobile-phone mindfulness intervention reduced anxiety symptoms in university students under quarantine [42]. Mindfulness interventions may help children cope with adverse events like the COVID-19 pandemic.

Several limitations of this study may be noted. First, the children and their families were self-selected participants in a multi-week intervention study. Self-selection yielded a more educated and higher income sample than originally intended. Most of the children were from high SES families, and thus may not represent the kinds of children who were most vulnerable to the life disruptions of the COVID-19 pandemic. In fact, on average, children in this study reported lower rates of clinical anxiety and depression than norms for the measures (mean T-scores for our sample were 42% and 43% respectively). Some studies have reported that the sudden and severe changes on account of the pandemic, such as school closures and social isolation from peers, had broad, negative influences on children [43–45]. The children in the present study, however, appeared to be adapting well to the pandemic (although we cannot exclude the possibility of children wanting to report socially desirable responses). Other limitations were that the COVID-specific questionnaire was invented for the study and not standardized, and that remote test administration is not standard for the field.

A final limitation is that this is a correlational study that cannot determine that mindfulness causes emotional resilience. Moderation analyses cannot provide cause-and-effect evidence (rather, they show how a relationship between survey constructs can be altered by a third variable). Other studies on trait mindfulness and resilience have adopted different approaches. For example, Park et al. assessed COVID-related distress in adults at three time-points [46]. They found baseline mindfulness not only correlated with less distress at follow-up, but also correlated with more substantial decreases in distress over time. Similar longitudinal studies in children could be used to best assess whether mindfulness promotes emotional resilience in response to COVID-19 stressors.

Despite these limitations, the present finding that trait mindfulness moderated the relationship between pandemic stress and negative affect suggests that mindfulness supports resilience in the face of adverse experience. There is substantial evidence in adults that trait mindfulness promotes resilience to COVID-19 stressors [46–51]. For example, Vos et al. found that worry about COVID-19 was only associated with anxiety for adults with low but not high mindfulness [50]. What is the specific mechanism by which mindfulness promotes emotional resilience in the face of adversity? One idea is that mindfully treating experiences in a non-judgmental and accepting manner could help individuals decrease depressive rumination [23, 24]. Alternatively, or additionally, mindfulness practices like body scans that involve present-moment attention to body sensations may be key to the benefits of mindfulness. These practices may support more accurate appraisals of bodily sensations and diminish anxiety [22, 52, 53]. Further mindfulness research could help identify which cognitive and affective traits of children allow them to meaningfully and constructively respond to emotional challenges.

The finding that mindfulness in children moderated negative affect in response to the sudden, comprehensive, and chronic disruptions of school and home life brought on by a global pandemic, further motivates research into the implementation of mindfulness instruction for children. The present findings are consistent with evidence from randomized controlled trials that mindfulness interventions can reduce stress and negative affect in children [6]. In one study, reductions in stress after a school-based mindfulness intervention were associated with changes in brain function [54]. Taken together, these findings encourage the adoption of mindfulness instruction in schools or other settings to help children be more emotionally resilient. More resources for promoting mental health in children are provided by the American Academy of Child and Adolescent Psychiatry (https://rb.gy/i0ba4).

Conclusions

We conducted a cross-sectional study with 163 eight-to-ten-year-old children during the height of the COVID-19 Pandemic. We assessed relationships between child-reported mindfulness and several measures of mental health outcomes like stress, anxiety, and negative affect, along with a specifically designed measure of COVID-19 impact on their lives. Ultimately, we found mindfulness was associated with resilience, defined as positive mental health outcomes in the face of adversity. These findings encourage the adoption of mindfulness instruction in schools or other settings to help children be more emotionally resilient.

Supporting information

Acknowledgments

We thank our testers: Amanda Miller, David Bates, Ross Weissman, Joohee Baik, June Okada, William Oliver, and Harriet Richards. We also thank Xochitl Arechiga, Yesi Camacho Torres, Hope Kentala, Natalie Gardino, Jeff Dieffenbach, for helping to run the study, Yilei Chen for data preprocessing, and Sadie Zacharek for helpful comments on the manuscript. We thank the Hock E. Tan and K. Lisa Yang Center for Autism Research at Massachusetts Institute of Technology.