Mindfulness Interventions to Reduce Impact of Interparental Conflict on Adolescents

Abstract

Exposure to frequent, intense, and poorly resolved interparental conflict puts adolescents at risk for problems in many domains, including internalizing and externalizing problems, and stress physiological dysfunction. Existing intervention strategies to target these adolescents focus almost solely on improving marital dynamics, for example, through relationship education or couples therapy. However, interventions that aim to enhance marital communication require high levels of parental commitment and motivation for change, and may be expensive and time-consuming. In the current paper, we argue that it is essential to also apply intervention strategies that directly promote the regulatory capabilities of adolescents to improve outcomes for youth from high-conflict homes. Mindfulness, or present-moment, nonjudgemental awareness, is associated with myriad positive outcomes in adults (e.g., lower levels of depression and anxiety, and greater emotion regulation). We propose that mindfulness interventions are an ideal intervention strategy for adolescents from high conflict homes. Mindfulness interventions may target the mechanisms whereby destructive marital interaction impacts youth, by providing distance between experiences and evaluations, training regulation of attention, and enhancing self-compassion and nonjudgement, as well as by enhancing relationships. We also provide an example of a specific intervention model designed to increase mindfulness in youth, Learning to Breathe (L2B).

Exposure to hostile, frequent, and poorly resolved interparental conflict puts offspring at serious risk for adjustment and regulation difficulties (e.g., Lucas-Thompson et al. 2015; Zimet and Jacob 2001). Adjustment problems in adolescence are becoming increasingly common (Collishaw et al. 2004) and have negative lifespan consequences (Last et al. 1997) but are difficult to treat, particularly in the teenage years (Hammen et al. 1999). Unfortunately, the frequent, intense, and unresolved interparental conflict that produces these negative outcomes is prevalent in the U.S. (National Institutes of Health 2003). Existing intervention programs to support adolescents exposed to high levels of destructive interparental conflict have almost exclusively focused on improving marital dynamics. The goal of the current paper is to advocate for an additional approach for adolescents exposed to such conflict: the application of intervention strategies that directly target the improvement of regulatory skills. Finally, we argue that mindfulness interventions are likely to be particularly effective, as they target the specific internal processes that adolescents from high-conflict homes often experience, and also provide an example of such a mindfulness intervention.

Exposure to Destructive Interparental Conflict as a Risk Factor

Conflict in marriage is normative, as it occurs in every relationship (McCoy et al. 2009). However, the nature of this conflict ranges from quite destructive for families and children to constructive for that relationship and the children who observe it (Goeke-Morey et al. 2003).Constructive behaviors during conflict include problem-solving, effective resolution, support, and physical affection (Cummings and Davies 2002). When parents engage in these constructive behaviors during conflict, it can reduce stress; in addition, children often model these healthy and positive conflict strategies (Goeke-Morey et al. 2007). Furthermore, increases in constructive interparental interactions predict later improvements in child adjustment (Cummings et al. 2008).

Interparental interactions often have destructive effects when they are hostile, aggressive, and/or violent, particularly when they are frequent, poorly resolved, and/or when children are a source of disagreement (Goeke-Morey et al. 2003). These negative effects include problems with both internalizing symptoms such as anxiety and depression as well as externalizing behaviors (Ablow et al. 2009; Buehler et al. 1997; Zimet and Jacob 2001). In fact, research suggests that interparental conflict may impact children’s mental health more negatively than divorce (Zimet and Jacob 2001). Symptoms often surpass clinical thresholds (Turner and Kopiec 2006), and even problems below these thresholds have long-term adverse consequences (Johnson and Greenberg 2013; Zimet and Jacob 2001). Destructive interparental conflict is also linked with dysregulated stress physiology, both in response to acute stressors (Lucas-Thompson 2012; Lucas-Thompson and Granger 2014) and in normal daily functioning (Lucas-Thompson and Hostinar 2013; Lucas-Thompson et al. 2015). It is also associated with deficits in cognitive and academic functioning (George et al. 2010), reduced quality and quantity of sleep (El-Sheikh et al. 2006), and increases in disordered eating patterns (George et al. 2014). Therefore, studies consistently indicate that destructive interparental conflict puts adolescents at risk for problems in a variety of adjustment and regulatory domains.

The mechanisms of these effects are considered both direct (because of changes to the adolescent, notably cognitive and emotional responses to interparental conflict) and indirect (because of changes to other elements of the family system). In terms of direct effects, destructive interparental interactions are stressful for adolescents to observe (Davies et al. 2007; El-Sheikh 1994), provide children with poor models of effective coping (Chorpita and Barlow 1998), and threaten children’s safety and security within the family system (Davies and Cummings 1994). Children and adolescents also appraise their parents’ interactions in ways that have important consequences for their own functioning, including their emotional responses to conflict, the coping strategies utilized to deal with it, and subsequent adjustment outcomes (Grych and Fincham 1990; Mueller et al. 2015). Appraising conflict as threatening to the self or family, and/or feeling self-blame for interparental conflict is particularly risky for children in terms of adjustment and regulation (Gerard et al. 2005; Lucas-Thompson et al. 2015). Therefore, the direct effects of interparental conflict on children’s emotional security and cognitive appraisals are considered important mechanisms by which frequent, intense, and poorly resolved interparental conflict has negative effects on children’s developmental outcomes.

Interparental conflict indirectly effects children because of damages to other aspects of the larger family system: destructive interparental relationships are consistently associated with more-negative parent-child interactions (Erel and Burman 1995). Conflictual marital relationships drain parents’ emotional resources, and, as a result, inhibit parents’ abilities to serve as external supports of child regulation (Kopp 1989) and/or provide their children with adequate attentional and emotional resources (Easterbrooks and Emde 1988). Therefore, damages to parent-child relationships are an additional important mechanism linking interparental conflict to negative developmental outcomes.

These effects of exposure to destructive interparental conflict can be quite long-lasting (Amato et al. 1995) and can worsen over time. Children, in particular, appear to become sensitized to interparental conflict over time, in terms of their emotional and physiological responses to stressful experiences like interparental conflict (i.e., their stress reactivity is heightened) (Cummings et al. 1985; Davies et al. 2006; El-Sheikh 1994). Although adolescents exposed to interparental conflict display sensitized emotional stress responses (Cummings et al. 2007; Lucas-Thompson 2012), they often also display dampened physiological stress functioning (Lucas-Thompson 2012; Lucas-Thompson and Granger 2014; Lucas-Thompson et al. 2015), suggesting failures to mount appropriate physiological responses to events that are experienced as stressful. Patterns of both heightened and dampened physiological reactivity predict functioning that worsens over time (Chrousos 2009). In the context of high interparental conflict it may be important to intervene directly with youth particularly during adolescence, given findings that adolescents are particularly vulnerable to the effects of interparental conflict as compared to younger children (Rhoades 2008).

Existing Intervention Strategies

Although adolescents from high-conflict homes are an important group to target to prevent or reduce the occurrence or severity of long-term problems, there are few existing intervention programs that directly target these youth. Most programs that focus on reducing the effects of interparental conflict have instead focused on preventing or reducing destructive marital interactions (Blanchard et al. 2009; Cummings et al. 2008; Faircloth and Cummings 2008; Faircloth et al. 2011). It is indeed feasible to reduce interparental conflict by means of parent, marital, or relationship education or therapy (Blanchard et al. 2009; Faircloth and Cummings 2008; Faircloth et al. 2011; Hawkins et al. 2008). Evidence suggests that targeting interparental dynamics may benefit adolescents (Faircloth et al. 2011), but this evidence is relatively limited, and more research on this topic is warranted (Cowan and Cowan 2014; Faircloth et al. 2011). Most of the research that evaluates the effects of relationship interventions do not investigate the effects of such interventions on children, and of those that do, most have focused on the effects on children who are in early childhood. For example, of the more than 150 adequately designed studies investigating the effectiveness of Couple Relationship Education (CRE) programs, only nine included measures of children’s functioning, and of these, only one intervention was tested for effects on adolescents as well as children (ages 4–17 years), with others only on those in infancy and early elementary school years (Cowan and Cowan 2014). Thus, there is a dearth of literature examining the effects of relationship interventions on children, and especially those in the adolescent years. The small amount of research testing the effects of relationship interventions on children has suggested limited effectiveness in improving outcomes for children; for instance, in the relatively small number of studies investigating the effects of marital programs on children’s development, effect sizes are typically small (i.e., d < 0.10) (Cowan and Cowan 2014). Although there is an important need for interventions that improve marital communication to reduce children’s exposure to destructive marital conflict, it is also important to develop additional intervention strategies for children and adolescents from high conflict homes.

There are several challenges to the approach of improving interparental relationships to address adolescent problems. First, improving marital interaction patterns is difficult, time-consuming, and expensive, particularly when couples are distressed (Blanchard et al. 2009) or interaction patterns are well-established (Cummings and Schatz 2012). Second, such an approach requires parental commitment to change, making adolescents dependent on parents for improvement in their own functioning. Both parents in a family may not be interested in changing destructive marital communication patterns, or motivated to devote the time and/or energy required to do so. The challenges of such an approach highlight the importance of effective interventions for adolescents from high-conflict families that reduce problems with adjustment as well as regulation and also do not require (a high-degree of) parental involvement or commitment to participate in treatment. Although targeting interparental dynamics is consistent with a family-systems perspective, and may be effective as such (Cox and Paley 1997), there is a need to supplement these established family-based approaches with interventions that also leverage change through intervening directly with adolescents. Such programs would not require that both parents be interested and motivated for change, and would only require limited parental involvement (i.e., parental consent) for an adolescent to receive such services. With such barriers removed, adolescents may be empowered to take responsibility for their own mental health. In addition, mindfulness interventions can be delivered as part of school-based universal prevention (Carsley et al. 2017), so that individuals do not need to be at elevated risk to participate. Although there are many interventions that have targeted the interparental relationship to improve outcomes for children exposed to marital conflict, interventions that directly target the children or adolescents who are exposed to marital conflict are much more scarce (Cummings and Schatz 2012).

Individual therapy methods have been used to directly target children and adolescent mental health. Some of these individual therapy modalities have minimal research support for improving child or adolescent anxiety or depression (as in the case of psychodynamic therapy, hypnosis, biofeedback, and play therapy) (Chorpita et al. 2011). Others have received some empirical support, including psychoeducation, exposure methods, modeling methods, and relaxation training (Chorpita et al. 2011). However, meta-analyses of individual therapy methods for children and adolescents clearly show that the “vast majority” (Chorpita et al. 2011, p. 159) of research supports Cognitive Behavioral Therapy (CBT) as the most effective treatment for adolescent anxiety and depression (Chorpita et al. 2011; Reynolds et al. 2012). In fact, according to some researchers’ designations, CBT is the only evidence-based treatment for youth (Seligman and Ollendick 2011). The focus of CBT is on changing maladaptive automatic thoughts that arise in the mind to reduce negative emotions and behavioral problems. These maladaptive automatics thoughts are targeted through such mechanisms as psychoeducation, cognitive restructuring, and skill-building (Coyne et al. 2008). Psychoeducation in CBT includes education about maladaptive thoughts and their influence on emotion and behavior. Cognitive restructuring includes helping clients to identify and then modify maladaptive automatic thoughts and beliefs, with the goal of modifying the content of the client’s thoughts and thus removing problematic behaviors (Coyne et al. 2008). For example, a CBT therapist may encourage a client to question the logic of their beliefs. In the skill-building portion of CBT, clients engage in behavioral experiments, in which the clients exposes themselves to a feared situation and are asked to “test” their automatic thoughts and beliefs about that situation (Seligman and Ollendick 2011). As such, the focus of CBT is on changing irrational thoughts and emotions. In the case of adolescents exposed to interparental conflict, unfortunately, the troubling thoughts that are so disturbing for these adolescents (e.g., “if my parents fight severely and intensely, they may divorce”) may not be irrational and therefore it may not be helpful to try to target such thoughts through psychoeducation or cognitive restructuring. In addition, given that adolescents’ interparental conflict is often out of their control, skills-building techniques involving further exposure may not be helpful, and may actually be harmful, for this population. Therefore, there are limitations to CBT for targeting children exposed to interparental conflict, which may explain why CBT treatment outcomes are attenuated for children exposed to interparental conflict (Coyne et al. 2008).

In addition to individual psychotherapy, several group programs have been used to take a universal approach to improving adolescent mental health, not only targeting children exposed to interparental conflict, but teaching a wide variety of children (e.g., “I CAN DO” Program) and adolescents (e.g., Resourceful Adolescent Program) how to problem-solve and cope with life stressors in general (Turner and Dadds 2001). Other programs directly involving children exposed to interparental conflict have been specifically for children exposed to interparental violence, for example ‘En nu ik…!’ (‘It’s my turn now!’), a psychoeducational program involving both parents and children (Overbeek et al. 2012); Child Parent Psychotherapy (Lieberman et al. 2005), a psychotherapeutic program also involving both parents and children; and, Positive Adolescent Choices Training, a psychoeducational and skills-based program for adolescents at risk for violence (Yung and Hammond 1998). Also related to our purposes of targeting children exposed to high interparental conflict, interventions have aimed to target children after parental divorce to prevent the negative effects of divorce, including the ensuing interparental conflict (Bowers et al. 2011). However, interventions that seek to directly target children and adolescents exposed to frequent and/or intense interparental conflict in the absence of domestic violence or divorce are much more scarce (e.g., Harold and Sellers 2018). It is important that interventions target children and adolescents who are from high-conflict, intact homes, given that exposure to interparental conflict in intact families is damaging to children’s functioning across a variety of domains, even when physical violence is absent (Cummings and Davies 2002). The fact that such hostile and frequent interparental conflict in the absence of physical violence is so damaging for children and adolescents is concerning, given the relatively high prevalence of such conflict in the United States.

Although there have not been any interventions aimed directly at children or adolescents from high-conflict homes in the absence of divorce of violence, Cummings and Schatz (2012) developed one of the only interventions aimed at preventing/reducing the negative effects of interparental conflict targeted at adolescents. However, this program was designed to fit within a universal prevention strategy (Cummings and Schatz 2012); therefore, all adolescents were included and teens exposed to destructive marital conflict were not directly targeted. This psychoeducational intervention, which involves both parents and adolescents and focuses on improving family conflict resolution skills, has been effective in improving family communication and increasing adolescent emotional insecurity. However, the researchers did not investigate measures of adolescent emotional health such as depression or anxiety, and such family interventions require the involvement of parents in addition to adolescents, which requires parental commitment to change. A promising alternative approach to intervening at the interparental level is building the regulatory capabilities of adolescents exposed to destructive interparental conflict. However, no studies have investigated the efficacy of such an approach.

The Case for Mindfulness

To directly target adolescents exposed to destructive interparental conflict (in addition to or instead of family intervention), it is necessary to identify an approach that is accepted by adolescents, is developmentally appropriate, and that targets important mechanisms that explain the effects of interparental conflict. We propose that mindfulness interventions are just such an approach. Mindfulness interventions provide and guide opportunities to practice cultivating attention on the present-moment with self-compassion, in line with the definition of mindfulness as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn 1994, p. 4). The ability to redirect attention to present experience with openness and without automatic reactivity or elaboration helps reduce negative consequences that tend to accompany a focus on the past (e.g., rumination) or future (e.g., anxiety) (Broderick and Frank 2014). Acknowledgment and acceptance without judgment of present moment experiences helps individuals understand that thoughts and feelings do not necessarily require fear/avoidance (Baer 2003). The core tenant of mindfulness practice is present-focused, nonjudgmental awareness, whether this be in regard to body sensations, internal thoughts or feelings, or internal processes regarding the self or others. As such, mindfulness practice may take a variety of different forms. Mindfulness practices can promote mindfulness of the body (e.g., body scan meditations, mindful movements), mindfulness of thoughts or emotions (e.g., awareness of thoughts or emotions meditations), or compassion for self or others (as in loving kindness meditation) (Broderick and Frank 2014).

Purported Mechanisms of Mindfulness for Improving Mental Health for Adolescents Exposed to Interparental Conflict

Direct Effects

Consideration of the indirect and direct mechanisms by which destructive interparental conflict affects adolescents also highlights the potential mechanisms of change in terms of increasing mindfulness with this population. In terms of direct effects on children’s emotional and cognitive responses to conflict, there are several reasons to expect that increasing mindfulness may help reduce feelings of self-blame and threat to the self or family after exposure to interparental conflict. First, mindfulness training reduces the automaticity of judgments like appraisals. Mindfulness training emphasizes that thoughts and feelings are distinct from the self (rather than self-defining) and can be observed with curiosity rather than immediate judgment. This practice helps to provide distance between experiences and evaluations (Bishop et al. 2004), a process called decentering, and as a result may reduce the likelihood that adolescents exposed to conflict immediately feel responsibility or fear in response to conflict exposure. Second, mental training in regulation of attention can prevent “getting caught up in ruminative, elaborative thought streams about one’s experience and its origins, implications, and associations” (Bishop, p. 232). Appraisals of self-blame and threat to some extent reflect mental focus on the past, through a concern about the origins of the conflict (e.g., “I did something to cause this”), and/or the future, through a concern about the implications of the conflict (e.g., “This is going to be bad”). Although interparental conflict may very well be caused by actions on the part of the adolescent, or have negative consequences for youth or their family, mindfulness training may help adolescents to more realistically and less automatically discern what they can do to change the situation and what they can’t, and what the actual consequences for the family system are likely to be. Third, practice in self-compassion and nonjudgement may be particularly important for reducing self-blame appraisals –the likelihood that they occur, and/or the negative feelings that result from recognizing some responsibility for interparental disagreements. In comparison to therapeutic approaches like CBT, because adolescents have little agency over their parents’ level of conflict and their attributions of this conflict may be founded in truth, it may be that mindfulness approaches (which focus on acceptance rather than modification of thoughts) particularly appropriate for this population.

Indirect Effects

In terms of indirect effects, there is some evidence to support the argument that mindfulness training may improve parent-adolescent relationships. Multiple studies suggest that mindfulness training can improve relationship satisfaction and quality, although these studies have targeted adults in romantic relationships (e.g., Carson et al. 2004) or parents (e.g., Coatsworth et al. 2015). In addition, there is qualitative evidence from college students who experienced a mindfulness intervention that it improved their relationships (Mahfouz et al. 2018). Therefore, although speculative given the lack of evidence in adolescence, it is possible that mindfulness training for adolescents may improve the relationships of those youth with their parents. Given evidence that high-quality relationships with parents can buffer adolescents from the negative effects of interparental conflict (Lucas-Thompson and Granger 2014), adolescents may benefit from these improved relationships with parents even if interparental conflict does not improve.

Although targeting adolescent mindfulness may not change the stressor of interparental conflict itself, it may have positive ripple effects nevertheless. There is evidence for reciprocal associations between interparental conflict and adolescent adjustment, with conflict increasing as well as being exacerbated by adolescent depressive symptoms and externalizing behaviors (Cui et al. 2007). A fascinating but speculative possibility is that mindfulness training that only targets adolescents may serve to improve interparental interactions through reductions in adolescent problematic behavior. For instance, evidence from One Person Family Therapy suggests that intervening with just one person in a problematic family system can create positive family-wide change (Foote et al. 1985).

Second is evidence that conflict appraisals of threat and self-blame are shaped by much more than actual exposure to interparental conflict. More specifically, controlling for parent-reported and observer-rated interparental conflict, conflict appraisals are predicted by parent-adolescent relationship quality and stressful life events, with more-negative appraisals reported by adolescents with lower quality relationships with parents and more stressful life events (Lucas-Thompson and George 2017). Furthermore, although siblings within the same family make similar appraisals of the objective properties of their parents’ conflict, siblings have statistically independent appraisals of self-blame and threat (Lucas-Thompson and George 2017). Given that youth conflict appraisals are more consistently associated with adjustment outcomes than are parent-reports of conflict (Grych et al. 1992), even if mindfulness training does not change interparental conflict, if it is able to reduce the automaticity and negativity of adolescent conflict appraisals, decrease perceptions of stress more broadly, improve adolescent coping self-efficacy, or improve parent-adolescent relationships, it can very likely improve adolescent outcomes.

Effects of Mindfulness on Attention and Emotion Regulation

There is growing evidence that mindfulness interventions are well-liked by adolescents, successfully increase mindfulness, and also produce meaningful improvements in the very domains in which adolescents exposed to destructive conflict are likely to suffer. Notably, many of the negative effects of interparental conflict are in regulatory domains, due in part to the chronic stress of exposure to interparental conflict. Therefore, an intervention strategy that directly targets stress regulation is arguably most appropriate. Although many intervention strategies target mental health and adjustment outcomes, mindfulness interventions are designed specifically to improve attentional skills and self-regulation. More specifically, mindfulness training focuses on both top-down regulatory functions as well as bottom-up arousal processes. The mental training that occurs as part of a mindfulness intervention encourages self-regulation of attention (e.g., cultivating present-moment attention) and emotion (e.g., cultivating self-compassion and nonjudgmental awareness) (Zelazo and Lyons 2012). In addition, mindfulness training focuses on reducing bottom-up contributors to regulation, namely arousal, stress, and anxiety (Zelazo and Lyons 2012). Individual studies highlight the effectiveness of mindfulness interventions for increasing emotion- and self-regulation (Eva and Thayer 2017; Fung et al. 2016; Metz et al. 2013). There is growing evidence from neuroscientific studies that mindfulness training is related to structural and functional neuroplasticity in brain regions that are key to attention and emotion regulation (Tang et al. 2015). Adolescence is a period defined by dramatic and cascading changes to the body and brain (Andersen 2003); therefore, we argue that the intervention strategy selected to directly target adolescents at-risk for regulatory problems because of interparental conflict should be one that has the potential to positively affect neuroplasticity of developing brain regions in ways that can have long-lasting benefits for regulation. To our knowledge, other intervention strategies (e.g., CBT, psychoeducation) do not have the neuroscientific evidence supporting their efficacy at changing neuroplasticity of regulatory structures and functions. In addition, approaches like CBT are heavily cognitive, whereas mindfulness training simultaneously targets bottom-up as well as top-down regulatory functions. Therefore, we propose intervening to increase mindfulness is likely to be a powerful and effective intervention strategy for adolescents exposed to interparental conflict.

Other Benefits of Mindfulness

Meta-analyses have indicated that mindfulness training in adolescence results in significant reductions in internalizing and externalizing symptoms, including symptoms of depression and anxiety (Zoogman et al. 2014). In addition, cognitive performance can be improved following mindfulness programs (Carsley et al. 2017; Zenner et al. 2014). In addition, these effects actually increase in size at follow-up relative to immediate post-test (Klingbeil et al. 2017). Mindfulness has also been shown to reduce stress (Bluth et al. 2016), and also reduce sleep problems (Dvorakova et al. 2017). Evidence from work with primarily adult populations also suggests that mindfulness training can improve physiological stress regulation (Brewer et al. 2009; Delgado et al. 2010; Lindsay et al. 2018). The research supports that mindfulness is an effective method for promoting positive development.

Developmental Appropriateness

During adolescence, there are dramatic social and biological changes that have ramifications for attentional and emotional regulation. By mid-adolescence, individuals are cognitively capable of engaging in adult-like decision-making, but are still quite vulnerable to emotional and social influences on cognition (Blakemore 2008; Steinberg 2005). The areas of the brain that most dramatically change during adolescence are in the corticolimbic and prefrontal brain regions that regulate emotion and executive functioning (for a review, see Crews et al. 2007). It isn’t until late adolescence when frontal lobes in the brain are fully matured that adolescents are fully capable and competent at self-regulation (Steinberg 2005). Adolescence also appears to be a period of development in which individuals are particularly sensitive to stressors (Broderick and Jennings 2012; Romeo 2013). Therefore, adolescence is a period during which regulatory systems are in flux, and as a result sensitive to both positive and negative environmental influences, making adolescence a period of both vulnerability and opportunity (Andersen 2003; Steinberg 2005).

Relative to other treatment modalities like CBT, mindfulness approaches may be particularly developmentally appropriate, as they facilitate and guide opportunities for emotion regulation and executive function (e.g., direction and maintenance of attentional focus) during a period when these skills are developing and therefore sensitive to experience-dependent learning (Kolb et al. 2012). For instance, there have been arguments that many of the limitations of existing treatment modalities for children and youth are rooted in the fact that the treatments are simply downward extensions of approaches used with adults, “resulting in the relative neglect of important developmental considerations” (Hammen et al. 1999, p. 65). There is emerging support for the effectiveness of Learning to BREATHE (L2B) (Broderick and Metz 2009), a mindfulness program designed specifically for adolescents that is rooted in the philosophy of mindfulness-based stress reduction (Kabat-Zinn 1990). As a result, mindfulness approaches are a developmentally appropriate strategy to target the regulatory challenges that are likely to be experienced by those exposed to interparental conflict.

A Specific Clinical Recommendation

Many mindfulness programs for adolescents have been developed, including several that have adapted interventions that were originally designed for adults. As noted above, L2B (Broderick and Metz 2009), was developed specifically for adolescents. This program can be implemented at school or in the community. As it is rooted in the philosophy of MBSR, L2B focuses on the same three families of practices, including focused attention (e.g., on the breath), open awareness (e.g., of sensations or thoughts/feelings as they happen), and compassion (e.g., towards self and others). However, L2B was designed specifically to meet the developmental needs of adolescents: it is designed to support autonomy and self-efficacy during stress, build emotion regulation skills, encourage group cohesion (through emphasis on the common experiences of adolescents), reduce self-judgment and social comparison, and encourage peer acceptance and support. A likely reflection of this developmental appropriateness is that mindfulness interventions like Learning 2 BREATHE are highly acceptable to adolescent participants (for reviews, see Broderick and Frank 2014; Burke 2010). In addition, there is consistent evidence that L2B results in increases in mindfulness and emotion regulation, as well as reductions in stress, depression, and externalizing behaviors (Bluth et al. 2016; Broderick and Metz 2009; Dvorakova et al. 2017; Eva and Thayer 2017; Fung et al. 2016, 2018; Metz et al. 2013; Shomaker et al. 2017). Because of its flexibility in implementation, developmental appropriateness, acceptability to adolescents, and building evidence base, L2B is an ideal intervention platform to explore with adolescents from high-conflict homes. Given that L2B targets the specific mechanisms by which destructive interparental conflict affects adolescents, as reviewed, the program is appropriate for this population as-is and need not be adapted or changed to benefit youth from high conflict homes. We have argued elsewhere (Lucas-Thompson et al. 2019) that is important for future implementations of mindfulness interventions with adolescents to begin to incorporate ecological momentary intervention supplements (e.g., through text-messaging and/or online digital libraries) to support skill transfer from the group meeting to daily life. As a result, we advocate for an intervention model for adolescents from high-conflict homes that focuses on practicing mindful attention, implemented in the community and/or at school, that provides opportunities to practice skill-building in real life through technological supports between group sessions.

L2B is likely to be helpful for adolescents from high-conflict homes because it targets the emotion regulation, stress, and adjustment struggles that this population is more likely to struggle with. Mindfulness training can reduce the negative impact of automatic negative thoughts regarding adolescents’ exposure to family conflict so that adolescents can more effectively cope which such stressors. As such, these interventions need not be focused to teach adolescents how to cope specifically with family conflict, as the focus is on building the internal strength (i.e., empowerment, the overall L2B program goal) to face a wide range of stressors in life. Adolescents can use newly-gained mindfulness skills to face the stressor of interparental conflict with openness to present-moment experience and nonjudgement. In addition, because the focus of L2B is on directly targeting and improving the regulatory capacity of teens, this intervention requires minimal interface with the teen’s family. As such, the teen is given agency in their personal growth. However, given the benefits of mindfulness for interpersonal relationships, intervention and therapeutic approaches that target parents and couples are increasingly incorporating mindfulness (Carson et al. 2004; Coatsworth et al. 2015), working to increase adolescent mindfulness would fit well with a therapeutic approach aimed at parents to increase mindfulness.

Indeed, the largest benefits for youth might be evident if a mindfulness intervention approach targeted both adolescents and parents, consistent with some evidence that combining adolescent and parent treatment can bolster effects as compared to just adolescent treatment alone (Spoth et al. 2002). For instance, parents who are themselves more mindful have better coparenting, as well as more satisfied relationships, which is then indirectly related to more-positive adolescent perceptions of parenting as well as reduced internalizing and externalizing behaviors (Parent et al. 2014; Parent et al. 2016; Parent et al. 2016). In addition, the benefits of parent participation in a mindfulness intervention spill over from parents’ themselves as individuals to the parent-child relationship and, in turn, youth outcomes (Bogels et al. 2013; Chaplin et al. 2018; Coatsworth et al. 2015). Therefore, incorporating at least one parent (e.g., with an individual or mindful parenting intervention) if not both (with the addition of a mindful coparenting intervention) into the intervention strategy may result in the most dramatic benefits for parents, adolescents, and the broad family system. However, in the absence of parental commitment to participation in a mindful parenting and/or coparenting intervention, targeting adolescents directly may in and of itself reduce or prevent the negative effects of interparental conflict.

Conclusion

Adolescents exposed to destructive interparental conflict are a critical group to target, as that exposure renders them more vulnerable to a wide range of long-lasting, negative developmental outcomes. However, past intervention strategies may be insufficient (or not benefit adolescents to the fullest extent possible) by focusing almost exclusively on changing interparental dynamics. Consistent with a family systems perspective, it is important to work to reduce destructive parent-parent conflict to promote parent, child, and family functioning. In addition, it is important to explore intervention strategies that directly target the regulatory capabilities of adolescents in a developmentally sensitive framework. We have argued that mindfulness interventions are an ideal strategy to target adolescents from high-conflict homes. Mindfulness interventions can be delivered directly to adolescents, and require only individual commitment to change. In addition, they are likely to target the direct and indirect mechanisms that explain the effects of interparental conflict on the adjustment and regulatory outcomes that youth from high-conflict homes are likely to experience (see Fig. 1). To date, however, mindfulness interventions have not been used with adolescents who are at risk for adjustment problems from exposure to interparental conflict. Directly targeting adolescents to increase mindfulness can be implemented in conjunction with, or instead of (e.g., if parents are unwilling to engage in treatment themselves) targeting problematic interparental interactions. It is necessary to determine the extent to which intervening to improve mindfulness is a feasible, acceptable, and potentially efficacious strategy to improve functioning in adolescents from high-conflict homes. In the absence of such knowledge, we will continue to utilize strategies with limited effectiveness to support adolescents from high-conflict homes who are high-risk and underserved.

Fig. 1.

Conceptual Model Supporting Promoting Mindfulness as an Intervention Strategy for Adolescents Ecposed to Destructive Interparental Conflict