Some teens remain depressed even after receiving treatment. On October 23, researchers led by the University of Cambridge and King’s College London published a protocol in the journal Trials for a randomized clinical trial of a mindfulness program that includes sessions for parents. The trial will enroll 480 young people ages 15 to 18. The trial is called ATTEND, and the program is called MAC (Mindfulness for Adolescents and Carers). This is not a report of results; it is a research protocol setting out in advance what the researchers will measure and how.
14,000 UK teens do not improve with treatment
According to the trial description registered by the researchers, about 140,000 people ages 15 to 19 in the UK experience depression. Of those, about 35,000 receive treatment through the National Health Service (NHS). The researchers say about 14,000 do not respond to treatment, while roughly 8,000 more are at high risk of relapsing even after initially responding well. The researchers are concerned that teens whose symptoms persist face increased risks of self-harm, substance misuse, and difficulties at school and in relationships, and that their physical and mental health in adulthood may also be affected.
The trial is aimed at these young people. Eligible participants are ages 15 to 18 and have completed at least one evidence-based treatment for depression or anxiety but still have depressive symptoms or have worsened again. The researchers will randomly assign 480 participants to two groups: one will receive MAC in addition to their usual treatment, and the other will continue with usual treatment alone. Child and adolescent mental health services in London, Devon, Sussex, the East of England (Cambridge and Peterborough), Oxford and Nottingham are taking part. The National Institute for Health and Care Research (NIHR) is funding the study. Teens currently receiving active care for suicide risk or self-harm, or for an eating disorder, as well as those with psychosis or post-traumatic stress disorder, will not be eligible.
Adapting adult mindfulness for teens—and holding parent sessions next door
MAC is based on mindfulness-based cognitive therapy (MBCT), a group program that combines meditation practice and cognitive therapy. It teaches participants to recognize early signs of depression and step out of recurring thought patterns that can fuel it. The UK National Institute for Health and Care Excellence (NICE) recommends MBCT for adults with recurrent depression, but the researchers say it has not yet been properly tested in adolescents.
The researchers adapted the program for teens. According to announcements from the University of Cambridge and King’s College London, MAC runs for eight weeks, with one in-person or online group session each week. Sessions last between 1 hour 30 minutes and 1 hour 45 minutes. Compared with the adult program, it includes more movement breaks and shorter periods of skills practice. It also includes snacks and activities teens may enjoy. Between sessions, participants use an app developed with families to record their at-home practice. Trained facilitators lead groups of six to 14 teens.
One notable feature is a separate program for parents and carers. While the teens attend their sessions, parents take part in mindfulness sessions in another room. Participation is optional, so teens can join the trial even if their parents do not want to take part. The researchers point to the stress of raising a depressed teen and the strain it can put on family relationships. They also note that teens whose parents experience depression are more likely to have mental health problems as adults. Professor Patrick Smith of King’s College London, a co-lead of the study, said parents often struggle because they do not know how to help their children. He said he hopes the parent sessions will help them understand and support their children’s recovery.
Tracking mood every two weeks for 12 months—and parents’ well-being, too
The trial has also specified in advance what it will count as an effect. Its primary measure is the Short Mood and Feelings Questionnaire (SMFQ), completed by the teens. After random assignment, participants will complete the questionnaire every two weeks for 12 months. Rather than comparing scores at just one point in time, researchers will compare the two groups to see how mild and how brief depressive symptoms were over the year. That is because the program aims to prevent depression from improving and then returning.
Parents will also complete the depression questionnaire (PHQ-8) every two weeks over the same period. At the start of the trial, about 14 weeks later, and again at 12 months, both teens and parents will separately report on anxiety, quality of life, their ability to cope with life, and the quality of their relationship. The schedule in the study protocol also includes weekly records of mindfulness practice by MAC participants, as well as interviews with some participants after the program ends. This will allow researchers to examine who the program works best for and how the amount of practice relates to outcomes.
The researchers will also assess costs. They will calculate the costs and effects of adding MAC to usual treatment from the perspectives of health care, social care, education and society as a whole. The calculation reflects the need to show that the program is affordable for public health care, even if it works, before it can be expanded across the NHS. According to the trial registration, recruitment was scheduled to run from August 2024 through February 2026, and the study is expected to conclude in September 2027.
Results are still pending—but why study mindfulness practiced with family?
This trial has not proved that mindfulness works. Results will take time, and they may not match expectations. The UK has already seen such a result. A 2022 study called MYRIAD, published in the journal Evidence-Based Mental Health by Professor Willem Kuyken of the University of Oxford and colleagues, examined 8,376 students ages 11 to 14 at 84 schools. It found no evidence that mindfulness lessons given to all students at school improved mental health more than regular lessons. Professor Kuyken is also listed as an author on the ATTEND study protocol.
ATTEND takes a different approach. Rather than giving every child the same lessons, it focuses on young people who are still struggling after treatment and adds mindfulness to their existing care. And instead of leaving the teens to practice alone, it brings their parents into the next room. Kat Nellist, who took part in an eight-week MBCT group at age 15 and now co-leads patient and public involvement in the study, told the University of Cambridge that the program helped her manage negative thoughts and improved her relationship with her parents.
For South Korea’s teens, who spend their days immersed in information and screens, a meditation that asks them to sit still for a long time may feel out of reach from the start. MAC’s longer movement breaks and shorter practice periods are worth noting as ways to make mindfulness more accessible. Its design also offers a point of reference for practitioners in South Korea considering family-based mindfulness: it treats parents’ well-being alongside the child’s, rather than making the child’s struggles a problem to solve alone. However, the program was designed to supplement—not replace—professional treatment. If a child is struggling with depression, consult a professional first. At home, parents and children could start with a small practice, spending even a few minutes a day noticing their own breathing. Healing News will be watching to see what answers this UK trial yields in 2027.
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