Therapeutic applications of mindfulness in paediatric settings

Cognitive–behavioural therapy (CBT) has evolved over three waves of psychotherapeutic approaches since its beginnings in the 1950s. The first wave of scientifically based psychotherapy was behav­ ioural therapy, which focused directly on the modification of behaviour and emotion, based on conditioning principles. The second wave was cognitive therapy, as information processing and meaning­making were seen as mediators between stressors and psychopathology, thus implying the therapeutic change of negative thoughts, cognitive distortions, irrational beliefs or dysfunctional schemas, by means of their restructuring (e.g. detection, correction, disputation) and testing. The third wave of CBT represents a fundamental paradigm shift, embedded in postmodernist philosophical theories such as functional contextualism that assumes reality as a dynamic process of continuous change and thought content as largely irrelevant to psychological disturbance (Hayes 2004a; Harrington 2009). Case formulation is especially sensitive to the context and functions of psychological phenomena within third­wave CBT, and treatments highlight contextual and experiential change strategies in addition to more direct and didactic ones (Hayes 2004a). Although there is no consensual classification of which psychotherapeutic approaches constitute ‘third­wave CBT’, there seems to be considerable agreement on including dialectical behaviour ther­ apy (Linehan 1993), acceptance and commitment therapy (Hayes 1999) and mindfulness­based cog­ nitive therapy (Segal 2002) under that umbrella term (see Öst 2008; Kahl 2012). Among the com­ mon features shared by these therapies (e.g. the focus on mindfulness, acceptance, the person’s values in life), mindfulness is arguably the most cross­cutting characteristic. In this article, we aim to illustrate the potential therapeutic applications of mindfulness to paediatric health contexts – in the most general sense of encompassing paediat­ ric psychological disorders and chronic physical conditions, and as targeting parents’ and their children’s needs – and to provide clinical guide­ lines for effectively conducting mindfulness­based interventions in paediatric settings. The article starts with a functional definition of mindfulness and its spectrum of therapeutic indications, fol­ lowed by the presentation of essential guidelines and clinical examples for mindfulness in practice, while applying a dyadic parent–child approach to mindfulness­based intervention strategies and processes.