Mindfulness supports emotional resilience in children during the COVID-19 pandemic

Isaac N. Treves; Cindy E. Li; Kimberly L. Wang; Ola Ozernov-Palchik; Halie A. Olson; John D. E. Gabrieli

doi:10.1371/journal.pone.0278501

Peer Review History

Original SubmissionNovember 16, 2022
25 Apr 2023 Decision Letter - Lucinda Shen, Editor PONE-D-22-31625Mindfulness supports emotional resilience in children during the COVID-19 PandemicPLOS ONE Dear Dr. Treves, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 09 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The reviewers have congratulated the authors on an excellent mansucript. They feel that the results of the work further scientific understanding in the field. One reviewer has raised a minor query about the regarding the demographic of the study participants and suggested a discussion on whether schools provided mindfulness training to students Please could you address this comment. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes Reviewer #5: Yes Reviewer #6: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Children's lives were dramatically and abruptly changed by the COVID-19 pandemic. Stress, anxiety, depression, and other mental health issues arose as a direct result of these shifts. Increased awareness of one's emotional bodily sensations and a less critical or judgemental outlook on one's experiences are both benefits of practicing mindfulness. This research shows that children who practice mindfulness during a pandemic have better mental health as a result. In line with previous research, this data indicates that those who reported higher levels of mindfulness experienced less emotional discomfort during the pandemic. The children and their families volunteered to take part in the multi-week intervention research, which is one of the drawbacks the authors have discussed. By choosing themselves, the participants in this study have higher levels of education and money than was anticipated, which could have skewed the findings in favor of the research question. The authors correctly point out that they cannot rule out the potential that the findings of this study would be influenced by the fact that the participants were children who were trying to report socially desirable responses. This is only a correlational study, therefore it cannot prove that mindfulness is what actually makes people more resilient to negative emotions. Furthermore, moderation analyses do not produce proof of causation. Despite these caveats, the findings are still pertinent, and it is hoped that publication of the findings may encourage doctors and educators to employ Mindfulness approaches when working with children. Reviewer #2: Authors have done a cross-sectional study to investigate whether trait mindfulness was related to emotional resilience in response to stressful changes in education and home-life during the COVID-19 pandemic in the United States. They have used surrogate markers toidentify resilience. Introduction is well written, highlights the need and importance of current study and providing some background data. It is an important topic and authors have accordingly highlighted it. Methods are well structuresd, clearly explaining the data collection process, scales used and their questionnaire and its interpretation. Statistical analyses is wisely used to identify potential relationship, after normalizing the data and removing the outliers that can often drive false results in these kind of analyses. Results are clearly explained. Tables and figures are very useful to see the relationships. Their results do highlight the important corelation that authors hypothesized. Discussion and conlusion is robust, they have done a great job in explaining what their results signifies and previous studies on similar topics. It was also interesting to note the gender differences that were observed in the current stuies. Limitations of the study are accurately identified and mentioned. I would like to congratulate the authors on conducting this important study, meticulously and accurately reporting their findings with their limitations. Reviewer #3: Thank you for submitting this manuscript for review. It was quite well written and comprehensive. The results help confirm association of mindfulness with resilience and serves an important purpose in understanding the importance of inclusion of mindfulness in school curricula. The virtual nature of the study is also interesting though you rightly pointed out some of the limitations with it. Reviewer #4: This is a well written article with a clear research question. The study performs a good analysis of the data it presents. The study utilized a good method, and the study design appears clear and easy to replicate. There does not appear to be any bias or error. The study identifies its limitations well, and the discussion section is well written. This article suffers from lacking a conclusion section. Having a concise conclusion section to identify pertinent findings of this study will significantly increase its relevance to the average clinician. Minor concern 1. line 183 mentions "All analyses were conducted in R." Reviewer was unsure of the meaning of this sentence Reviewer #5: Congratulations to the authors for their rigorous work on this vital subject matter. If any participants had a psychiatric diagnosis or received any mental health treatment. It would be interesting to know if the school provided mindfulness training to students. The author could comment on the same. Reviewer #6: Thank you for shedding light on this vital topic. I have read this study's relationship between mindfulness and mental health resilience with great interest. The study population has lower rates of clinical anxiety and depression than norms, so any result extrapolation to draw a general conclusion should be considered with caution. However, the authors adequately explained the limitations. The introduction is well-framed, and the methodology discusses the covid-specific questionnaire and data-gathering process in terms of clinical presentation, known etiology, and neurobiology at length. Paper may benefit from adding any specific resources, if they exist (CDC, AACAP, etc.), that clinicians can access to learn more about it or seek guidance. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No Reviewer #4: Yes: Lakshit Jain MD Reviewer #5: No Reviewer #6: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
10 May 2023 Author Response Response summary: We thank the editor and reviewers for their useful comments. We have included a concise conclusion, provided more information about children’s previous mindfulness experience and demographics, and included a link for mental health resources. Additionally, we have updated the formatting of the manuscript and supplement to match PLOSOne’s style guide. Reviewer comments Reviewer #1: Children's lives were dramatically and abruptly changed by the COVID-19 pandemic. Stress, anxiety, depression, and other mental health issues arose as a direct result of these shifts. Increased awareness of one's emotional bodily sensations and a less critical or judgemental outlook on one's experiences are both benefits of practicing mindfulness. This research shows that children who practice mindfulness during a pandemic have better mental health as a result. In line with previous research, this data indicates that those who reported higher levels of mindfulness experienced less emotional discomfort during the pandemic. The children and their families volunteered to take part in the multi-week intervention research, which is one of the drawbacks the authors have discussed. By choosing themselves, the participants in this study have higher levels of education and money than was anticipated, which could have skewed the findings in favor of the research question. The authors correctly point out that they cannot rule out the potential that the findings of this study would be influenced by the fact that the participants were children who were trying to report socially desirable responses. This is only a correlational study, therefore it cannot prove that mindfulness is what actually makes people more resilient to negative emotions. Furthermore, moderation analyses do not produce proof of causation. Despite these caveats, the findings are still pertinent, and it is hoped that publication of the findings may encourage doctors and educators to employ Mindfulness approaches when working with children. Response: Thank you for your comments and your summary of the relevance of the paper. Reviewer #2: Authors have done a cross-sectional study to investigate whether trait mindfulness was related to emotional resilience in response to stressful changes in education and home-life during the COVID-19 pandemic in the United States. They have used surrogate markers to identify resilience. Introduction is well written, highlights the need and importance of current study and providing some background data. It is an important topic and authors have accordingly highlighted it. Methods are well structuresd, clearly explaining the data collection process, scales used and their questionnaire and its interpretation. Statistical analyses is wisely used to identify potential relationship, after normalizing the data and removing the outliers that can often drive false results in these kind of analyses. Results are clearly explained. Tables and figures are very useful to see the relationships. Their results do highlight the important corelation that authors hypothesized. Discussion and conlusion is robust, they have done a great job in explaining what their results signifies and previous studies on similar topics. It was also interesting to note the gender differences that were observed in the current stuies. Limitations of the study are accurately identified and mentioned. I would like to congratulate the authors on conducting this important study, meticulously and accurately reporting their findings with their limitations. Response: Thank you for your comments. Reviewer #3: Thank you for submitting this manuscript for review. It was quite well written and comprehensive. The results help confirm association of mindfulness with resilience and serves an important purpose in understanding the importance of inclusion of mindfulness in school curricula. The virtual nature of the study is also interesting though you rightly pointed out some of the limitations with it. Response: Thank you for your comments. Reviewer #4: This is a well written article with a clear research question. The study performs a good analysis of the data it presents. The study utilized a good method, and the study design appears clear and easy to replicate. There does not appear to be any bias or error. The study identifies its limitations well, and the discussion section is well written. This article suffers from lacking a conclusion section. Having a concise conclusion section to identify pertinent findings of this study will significantly increase its relevance to the average clinician. Minor concern 1. line 183 mentions "All analyses were conducted in R." Reviewer was unsure of the meaning of this sentence Response: Thank you for your comments and notes. R is a programming language for statistical computing. For clarity, we have added “All analyses were conducted in R programming language. “ We have also added a concise conclusion section: “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. “ Reviewer #5: Congratulations to the authors for their rigorous work on this vital subject matter. If any participants had a psychiatric diagnosis or received any mental health treatment. It would be interesting to know if the school provided mindfulness training to students. The author could comment on the same. Response: Thank you for your comments and questions. We asked caregivers whether the children previously received any mindfulness training at home, school, or somewhere else. If they answered yes, they were asked several follow-up questions about how many sessions they partook in training, what the training generally consisted of, and whether they continued to practice mindfulness (or SEL) on their own or with anyone else, and if so how often. We summarized the total number of children with previous mindfulness experience, at line 268. In addition, we have included a flowchart with a breakdown of previous mindfulness experience by diagnostic category, in the revised supplement, figure 3. Reviewer #6: Thank you for shedding light on this vital topic. I have read this study's relationship between mindfulness and mental health resilience with great interest. The study population has lower rates of clinical anxiety and depression than norms, so any result extrapolation to draw a general conclusion should be considered with caution. However, the authors adequately explained the limitations. The introduction is well-framed, and the methodology discusses the covid-specific questionnaire and data-gathering process in terms of clinical presentation, known etiology, and neurobiology at length. Paper may benefit from adding any specific resources, if they exist (CDC, AACAP, etc.), that clinicians can access to learn more about it or seek guidance. Response: Thank you for your comments. We have inserted a link to mental health resources from the American Academy of Child and Adolescent Psychiatry in the discussion section. https://www.aacap.org/AACAP/Families_Youth/Resource_Libraries/Coronavirus_Resource_Library/AACAP/Families_and_Youth/Resource_Libraries/Coronavirus.aspx?hkey=e254d570-c7cf-412b-833e-bb342ac4f312 Attachments Attachment Submitted filename: ResponseToReviewers.docx https://doi.org/10.1371/journal.pone.0278501.r002
12 Jun 2023 Decision Letter - Dario Ummarino, PhD, Editor Mindfulness supports emotional resilience in children during the COVID-19 Pandemic PONE-D-22-31625R1 Dear Dr. Treves, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Dario Ummarino, PhD Senior Editor PLOS ONE https://doi.org/10.1371/journal.pone.0278501.r003
Formally Accepted
4 Jul 2023 Acceptance Letter - Dario Ummarino, PhD, Editor PONE-D-22-31625R1 Mindfulness supports emotional resilience in children during the COVID-19 Pandemic Dear Dr. Treves: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr Dario Ummarino, PhD Staff Editor PLOS ONE https://doi.org/10.1371/journal.pone.0278501.r004

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