Mindfulness and Islam: Mindfulness-Based Interventions for the Prevention of Depressive and Anxiety Symptoms in Muslim Adolescents
University of Amsterdam
College of Child Development and Education: Bachelor Pedagogical Sciences
Bo Peperkamp (10982043) Bachelor Thesis
Final Version
Teacher: Merel de Wit
Amount of words: Abstract: 148, Paper: 4850 Date: 28 January 2019
Contents
Abstract 3
Introduction 4
Can results on the effectiveness of mindfulness-based interventions for the prevention 8 of depressive and anxiety symptoms be generalized to Muslim adolescents?
In what way can mindfulness be implemented as an intervention for Muslim 12 adolescents?
Discussion 16
Abstract
The popularity of mindfulness-based interventions has increased over the past thirty years. However, research on the effectiveness of mindfulness-based interventions is mainly based on a white, highly-educated, middle-class population, causing the effectiveness of mindfulness-based interventions for the Muslim population to remain unknown. Therefore, this paper examines the possibilities of mindfulness-based interventions for the prevention of depressive and anxiety symptoms in Muslim adolescents. It is examined to what extent research results on the effectiveness of mindfulness-based interventions can be generalized to Muslim adolescents. No indications are found that the effectiveness of mindfulness-based interventions will be different for Muslim adolescents than for Western non-religious adolescents. Further, it is examined how cultural adaptations of mindfulness-based interventions can be made, leading the intervention to be more convenient for Muslim adolescents. These adaptations are recommended to be based on the described similarities between Mindfulness, Islam, Sufism, and Muraqaba, wherefore practical suggestions are made.
Key-words: Mindfulness-based interventions, Islam, Internalizing Problems, Adolescents, Prevention
Mindfulness and Islam: Mindfulness-Based Interventions for the Prevention of Depressive and Anxiety Symptoms in Muslim Adolescents
In 1982 Jon Kabat-Zinn introduced mindfulness in Western society (Kabat-Zinn, 1982). He removed religious elements from the tradition of mindfulness and introduced it as a therapy for patients with chronic pain. Since then, mindfulness has increasingly been
implemented as a therapy for people with chronic pain as well as treatment and prevention of multiple internalizing and externalizing problems (Segal, Williams, & Teasdale, 2013; Williams & Kabat-Zinn, 2011). Furthermore, the amount of studies on the effectiveness of mindfulness-based interventions has grown rapidly (Chiesa, Fazia, Bernardinelli, & Morandi, 2017). However, studies examining the effectiveness of mindfulness-based interventions for the treatment and prevention of internalizing problems are mainly based on a white, highly-educated, middle-class sample (e.g., Bear, 2003; Laird, Amer, Barnett, & Barnes, 2007). This means that the results of these studies cannot be generalized to people with other backgrounds (e.g., Muslims) (Laird et al., 2007). Therefore, this paper aims to examine the possibilities of mindfulness-based interventions for the prevention of depressive and anxiety symptoms in Muslim adolescents.
The aim of mindfulness is to focus on the current moment and to become aware of automatic, maladaptive thoughts (Kabat-Zinn, 1994). This can be achieved through meditation, where one focuses on the breath and observes thoughts and events in a non-judgmental way. One of the core exercises of mindfulness is the bodyscan whereby one checks his or her entire body for tensions, pain, and sensations by means of attention and breath (Kabat-Zinn, 1994). So, mindfulness and mindfulness-based interventions focus on universal vulnerabilities like thoughts, breath and stress, instead of specific, individual
problems (Bögels, Hoogstad, Van Dun, De Schutter, & Restifo, 2008). Mindfulness is mostly associated with Buddhism and Hinduism, nevertheless, mindfulness has roots in Judaism,
Christianity, and Islam as well (Trousselard, Steiler, Claverie, & Canini, 2014). A benefit of mindfulness is the broad applicability, mindfulness-based interventions can be group or individual interventions; mindfulness-based interventions can be used as a treatment and as a preventive method; and, when the basics of mindfulness are adopted in daily life, mindfulness can be seen as a lifestyle as well (Kabat-Zinn, 1982; Kabat-Zinn, 1994).
In mindfulness as an intervention, the basics of mindfulness are taught in eight group sessions (Kabat-Zinn, 1994). These basics are: creating more awareness in daily activities, preventing living on an automatic pilot, developing self-compassion, gathering the scattered mind, recognition of negative thoughts and emotions, letting things be as they are, the realization that thoughts are not facts, taking care of yourself, and maintaining mindfulness practice after the intervention (Kabat-Zinn, 1994). Studies on mindfulness-based interventions show a wide range of possibilities of mindfulness within the mental health practice of
adolescents (Harnett & Dawe, 2012). Adolescents can follow the regular mindfulness intervention since it is assumed that they have enough concentration and self-regulation to perform the exercises and complete the training (Bögels et al., 2008). Furthermore, specific interventions are developed for adolescents, among which MyMind for adolescents with autism and ADHD, and a combined Parent-Child mindfulness training for the improvement of child and family functioning (Harnett & Dawe, 2012; Meppelink, De Bruin, & Bögels, 2016; Ridderinkhof, De Bruin, Blom, & Bögels, 2018). Besides, mindfulness can be combined with other therapies as well, resulting in mindfulness-based stress reduction and mindfulness-based cognitive therapy (Kabat-Zinn, 1982; Kabat-Zinn, 1994; Segal, Williams, & Teasdale, 2013). Lastly, since mindfulness-based interventions are mostly group interventions, they can also be offered at schools as a preventive intervention of internalizing problems (Kabat-Zinn, 1982; Van de Weijer-Bergsma, Langenberg, Brandsma, Oort, & Bögels, 2014).
With regard to internalizing problems, mindfulness-based interventions are mainly used for the treatment and prevention of generalized anxiety disorder, panic disorder, social anxiety disorder and depression (Hofmann, Sawyer, Witt, & Oh, 2010). Generalized anxiety disorder is characterized by constant worry about different life aspects and has a worldwide prevalence between 1 and 3% in adolescence (American Psychiatric Association, 2013; Hofmann et al., 2010; Kessler et al., 2012; Ormel et al., 2015). Social anxiety disorder is characterized by anxiety about social situations in which the person could be criticized by others, this type of anxiety has a worldwide prevalence of 10% (Hambour, Zimmer-Gembeck, Clear, Rowe, & Avdagic, 2018; Kessler et al 2012; Ormel et al., 2015). Depressive symptoms are feelings of helplessness and hopelessness; loss of interest in daily activities; appetite or weight changes; sleep changes; anger or irritability; loss of energy; feelings of worthlessness or guilt; concentration problems; and psychosomatic symptoms; these depressive symptoms have a worldwide prevalence between 3 and 8% in adolescence (American Psychiatric Association, 2013; Brent & Maalouf, 2015; Ormel et al., 2015). Further, depressive and anxiety symptoms can occur together with a panic disorder, characterized by panic attacks in stressful situations, this comorbidity has a prevalence around 2% in adolescence (Hankin, 2012; Hofmann et al., 2010; Kessler et al., 2012; Ormel et al., 2015; Schenberg, 2014). Lastly, the comorbidity between depressive and anxiety symptoms is estimated between 25 and 50% in adolescence (Axelson & Birmaher, 2001). These numbers indicate that depressive and anxiety symptoms are a great issue of mental health, influencing many adolescents
worldwide.
Research has been done to determine if the prevalence of these internalizing problems in Muslim and Western religious adolescents are the same. For instance, native non-religious Dutch adolescents and Muslim adolescents living in the Netherlands reported the same symptoms and prevalences of depressive and anxiety symptoms in a longitudinal study
at the age of 11 and 19 (Ormel et al., 2015). Similar results were found in Norway, where native Norwegian adolescents and Norwegian Muslim adolescents reported similar
prevalences of depressive and anxiety symptoms at the age of 15 years (Oppedal & Røysamb, 2007). These results suggest that ethnicity and migration have no effect on the prevalence of internalizing problems in Muslim adolescents in Western countries (Dimitrova et al. 2016; Oppedal & Røysamb, 2007; Ormel et al., 2015; Zwirs et al., 2007).
Because depressive and anxiety problems affect Muslim adolescents as much as Western non-religious adolescents, it is important that more knowledge is gained about the effectiveness of existing interventions for Muslim adolescents. Further, Muslims cover a big part of Western society; the Muslim population in Europa was 5% in 2017, and this
percentage is expected to grow to 14% by 2050 (PEW Research Center, 2017). Because culture and sometimes language differ between Muslim and Western non-religious adolescents, the effectiveness of mindfulness-based interventions might be different for Muslim adolescents. There are some indications that the effectiveness of interventions is influenced by language and culture (Bernal, Jiménez-Chafey, & Domenech Rodríguez, 2009) although other studies do not support this (e.g., Greeson et al., 2015). Thus, we lack
knowledge about the possible effectiveness of mindfulness-based interventions for Muslim adolescents (e.g., Laird et al., 2007). This can lead to an increase in inequality between the health and wellbeing of Muslim and Western non-religious adolescents in Western societies, which, in turn, could result in higher health expenses, poor integration and more internalizing problems among Muslim adolescents, causing a burden for the entire society (Laird et al., 2007).
Therefore, this paper explores the possibilities of mindfulness-based intervention as a preventive method of depressive and anxiety symptoms in Muslim adolescents. To examine if mindfulness-based interventions can be effective for Muslim adolescents as well, it will be
explored to what extent results on the effectiveness of mindfulness-based interventions can be generalized to Muslim adolescents (e.g., Greeson et al., 2015). Subsequently, similarities between mindfulness and Islamic traditions will be discussed (Isgandarova, 2018; Mirdal, 2012). These similarities will give possible leads for cultural adaptations of mindfulness-based interventions. Further, practical recommendations will follow on how to apply these cultural adaptations in mindfulness-based prevention of depressive and anxiety symptoms in Muslim adolescents, and suggestions for future research will be made. The aim of this paper is to explore the generalizations that can or cannot be made to the Muslim population in research and mental health practice and to explore the possibilities for cultural adaptations of mindfulness-based interventions for Muslim adolescents. Thereby this paper contributes to the psychological help of Muslim adolescents in Western society.
Can results on the effectiveness of mindfulness-based interventions for the prevention of depressive and anxiety symptoms be generalized to Muslim adolescents?
Multiple studies have shown an improvement in the psychological functioning of adolescents as a result of a mindfulness-based intervention, whereby cognitive change, self-management, relaxation and acceptation are mentioned as the effective elements of
mindfulness-based interventions (Bear, 2003). For instance, adolescents report a decrease in depressive, anxiety, stress-related, eating disorder and panic disorder symptoms after a mindfulness-based intervention (Bear, 2003; De Bruin, Zijlstra, Van de Weijer-Bergsma, & Bögels, 2011; Tan, 2016). Besides, adolescents report an increase of mindful attributions on the Mindful Attention Awareness Scale for Adolescents (MAAS-A) after a mindfulness-based intervention (De Bruin et al., 2011). Subsequently, adolescents report an increase in happiness and self-regulation after a mindfulness-based intervention (Bear, 2003; De Bruin et al., 2011). This increase in happiness and self-regulation might prevent the development of internalizing problems since they are mentioned as a protective factor of internalizing problems (Brent &
Maalouf, 2015; Mammarella, Donolato, Caviola, Giofre, 2018). Furthermore, the score on the MAAS-A of adolescents has a negative correlation with the amount of internalizing problems and has a positive correlation with the score on happiness, supporting the suggestion of a preventive effect of mindfulness-based interventions (De Bruin et al., 2011). However, mindfulness-based interventions are believed to only be effective if trainers practice
mindfulness on a daily basis because this enables them to understand the process, difficulties, and resistance the trainees are going through (Segal, Williams, & Teasdale, 2013).
Although the studies on the effectiveness of mindfulness-based interventions show positive results on internalizing problems, happiness and mindful awareness, these studies are mainly based on a white, highly-educated, middle-class sample (e.g., Bear, 2003; De Bruin et al., 2011). It is unclear to which extent results of these studies can be generalized to other populations, meaning that these results may not generalized to Muslim adolescents (Bernal et al., 2009; Laird et al., 2007). Because it can be possible that the effectiveness of interventions is influenced by language and religion and these are different for Muslim adolescents than for Western non-religious adolescents (Bernal et al., 2009), it has to be examined to what extent the result of these studies can be generalized to Muslim adolescents. Therefore, studies that examine the effectiveness of multiple interventions for the prevention of internalizing problems in cultural minority groups (e.g., Muslims) will be discussed.
Research shows that participants report a comparable decrease in depressive
symptoms on the Hospital Anxiety and Depression Scale (HADS) and a comparable increase in mindful awareness on the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) after a standardized eight-week mindfulness-based stress reduction intervention, despite religion, age and gender (Greeson et al., 2015). These results indicate that mindfulness-based interventions decrease the amount of internalizing problems for multiple religious groups. Which is contrary to the claim that the effectiveness of interventions can be influenced by
language and religion (Bernal et al., 2009). However, this study did not include Muslim participants or adolescents but only White, Hispanic, Black, American Indian, Alaska Native and Asian adults. Therefore, it stays unknown if the decrease of anxiety symptoms after mindfulness-based interventions is the same for Muslims adolescents as well.
One study is found for the effectivity of a mindfulness-based intervention for Muslim participants (Thomas, Raynor, & Bakker, 2016). In this study, 12 female Muslim university students followed a mindfulness-based stress reduction program consisting of 10 sessions; the regular mindfulness-based stress reduction intervention (Kabat-Zinn, 1994), an introductory session and a debriefing session. The female Muslim students reported that they accept mindfulness as an intervention for stress-reduction but had the opinion that the examples and phrases that were used during the meditation and exercises were not matching to their Islamic lifestyle (Thomas et al., 2016). Despite this mismatch between the used phrases and the Islamic lifestyle, the female Muslim students did report improvements in academic performance, diet, sleep, and relationships, and did report a decrease in anxiety and
depressive symptoms (Thomas et al., 2016). Thus, the mindfulness-based stress reduction was an effective method for them, despite the comments of the Muslim students that the used phrases and examples of intervention were not matching to their Islamic lifestyles.
This study indicates that mindfulness-based interventions can be effective for Muslims as well, though, no research on the applicability of mindfulness-based interventions for Muslim adolescents has been conducted yet. However, multiple research has been done to examine the applicability of interventions, which were developed for white, middle-class participants, to minority groups (e.g., Muslim) (Huey & Polo, 2008; Weisz, Jensen-Doss, & Hawley, 2006). For instance, A meta-analytic review on the effectiveness of evidence-based treatments of internalizing and externalizing problems for ethnic minority youth found that cultural sensitivity of the treatment did not moderate the effectiveness of the treatment (Huey
& Polo, 2009). These results are in line with the results of a meta-analysis that analysed the differences between evidence-based youth psychotherapies and non-evidence-based clinical care and controlled for the influence of ethnicity as well (Weisz et al., 2006). No effect of ethnicity was found for the effectiveness of the evidence-based psychotherapies for children and adolescents (Weisz et al., 2006). So, the results of these meta-analyses indicate that the effectiveness of interventions is not influenced by culture and cultural sensitivity of the intervention. However, studies that were included in these meta-analyses had low statistical power, a small representation of minority youth, and mostly did not include Muslim
adolescents, as a result of which the results of these meta-analyses must be interpreted
carefully. These studies do, however, support the notion that the effectiveness of mindfulness-based interventions could be the same for minority groups as for non-minority groups, and that the results on the effectiveness of mindfulness-based interventions may possibly be generalized to minority groups (e.g., Muslims) as well.
Moreover, the genesis of depressive and anxiety symptoms are independent of culture and religion and therefore the same for Muslim and Western non-religious adolescents; for instance the development of depressive and anxiety symptoms are influenced by family structure, family functioning, parental functioning, socioeconomic status, deviant brain and neural activity, gender, heredity, information-processing, temperament, and comorbidity with other forms of psychopathology (e.g., Beesdo-Baum & Knappe, 2012; Copeland et al., 2009; Dalrymple, 2012; Merikangas et al., 2010). Concluding, there are no indications found that results of studies which examine the effectiveness of mindfulness-based interventions cannot be generalized to Muslim adolescents, the genesis of internalizing problems are the same for Muslim and Western non-religious adolescents, and the literature suggests that it is possible that mindfulness-based interventions have the same effectiveness for Muslim adolescents as
for white, middle-class adolescents (e.g., Greeson et al., 2015; Thomas et al., 2016; Weisz et al., 2006).
However, there are indications that not all Muslims accept mindfulness as an intervention for the treatment and prevention of depressive and anxiety symptoms (Amri & Bemak, 2013; Laird et al., 2007). Literature and case studies indicate that Muslims do not seek help for their internalizing problems in the Western society due to cultural mistrust and the desire of a cultural and religious context of a treatment or intervention (Amri & Bemak, 2013; Weatherhead & Daiches, 2015). This rejection and mismatch can influence the effectiveness of mindfulness-based interventions since mindfulness-based interventions require motivation and daily practice (Bear, 2003; Kabat-Zinn, 1994). Therefore, cultural adaptations are desired for mindfulness-based interventions to be more convenient Muslim adolescents, and so that these interventions would be fully accepted by them (Bernal et al., 2009; Richards, Sanders, Lea, McBride, & Allen, 2015). The cultural adaptations will consist of modifications of the intervention protocol based on language, culture, and context, causing the mindfulness-based interventions to be compatible with Islam (Barrera, Castro, Strycker, & Toobert, 2013; Richards et al., 2015). Therefore, similarities between Islamic traditions and mindfulness will be discussed in the following section of this paper.
In what way can mindfulness be implemented as an intervention for Muslim adolescents?
Making religious and cultural adaptations of interventions is growing popularity within social science, thereby it is believed that by making cultural adaptation an intervention can be effective for all patients (e.g., Richards et al., 2015). For instance, a meta-analytic review shows that religious and spiritual faith has been adopted in cognitive and cognitive-behaviour therapy and that the participants who followed these culturally adopted therapies for the treatment of depressive and anxiety symptoms improved more than the participants in
a control group, who received the regular cognitive behaviour therapy (Anderson, Heywood-Everett, Siddiqi, Wright, Meredith, & McMillan, 2015). In total this meta-analysis included 16 studies among which four studies examined the effectiveness of cultural adopted cognitive behaviour therapy for Muslim participants with depressive and anxiety symptoms. However, these results have to be interpreted cautiously, since multiple methodological limitations (e.g., researcher allegiance) were found for the included studies (Anderson et al., 2015). Despite these limitations, the results of this meta-analysis are in line with the conclusion of a literature review on the possibilities to integrate Islamic traditions in Western psychology, wherein it is concluded that there are possibilities to apply Islamic traditions into cognitive behaviour therapy and that these adopted therapies would be more meaningful for the Muslim patients than the regular therapies (Haque, Khan, Keshavarzi, Rothman, 2016). These studies suggest that culturally adopted therapies would be more effective than non-adopted therapies for the prevention of internalizing problems in Muslim adolescents. However, these studies are about cognitive-behaviour therapy and not about mindfulness-based interventions.
For other religions, cultural adaptations of mindfulness-based interventions have already been made. For instance, a qualitative study describes the case of Ruby, a Christian woman who desired that her religion could have a place in the treatment of her eating
problem, depressive and anxiety symptoms (Hathaway & Tan, 2009). Cultural adaptations of a mindfulness-based cognitive therapy were made for the intervention to be accepted by Ruby and to be effective for her. The adaptations that were described were the association of
multiple phrases of the mindfulness-training with phrases of the Bible. For instance, accepting yourself and self-compassion was linked to the unconditional acceptance of God, and the awareness and the focus on the present moment were associated with the awareness of God in daily life (Hathaway & Tan, 2009). After the culturally adapted intervention, Ruby reported a decrease of anxiety and depression symptoms, besides she felt more connected with God and
was grateful that there was room for her religion during her treatment. The case of Ruby provides a starting point for making cultural adaptations of mindfulness-based interventions since the cultural adaptations supported Ruby to accept and benefit from the treatment of her internalizing problems (Hathaway & Tan, 2009).
Such cultural adaptations of an intervention can be implemented for mindfulness-based interventions for Muslim adolescents as well (e.g., Hathaway & Tan, 2009). These adaptations could consist of reframing the used examples, with Islam in mind (e.g., Keshavarzi & Haque, 2013). Thereby, it is suggested that by adding specific traditions of Islam instead of phrases about God that are applicable for multiple religious and spiritual beliefs, the cultural adopted interventions would be more convenient for Muslim adolescents (Keshavarzi & Haque, 2013). By adopting the mindfulness-based interventions it is more likely that Muslim patients can build a trustful relationship with their therapist (Barrera et al., 2013; Haque et al., 2016). Therefore, the similarities between Islamic traditions and
mindfulness will be discussed to give possible leads to the adaptation of mindfulness-based interventions for Muslim adolescents. This overview will provide a starting point for the implementation of mindfulness-based interventions for Muslim adolescents, and therefore will increase the equality of mental help of Muslim and Western non-religious adolescents.
There are multiple similarities between mindfulness and Islam. For instance, the aim to remove distractions and the emphasis on the present moment (al-Ghazālī, 2010). This present moment refers to thoughts, which should not be in the past or future but in the present moment in mindfulness (Bishop et al., 2004; Segal, Williams, & Teasdale, 2013). And this present moment refers to praying, preferred in places without distractions, in Islam (al-Ghazālī, 2010). Another similarity is the aim to prevent maladaptive reactions such as anger. In mindfulness, this is discussed through the explanation and detection of automatic responses and negative thoughts (Bishop et al., 2004; Segal, Williams, & Teasdale, 2013). In Islam,
anger is seen as evil and should be prevented. This is described in the tradition of al-Bukhari 6116, illustrated by a conversation between a man and prophet Mohammed, who emphasizes that the man should never become angry and furious (Sahih al-Bukhari 6116). Further, the acceptance of the circumstances of one’s life takes place in both mindfulness and Islam. Whereby mindfulness focuses on letting things be as they are, without the constant tendency to act, and Islam focuses on accepting the path of life God has chosen for you (Bishop et al., 2004; Mirdal 2012).
Besides these general similarities, the Islamic tradition of Sufism, in particular, shows multiple similarities with mindfulness. Sufism is the spiritual tradition of Islam and is used as a clinical practice as well (Chittick, 2007; Elias, 1998; Isgandarova, 2018). The moral and ethical aims of Sufism are described by the Sufi philosopher Rumi (1207-1273). The key concepts of Rumi’s philosophy are: the acknowledgement and acceptance of experiences (positive and negative), the unlearning of habits to make it possible to look at the world with a new and different view, the change of focus from oneself to others, and the alignment of the mind and body (Mirdal, 2012). All of these described concepts also occur in mindfulness-based interventions, in which these concepts are respectively referred to as letting things be as they are, the recognition of aversion, letting go of the automatic pilot, looking at the world with a beginner’s mind, compassion, and the awareness of body and mind (Bishop et al., 2004; Harnett & Dawe, 2012; Kabat-Zinn, 1994). Another similarity between Sufism and mindfulness is Muraqaba, which can be seen as the Islamic version of meditation
(Isgandarova, 2018). The aim of Muraqaba is to take care of the soul through the observation of thoughts, feelings and bodily sensations (Isgandarova, 2018). Muraqaba is similar to the bodyscan used in mindfulness-based interventions (Kabat-Zinn, 1994).
These similarities of mindfulness, Islam in general, and the Islamic traditions of Sufism and Muraqaba give possibilities for the cultural adaptation of mindfulness-based
interventions for the prevention of depressive and anxiety symptoms in Muslim adolescents. The aim of the cultural adaptation of mindfulness-based interventions would be the
development of effective and proper prevention of depressive and anxiety symptoms in Muslim adolescents. These adaptations would most conveniently be applied for the elements of mindfulness that already show similarities with Islam (e.g., the emphasis on the present moment, the prevention of maladaptive reactions, acceptance of the circumstances of one’s life, the moral and ethical aims of Sufism, and the exercise of Muraqaba). These cultural adaptations are desirable since internalizing problems are one of the biggest health problems in Muslim adolescents, and there are no preventive interventions available with a proven effectiveness for Muslim adolescents in the Western society (Bener, Ghuloum, & Abou-Saleh, 2012; Ferrari et al., 2013; Laird et al., 2007).
Discussion
This paper explored the possibilities of Mindfulness-based interventions for the prevention of depressive and anxiety symptoms in Muslim adolescents. It is explored to what extent results on the effectiveness of mindfulness-based interventions can be generalized to Muslim adolescents. Although no research has been found that examines this question, no indications were found that the effectiveness of mindfulness-based interventions would be different for Muslim adolescents than for other groups (e.g., Greeson et al., 2015; Thomas et al., 2016). However, it is possible that Muslim adolescents do not accept mindfulness-based interventions because of cultural mistrust and the desire of a cultural and religious context of a treatment or intervention (Amri & Bemak, 2013; Weatherhead & Daiches, 2015). To eliminate this rejection and to make mindfulness-based interventions more convenient for Muslim adolescents, cultural adaptations are recommended (Bernal et al., 2009; Richards et al., 2015). Therefore, similarities between mindfulness and Islam have been discussed: the emphasis on the present moment, the prevention of maladaptive reactions, acceptance of the
circumstances of one’s life, the moral and ethical aims of Sufism, and the exercise of Muraqaba (e.g., Isgandarova, 2018; Mirdal, 2012). These similarities give possible leading points for the cultural adaptation of based interventions to make mindfulness-based interventions convenient and effective for the prevention of depressive and anxiety symptoms in Muslim adolescents.
There are multiple possibilities for cultural adaptations to be implemented in
mindfulness-based interventions, for instance by telling the adolescents about the similarities, like was done in the case of the Christian woman Ruby (Hathaway & Tan, 2009). Another possibility is that mindfulness trainers could be Muslim so that they can determine where to make cultural adaptations of the intervention and tell the participants about the possibilities to implement mindfulness in an Islamic lifestyle. Another, more desirable, possibility is to develop a new protocol of a mindfulness-based intervention in which the examples and description of the intervention are based on Islamic traditions and Islamic lifestyle. This will make standardization possible and therefore also be appropriate for research (Bear, 2003). Finally, mindfulness could be embedded in the clinical practice of Sufism, since this practice is acknowledged by Muslim families and since it has experienced teachers as well
(Isgandorava, 2018). To determine which method will be best suited, more research has to be conducted on this topic.
However, the cultural adaptations cannot replace the effective elements of mindfulness-based interventions, which are believed to be cognitive change,
self-management, relaxation and acceptation (Bear, 2003; Kabat-Zinn, 1982). When the cultural adaptations of mindfulness to Islam are made, these assumed effective elements will have to be taken into account en will have to be respected. It is assumed that only then the cultural adapted mindfulness-based intervention for the prevention of depressive and anxiety
2009). Future research will have to determine if a cultural adapted mindfulness-based
intervention can indeed preserve the effective elements of mindfulness. It is likely that this is indeed possible, since making cultural adaptations of interventions has been done before and is shown to be an effective method to increase the effectivity and acceptability of
interventions for Muslim adolescents and families (e.g., Greeson et al., 2015; Thomas et al., 2016; Weisz et al., 2006).
A remaining question is if Muslim adolescents need mindfulness-based interventions for the prevention of their depressive and anxiety symptoms since there is no data available about the demand of mindfulness-based interventions by Muslim adolescents and families. It may be possible that Muslim adolescents feel that they do not need mindfulness and find enough support in their religion. Studies indicate that the Islam can be a coping mechanism and a preventive method for stress, depressive and anxiety symptoms, which is not found for other religions (Oppedal & Røysamb, 2007; Pouralkhas, Rajabi, & Pishgar, 2012; Radzi, Ramly, Ghazali, Sipon, & Othman, 2014). Resulting in less depressive and anxiety symptoms among Muslim adolescents comparing to other non-Western adolescents, but not comparing to native, Western non-religious adolescents (Oppedal & Røysamb, 2007; Stuart & Ward, 2018). However, Muslim female university students and their families are positive about and open to mindfulness as an intervention for stress-reduction, especially when cultural
adaptations would be made (Thomas, Furber, & Grey, 2017; Trousselard et al., 2014). Furthermore, Muslim adolescents have the same number of internalizing symptoms as non-religious Western adolescents, indicating that Islam alone cannot preventive depressive and anxiety symptoms in Muslim adolescents (Dimitrova et al. 2016; Oppedal & Røysamb, 2007; Ormel et al., 2015; Zwirs et al., 2007). Causing that there may indeed be a demand for
mindfulness-based interventions from Muslim families. Future research is recommended to examine this claim.
Concluding, this study provided an overview of the current literature about the
possibilities of mindfulness-based interventions for Muslim adolescents. Taking into account the expectations about the possibilities about the generalization of research results on the effectiveness of mindfulness-based intervention to Muslim adolescents; the similarities between the prevalence and genesis of depressive and anxiety symptoms in Muslim and Western non-religious adolescents; the similarities between Islamic traditions and mindfulness; and the possible obstacles for the implementation of mindfulness-based
interventions for Muslim adolescents, it can be concluded that there are great possibilities for the implementation of mindfulness as a preventive intervention of depressive and anxiety symptoms in Muslim adolescents. This paper contributes to a clearer picture of the differences and similarities between the mental health of Muslim and Western non-religious adolescents, provides an overview of the possibilities for the implementation of interventions into different cultural populations, and provides information about the cultural generalization to the Muslim population that can or cannot be made in research and in health practice. This paper can be seen as a contribution to the mental health of Muslim adolescents in Western society, and as a contribution to the attainment of more equality in the mental health care of Muslim and Western non-religious adolescents. Lastly, this paper can be seen as a contribution to the applicability and acceptability of mindfulness-based interventions for all adolescents that could benefit from being mindful.
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