Interventions have attempted to promote mental health via several different practices, such as engaging in relaxation practices or practicing mindfulness. While intervention studies have examined effectiveness on mental health outcomes, evaluations rarely investigate social cognitive responses (e.g., attitudes, norms, and intention to practice) and the uptake of practice after the intervention, or their changes in the long-term. Moreover, evaluations of mental health-promoting interventions often fall short of making sense out of participant engagement due to an absence of a meaningful comparison arm. Usually control arms in such trials are passive, i.e., are not subjected to any other alternative, active treatment. Therefore, the levels of the resulting attitudes, motives, strength of motivation, etc., have no reasonable comparison point, a “benchmark,” which would aid in making better sense of the results.

In order for health behavior interventions to have their intended effects, the intervention has to be well received by the participants: They need to be motivated to enact the skill taught in interventions later in their daily lives (Bellg et al., 2004). If this chain of implicit assumptions in RCTs does not occur, conclusions drawn from the trial may not be valid. Unfortunately, there is a dearth of research into receipt and enactment of health behavior change interventions (Rixon et al., 2016; Walton et al., 2017; Hankonen, 2020). This study has a unique opportunity to compare and contrast social cognitive responses to mental health promoting interventions and asks: Are the motivation base and cognitive response to mindfulness practices essentially different from relaxation practices, in a school-based intervention? Do motivational factors predict similarly both types of practice?

We study several motivational, social cognitive factors that could potentially explain practice behavior, based on the reasoned action approach (RAA). Motivation to practice, or motivational responses to interventions can be studied from the perspectives of (1) social cognitive determinants of motivation, e.g., the RAA constructs, and (2) perceived reasons for non-practice and benefits experienced. The RAA posits that attitudes, perceived norms, and perceived behavioral control/self-efficacy regarding the behavior predict intention to perform the behavior, which predicts performance of the behavior. In adolescent populations, a particularly strong link has been found between descriptive norms and behavior (McEachan et al., 2016). Attitudes toward the behavior, perceived norms, and perceived behavioral control have been found to be associated with intention to meditate (Lederer and Middlestadt, 2014; Beattie et al., 2019, 2020; Erbe et al., 2019). However, to date, there is still a dearth of empirical evidence, however, on what factors predict mindfulness and relaxation practice at home for adolescents in spite of low adherence (Zenner et al., 2014; Felver et al., 2016). Due to the lack of previous research, our research is exploratory, and we did not form hypotheses about what the differences would be. We may conjecture that there could be differences, e.g., mindfulness practice may be seen as more foreign, hippie, or religious or may be experienced as more difficult, even frustrating.

Secondly, motivation to practice can also be studied from the perspective of reasons for not practicing (e.g., barriers), and perceived benefits. As for reasons for not practicing, time constraints are one of the most frequently found reasons in previous research (Gryffin et al., 2014; Laurie and Blandford, 2016; Kerr et al., 2019; Toivonen et al., 2020). As for experienced benefits post-intervention, improvements in relationships and stress management have been reported in adult populations (Parra et al., 2019; Erbe et al., 2020). However, there are more that have not been studied, potentially specific to an adolescent student population (e.g., concentration when involved in school). Reasons for not practicing and benefits are conceptually similar to RAA constructs, but unlike the RAA constructs, they are explicitly stated as reasons for not practicing and benefits experienced from having practiced. In other words, participants themselves report them as preventing practice or resulting from practice (respectively); by contrast, RAA constructs are tested as being related to practice statistically.

The authors’ previous work has found the RAA to be applicable to the prediction of mindfulness uptake in the same Healthy Learning Mind trial (Beattie et al., 2020). Here we extend the analyses to the relaxation arm and compare predictors of practice uptake in the same trial. This will help make sense out of the immediate evaluative, cognitive response of mental health-promoting interventions, which can be a sign of intervention acceptability and successful receipt (Rixon et al., 2016). In order to understand the specific, explicit barriers and benefits the participants perceive, the present study examines these in addition to the RAA.

We investigate, in a longitudinal follow-up of two active trial arms:

Social cognitive and behavioral responses and changes over time

Are there differences in social cognitions (outcome expectations, perceived norms, self-efficacy, and intentions) and practice between the arms and across time?

Does the RAA predict intention and behavior for both relaxation and mindfulness practice similarly?

Self-reported motives and gained benefits

What reasons do youth self-report for non-practice, what benefits do the youth report from practicing, and do the arms differ?

This study set out to investigate social cognitive, motivational responses to two interventions teaching mental health-promoting practices to young adolescents. These are indicators of both the receipt (or even acceptability) and the future continuation of the practice behavior. We found that, on average, participants of both relaxation and mindfulness interventions reported moderately high positive outcome expectations for engaging in the taught practices, moderate negative outcome expectations, moderately high injunctive norms (friends’ and parents’ approval), moderately low descriptive norms (friends’ behavior), and moderate self-efficacy. Immediately post-intervention, social cognition regarding mindfulness was more positive in the mindfulness arm compared to the relaxation arm. However, these differences seemed to disappear; the decline in these variables was stronger for the mindfulness arm (except the descriptive norm), rendering the mean levels similar at 26 weeks. These results then do not show differences in injunctive norms as may have been expected if mindfulness were perceived as more foreign, hippie, or religious, or in self-efficacy if mindfulness exercises were perceived as more difficult.

It should be noted, that although there were slight or major decreases in most social cognitive variables, the means of positive outcome expectancies and self-efficacy remained the same at follow-up. The driver in the major drop for intention, thus, may mostly reside in negative outcome expectations and normative beliefs. Descriptive norms showed the greatest drop, possibly due to the active intervention sessions at school having ended. It should also be noted that whereas “short mindfulness exercises” decreased more over time than did other forms of behavior, this may be due to a floor effect for the other behaviors rather than that the participants would keep up these other forms of exercises more than the short mindfulness ones: Short mindfulness exercises were higher to begin with. Also, the size of decrease was not very large, rendering practical significance of the decrease questionable (from 1.55 to 1.42).

This is the first study to compare social cognitive responses related to the mental health-promoting exercises (relaxation vs. mindfulness), and how they predict later behavior, to our knowledge. Evaluation of engagement with (fidelity of receipt and enactment) and acceptability of mental health-promoting programs is important across different phases of behavioral trials: (1) In pilot and feasibility trials, investigating responses gives important information for intervention optimization (feasibility and optimization). (2) Process evaluations in general can help interpret main outcomes of a trial (definitive trial phase). (3) Finally, as universal mental health-promoting programs are being increasingly rolled out nation-wide, we need to know what target participants’ (likely) attitudes toward these programs are (implementation phase; Skivington et al., 2021). This study in particular provides information for intervention optimization.

Limitations of this study include self-report measures and partly suboptimal operationalizations of the RAA constructs [see section “Discussion” in Beattie et al. (2019)]. Strengths include a multifaceted investigation of various indicators of receipt and the design, which enabled a comparison of two active intervention arms. Secondly, the sample size allowed for reliable comparative investigations, rarely available thus far. Thirdly, it should be noted that these results about reasons for not practicing should be taken with caution as missing responses and not choosing the responses deliberately cannot be distinguished.

For mental health-promoting programs, it may be useful to consider the communication within the programs in terms of likely effects on recipients’ self-efficacy, attitudes toward the behavior, and perceived norms. Such factors may influence enrollment into mindfulness programs as well as uptake and sustained use of mindfulness practices. In this intervention, there was room for all social cognitions to be improved by at least a point on the scale.

As for implications for future research, motivation and self-regulation theories may present an interesting addition to studying mental health promoting behaviors: they may pave the way for improved effectiveness of interventions through effectively intervening on predictors of practice behaviors (Hagger et al., 2020). These kinds of findings can inform the design of interventions to improve fidelity (Beattie et al., 2019). Improved attention to fidelity (receipt and enactment) of behavior change intervention trials helps acknowledge and tackle possible threats to trial validity (Toomey et al., 2020).

This study shed light on similarities and differences in reception and acceptability of two mental health-promoting interventions, through the lens of social cognitions and perceived benefits and barriers. Essentially, the results imply that both mindfulness and relaxation exercises are similarly acceptable, and have similar perceived benefits and the barriers for practice.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Humanities and Social and Behavioral Sciences Ethical Review Board of the University of Helsinki (Statement 1/2014). Written informed consent to participate in this study was provided by the participants or their legal guardian/next of kin.

MB: conceptualization, formal analysis, writing – original draft and review and editing, funding acquisition, and methodology. NH: conceptualization, writing – original draft and review and editing, supervision, funding acquisition, and methodology. HK: methodology, formal analysis, writing – review and editing, supervision, and conceptualization. S-MV: investigation, resources, writing – review and editing, supervision, and funding acquisition. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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