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SPECIAL SECTION: INTERVENTION STUDIES

The Effect of Meditation on Physical and Mental Health in Junior College Students: A Quasi-Experimental Study

Yang, Ke-Ping; Su, Whei-Ming*; Huang, Chen-Kuan**

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doi: 10.1097/JNR.0b013e3181c17f77
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Abstract

Introduction

The stresses prevalent in the present-day society have caused many people to suffer from physical and mental distress. The modern mindset has also been conditioned to face many crises in terms of larger concerns regarding the handling of a variety of life stresses and increasing the happiness (Kieviet-Stijnen, Visser, Garssen, & Hudig, 2008). Such crises are particularly apparent in adolescents, who account for 15% of Taiwan's total population. While maturing into adulthood, adolescents have a greater tendency toward behavioral disorders, which has social and economic impacts (Wang & Wu, 2006). The Teacher Chang Foundation reported that adolescents suffer significant stress arising from academic or family pressures (cited in Wang & Wu, 2006). Hence, adolescents must strive hard to reach their goals in a highly competitive environment. In addition, parents often map out the life career of their children, who then lack the freedom to choose their own life path. Weak internal stress coping mechanisms can easily affect one's physical and mental health.

Recent research on the benefits of meditation in reducing stress-related illness has convinced many corporations nationwide-including Adolf Coors, Marriott, Polaroid, Hughes Aircraft, Pacific Bell, and the National Aeronautics and Space Administration-to use meditation training as an integral part of their stress management programs (Pemberton, 2009). Meditation has been the subject of hundreds of clinical studies in recent years, suggesting that it controls high blood pressure, reduces chronic pain and insomnia, and relieves a variety of symptoms or distresses (Loizzo, 2009). It is increasingly well known for therapeutic efficacy in a variety of illnesses and conditions (Garland, Gaylord, & Park, 2009). These pilot data represent a preliminary investigation of the relationships between meditation program participation and health, highlighting the need for better controlled studies in this area.

Review of the Literature

The meta-analysis study of Wu, Yen, and Yu (2007) of 195 articles related to adolescent suicide in Taiwan and abroad found that different risk factors of adolescent suicide are correlated to various degrees. Emotional degree and overall suicidal behavior, mindset, and intention are highly correlated. Adolescents face stress from teachers and parents to do well academically and from conflicts in interpersonal relationships, peer identification, and the external environment (Wang & Wu, 2006). Physical, mental, or social problems may arise in the absence of support or proper coping assistance. Realization of life education and emotion education can assist adolescents to deal with stress and other problems. Thus, sufficient mental energy to solve an emotional crisis and adjust to distress is expedient (Lo, 2007).

The Industrial Revolution, the Information Revolution, and other scientific "revolutions" have ratcheted up levels of competitiveness and hastened the pace of life. Values have been transformed accordingly. Those facing environmental stress from work, the economy, family life, and complicated interpersonal relationships may use psychiatric medication, psychological counseling, and philosophical concepts to release temporarily their stress and maintain balance in their lives. Such methods, however, merely alleviate symptoms, which is why the population defined as "melancholic" continues to rise linearly. Life stresses may be resolved through the practice of meditation, a finding noted by many researchers (Beauchemin, Hutchins, & Patterson, 2008; Gill, Kolt, & Keating, 2004; Lamanque & Daneault, 2006; Solberg, Halvorsen, Sundgot-Borgen, Ingjer, & Holen, 1995; Yogi, 2001).

Many people today believe and suggest that meditation goes hand-in-hand with physical and mental health. Eastern meditation practices have become a trend in the West as an approach to enriching "spiritual systems." An article entitled "The Science of Meditation" in a mainstream news magazine explored the development and growth of meditation in Western culture (Time Magazine, 2003). The authors contended that the art of meditation, lost for centuries, has been revived in recent years. One journalist described his own experience practicing meditation. Despite his own suspicions, he still elaborated on its positive effects. Although there are various techniques used in meditation, many of which vary greatly, all have beneficial results in the promotion of better physical health.

Years of scientific research have demonstrated that meditation is one of the safest practices in complementary and alternative medicine; it is very effective to balance physical, emotional, and psychological states (Ramaswami & Sheikh, 1989). Meditation releases stress to upgrade spirituality, change brain structures, and create positive psychosomatic health (Yogi, 2001). The quasi-experimental study of Solberg et al. (1995) attempted to explain in scientific terms the effect of meditation on the body by analyzing the blood of male participants in six experimental and control groups. They found that meditation may modify the suppressive influence of strenuous physical stress on the immune system. In general, meditation has been incorporated into health and fitness programs to complement modern medicine (Xutian, Zhang, & Louise, 2009). Results from many studies have demonstrated the ability of meditation to reduce the symptoms of many psychosomatic disorders (Bertisch, Wee, Phillips, & McCarthy, 2009), pain (Tekur, Singphow, Nagendra, & Raghuram, 2008), emotional distress (Beauchamp-Turner & Levinson, 1992), insomnia, and depression (Ramaswami & Sheikh, 1989). It has also been shown to promote physiological and psychological health (Fernros, Furhoff, & Wändell, 2008) and improve mental and physical health (Davidson et al., 2003).

Stress and Coping

From a biological perspective, stress is a physical reactive-defensive force (Mason, 1975; Selye, 1975). One often adopts a strategy to change or copes with the origin of stress while facing the impact of a situation. By coping, one can reconstruct the balance between mental and physical distress, adjust emotional state, and achieve a comfortable condition (Miller, 1992). Coping can be categorized into two types: problem focused and emotion focused (Lazarus & Folkman, 1984). Problem-focused coping is a positive coping behavior, meaning that while facing stress, an individual will use major and direct methods to analyze and solve the threat. The individual evaluates the costs and effects of all methods and then chooses the one that is most effective to solve the problem. The most common coping behaviors include using direct or indirect problem solving, analyzing and discussing stressors, changing expectations, developing new behavioral standards, learning new skills, and seeking help or support (Lazarus & Folkman, 1984). Emotional-focused coping uses negative coping behaviors, indicating that individuals use emotional expression or support, such as anxiety or sadness, to control emotional reactions elicited by stressful situations. This kind of coping does not deal directly with the stressful condition. Common coping behaviors include avoidance of problems, denial, minimizing problems, selective attention, and other psychological defensive mechanisms (Lazarus & Folkman, 1984). Generally speaking, stress consists of positive and negative effects, which determines the coping strategies that individuals adopt. Coping is the major element between a stressful event and a coping result (Miller, 1992). If individuals could adopt more positive coping strategies in the process of handling stress, they will be more able to adjust both physically and mentally.

Meditation Treatment

Millions are learning meditation in the United States, with the population involved in meditation significantly more educated than the general population. A search of the Medline database yielded 532 articles published on meditation since 1966. More than 200 of those articles (approximately one third) were written between 2005 and 2008, indicating that meditation is not practiced exclusively by monks, lamas, yoga masters, or religious followers (Hwa, 1981). The number of published papers suggests that meditation has transcended from self-cultivation to the domain of medical therapy. Lamanque and Daneault (2006) searched the Medline database from 1996 to 2004 and discovered five research articles in which meditation was used in a clinical experiment to improve the condition of patients with cancer. Research results concluded no strong evidence in support of actual cancer condition improvement but strong evidence in support of meditation benefits in terms of reducing depression and anxiety and improving a patient's sense of spiritual well-being. However, researchers note that the effects of meditation may be "diluted" due to the diverse treatment approach to cancer. To obtain tangible evidence on the effects of meditation, the measures of comfort and the sense of spiritual well-being should be evaluated separately. Nonetheless, both comfort and spiritual well-being should be incorporated into any research related to improving quality of life.

Goleman (1976) segmented meditation into two categories. One is transcendental meditation, founded by Maharishi Mahesh Yogi in India, which is also known as concentrative meditation. This category is a "focused" meditation in which continuously chanting a sentence (with functions of comforting and calming the mind) transforms one's attention from active to passive, giving the meditator a super consciousness experience that transcends subjective and objective consciousness (Toane, 1976). This method shares similar functions with religious ceremonies such as Amitabha chanting, sutra chanting, and spell chanting. The other category, "insight" meditation, is derived from the breathing meditation advocated by Zen practitioners in China. Starting with breath counting, the practitioner reaches a focused "being" condition that leads to global awareness of insight. The cultivation of breathing and global awareness is intended to achieve a balance of body and mind and foster wisdom and potential (Falkenstrom, 2003; Huang & Chen, 2003). Transcendental meditation was first introduced in the United States in the early 1960s. Kabat-Zinn (1982) founded the stress reduction department at the University of Massachusetts Medical Center to promote mindfulness-based stress reduction (MBSR). The MBSR curriculum was introduced in the West to applying MBSR as one of the medical health promotion strategies (Kabat-Zinn, 2003). The standard MBSR curriculum runs 8 to 10 weeks, with about 30 participants. For 2 to 2.5 hours, participants practice MBSR skills and discuss stress and coping strategies. Homework is assigned from time to time, and a whole-day advanced class of 7 to 8 hours is conducted during Week 6 to teach the transformation of mind and body, share MBSR experiences, discuss how to practice MBSR at home, and challenge the process of their experiences (Matchim & Armer, 2007; Ott, Norris, & Bauer-Wu, 2006).

Beauchemin et al. (2008) used a 5-week mindfulness meditation course to treat 34 adolescents with learning disabilities suffering from high levels of anxiety, learning stress, and lack of interpersonal relationship skills. The pretest and posttest research comparison indicated the mindfulness meditation course as significant and effective in reducing both anxiety and detrimental self-focus of attention. It indirectly upgraded social skills related to interpersonal relationships. Another research project employed multiprocess theory and progressive relaxation with 76 university students to explore degree of anxiety improvement (Gill et al., 2004). It was discovered that the two aforementioned skills can reduce awareness and physical anxiety conditions. In addition, this approach allows people to increase levels of confidence.

Since the 1970s, there has been a steady flow of research data on the effects and benefits of meditation. Results overwhelmingly point to numerous benefits associated with meditation (Baskerville, 2009). Meditation is one of the methods used to reach progressive relaxation (Gill et al., 2004) and promote both mental and physical health (Davidson et al., 2003). For the purpose of this study, physical and mental health measures focused only on the relief of certain common symptoms or distresses in adolescent students, for example, headache, fatigue, dizziness, pimples, menstrual cramps, canker sores, and insomnia.

Purpose

This study investigated the impact of meditation on students' physical and mental health. Specifically, the purpose of this study was to examine the effect of meditation on student physical and mental health and to compare physical and mental life coping strategies between students who meditated and those who did not.

Methods

Design

This study was designed as a quasi-experimental research study.

Sampling

This study used convenience sampling from among freshmen admitted to the 2007 two-year program at a junior college in northern Taiwan. The sample group was first approved by the Board of Human Research Protection (institutional review board) at that institution. Participants were recruited from six freshmen classes and were asked to volunteer to participate in the research project. The research process was described in detail, and signed consent forms were collected. The sample was then randomly segmented into two groups: experimental and control. All participants were female and 19 to 20 years of age.

Instrumentation and Measurement

A five-point Likert-type Life Adaptation Scale (LAS) was given as a pretest (total, 300 returns; 283 valid) and a posttest (total, 280 returns; 274 valid). The posttest scale was given to both groups 18 weeks after test administration. There were a total of 242 valid sets of data for both pretest and posttest, including 119 copies from the experimental group and 123 from the control group, with a valid return rate of 80.67%.

The LAS was designed by Chen and Wu (1987). Part of the content of the scale was borrowed from the Derogatis (1977) Symptom Checklist 90-Revised. Another part was based on stress model concepts proposed by Lazarus and Folkman (1984, 1988), who divided stress into positive and negative according to stress coping methods. The LAS includes three parts: physical and mental distress, positive coping strategies, and negative coping strategies. Scale reliability was confirmed by testing and retesting the internal consistency reliability coefficient (Cronbach's a = .78-.90). Content validity was established by five bilingual and bicultural professionals with translation experience (Ou, 1989). The internal consistency coefficient of the pretest and posttest was greater than .88 in this study. Scoring of the LAS is described as follows.

For physical and mental condition, there were three questions asked in this part. The first described 35 physical and mental symptoms, with one point for each symptom. The higher the score, the more physical and mental distress. The second and third questions described the participant's current physical and mental health condition. They were phrased, respectively, as "In comparison with other same-age counterparts, what is your physical and mental health condition?" and "In comparison with yourself 6 months ago, how would you rate your current physical and mental health conditions?" These two questions were evaluated on a 5-point Likert scale in the range of "much worse," "worse," "no difference," "better," and "much better." The higher the score, the better the physical and mental health condition.

Positive coping strategy was evaluated using a 5-point Likert scale ("never, "seldom," "sometimes," "often," and "always"). Points assigned to each response ranged from 0 to 4. The content of the scale, with a total of 28 questions, was answered depending on daily life events. Higher scores represented more positive resources and more effective coping with diversified life changes.

Negative coping strategy examined participant responses to life events in a negative way. Points assigned to each item ranged from 0 to 4. Higher scores correlated with higher levels of emotional distress and lower life coping abilities.

The Intervention

This meditation treatment was conducted by an experienced master with more than 20 years of spiritual practice. The meditation began with exercise training: the sitting position, hand pose, and mind and body balance, for example, regulation of body functions (diet and sleep), regulation of the mind (thoughts and ideas), and regulation of breathing (breathing techniques and key concepts). Participants were asked to remain motionless with their eyes closed, giving quiet thought and reflection to all feelings and sensations that they felt associated with their breathing. At this time, their physical body is still and suspended in quiet. At the beginning, for about 20 to 30 minutes, a fundamental principle is to achieve a desired state of rumination by means of focused attention on the deep and slow breathing. The master then guided participants to allow them to remain in such a state in calm and peace. Two hours of meditation treatment was given to the experimental group for 18 weeks, for a total of 36 hours. No meditation treatment was given to the control group. The pretest was administered during week 1, before the beginning of meditation treatment. The posttest was administered after the meditation treatment was completed during week 18. Data were analyzed by SPSS for Windows 11.0.

Results

The Effect of Meditation on Participants' Physical and Mental Health

Thirty-five symptoms were measured in the survey. Average physical and mental distress symptoms measured 7.33 before the intervention and 6.64 afterward. Before meditation, the top five physical and mental symptoms suffered by the experimental group included pimples (n = 71, 59.7%), fatigue (n = 62, 52.1%), headache (n = 58, 48.7%), dizziness (n = 57, 47.9%), and menstrual cramps (n = 46, 38.7%). In contrast with distresses after the meditation, symptoms remained approximately the same, with the exception of dizziness and constipation. For the control group, the top five physical and mental symptoms included fatigue, pimples, headache and menstrual cramps, dizziness, and insomnia. A comparison of the pretest data between the two groups indicates the five top symptoms reported to be similar, with the exception of insomnia in the control group (Table 1).

TABLE 1
TABLE 1:
Top Five Symptoms of Physical and Mental Distress in Study Participants (N = 242)

Results showed that differences in physical and mental health conditions between the two groups were not statistically significant for either of the two health condition questions. The two questions regarding comparison with same-age counterparts and a retrospective self-comparison within a 6-month period revealed a mean score between 2 ("slightly lower") and 3 ("no difference") on a 5-point Likert scale. Although both groups showed a higher posttest than pretest mean score, no significant difference was found.

Table 2 shows that the mean score of the participants' physical and mental condition in the pretest for the experimental group (M ± SD = 19.42 ± 13.81) was higher than that for the control group (M ± SD = 18.60 ± 13.08) and that this result was reversed in the posttest. The mean score for the experimental group (M ± SD = 18.91 ± 12.93) was lower than that for the control group (M ± SD = 22.93 ± 13.08).

TABLE 2
TABLE 2:
Physical and Mental Health Conditions of the Participants (N = 242)

Comparison of Health Coping Strategies Between the Two Groups

In light of positive coping strategies, Table 3 shows pretest and posttest scores for the experimental group to be higher than those for the control group and a mean posttest score (M ± SD = 59.75 ± 16.16) lower than the pretest score (M ± SD = 60.29 ± 14.99) for the experimental group.

In terms of negative coping strategies, mean pretest (M ± SD = 27.42 ± 15.33) and posttest (M ± SD = 28.08 ± 14.67) scores for the experimental group were lower than those for the control group. Mean posttest scores for both groups are higher than mean pretest scores, although differences are not significant (Table 3).

TABLE 3
TABLE 3:
Analysis of Participants' Life Coping Strategies (N = 242)

An analysis of covariance (ANCOVA) was further applied to exclude pretest differences among participants in the two groups. A test of homogeneity of regression coefficient analysis within the groups indicated an F value of 0.003 (p = .957, >.05), which is compatible for the ANCOVA hypothesis. The ANCOVA proceeded continuously, and the F value was computed as 8.428 (p = .004, <.05), suggesting a conclusion that the effect of the experiment treatment is significant after participants' physical and mental distress scores in the pretest were controlled. The score of physical and mental symptoms for the experimental group (adjusted mean = 6.553) was lower than that of the control group (adjusted mean = 8.078; Table 4). In terms of coping strategies, both positive and negative, there was no statistical difference between the two groups after ANCOVA was applied.

TABLE 4
TABLE 4:
ANCOVA Between Groups on Participants' Physical and Mental Distress

Discussion

Study participants were all female and in roughly the same age group (19-20 years). Most suffered some degree of physical and mental distress. Before the experiment, only 13 participants (4.5%) reported no distresses, with 105 participants (43.4%) reporting between one to five kinds of physical and mental distress symptoms (M = 6.64-7.33). This finding is congruent with the study of Rhee (2003), in which American adolescents described similar physical and mental distresses. Rhee investigated the weekly health condition of 18,722 adolescents and found that only 33% indicated multiple symptoms. Thus, Taiwanese students may have a greater prevalence of multiple symptoms than do their American counterparts.

Further exploring physical and mental distress revealed that before meditation, the top five physical and mental symptoms of the experimental group included pimples, fatigue, headache, dizziness, and menstrual cramps. After the meditation, symptoms remained approximately the same, with the exception of dizziness and constipation. The top five physical and mental symptoms for the control group included fatigue, pimples, headache and menstrual cramps, dizziness, and insomnia. Symptoms were almost the same as those of the experimental group, with the exception of insomnia. Results were identical with those of the study of Rhee (2003) of American adolescents' physical and mental health symptoms, which identified headache (29%), muscle/joint aches (27%), fatigue (21%), and stomachache (18%). In another research study, 9,141 adolescents were segmented into four subgroups according to their symptom types: no symptoms (41%), moderate symptoms (38%), high symptoms (19%), and severe symptoms (2%), with results indicating that high-symptom and severe-symptom groups had negative mental coping abilities and poor interpersonal relationships (Rhee, 2005). In addition, because all the participants in this study were female, gender may be a factor influencing symptom types, as suggested in the literature (Goldstein, 2003). Female adolescent symptoms, including headaches and muscle/joint aches, differ from those of men. Other meaningful influential variables such as ethnicity, social economic status, and social expectations should be taken into account (Goldstein, 2003; Rhee, 2005).

Participants' self-reported current health condition showed a slightly lower health status than did that of their same-age counterparts. Their health conditions were no different when compared with those 6 months ago. The pretest mean score between the experimental group and the same-aged group was higher than that on the posttest. The mean score from other items for posttest was higher than the mean scores for the pretest, including the pretest and posttest of the control group. These two scores do not meet criteria for significance. Our results reflect those obtained in a study by Chung, Chang, Shih, and Wen (2003), who investigated Taiwan residents' self-perceived mental health status in 2001. The study of Chung et al. found that self-awareness of physical health distress, physical function, age, and gender are relevant to one's self-perceived mental health condition. In the study of Chung et al., those who rated themselves low in terms of health condition were those with disabilities (difficulty handling daily life activities), those who had lost their jobs, and women aged 20 to 44 years. Participants in this study were adolescents at an unstable physical and mental stage. They are sensitive and display low tolerance for frustration, so they are prone to physical and mental symptoms in response to stress (Luo, 2006).

After excluding the influence of pretest scores on physical and mental symptoms, the effect of meditation on the experimental treatment was found to be positive. Physical and mental symptoms in the experimental group were less severe than in those in the control group after the intervention. There are many studies that confirm the effective application of meditation on medical-related studies, such as on metabolism complications and prevention and treatment of cardiovascular disease (Andrade, 2006; Paul-Labrador et al., 2006; Schneider, Walton, Salerno, & Nidich, 2006) and on nervous system diseases (Fehr, 2006; Lansky & St. Louis, 2006; Orme-Johnson, 2006).

In terms of positive and negative coping strategies, ANCOVA results were not significant, and our results do not support the quasi-experimental study of Solberg et al. (1995), which found that meditation may modify the suppressive influence of strenuous physical stress on the immune system. Lazarus and Folkman (1984, 1988), remarking on the stress and coping awareness theory, explained that stress is the result of interactions between individuals and their environment and that coping is a reaction derived from actions taken to modify stresses between individuals and their environment. Furthermore, they stated that coping is a three-stage process during which individuals become aware of stress, evaluate their environment, and work to change behavior. When individuals or environmental demands increase above an individual's ability to handle the change, that individual will then evaluate via awareness and work to modify behaviors to cope with the threatening environment and reduce expected harm.

Accordingly, future research on adolescent stress and positive and negative coping behaviors should be event oriented, such as taking examinations or living away from home on campus. Comparison of similar conditions should be conducted to discuss tangible changes. In addition, the authors believe that the nonsignificant nature of the ANCOVA results related to positive strategy and negative emotional reactions to life coping may be related to the duration of meditation and to the personal habits of participants, which are difficult to change in a short period of time. Unlike physical and mental distress, coping requires a change in personal nature to achieve a harmony between body and mind. Nearly all forms of meditation have one thing in common, that is, physical relaxation. When the body relaxes, the mind follows. Directly experiencing the interrelationship between body and mind is then a significant benefit of meditation. It is thus suggested that future research may adopt different teaching durations to investigate the impact of time length on adolescent students' physical and mental life adjustment capabilities. That we did not consider time factors in this study represents a study limitation as well.

Following certain meditation practices, participants progressively start to become very aware of their ability to focus attention and the natural flow of thought slowing to a very calm and relaxed state of rumination. This awareness is a doorway to increasing self-awareness and self-empowerment. Unfortunately, this study failed to measure the various benefits to be achieved through meditation (e.g., consciousness-awareness, concentration, self-confidence, quality-of-life enhancement, inspiration, and moral support). This limitation also underscores the need for additional research.

Conclusions

Meditation refers to a variety of techniques or practices intended to focus or control attention. It is rooted in millennia-old Eastern traditions, especially prevalent in China. This study is grounded in traditional Chinese wisdom that advocates a process of insight meditation with college students, and its results were effectively supported. Results reveal a significant difference in physical and mental distress among participants, with the exception of pretest scores after meditation was administered. Creating a state of harmony between the body, mind, and spirit, herefore, is a foundation for holistic health. It is worth enhancing and promoting so that more people may realize their potential through meditation, not only for health but for world peace as well. Methods employed are not only simple and personal but also free.

Acknowledgments

This study was supported by the Cardinal Tien College of Healthcare and Management through Grant No. CTCN-97-01. We thank the study participants for their kind participation.

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Keywords:

meditation; physical and mental health; quasi-experimental research; junior college students

© 2009 Lippincott Williams & Wilkins, Inc.