The Effectiveness of using Mindful Meditation Intervention in Reducing Stress/Psychological Distress in College Students
Teen-age college students are mostly living away from their families for the first time. These students have to balance their social life and study life in a challenging environment. Apart from getting used to the new environment, the students have to handle the pressure of finding a favourable profession after their college life and this is majorly dependent on the career choice they make (Seaward, 2006). Therefore career choice becomes one of the stressors in college. Some students also face financial challenges brought about by the need to work so as to raise tuition fees (Minor et al, 2006). All the above mentioned situations are sources of physiological distress to teen-age college students. Mindful Meditation is considered as paying attention in a particular way to the present moment in a non-judgemental way. Techniques using mind meditation are known to improve health of a person by reducing the harmful effects of stressors. Such techniques like the Meditation-based stress reduction (MBSR) have been used in assisting teen-age students to cope with the various stressors that they encounter (Minor et al, 2002). This study proposes to investigate the efficacy of Mindful Meditation Intervention as a technique of reducing stress in teen-age college students.
Findings of the study will assist in formulating appropriate teaching mechanisms and material that make college experience for students less stressful as well as ensuring that students who are unable to cope with the college workload due to personal circumstances receive guidance and counselling from well-trained personnel using non-medical approaches. Health promotion in college is much concerned with reducing stress and findings of the study shall allow practitioners to make informed decisions while formulating their teaching materials and any other aids.
Stress has been linked with poor sleep qualities among students and consequently affects their mental and physical health. Studies have shown that reported sleep difficulties among college students ranges from 31.6% to 64% though this depends on the measures used in calculation (Caldwell et al, 2010). Mindful Meditation Intervention is a new technique that is increasingly being embraced by western medical care. It originated in the eastern philosophies of meditation as an alternative way of reducing physiological tensions in the body that result to medical discomforts such as stress (O’Donohue, 2005). The technique has been practiced and studied mainly on adults in different occupations such as nursing, care for the disabled, and on students to see its relation and effectiveness in lowering stress levels. As a behavioural intervention, Mindful Meditation does not offer side effects as pharmaceutical even though they also offer relief to stress. The term Mindful-based stress reduction was coined by Kabat-Zinn (Black, Milam & Sussman, 2009). The purpose of this study is to see if there is a correlation between the use of Mindful Meditation intervention and a reduction in the psychological distress faced by teen-age college students. The study shall give an answer to the following questions; what is the reported effect on the mindfulness meditation on reducing stress in-teen age college students? Secondly, what is the overall effectiveness of the use of mindfulness meditation intervention in teen-age college students?
The use of Mindful Meditation intervention in managing stress has been shown to significantly yield positive outcomes. Mindful Meditation intervention involves a set of skills taught to the subject for subsequent practice whenever they face stressful situations. The intervention includes relaxation response (RR) which “is an integration of the physiological responses that are opposite of flight or fight responses” (Gross et al, 2010), the intervention is based on the premise that RR is made possible by consciously repeating word(s), prayer or song when the subject is actively ignoring other distractive thoughts. Eliciting RR in the long term has resulted in an increase in the person’s resilience to stress. Another Mindful Meditation intervention is the cognitive behavioural intervention (CBI) based on the premise that thoughts trigger emotions and that many negative emotions are often exaggerated and full of distortions. The relaxation response and cognitive behavioural intervention compose the mindful-based stress reduction which is an intervention commonly used in the facilitation of adaptation to stress causing environments or situations. Mindful-based Stress Reduction (MBSR) is formed on the foundations of Mindful Meditation and assists in self-regulation of one’s attention purposefully on the present moment without being judgemental. The technique increases the awareness of one’s inner thoughts, their body sensations and also their emotions. It further nurtures the outlook of acceptance (Gross et al, 2010).
Mindful Meditation interventions are learnable in a classroom setting with a teacher. The whole MBSR program takes eight weeks and has a curriculum containing assignments and techniques that are taught to the participant. It also has a training program that provides certification for teachers and is consistent such that it is deliverable in a community setting (McCown, Rebiel & Micozzi, 2010). The MBSR emphasizes on teaching participants a variety of meditation technique with the goal of a lifetime engagement. The participants learn how to become aware of their emotional states as well as their physical states while letting thoughts come and go without trying to dwell on the interpretation of the on thoughts. Then the participants are taught how to respond using their minds consciously to normal day stressors using techniques learnt in relaxation response. MBSR relies on the hypothetical impact of health matters through cognitive and behavioural mechanisms (Zeidan et al, 2010).
Nurses work in an environment that has a lot of stressors and they consequently face burnouts (Cohen-Katz et al 2005a). The nursing profession is characterised by long working hours, odd working hours, administering emotional support to suffering patients, witnessing patients as they undergo sessions of pain and suffering as well as having to put up with work environments controlled by physicians. The effect of such stressful environments is an exhaustion and development of cynicism and failure to show empathy. Nurses also become disillusioned and fail to see a sense of accomplishment in what they do. According to studies, the effects of nurse burnouts are devastating to the nurses and also to the patients they take care of. When nurses face a burnout, they cannot cater for the needs of teen-age students who depend on their care and expect to be taken care of properly so that they are guaranteed a speedy recovery and resumptions to their normal duties and study. When nurses suffer burnout, they become physiologically devastated, coordinate poorly with their seniors and peers as well as with physicians and as a result, a lot of time is wasted while their productivity diminishes (Cohen-Katz et al, 2005a).
Patient evaluation becomes poor and overall health care standards tumble. Nursing students also fall in the category of college students and therefore suffer due to their ignorance of an effective way to manage stressors that they encounter daily. The study of effectiveness of Mindful Meditation to teen-age college students is relevant as its findings are applicable to nursing students as well as professional nurses. The findings allow for creation of a proper curriculum for student nurses to ensure that they are able to pass through college experience successfully and contribute meaningfully to the nursing fraternity. On the other hand professional nurses will use the findings to understand the relation between their health and wellbeing and that of their patients. They will also be able to maintain high care standards in their respective institutions of work and reduce personal burnout by learning Mindful Meditation interventions (Cohen-Katz et al, 2005b).
Reviewing of literature on the effectiveness of Mindful Meditation intervention in reducing stress among teen-age college students shall assist both the reader and the researcher to establish what research areas of the topic have already been covered. The extent of the research already done in the identified topics relevant to this research shall also be established as well as the gaps that need to be filled in the various researches. As an overall consideration of matters already handled in the topic, this literature review shall serve as a guide for future research since by pin pointing gap areas of research. This literature review shall analyse empirical research findings so as to show their relevancy to the topic of study. Additionally, published articles of research relevant to the topic under study will be reviewed and arguments placed on their relevancy on the topic under study.
Research articles for this literature review have been obtained from a search on electronic journals (PubMed, Ovid, Web of Science and Google Scholar) with the aim of finding empirical articles relevant to the use of Mindful Meditation to reduce stress among college students. For this review only Mindful Meditation intervention are examined. No pharmaceutical alternative is considered. The search terms used for obtaining relevant literature in the electronic databases were; mindful, meditation, college students, teen-age, and mindful-based stress reduction. Only English language journals shall be cited in this literature review.
Experiments on the effectiveness of Mindful Meditation have been largely carried out among adults. Only few researches have been done using teenagers. Those done on teenagers have focused on adolescents and have covered specific issues causing stress such as disability (Zylowska et al, 2008). However in all empirical researches examined, common methods of sampling and analysing data were used. The main research design used was MBSR. This is a group-based intervention and was most appropriate as a qualitative data collection method for college students. It provides instructions on mindfulness techniques that include meditation and conscious thought movement (Young & Baime, 2010). The program involves a given time allocation that is spread regularly for a total of eight weeks. Although each experiment differs in the duration of individual sessions, all satisfied the requirement of covering eight weeks. In addition, all experiments on MBSR covered the following areas in their regular sessions; lecturing and discussing with the participants and also demonstrating any new material. Secondly, participants held weekly group discussions and lastly there was the experience of mind relaxation response (RR) and cognitive behavioural intervention (CBI) skills. The Relaxation-response-based skills are: Diaphragmatic breathing, Guided imagery, Progressive muscle relaxation exercises, yoga stretches and mindfulness. Cognitive behavioural interventions included identifying automatic thoughts, challenging cognitive distortions, affirmations and goal setting. The Lectures and discussion points explored the topics of stress, stress symptoms and coping, the mind and body connection, the physiology of stress and the relaxation response and lastly the weekly discussion on relaxation practice. Finally individual practice given as homework included daily relaxation-response practice and completion of practice log given to each participant. The homework included meditation for a given maximum duration of time daily (Deckro, 2002).
During the recruitment of participants, voluntary information is obtained as well as during the program. Profile of Mood States – Short Form (POMS-SF) are completed by each participant before and after the MBSR training. This is a 30 minute self-assessment that measures emotional distress with scores ranging from 20 to 100. It also has a total mood score (TMS) that is a representation of the total mood score of the participant. The POMS-SF contains subscales that measure tension/anxiety, depression/dejection, anger/hostility, fatigue/inertia, confusion/bewilderment and vigour/activity (Young & Baime, 2010). The POMS-SF validity and reliability is based on the credible results obtained using its parent survey, the Positive States of Mind (PSOM) which has been tested on older populations which is a six-item scale that measures different positive emotional as well as cognitive experiences. The PSOM assesses productivity, responsibility in caretaking, degree of focused attention and sensuous non sexual pleasure (Branstrom et al, 2010).
In the empirical experiments studied, participants had to complete the MBSR program and fill the PSOM/POMS-SF, and any participant failing to complete the form was disqualified from the final analysis of the research (Young & Baime, 2010). In order to gather qualitative data, several tools were used in the researches reviewed (Polit & Beck, 2008). The POMS-SF and POMS created a profile of the mood state of the participants while the symptoms of stress inventory (SOSI) was used to measure the symptoms of stress in the implementation of the MBSR program (Minor et al, 2002). Other measurement tools used in MBSR programs were the State-Trait Anxiety Inventory (STAI) which is a self-evaluation that asses the participant state and trait anxiety, and the Social Skill Rating System (SSRS) which offers qualitative data on social reliability (Polit & Beck, 2008) and is a standardized design measuring the perceived frequency and importance of the behaviours that influence the proper functioning of students (Beauchemin et al, 2008).
In setting up of the experiments, participants were recruited using various means, such as email notification, use of brochures detailing the nature of experiment and use of staff that are regularly in contact with the participants. While using students as participants, approval direct mail, advertisements and posters were mainly used to create attention. In some studies participants were offered a stipend amount for their participation (Deckro et al, 2002). Each participant was thoroughly informed about the studies before being engaged as a participant. All participants are then randomized into control groups or experimental groups then a demographic analysis is done. Those in the control group received no intervention whatsoever. In order to ensure that participants attended all sessions, the researchers made provisions for the participants to switch MBSR sessions that were causing conflicts on their schedules (Deckro et al, 2002). In one example of analysing MBSR for solid organ transplant recipients, patients were stratified based on the type of transplant. A two stage randomization scheme was then used to maximize the number of transplant recipients being compared on active interventions. Such randomization was made possible using computer generated lists cared for by the study statistician (Gross et al, 2010).
During the final analysis, unpaired t tests and analyses of variance (ANOVAs) were done so as to compare the demographic data between participants who completed POMS-SF and those who did not to determine if the completed forms scores vary by demographic variables in the participants. Results were reported as percentages, means and standard deviations. Researchers used a number of software for data analysis such as the Statistical Package for Social Sciences (SPSS). Demographics used in the study were provided in the final analysis using frequency distribution statistics. The changes in pre-intervention and post-intervention were calculated by getting the difference in the POMS-SF/POMS and SOSI totals of the two evaluation forms as well as subscales totals of the evaluation forms. Negative scores or cases where post-intervention total was lower than pre-intervention totals indicated that there was a decrease in the symptoms measured (Minor et al, 2002).
Review of Relevant Articles
Beauchemin et al (2008) have studied Mindful Meditation effects students with learning disabilities. In their study they note that students with learning disabilities face an increased level of anxiety, lack adequate social skills and demonstrate a high level of school related stress. Their study was based on previous health research that had indicated an effectiveness of relaxation and meditation in improving social skills. As a pilot study, pre-test and post-test were used and the study had no control design. The researchers examined the feasibility of the experiment, the attitudes towards the experiment and the outcomes of the experiment used in the study. In the study, 5-week Mindful Meditation intervention was administered to 34 adolescents who had been diagnosed with Learning Disabilities. The study used 34 participants aged 13 to 18 recruited from four high school classes in a private residential school. All participants had been primary diagnosed with Learning Disability. Social Skills Rating System (SSRS) and the State-Trait Anxiety Inventory (STAI) were used to measure study results. The study also used feedback from additional questions completed informally and anonymously in post intervention questionnaires. The study findings demonstrated the relationship between Mindful Meditation and its outcome measures; the measurement of trait and state decreased significantly from pre-test to post-test. Furthermore they indicated that meditation and relaxation training may contribute to better improved results across the range of targets. Additionally, the study notes that teachers and students were uniformly positive, in their attitudes about the intervention, in their anecdotal reports. The study is important as it provides a preliminary and feasibility outcome regarding the effectiveness of meditation and relaxation training as an intervention in reducing anxiety as well as promotion of social functioning and academic performance of adolescent with Learning Disabilities (Beauchemin et al, 2008).
Studies of Mindful Meditation and Stress
Increasing attention has been put on the use of Mindful Meditation intervention in reducing stress. Branstrom et al (2010) examined the effects of mindfulness stress reduction training on the perceived stress and physical wellbeing. The study uses a randomized sample of 70 female participants and one male participant. All participants involved in the study had previously been diagnosed with cancer. The study used five-facet mindfulness questionnaire to measure effects and report the effects of the mindful intervention on the perceived stress by participants. The research findings indicated a significant decrease in perceived stress levels and little posttraumatic avoidance symptoms in the intervention group. The participants also demonstrated positive mind states during the intervention. The researchers then approve that the training of mindfulness stress reduction can meaningfully improve the physiological wellbeing of the participants (Branstrom et al, 2010).
Oman et al (2008) evaluated the effects of Mindful Meditation on stress, rumination forgiveness and hope for a period of eight weeks. Each week had a 90 minute training program for college undergraduates in meditation based stress management tools. The study had a total of 44 participants who were divided into three groups of wait list control, Eswaran’s Eight-point Program (EPP) and mindful based stress reduction. Each group had 15 participants except for the EPP which had 14 participants. Using relevant self-reporting measurement tools the authors collected pre-test, post-test and 8-week follow-up data. In their findings, Oman et al observed that there was no significant difference in the results obtained by the EPP group and MBSR group. They also noted that there was no significant difference in the post-test results and those of the 8-week follow-up. Unlike in the control, treated participants demonstrated a significant increase in the benefits for stress and forgiveness and a marginal benefit for rumination. The findings by Oman et al, (2008) confirmed their hypothesis that college students are able to reduce their levels of perceived stress significantly using meditation based stress management tools. They also show that effects of both EPP and MBSR are the same in reducing the perceived level of stress in undergraduate students. Their findings support the argument of offering meditation based programs like MBSR and EPP to college students. The study however does not fully offer answers to the question of long term resilience on stress. Their findings only demonstrate a reduction in the perceived stress in the short term. However it is hoped that the programs studied assist the participants in having resilience because they offer growth and refinement strategies of coping with day to day stressful conditions (Oman et al, 2008). The results by Oman et al (2008) were based on tests done mostly on white first year undergraduate women and therefore might not be applicable fully to men. Other limitations of the study were the small sample size used and the decreased precision in accessing changes over time. The later was an effect of a reduced statistical power associated with the low sample size. In addition, the study did not have an active control group that would have made it possible to account for the observed changes. Finally the study failed to use psychological measures of stress and wellbeing and only relied on paper and pencil reports (Oman et al, 2008).
Studies of Mindfulness Meditation and Blood Pressure/Heart rate
Psychological distress is a major contributor of hypertension in young adults. Hypertension affects approximately 33 per cent of US adults and college aged persons having mild blood pressure elevation have a three times more likelihood of developing hypertension within a period of 30 years, than their normal counterparts (Nidich et al, 2009).
Nidich et al (2009) did a research on mind-body intervention. They looked at its effect on blood pressure and psychological distress. Additionally, they looked at how college students were coping. Their study used a randomized control trial (RCT). Two hundred and ninety eight students formed their study sample. The students were allocated to either a Transcendental Meditation or a wait-list control group. The blood pressure, psychological distress and coping abilities of participants, at baseline and after 3 months was noted. The study also analysed 159 subjects having hypertension in a similar way (Nidich et al, 2009). Casual BP was measured as the primary outcome while psychological stress and coping ability were secondary outcomes. Among the 298 participants, the average age was 25.5 and 40 per cent were men, with the majority 62 per cent being Caucasian. Regression analysis of the study findings showed that changes in systolic blood pressure and diastolic blood pressure were significantly related to the changes in psychological distress. The researchers explain the correlation that psychological distress results to a hyper activation of the sympathetic nervous system which causes a chronic elevation in blood pressure (Nidich et al, 2009). The study therefore attributes the reduction in blood pressure to the reduction in psychological distress. The study also notes that external stressors such as financial concerns and school stress induce a negative feeling like anxiety and anger which consequently adversely affect blood pressure. In the study, increased coping ability to the external stressors was identified as a key component of reducing psychological strengths and therefore indirectly contributed to lower blood pressure (Nidich et al, 2009). The main strengths of the study are the use of a random assignment in the methodology, the use of assessors that were marked to treatments and reduced demand characteristics. Another strength is that the study uses a sizably diverse subject sample of Caucasians, African Americans, Hispanics and others which make the generalizability of the findings to a population of college students credible (Nidich et al, 2009).
The limitation of the study is that 30 per cent of the sample used at baseline pre-test was not used at post-test. The study recommends that future research evaluate a longer-term intervention period in accessing how psychological stress relates to blood pressure in the long run. Finally, the study is the first randomized control trial to indicate that selected mind-body intervention together with the Transcendental Meditation program significantly reduced blood pressure. It also establishes an improvement in psychological distress and coping ability of young adults facing the risk of hypertension. Therefore the study recommends the practice of mind-body interventions to reduce the risk of hypertension in young adults (Nidich et al, 2009).
The researchers evaluated whether mindfulness or sham mindfulness meditation intervention improves mood and cardio-vascular variables. Their study sample had eighty-two undergraduate students comprising of 34 males and 48 females who had no previous meditation experience. Heart rate and blood pressure were measured. The meditation intervention used lasted one hour daily for three days. Psychological variables like Profile of Mood States and State Anxiety Inventory before the intervention and after the intervention were also measured. Zeidan et al (2010) also report that the meditation intervention was much effective. They observed a reduction in negative disposition, despair, weariness, misperception, and heart rate as compared to control group and sham. Sham meditation uses breathing exercises and requires the subject to believe that they are actually meditating. In this experiment, both sham and Mindful Meditation were conducted by the same facilitator. The study findings of the research note that there was no significant difference in the baseline scores in any of the demographic used. However the study report notes that the sham mindfulness meditation group had a lower systolic and diastolic Blood Pressure at baseline while other groups did not. The strength of this research is the comparison of Mindful Meditation with sham meditation which provides an effective way of managing the demand characteristics that are associated with other experimental trials dealing with meditation practice. The study uses a relatively small sample that might show a bias and therefore is not fully reflective of the overall student population in the institution of study (Zeidan et al, 2010).
Gaps in literature
All studies reviewed above have used relatively small sample sizes of less than 600 participants in their research. Therefore there exists a research gap on the reflectiveness of the research findings when an entire college population of a state is considered (Catane, 2002). Filling the identified gap will require that bigger samples are used. The sampling of participants from a single institution has also resulted in a rather homogenous outfit that does not well represent the heterogeneous nature of a larger population than that of the institutions used. Homogenous samples have limited the studied research reflectiveness to the population of the studied institutions or localities. This literature review has established that there is a limited research covering the use of Mindful Meditation among teen-age college students. Majority of research studied covered adults and also referred to other research that was based on adults. There is a need to carry research that specifically addresses the use of Mindful Meditation on teen-age college students as well as analyse its effects. This review has also established that min some cases, participants did not complete the various intervention programs and were therefore eliminated from the final analysis of data (Branstrom et al, 2010). This had an effect of reducing the overall sample size of the research. In Minor et al (2006) participants failing to participate fully in the intervention were allowed to skip other procedures or substitute them. This created a possible source of error in the data analysis of the experiment. Future research should take into account the possibility of participants or subjects dropping out of the intervention so sample size does not become a cause for a skewed analysis. Finally the reliance on voluntary submission as subjects to the various researches studied limits sampling only individuals aware of the trials and therefore presents another source of bias (Zeidan et al, 2010).
Mindful Meditation as an intervention in reducing stress or psychological distress among teen-age college students is credited with a reduction in the stress level of the participants of the respective researches carried out. It can be formally declared that Mindful Meditation improves the wellbeing of the person practicing the intervention (Roberts & Danoff-Burg, 2010). The most popular mindful intervention program used is the Mindful-Based Stress Reduction (MBSR) which incorporates relaxation response (RR) and cognitive behaviour intervention (CBI). Other interventions studied are Transcendental Meditation (TM) and Eswaran’s Eight-point Program (EPP). This review has found significant evidence that suggest Mindful Meditation majorly contributes to the lowering of stress and levels of psychological distress among teen-age students.
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