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COMPARING THE EFFICACY OF SPIRITUAL , SECULAR MEDITATION, AND IN DEPRESSED COLLEGE STUDENTS

Meryl Reist Gibbel

A Thesis

Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of

MASTER OF ARTS

May 2008

Committee:

Kenneth Pargament, Advisor

Annette Mahoney

Michael Zickar

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ABSTRACT

Kenneth I. Pargament, Advisor

Working with a sample of 54 mildly depressed undergraduates, the present study compared the effects of spiritual meditation, secular meditation, and relaxation techniques on mood and spiritual well-being. Upon random assignment to the Spiritual Meditation group, the

Secular Meditation group, or the Relaxation group, participants were taught how to practice a meditation or . They were instructed to practice their assigned technique 20 minutes per day for two consecutive weeks. Participants completed criterion measures for affect and spiritual well-being at three time points during the course of the study: prior to beginning the two-week meditation/relaxation intervention, directly following the two-week intervention, and one month following the completion of the intervention.

Overall results suggest that the addition of an explicitly spiritual component to the practice of meditation does not appear to add to the effectiveness of this technique among depressed college students. Although spiritual meditation was shown to significantly improve positive mood, this finding should be interpreted with caution as this was the only significant time x treatment group interaction. However, results do indicate that all three treatment groups showed improvement in psychological and spiritual variables across time. In addition, spiritual intensity appeared to moderate the relationship between treatment group and daily spiritual and several measures of mood. iii

To Ethan and Pam, for all your support and inspiration. iv

ACKNOWLEDGMENTS

First and foremost, I would like to thank my advisor, Dr. Kenneth Pargament, for his invaluable guidance throughout the development of this project. Thank you for your commitment to seeing this project through to completion. I am particularly grateful for how quickly you returned draft after draft of my thesis. I would also like to thank my committee members, Dr.

Annette Mahoney and Dr. Michael Zickar, for their insight and valuable contributions to my project.

Finally, I would like to thank my family and friends for providing unending encouragement throughout this process. I would particularly like to thank my husband, Ethan, my parents, Dave and Pam, and my sisters, Erin, Jennie, and Dana. Thank you for believing in me. v

TABLE OF CONTENTS

Page

INTRODUCTION ...... 1

Risk Factors and Costs of ...... ………… 5

Psychological Benefits of Religious and Spiritual Practices ...... 8

Two Types of Meditation...... 9

Is Meditation Spiritual in ?...... 12

Meditation and Psychological Well Being…………………………………………. 15

Meditation and Depression…………………………………………………………. 18

The Present Study...... 22

METHOD……………...... 23

Participants……...... 23

Screener………...... 23

Psychological Measures...... 24

Spirituality Measures...... 25

Adherence…………………………………………………………………………... 28

Procedure…………………………………………………………………………… 29

RESULTS……………...... 32

Preliminary Analyses...... 32

Psychological Measures...... 32

Spirituality Measures...... 33

Daily Adherence Diary ...... 35

Post Hoc Analyses ...... 35 vi

Spirituality and Mood...... 36

Spirituality and Daily Spiritual Experiences...... 36

DISCUSSION………...... 38

Mood and Meditation/Relaxation ...... 38

Spirituality and Meditation/Relaxation...... 43

Spiritual Intensity as a Moderating Variable ...... 45

Implications…...... 46

Limitations and Future Directions…………………………………………………. 49

Conclusions…...... 50

REFERENCES ...... 52

APPENDIX A. POTENTIAL PATHWAYS BETWEEN SPIRITUAL MEDITATION

AND DECREASED DEPRESSION ...... 68

APPENDIX B. DEPRESSION SCREENING FORM ...... 69

APPENDIX C. DAILY ADHERENCE DIARY…………...... …….. 73

APPENDIX D. RELIGIOUS MEASURES QUESTIONNAIRE…………………………. 74

APPENDIX E. SPIRITUAL WELL BEING SCALE……………………………………... 76

APPENDIX F. DAILY SPIRITUAL EXPERIENCES……………………………………. 78

APPENDIX G. SCALE…………………………………………………….. 80

APPENDIX H. PROCEDURE…………………………………………………………….. 82

APPENDIX I. MEDITATION SCRIPT……………………………………... 84

APPENDIX J. RELAXATION TRAINING SCRIPT…………………………………….. 86 vii

LIST OF TABLES

Table Page

1 Demographics by Group…………………………………………………………… 88

2 Cronbach’s Alphas for Pre-Intervention Measures………………………………… 89

3 Pre- and Post-Intervention Psychological and Spiritual Measures by Group……… 90

4 Pearson r Correlations for the Primary Psychological and Spiritual Variables

in the Total Sample at Time 1……………………………………………… 91

5 Pre- and Post- Adherence Diary Mood Ratings…………………………………… 92

6 Main Effects and Interactions for 3x3 (time x group) Repeated Measures

ANOVA…………………………………………………………………… 93

7 Main Effects and Interactions for 3x3 (time x group) Repeated Measures

ANOVA…………………………………………………………………… 94

8 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Positive Affect…………………………………………………. 95

9 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Negative Affect……………………………………………….. 96

10 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Spiritual Well Being…………………………………………... 97

11 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Religious Well Being…………………………………………. 98

12 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Existential Well Being………………………………………… 99

13 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

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Predicting Daily Spiritual …………………………………... 100

14 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Mysticism………………………………………………...... 101

15 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Extrovertive Mysticism…………………………………….... 102

16 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Religious Interpretation……………………………………… 103

17 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Introvertive Mysticism………………………………………. 104

18 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity

Predicting Mood………………………………………………………… 105

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LIST OF FIGURES

Figure Page

1 Positive Affect by Group and Time……………………………………………… 108

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INTRODUCTION

Effecting more than 19 million Americans each year (National Institute of Mental ,

2006), depression is the most prevalent serious chronic mental illness and has been considered by some to be an “epidemic” in Western societies (Blazer, 2005). In addition to its pervasiveness, depression is a risk factor for other health problems. Research suggests that depression is linked to coexisting psychiatric disorders (Kessler, et al., 1994; Kessler, et al.,

1996), including disorders (Sanderson, Beck, & Beck, 1990; Zimmerman, McDermut, &

Mattia, 2000), eating disorders (Grubb, Sellers, & Waligroski, 1993; Hill & Robinson, 1991;

Willcox & Sattler, 1996), and /dependence (Bukstein, Brent, & Kaminer, 1989;

Kessler, et al., 1996; Meyer, 1986; Sanderson, et al., 1990). Additionally, studies have shown that depression is related to suicide (Black & Winokur, 1990; Guze & Robins, 1970; Regier &

Moscicki, 1987), increased mortality (Folstein, Mailberger, & McHugh, 1977; Morris, Robinson,

Andrzejewski, Samuels, & Price, 1993; Rovner, 1991), and disease (Barefoot & Schroll,

1996; Ferketich, Schwartzbaum, Frid, & Moeschberger, 2000; Katon & Sullivan, 1990). Equally devastating, depression places significant economic burden on the individual, family, caregivers, employers, and society at large (Greenberg, et al., 2003).

Although researchers suggest that various therapeutic approaches are effective in alleviating depressive symptomotology, by and large, reviews of depression treatment literature have yielded unclear and inconsistent results. Several meta-analyses addressing the efficacy of various forms of for the treatment of depression suggest no reliable differences when the effects of psychotherapy are compared with the effects of treatments (Lambert,

Weber, & Sykes, 1993; Prioleau, Murdock, & Brody, 1983; Robinson, Berman, & Neimeyer,

1990). In his book The Illusion of Psychotherapy, Epstein (1995) writes that the commonly-

2 utilized short-term psychotherapeutic interventions appear to be superficial and lack sufficient control groups, creating the possibility that natural remission—a natural decline of depressive symptoms over time—may be as probable a cure as various forms of . According to psychotherapist Richard O’Connor (2001), researchers are increasingly recognizing that depression is a long-term and debilitating illness that cannot be effectively treated with or short-term psychotherapy program. In his opinion,

depression is more difficult to treat than we want to acknowledge.

Everyone that research has proven that cognitive

behavioral therapy, interpersonal psychotherapy, and medication

are demonstrably and equally effective in treating depression. But

that was at three months after treatment. At eighteen months, not a

single one of the patients, no matter what treatment they’d

received, was any better off than the control group (Shea, et al.,

1992). In order to truly help people who are suffering with this

venomous and insidious condition, we have to be willing to

challenge some of the assumptions we hold dear… if we are honest

with ourselves, we will…admit that our batting average is not so

good…For every patient we can help, we probably see two whom

we can’t…Patients must learn, practice, and plan to reinforce more

adaptive ways of functioning—they must change how they…take

care of themselves, cope with … (p. x-xi)

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O’Connor further added that, in spite of a heightened of treatment limitations, serious discussion of alternative treatments is nearly nonexistent among researchers and professionals.

Several researchers have uncovered fascinating differences in treatment efficacy when distinguishing more severe forms of depression from milder forms. In a study in which patients with major depressive disorder were randomly assigned to one of four groups, including cognitive-behavior therapy (CBT), interpersonal therapy (IPT), imipramine plus clinical management (IMI-CM), or “placebo” plus clinical management (PLA-CM), Elkin et al. (1989) found no differences between the four groups among the less depressed participants. However, for the more severely depressed participants, greater improvement was seen in the IMI-CM and

IPT groups than the other groups. More recently, Elkin et al. (1995) again found no differences between the treatment groups for the mildly depressed, but greater differentiation between groups for those with higher levels of depressive symptomotology. Roth, Fonagy, Parry, Target, and Woods (1996) believe that, although more severely depressed patients benefit from some forms of treatment, minimal counseling or support is effective with the less depressed. In agreement with these findings, Rush and Thase (2002) have concluded that pharmacotherapy is not expected to be effective in less severe forms of depression. Other researchers have suggested, however, that mild depression is treatable. Unfortunately, empirical support for treatment interventions specifically for minor depression is limited (Lynch, Tamburrino, Nagel, & Smith,

2004). One such study by Lynch et al. examined the effectiveness of problem-solving therapy vs. stress-management training and treatment-as-usual with a sample of 54 patients with mild depression. Results indicated that participants in all three treatment groups reported equal decreases in depression. According to Thase and Lang (2004), individuals with dysthymia who

4 receive several months of either psychotherapy or pharmacotherapy have a 50 percent chance of

“full recovery,” and 85 percent chance of recovery if these forms of treatment are combined. In light of inconclusive research findings on the efficacy of depression treatment, particularly in patients with milder forms of depression, exploration of alternative forms of treatment, such as meditation, may prove fruitful.

Depression may be particularly pertinent to college students, considering that they are experiencing a developmental stage in which they complete high school, move away from home, and face the pressures of college life. Other reasons why college students may be particularly prone to depression relate to finding their identity apart from their parents and families, having questions about their religious or spiritual identity and experiencing religious , formulating their political identity, defining their sexual orientation, making decisions about dating and romantic relationships, and choosing a career path (Abouserie, 1994). According to a recent study conducted by researchers of Johns Hopkins University, more than 40% of students in the freshmen class turned to the university counseling center for help in their adjustment (National

Mental Health Association). Considering that a significant percentage of college students struggle with their adjustment to college life, it is important to identify effective methods of treatment to dispel the negative effects of depression during this critical developmental stage.

Research has indicated that meditation can significantly alleviate psychological distress and promote psychological development (Alexander, Rainforth, & Gelderloos, 1991; Astin,

1997; Sagula & Rice, 2004; Surawy, Roberts, & Silver, 2005; Teasdale, et al., 2002). Meditative theorists and researchers often emphasize that meditation is not necessarily spiritually-rooted.

However, the question remains open as to whether the spiritual aspect of meditation is in fact a critical ingredient of this practice. In this vein, research indicates that transcendental meditation

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(TM), considered by many to be a spiritual form of meditation, can improve mental health

(Alexander, et al.). According to a meta-analytic review comparing various forms of meditation and relaxation, TM may result in greater improvement in mental health in comparison to other forms of meditation and relaxation techniques (Alexander, et al.).

In view of these findings, the question remains whether the subject material that an individual meditates on influences the . Do people who practice spiritual meditation experience greater psychological benefits than those who practice “secular” meditation or relaxation techniques? Or can the positive effects of meditation, including spiritual meditation, be reduced to the “relaxation response”?

TM serves as the model for this study as little research has been conducted on non-TM methods of spiritual meditation. This study is not, however, a pure replication of the practice of

TM.

Risk Factors and Costs of Depression

Next to heart disease, depression is the second largest public health concern (O’Connor,

2001), affecting close to 20 million Americans each year (National Institute of Mental Health,

2006). Depression occurs more often than any other psychiatric disorder (Blazer, 2005), and “is so widespread that it has been called the common cold of mental illness” (Montreal Gazette,

2002, October 7, p. D4, as cited in Blazer, 2005). Researchers have estimated that depression affects 20% of the population—that one in five people will experience a major depressive episode within his or her lifetime, and one in five individuals is battling depression at any given moment (Agency for Health Care Policy and Research, 1993). Some researchers believe the problem will only continue to worsen, claiming that “findings show that the number of people

6 affected by major depression will continue to grow exponentially” (Financial News, 2002,

August 1, as cited in Blazer, 2005).

Not only is depression a serious concern due to its high prevalence rate, it is a risk factor for other health-related concerns. About 50% of depressed individuals experience at least one other health problem (Montano, 1994).

First, depressed individuals are at increased risk of developing secondary psychiatric disorders. Research indicates that the majority of patients with an initial diagnosis of depression will later develop a secondary mental illness (Sanderson, et al., 1990). Considering that an estimated 83% of individuals with major depression, 91% with dysthymia, and 82% with any mood disorders experience one or more lifetime comorbid psychiatric diagnoses (Kessler, et al.,

1994), research clearly suggests that lifetime comorbidity is the norm.

Several psychiatric diagnoses, including anxiety, alcohol and substance abuse, and eating disorders, occur more frequently in depressed patients than patients with other diagnoses.

Research has suggested that anxiety is the most common form of mental illness that co-exists with depression (Sanderson, et al., 1990). Zimmerman and colleagues (2000) studied a sample of

373 outpatients with a diagnosis of unipolar major depressive disorder, and found that more than

50% of their sample met full criteria for at least one current anxiety disorder and 75% had a lifetime history of an anxiety disorder. The second most common disorder co-occurring with depression is substance abuse/dependence (Sanderson, et al.). Considering that the median age of onset of depression is 10 years earlier than the median age of onset of addictive disorders

(Kessler, et al., 1996), depression may have a causal influence on substance-related problems

(Stefanis & Stefanis, 2002). Some researchers have suggested that the use of alcohol and drugs is a form of -medication for the psychological distress caused by depression (Meyer, 1986).

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Third, research has indicated that eating disorders may be linked to various components of depression, including low self-esteem (Grubb, et al., 1993), lethargy (Hill & Robinson, 1991), helplessness (Hamburg & Herzog, 1990), drive for thinness (Troop, Holbrey, Trowler, &

Treasure, 1994; Willcox & Sattler, 1996), and social introversion (Slade, Newton, Butler, &

Murphy, 1991).

Not surprisingly, depression is a risk factor for suicide. According to the most recent estimate of the number of annual suicides in the United States by the Center for Disease Control

(2006), there were more than 31,000 suicides in 2003. Affective disorders are the largest single group of individuals with mental illness who commit suicide (Black & Winokur, 1990).

Approximately 90% of individuals who commit suicide suffer mental illness, and about half of these people are clinically depressed at the time of the suicide (Black & Winokur). Regier and

Moscicki (1987) found that the rate of suicide in individuals meeting diagnostic criteria for major depression and dysthymia is 18% and 17%, respectively.

Finally, depression has been linked to increased risk of coronary heart disease, stroke, and mortality (Simonsick, Wallace, Blazer, & Berkman, 1995). In patients with cardiac disease, depression is a predictor of major cardiac events, including angioplasty, coronary bypass surgery, myocardial infarction, and death (Barefoot & Schroll, 1996; Ferketich, et al., 2000;

Ford, et al., 1998; Katon & Sullivan, 1990). Depression places stroke patients at 50% to 70% elevated risk of mortality in comparison to their non-depressed counterparts (Everson, Roberts,

Goldberg, & Kaplan, 1998; Morris, et al., 1993).

In addition to its high prevalence rate and risk factors, depression places significant economic burden on the individual, family, caregivers, employers, and society at large

(Greenberg, Stiglin, Finkelstein, & Berndt, 1993). On the basis of a national survey, Greenberg

8 et al. (2003) estimated the economic burden of depression to be greater than $83 billion, $52 billion (62%) of which is work-related, $26 billion (31%) of which is direct treatment-related costs, and $5 billion (7%) of which is related to suicide. The economic burden of comorbid psychiatric disorders among depressed patients is estimated to be an additional $40 billion

(Greenberg, et al., 2003). Research has demonstrated that patients with depression accrue 4.2 times greater the medical costs than the general population (Birnbaum, et al., 1999).

Psychological Benefits of Religious and Spiritual Practices

Researchers acknowledge that various forms of religious and spiritual involvement are related to better functioning on a variety of mental health measures (McCullough, 1999).

Religious involvement, including intrinsic religious motivation, attendance at religious services, using one’s or religious congregation as a mechanism, and positive religious attributions of major life stressors, have been positively correlated with various measures of mental health (Bergin, 1991; Bergin, et al., 1987; Larson, et al., 1992; Pargament,

1997; Schumaker, 1992; Worthington, et al., 1996). and spirituality can serve as coping mechanisms, alleviating and distress by providing significance, meaning, and purpose to life stressors that are an inevitable part of the human experience (Pargament).

Various measures of spiritual/religious involvement are correlated with lower levels of depressive symptoms in particular (Bienenfeld, et al., 1997; Ellison, 1995; Kendler, et al., 1997).

For example, working with a sample of 89 retired Catholic and sisters, Bienenfeld et al. found that religious commitment, including perceived closeness to and frequency of private , was inversely correlated to depression (r = .40; p < .0001). Kendler and colleagues examined the relationship between various dimensions of religiosity and psychopathology in

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1,902 Caucasian same-sex female twins. Findings suggest that religious personal devotion is inversely related to depressive symptoms.

Just as research has demonstrated a positive link between religion and self-esteem

(Hathaway & Pargament, 1990), religious forms of counseling have been related to lower levels of depression (Johnson & Ridley, 1992; Propst, 1980; Propst, et al., 1992). With a sample of 41 mildly to moderately depressed undergraduate students, Propst found that religious imagery treatment resulted in significantly greater treatment effects than nonreligious imagery treatment or self-monitoring treatment. Propst et al. compared the effects of religious cognitive-behavioral therapy (RCT), nonreligious cognitive-behavioral therapy (NRCT), pastoral counseling treatment-as-usual (PCT), and waiting-list control (WLC) in 59 clinically depressed religious patients, and found that people in the RCT and PCT groups reported significantly fewer post- treatment depressive symptoms than those of the NRCT and WLC groups. Johnson and Ridley compared the efficacy of a Christian form of rational-emotive therapy (CRET) with the standard version of rational-emotive therapy (RET). Although patients in both treatment groups reported decreased depressive symptoms, only patients in the CRET group experienced reductions in irrational thinking.

Religiousness is a multi-dimensional phenomenon and many aspects of religiousness may have significant implications for depression. The present study will focus on potentially beneficial effects of one form of spirituality—meditation.

Two Types of Meditation

Although a spiritual component is recognized in some forms of meditation, other meditative practices are considered “secular.” These two types of meditation—the spiritual type and the secular type—will be explored.

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Throughout history meditation and spiritual and religious practices have been closely intertwined. Today, cultures throughout the world continue to weave meditation into these practices (Wachholtz & Pargament, 2005). The most frequently practiced and most widely studied form of meditation commonly thought to be spiritually-based is TM. TM is derived from the Vedic tradition of , which provides the most ancient and extensive descriptions of cultivating (Basham, 1959). Vedic tradition, which was formulated in the Vedic of Maharishi Mahesh , provides uniform procedures for the practice of TM

(Maharishi Mahesh Yogi, 1969, 1972). TM is a technique that allows to settle from active to quieter levels of the mind and is generally thought to have two aspects (Alexander,

Robinson, Orme-Johnson, Schneider, & Walton, 1994). The first aspect is a , or particular thought, which is chosen for its sound value (Alexander, et al.) and may have spiritual meaning.

The majority of studies on TM use the “Transcendental Meditation Program,” in which a mantra is selected from a limited number of that each teacher is given at the time of their training (Goodman, Walton, Orme-Johnson, & Boyer, 2003; Walton & Levitsky, 2003). Mantras are generally hand-picked by a teacher for each individual meditator (Alexander, et al.).

According to researchers of the Transcendental Meditation Program, the effectiveness of the mantra has little to do with any possible meaning of the sounds. Some of the sounds may be associated with a spiritual meaning in another language, but any association is accidental and might even interfere with the correct practice of the technique (Walton & Levitsky). The second aspect is the proper use of the mantra. When used properly, the mantra allows the ordinary thought process to spontaneously settle to a quieter state until even the most minute thought is transcended. The individual experiences a “unified wholeness of awareness beyond the ordinary division between subject (knower) and object (known)” (Alexander, et al., p. 244). This state is

11 known as “transcendental ,” in which “restful alertness” occurs and the individual is fully awake but without any other thoughts or (Maharishi, 1969). Although there is no particular spiritual meaning for the sounds, the sounds effectively promote the process of transcending, an experience of the mind becoming “unbounded,” that is, going beyond the thinking process to a state of consciousness without content. This transcendental unbounded awareness state has to do with wholeness (holiness), which, indeed, produces a spiritual experience (Walton & Levitsky). TM is practiced by diverse populations because it is relatively easy to learn, practice, and teach, requires no change in lifestyle, and follows a standardized course (Marharishi, 1969). Practitioners generally meditate using TM for 20 minutes, two times daily (Maharishi, 1969).

Shifting the focus away from spiritual meditation, a secular form of meditation called meditation (MM) has become a “hot” form of meditation for researchers and practitioners over the past few decades. Although mindfulness stems from the philosophical and cultural roots of ancient , its practice in present-day living is not necessarily tied to

Buddhism necessarily or with being Buddhist (Kabat-Zinn, 1994). In fact, MM’s core principles are consistent with the emphasis that Western cultures place on behavior, , and

(Epstein, 1999). According to Jon Kabat-Zinn (1994), mindfulness

has everything to do with waking up and living in harmony with

oneself and with the world. It has to do with examining who we

are…and with cultivating some appreciation for the fullness of

each moment we are alive…It wakes us up to the fact that our lives

unfold only in moments. If we are not fully present for many of

those moments, we may not only miss what is most valuable in our

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lives but also fail to realize the richness and the depth of our

possibilities for growth and transformation (p. 3-4).

Psychologist Marsha Linehan (1994) defined mindfulness as “…learning to observe internal and external events without necessarily trying to terminate them when painful or prolong them when pleasant…” (p. 77). Aimed at bringing awareness to the present free of self-criticism or judgment, the goal of MM is to simply observe thoughts, sensations, and feelings without reacting to or becoming absorbed in their content (Kabat-Zinn, 1982). The practice of MM is about developing the skill of focusing attention on the moment-to-moment experience of life, which offers an alternative to continuous about the past or the future that take away from one’s quality of life.

Is meditation spiritual in nature?

In light of researchers’ descriptions of MM, which are absent of sacred language and spiritual undertones, the question remains unanswered as to whether meditation is spiritual in nature, and whether a spiritual component of meditation enhances the effects of meditation in depressed individuals. Just as many individuals state that meditation is an expression of their spirituality, other people claim that their meditative practice has nothing to do with spirituality.

Because of these differing opinions, a controversy as to whether religiousness and/or spirituality are critical components of meditation has surfaced.

Although not surprising in America’s postmodern culture, MM researchers and practitioners are not alone in separating meditative practice and religious involvement. Many TM instructors and practitioners, particularly in Western cultures, are also adamant about keeping

TM apart from religious practice. (1970) voiced strong feelings about the religion-meditation separation: “It is quite important to dissociate this experience from any

13 theological or reference, even though for thousands of years they have been linked…” (p. 164). Others’ opinions stem from a reductionistic theory about meditation, such that the positive effects of meditation can be reduced to the “relaxation response” (Benson,

1977). Some researchers postulate that meditation simply serves the purpose of distracting an individual from his/her problems (Druckman & Bjork, 1991). In his book Meditation Without

Myth, psychologist Daniel Helminiak (2005) writes that “thinking about the meaning of your word during the meditative practice constitutes from the exercise of the meditation, so the meaning of the word should not matter and should not come into play during meditation” (p.

39). Some practitioners and researchers go further by trying to separate meditation not only from its connections with religion, but also from its connections with spirituality (Pargament, 2007).

On the other hand, others argue that meditation is inherently spiritual in character.

Meditation practitioners and researchers suggest that it is the sacred qualities, such as transcendence and boundlessness (Pargament, 2007), of TM that contribute to its greater effectiveness compared to other meditation or relaxation techniques (Alexander, et al., 1991).

TM has been described in terms of transcendence, or a sense of “extraordinariness” and the that there is something beyond self (Pargament). Transcendent experiences, which result from the practice of TM and are correlated with positive psychological change, have been described as “moments of high elevation and deep inspiration clearly set apart from ordinary life” (Alexander, et al., p. 192) and periods of “tremendous intensification of any of the experiences in which there is loss of self or transcendence of it” (Maslow, 1970, p. 165).

Boundlessness, or the perception of never-ending time and space (Pargament), is another sacred quality used to describe TM. TM involves “transcendence of ordinary time and space, accompanied by feeling of bliss and wonder” (Maslow, 1968, p. 249-253).

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Individuals who meditate often report experiencing that are deeply infused with spiritual meaning, such as deep gratitude, a sense of love and , feelings of awe, feeling uplifted, sensing a transcendent force outside themselves, and a sense of connectedness to their very being (Astin, 1997; Shapiro, Schwartz, & Bonner, 1998). Hay (1982) conducted a case study and reported that “peak” or transcendental experiences can create a sense of inner strength, relinquish of the fear of death, renewed optimism, psychological integration, increased awareness, and fresh meaning to life. It is worth noting that, although many people encounter the sacred indirectly through the experience of sacred emotions, meditation may represent a more direct pathway to God for others (Pargament, 2007).

Many forms of meditation used today have been modeled after meditative practices of non-theistic Eastern religious traditions. Similar to Eastern traditions, however, meditation in

Western religious traditions carries the same set of assumptions about life, such as the that meditation can cause a person to see underlying timeless “truths” (Pargament, 2007). The spiritual flavor of these assumptions, although rarely explicit, may explain—at least in part— meditation’s effectiveness (Pargament).

Acceptance, or an individual’s ability to tolerate and emotional vulnerabilities, is another important ingredient of meditation. Acceptance may be closely linked to the idea of surrender to the divine, or giving up control of freeing self of psychological distress to a force beyond self. Acceptance may also contribute to meditation’s effectiveness (Pargament,

2007).

Few treatment-outcome studies have been conducted comparing the effects of religious or spiritual therapeutic interventions with secular interventions (Harris, Thoresen, McCullough,

& Larson, 1999). A 10-year literature review by Worthington and colleagues (1996)

15 demonstrated that only two studies since 1984 have looked at therapy that utilized a religious meditation technique. Further, only one of these examined TM, comparing its effects to the practice of a secular form of meditation. The need is apparent for future research to “focus in on comparing explicitly religious or spiritually oriented meditation interventions with more secularized versions…” (Harris, et al., p. 420). Before direction for future research can be determined, it is necessary to have a clear understanding of the existing literature addressing the effect of religious/spiritual meditation on psychological well-being.

Meditation and Psychological Well-Being

By and large, researchers have concluded that meditation can significantly improve psychological well-being and alleviate depressive symptoms. Studies have indicated that participants report improved psychological health and increased relaxation after religious/spiritual forms of meditation or prayer (Elkins, Anchor, & Sandler, 1979; McKinney &

McKinney, 1999).

Regarding outcome studies on secular forms of meditation, research has demonstrated that MM significantly enhances psychological well-being. In a study of 19 college students randomly assigned to the treatment group or comparison group, Astin (1997) found a 64% mean decrease in self-report ratings of overall psychopathological severity among participants of the 8- week mindfulness meditation-based stress reduction program (F(2, 16) = 15.87, p < 0.002).

More specifically, significant effects for the intervention group were found for Anxiety (F(2, 16)

= 7.05, p < 0.02), Psychoticism (F(2,16) = 9.27, p < 0.01), Obsessive-compulsive (F(2, 16) =

9.55, p < 0.01), Somatization (F(2, 16) = 16.73, p < 0.005), and Paranoid ideation (F(2, 16) =

9.87, p < 0.01). Grossman, Nieman, Schmidt, and Walach (2004) conducted a meta-analytic review of the effects of minfulness-based stress reduction on psychological health, with data

16 from 771 individuals, 388 of whom received mindfulness training. The data set passed the test of homogeneity (χ2 = .89, df = 9, p = .999) and results demonstrated a significant mid-level effect

size of d = .54 (95%-CI .39-.68, p < .0001, two-tailed) for various mental health variables. Upon

further analyses for pre- to post-intervention effects, using data from 18 studies and a total of 894

participants, results were again significant (d = .54, 95%-CI .39-.68, p < .0001), although not

homogenous (χ2 = .89, df = 17, p < .0001).

Similar to the significant effects of secular meditation on psychological well-being,

research has shown that meditation with spiritual undertones also significantly enhances

psychological development and decreases psychological distress (Carter & Meyer, 1990). In two

meta-analytic reviews of studies which examined the effect of TM on psychological health,

Alexander and colleagues (1991) found that TM was significantly more effective than other

meditation practices and relaxation in promoting overall self-actualization, a component of psychological well-being that involves acceptance of self. TM produced a substantially larger

effect size (ES = .78) than other forms of meditation (.26) and relaxation (.27). In his U.S.

survey, Greeley (1975) found that “spiritual” or “transcendental” experiences, a result of TM,

were positively correlated with positive affect (r = .34), and negatively correlated with negative

affect (r = -.34). When transcendental experience was more stringently defined, the correlation

with positive affect increased further (r = .52).

Although TM is linked to positive affect, a few studies indicate that meditation with a

more explicit spiritual component yields greater positive effects than “secular” meditation and

relaxation techniques (Wachholtz & Pargament, 2005). Wachholtz and Pargament compared the

efficacy of spiritual meditation, secular meditation, and relaxation on psychological outcomes in

68 college students. Participants were randomly assigned to either the Spiritual Meditation

17 group, Secular Meditation group, or Relaxation group, and instructed to practice their assigned technique for 20 minutes a day for 2 weeks. Individuals in the Spiritual Meditation group were offered the choice of meditating to one of four spiritual phrases: “God [or other word for the divine that better fits the individual’s spiritual system] is love,” “God is joy,” “God is peace,” or

“God is good.” In the Secular Meditation group, participants chose from four secular meditative phrases: “I am happy,” “I am joyful,” “I am good,” or “I am content.” Participants in the

Relaxation group were not given explicit instruction for their technique. Instead, they were free to occupy themselves mentally in whatever way they chose. Confirming the researchers’ hypothesis that spirituality is a critical ingredient in meditation, results demonstrated that, in comparison to the Secular Meditation group and the Relaxation group, the Spiritual Meditation group reported significantly higher levels of positive mood (F(2, 65) = 4.32, p < .01) at post- intervention.

In a related study, Wachholtz (2005) compared the effects of spiritual meditation, two different forms of secular meditation (internally and externally focused), and relaxation on frequency of headaches, pain tolerance, and various psychological and spiritual variables in a sample of 83 college-age migraineurs. Participants were randomly assigned to either the Spiritual

Meditation group (SP), Internally Focused Secular Meditation group (IS), Externally Focused

Secular Meditation group (ES), or Relaxation group (RL). Participants in the SP group chose to meditate to one of four spiritual phrases: “God is love,” “God is joy,” “God is peace,” and “God is good.” In the IS group, participants were given the choice of meditating to one of four internally focused secular phrases: “I am happy,” “I am joyful,” “I am good,” or “I am content.”

Participants of the ES group were offered a choice from four externally focused secular phrases:

“Cloth is smooth,” “Grass is green,” “Cotton is fluffy,” or “Sand is soft.” Those in the RL group

18 were taught a progressive muscle relaxation technique. All participants practiced their assigned technique for 20 minutes per day for one month. In addition to finding that participants of the SP group experienced fewer migraine headaches, greater increases in pain tolerance, increased self- efficacy related to headaches, more daily spiritual experiences, and higher levels of existential well-being, Wachholtz found a significant effect for negative mood (F(3, 79) = 4.73, p < .005) with a moderate effect size (Eta2=.15), in which the SP group experienced a greater drop in

negative affect scores than the other treatment groups. Both studies by Wachholtz (Wachholtz,

2005; Wachholtz & Pargament, 2005) demonstrate that the effectiveness of meditation is

magnified when the meditative phrase is explicitly spiritual in content. These findings are exciting because they suggest that the effects of at least some forms of meditation can be enhanced when the spiritual component of meditation is made explicit (Pargament, 2007).

Congruent with the conclusions of Wachholtz’s research, Bush et al. (1999) found that more positive religious coping, including components of meditation such as repetitious praying,

was significantly related to more positive affect. Similarly, comparing Devotional Meditation

(DM) with Progressive Muscle Relaxation (PMR), Carlson, Bacaseta, and Simanton (1988)

found that those in the DM group reported less anxiety and anger than those in the PMR group.

Meditation and Depression

Just as meditation has a positive effect on psychological well-being in general, meditation

is beneficial for individuals who are struggling specifically with depression. Regarding outcome

studies on secular forms of meditation, research has demonstrated that MM significantly

improves self-reported levels of depression (Astin, 1997; Sagula & Rice, 2004; Surawy, et al.,

2005). Further, studies have shown that therapeutic off-shoots of MM, such as Mindfulness-

Based Cognitive Therapy and Mindfulness-Based Stress Reduction (MBSR), reduce the risk of

19 depressive relapse (Teasdale, et al., 2002) and decrease affective symptoms and ruminative tendencies (Ramel, Goldin, Carmona, & McQuaid, 2004). Working with a sample of individuals with a lifetime history of mood disorders, Ramel et al. found significant reductions in depressive symptoms in participants who completed an 8-week MBSR intervention [t(21) = 2.43, p < .024] with a medium effect size (Cohen’s D = .52). Sagula and Rice found a significant decrease in depression in participants who completed an 8-week mindfulness meditation program compared to the control group (F(1, 55) = 4.02, p < 0.05). In a similar study, Surawy et al. found highly significant decreases in depressive symptoms in patients with Chronic Fatigue Syndrome, with an effect size of 1.13. These effects were still present at 3-months post-intervention.

Researchers have also found that spiritually-based meditation reduces depressive symptomotology. In a meta-analytic review of 51 studies on various psychological variables, including depression, Ferguson (1980) found that the average effect size for TM was two times that of other forms of meditation, with effect sizes of .62 and .30, respectively. In a qualitative study with a sample of 143 cancer patients, Tatsumura, Maskarinec, Shumay, and Kakai (2003) found that spiritual meditation resulted in decreased self-reported levels of depression. Wolf and

Abell (2003) examined the effects of meditating to different mantras (meditative phrases) on depression in 61 participants who were randomly assigned to one of three groups—the group meditating to the “maha” mantra (a mantra of spiritual content that originates from ancient

India), the alternate or “secular” mantra group, or the control group. Results demonstrated that, in comparison to the alternate mantra and control groups, the maha mantra group experienced the largest decrease in depression scores with an effect size of 18.5%.

Considering that very few studies since the mid-80s have examined forms of psychotherapy that utilize religious/spiritual meditation techniques (Worthington, et al., 1996),

20 and that even fewer studies have compared spiritual meditation with its secular counterpart, the need for additional research is apparent. In reference to Wachholtz’s research, Pargament (2007) comments in Spiritually-Integrated Psychotherapy: Understanding and Addressing the Sacred that her “findings are intriguing and need to be extended to…clinical populations” (p. 259). In their study on spiritual vs. secular meditation, Wachholtz and Pargament (2005) suggest that

“further research is needed to determine whether spiritual meditation can…affect depression.

Since…anti-depressants may create a number of negative side effects, reducing or eradicating clients’ need for these may improve their quality of life while teaching lifetime skills that may empower them in the treatment of their mood disorder” (p. 383). The goal of the present study is to take a step forward in this direction by examining the effects of spiritual meditation vs. secular meditation in a mildly depressed sample.

Before turning to the study, it is important to consider some of the mechanisms that may account for the effects of spiritual meditation on depression. Below I discuss several potential meditating variables.

Mediating Variables

One potential variable meditating the relationship between spiritual meditation and depression is increased frequency of “peak” and spiritual experiences (Keefe, et al., 2001). This idea stems from Maslow’s theory of self-actualization (Alexander, et al., 1991; Maslow, 1968,

1970) (see Appendix A). Maslow viewed increased self-actualization as the cause or effect of peak experiences, also known as transcendental experiences (Maslow, 1964). Considering that research findings support the notion that transcendental experiences promote psychological integration, it is likely that cultivating transcendence is important for the development of

21 psychological health (Alexander, et al.). In his book , Values, and Peak Experiences,

Maslow (1964) shares with his readers:

My feeling is that…the power of [one peak] experience could

permanently affect the attitude toward life…it is my suspicion that

even one such experience might be able to prevent suicide, for

instance, and perhaps many varieties of slow self-destruction,

to violence, etc…Peak experiences might very well abort

“existential meaninglessness,” states of valuelessness, etc. at least

occasionally. (p. 75)

Maslow’s quote suggests that cultivating peak experiences through the practice of TM may benefit individuals who are suffering from psychopathology. It is interesting to note the depressive nature of the language within the quote. Terms such as “valuelessness” and

“meaninglessness” suggest that TM may be particularly relevant to depression.

As previously discussed, the experience of emotions with deep spiritual meaning is unique to the practice of spiritual meditation. Spiritual emotions may be another variable mediating the relationship between spiritual meditation and decreased depression. Additionally, acceptance, involving tolerance of one’s emotional vulnerability and giving control of one’s life circumstances to the divine, may also be a mediating variable.

Although not necessarily limited to meditation of a spiritual or religious nature, neuroendocrinological changes may be another meditating variable connecting the practice of meditation and decreased depression. Research has consistently demonstrated that depression is linked to elevated cortisol levels (Kling, et al., 1994; Schlechte, Sherman, & Pfohl, 1986) and low serotonin levels in proportion to other neurotransmitters (Goodwin & Jamison, 1990;

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Spoont, 1992). Research has shown that TM reduces cortisol in the moment of meditative practice (Jevning, Wilson, & Davidson, 1978) as well as long-term (Bevan, 1980). It appears that, as TM corrects for the hypersecretion of cortisol, there is a simultaneous increase in serotonin metabolism (Bujatti & Riederer, 1976). Research suggests that TM increases the breakdown and synthesis of serotonin, resulting in higher serotonin levels available during both the day and night (Bujatti & Riederer).

The Present Study

The current research addresses the question of whether spiritual meditation has greater benefits than secular meditation and relaxation with respect to mood and spirituality. More specifically, the present study examines whether the content of the meditative phrase effects self- reported levels of mood and spirituality. Pre-intervention, post-intervention, and one-month follow-up criterion measures were administered. It was hypothesized that participants who meditate to phrases of explicit spiritual content would report increased positive mood, decreased negative mood, and higher levels of spiritual well-being than participants who engage in secular meditation or relaxation. It was also hypothesized that participants of the secular meditation group would report similar degrees of change on criterion measures as participants of the relaxation group.

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METHOD

Participants

Fifty-four participants completed the entire study. All participants met criteria for mild to moderate depression as defined by the Beck Depression Inventory (Beck, Ward, Mendelson,

Mock, & Erdbaugh, 1961). There were 43 women and 11 men, all of whom were at least 18 years old.

The 54 participants were randomly divided into three groups: the Spiritual Meditation group (SP) (19 participants), the Secular Meditation group (SE) (17 participants), and the

Relaxation group (R) (18 participants). Participants largely described themselves as

“moderately” or “slightly” religious. More specifically 78.9% of SP participants, 76.4% of SE participants, and 94.4% of R participants described themselves as moderately or slightly religious. Similarly, most participants characterized themselves as “moderately” or “slightly” spiritual, including 84.2% of SP participants, 76.5% of SE participants, and 72.2% participants of the R group. Participants in the SP, SE, and R groups annually attended church an average of

13.9, 8.5, and 24.4, respectively.

A total of 595 undergraduates completed the screening process. Two hundred and sixty- five of these met inclusion criteria and were invited to participate in the intervention. Of these

265 individuals, 69 people agreed to participate in the study. Thirteen out of the 69 participants, however, did not complete the entire two-week long intervention or required questionnaires, including seven participants from the SP group, four participants from the SE group, and two participants from the R group.

Screener

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All participants met criteria for mild, moderate, or severe depression, a score between 10 and 25 on the Beck Depression Inventory (BDI) (Beck, Ward, Mendelson, Mock, & Erdbaugh,

1961) (See Appendix B). Individuals whose BDI score was ≥ 26 or who endorsed the suicide item were screened out of the study and referred to the university counseling center. Eighteen students were screened out of the study due to scoring ≥ 26 on the BDI, while five students were screened out due to suicidal ideation.

As part of the screening process, participants also completed a four-item scale measuring spiritual struggle (e.g. feeling abandoned or punished by God, experiencing anger toward God, religious ). Participants who reported experiencing “quite a bit” or “a great deal” of spiritual struggle were screened out of the study due to concern that, were they randomly assigned to the Spiritual Meditation group, their depression might be exacerbated throughout the intervention. Only one individual was screened out due to elevated levels of spiritual struggle.

Psychological Measures

Depression

The Beck Depression Inventory (BDI) was administered to participants during the screening process to determine whether they met inclusion criteria. The BDI is a self-report scale developed to assess clinical depression and is comprised of 21 forced-choice items (Beck, Ward,

Mendelson, Mock, & Erdbaugh, 1961). Each item consists of four possible responses.

Respondents are instructed to choose the response that best describes their feelings during the past two weeks. Each item results in a score of 0-3, with higher scores signifying more depression. In a meta-analytic review of the BDI’s estimated internal consistency, Beck, Steer, and Garbin (1988) found the mean coefficient alpha for nonpsychiatric participants to be .81.

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Beck et al. (1988) found that concurrent validities of samples with BDI clinical ratings and the

Hamilton Psychiatric Rating Scale for Depression were .60 and .74.

Affect

As a measure of mood, the Positive and Negative Affect Scale (PANAS) was given at three time points, prior to starting the intervention, immediately following the intervention, and one month after the completion of the intervention. The PANAS consists of two-10 item subscales, one measuring positive affect (PPANAS) and the other measuring negative affect

(NPANAS) (Watson, Clark, & Tellegen, 1988). Participants were asked to indicate the extent to which they experienced the emotion described by the item on a scale from 1 (“very slightly or not at all”) to 5 (“extrememly”). Prior to starting the intervention and immediately following the intervention, participants were instructed to indicate how they were feeling during the past two weeks, but at the one-month follow-up participants were asked to answer according to how they were feeling over the past one month. Example items of the PPANAS include “excited” and

“inspired,” while examples of the NPANAS include “distressed” and “upset.”

Both subscales show high internal consistencies, .89 for positive affect and .85 for negative affect, and are negatively correlated (r = -.15). In addition, the short-term version of the questionnaire shows moderately high stability when administered after an 8-week retest interval, specifically .54 for the positive affect subscale and .45 for the negative affect subscale. The positive affect subscale converges with other positive affect measures, ranging from .81-.92, and the negative affect subscale converges with other negative affect measures, ranging from .76-.91.

Spirituality Measures

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Spirituality measures were given at three time points, upon enrollment in the study, immediately following the two-week intervention, and one month following the completion of the intervention.

Religious/Spiritual Demographics

Two subscales of The Brief Multidimensional Measure of Religiousness/ Spirituality, developed by the Fetzer Institute/National Institute on Aging Working Group, were used to evaluate participants’ level of religiousness (Fetzer Institute, 1999) (See Appendix D). The first subscale, Private Religious Activities, is a five-item measure of the individual’s informal and noninstitutional religiousness, such as prayer and religious meditation, and has a moderate reliability level (α =.72). The present study used an adapted version of the Private Religious

Activities scale developed by Wachholtz (2005). Example items include “How much influence would you say that religion has on the way that you choose to act and the way that you choose to spend your time each day?” and “During the past year, how often have you experienced a feeling of religious reverence or devotion?” Religious Intensity, the second subscale, consists of two items inquiring about self-perceptions of levels of religiousness and spirituality, and has mid- level reliability (α =.77). Items included in this subscale include “To what extent do you consider yourself a religious person?” and “To what extent do you consider yourself a spiritual person?” For both items participants responded on a scale of 1 (“very”) to 4 (“not at all”).

Spiritual Well Being Scale

Developed by Paloutzian and Ellison (1982), the Spiritual Well Being (SWB) scale consists of 20 forced-choice items and assesses two components of spiritual health: Religious

Well Being (RWB) and Existential Well Being (EWB) (see Appendix E). Participants responded to all items on a scale from 1, “strongly agree,” to 6, “strongly disagree.” RWB is designed to

27 measure feelings of personal connection with God and has internal reliability coefficients ranging from .82-.94. An example item of the RWB scale is, “My relationship with God contributes to my sense of well-being.” EWB is designed to assess levels of satisfaction with life and sense of purpose, and uses no explicit religious language. A sample item from this scale includes, “I believe there is some real purpose for my life.” Internal reliability coefficients for the

RWB scale range from .82-.94, and .78-.86 for the EWB scale. RWB scores and EWB scores can be rated separately or combined to create a total SWB score, with an estimated internal reliability of .89-.94. Research addressing the validity of the SWB scale suggests that higher scores on the combined scale and both subscales are correlated with components of positive psychological quality of life, such as a higher sense of life purpose and fewer feelings of loneliness (Boivin,

Kirby, Underwood, & Silva, 1999).

Daily Spiritual Experiences Scale

Developed by Underwood in conjunction with the Fetzer Institute, the Daily Spiritual

Experiences Scale (DSES) is a 16-item scale intended to assess the individual’s experiences of the divine and the perception of interaction with the divine in everyday life. Example items include “I feel God’s presence” and “I experience a connection to all of life.” Response choices for all items range from 1, “many times a day,” to 6, “never or almost never.” The DSES has high internal consistency (α =.91) (Fetzer Institute, 1999) (See Appendix F). Underwood and

Teresi (2002) established preliminary construct validity through the examination of summary statistics for the DSES across various sociodemographic samples. Consistent with previous research, results showed that the DSES discriminated between sex, racial, and religion subgroups. Underwood and Teresi found further evidence of construct validity by significant correlations of the DSES with various quality of life and health variables.

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Mysticism Scale

The Mysticism Scale (M) (Hood, 1975) is a 32-item assessment of “peak” or transcendent experiences and, although originally developed as a single scale, consists of three subscales (Hood, Morris, & Watson, 1993): Introvertive Mysticism (IM) (feelings of unity with

“nothingness,” “I had an experience that cannot be expressed in words”), Extrovertive Mysticism

(EM) (feeling united with one’s external world, “I had an experience in which I realized the oneness of myself with all things”), and Religious Interpretation (RI) (experiencing “” of the divine, “I had an experience which I know to be sacred”) (see Appendix G). Participants rated all items on a scale from 1, “this description is definitely true of my own experience,” to 4,

“this description is definitely not true of my own experience.” The reliability alpha coefficients for IM, EM, and RI are .69, .76, and .76, respectively. Validity has been established by positive correlations between reports of mystical experiences and measures of openness to experience

(Hood, 1975), self-actualization (Hood, 1977), and others’ criteria of mysticism (Stace, 1960).

Researchers have found no evidence that mystical experience is linked to psychoticism or neuroticism (Caird, 1987). Items were modified for the present study to inquire whether participants had “peak” experiences during the intervention itself (post-test) and during the month following the intervention (follow-up).

Adherence

A brief on-line survey developed for the project served as a measure of adherence, which involved participants reporting on a daily basis whether they completed their meditation/relaxation practice and five mood ratings (See Appendix C). Participants were asked to rate the degree to which they felt “happy,” “angry,” “sad,” and “calm” on a scale from 1 (“not at all”) to 7 (“very much”). Participants were then asked to rate their “general mood” on a scale

29 from 1 to 7, 1 being “negative” and 7 being “positive.” The diary is an adapted form of the adherence dairy Wachholtz (2005) developed. Participants were required to complete their meditation/relaxation practice for a minimum of nine of the 14 days. Those who did not complete the task for at least nine days were dropped from the study.

Procedure

Recruitment

Students were recruited through an online system used by the university to advertise various research projects. In addition, fliers were posted in introductory psychology classrooms and the university’s counseling center in efforts to recruit participants. The project was described as a study of various methods of meditation and relaxation. Because the percentage of atheists among the university’s student body is quite low, estimated to be about 3% (Wachholtz &

Pargament, 2005), atheists were not screened out of the study. With the exception of a small number of religious variables, the vast majority of the survey questions were nontheistic in nature, making it likely that participants, including atheists or agnostics, would find survey items relevant and unintrusive.

Project

Direct contact between the experimenter and the participants took place only once at the onset of the intervention. Upon meeting criteria for mild to moderate or moderate to severe depression (a BDI score of 10-25, as used by Kendall, Hollon, Beck, Hammen, & Ingram, 1987) by completing an on-line form of the BDI, participants were asked to attend a group meeting in which the researcher described the project and answered participants’ questions. After agreeing to participate, participants reviewed and signed informed consent forms and completed multiple measures of spirituality (The Brief Multidimensional Measure of Religiousness/Spirituality,

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SWB, DSE, and The Mysticism Scale) (See Appendix H). The researcher randomly assigned participants to a treatment group according to the order in which they signed up to participate in the project (e.g., the first participant was assigned to the SP group, the second to the SE group, the third to the R group, and so on). During the group meeting participants were then taught how to practice their assigned technique. (See Appendices I and J for training scripts, which have been adapted from Wachholtz’s (2005) training scripts.) All participants were instructed to record whether they practiced their assigned technique and rate their mood on a daily basis in the online adherence diary.

All groups were given identical instructions for how to physically relax and create a relaxation-inducing environment free of distraction (e.g., no music, TV) prior to the practice of their respective techniques. Both meditation groups were instructed to mentally focus themselves on a meditative phrase during their meditative practice, and that, if they become aware of their attention drifting from the phrase, they should gently bring their attention back to the phrase without self-criticism or self-judgment. Using Wachholtz and Pargament’s (2005) study as a guide, the Spiritual Meditation group was given the choice of meditating to one of four spiritual phrases: “God is love,” “God is joy,” “God is peace,” or “God is good.” Participants were instructed to choose the meditative phrase that best fits their spiritual system. In addition, in the case that participants felt uncomfortable with use of the word “God,” they were offered the option of exchanging “God” with their own choice word for the divine. Participants of the

Secular Meditation group were given their choice of four secular meditative phrases: “I am happy,” “I am joyful,” “I am good,” or “I am content.” Participants in the Relaxation group were given instructions to focus on relaxing their body in a systematic way, starting with their feet and ending with their face. The relaxation technique closely resembles Progressive Muscle

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Relaxation (PMR), a technique in which muscles are systematically tensed and released. Because researchers have suggested that PMR may be construed as a form of treatment due to its vascular component (Wachholtz & Pargament, 2005; Wachholtz, 2005) and because the relaxation group served as the control group in the present study, a more passive form of relaxation was chosen.

Participants practiced their assigned meditation/relaxation technique in isolation for 20 minutes a day for two consecutive weeks.

One week into their meditation/relaxation practice, participants received an email reminding them that in one week they would be asked to complete a set of questionnaires online.

At the end of the two-week duration of the project, participants received a second email providing them the link to the online form of the PANAS and the same set of religion/spirituality measures. Participants received a third email two weeks after the completion of the intervention with the reminder that they would be asked to complete the same set of questionnaires in two weeks for a third and final time. One month after the completion of the intervention, participants received a final email with the link to the same online set of questionnaires.

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RESULTS

Preliminary Analyses

1 x 3 ANOVAs were conducted on variables that were assessed at pre-test only (e.g. demographic variables) to identify potential control variables. There were no significant differences between the groups on any of the pre-test variables, including prayer frequency, meditation frequency, self-reported religious and spiritual intensity, church attendance, and level of depression (See Table 1). All scales were generally reliable with the exception of the screening variables, which may be a reflection of restricted range of scores. Cronbach’s alphas for the screening measures are reported in Table 2, and alphas for all other scales are reported in

Table 3. A correlation matrix for primary psychological and spiritual variables for the total sample at pre-test is provided in Table 4.

A series of repeated measures 3 x 3 (time x treatment group) ANOVAs were then conducted to assess whether the three groups changed in different ways throughout the study with respect to the psychological and spiritual criterion measures. Time x treatment interaction effects were of particular interest in these analyses. 2 x 3 ANOVAs were conducted on variables included in the adherence diary as these data were collected at pre- and post-test only. The results of the ANOVA’s for the Psychological and Spiritual Measures (See Table 6), and the

Daily Adherence Diary (See Table 7) are presented below.

Psychological Measures

A series of repeated measures 3x3 ANOVAs (time x treatment group) assessed differences between the three groups on measures of positive and negative mood.

PPANAS

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A significant interaction between positive affect and treatment group was found (F

(4,100) = 2.82, p<.05) with a small to moderate effect size (Eta2 = .10). Consistent with predictions, Figure 1 indicates that the SP group experienced a greater increase in positive affect than the other groups (See Table 6 and Figure 1). Post hoc Tukey HSD Tests indicate that participants of the SP reported significantly higher levels of positive mood than participants of the SE group (p<.05) at post-test. However, there were no significant mean differences between the SP and R groups or between the SE and R groups at post-test. There were no significant mean differences in positive mood between treatment groups at one month follow-up.

Results also indicated a significant main effect of time (F (2,50) = 18.72, p<.05). A 1 x 3

ANOVA suggest that this main effect of time was largely driven by a change in positive mood from pre- to post-test, rather than post-test to one month follow-up. More specifically, the pre- post change scores indicates that, of all three treatment groups, participants in the SP group experienced the greatest increase in positive affect from pre-post test. Although results do not suggest that the SE group reported a significant change in positive affect over the course of the study, the R group experienced a significant increase in positive affect from pre-post test (See

Table 6).

NPANAS

According to the group means, all three groups experienced a decrease in negative affect.

However, there was no significant interaction between time and group with respect to negative mood (F (4,100) = .26, p=NS). A significant main effect did emerge for time (F (2,50) = 40.61, p<.05), and further analyses indicated that all three groups experienced a similar decrease in self- reported negative mood over time from pre- to post-intervention (See Table 6).

Spiritual Measures

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A series of 3x3 ANOVAs (time x treatment group) assessed differences on spiritual measures between the three treatment groups.

Spiritual Well Being

With respect to overall spiritual well being, analyses did not yield a significant time x treatment group interaction (F (3.15,77.11) = .41, p=.NS). However, results indicate a significant main effect of time (F (1.57,77.11) = 6.49, p=.005, Eta2=.12), in which all three groups

experienced a modest increase in spiritual well being (See Table 6).

The time x treatment group interaction on the Religious Well Being subscale was not

significant (F (4,96) = .42, p=NS). Regarding the Existential Well Being subscale, a significant

time x treatment group interaction did not emerge (F (3.32,81.25) = .19, p=NS). Results,

however, indicated a significant main effect of time (F (1.66,81.25) = 8.41, p=.001, Eta2=.15), suggesting that participants of all three treatment groups reported an increase in existential well being from pre- to post-test (See Table 6).

Daily Spiritual Experiences

3 x 3 ANOVAs revealed no significant time x treatment group interaction on the frequency of participants’ daily spiritual experiences (F (4,100) = .26, p=.NS). Results indicate a significant main effect of time (F (2,50) = 40.61, p<.05). The SP group experienced the greatest pre- to post-intervention increase in daily spiritual experiences, followed by the R group. Results indicated that the SE group experienced a marginally significant increase in daily spiritual experiences (See Table 6).

Mysticism

Analyses revealed no group x time interaction between the three treatment groups on overall mysticism (F (4,100) = .12, p<.NS). Results indicated a significant main effect of time (F

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(2,50) = 7.62, p=.001) in which all groups experienced an increase in mystical experiences. The main effect for time was driven by the change in self-reported mysticism from pre-test to one month follow-up (See Table 6).

Regarding the Extrovertive mysticism subscale, results failed to indicate a significant group x time interaction F (4,100) = .27, p=NS. Analyses revealed a significant main effect for time (F (2,50) = 4.85, p<.05), again driven by the pre-test to follow-up change. Results indicated that the group x time interaction was not significant on the Religious Interpretation subscale (F

(4,100) = .47, p=NS), nor the Introvertive Mysticism subscale (F (4,100) = .24, p=NS).

Regarding introvertive mysticism, analyses suggested a significant main effect for time (F (2,50)

= 12.55, p<.001), such that the SP group experienced a significant pre- to post-intervention.

Daily Adherence Diary

2 x 3 ANOVAs were conducted to look for group differences in the daily adherence diary consisting of five global mood ratings: Happy, Angry, Sad, Calm, and Overall Mood. In order to run these analyses, two mean scores were produced by averaging mood ratings for the first three days of the intervention and for the last three days of the intervention. The time x group interactions for all mood ratings were not significant (Happy, F (2,51) = 1.51, p=.NS; Angry, F

(2,51) = 1.10, p=.NS; Sad, F (2,51) = 1.45, p=.NS; Calm, F (2,51) = 2.46, p=.NS; Overall mood,

F (2,51) = .51, p=.NS). Main effects of time were found for Happy (F (1,51) = 15.74, p<.001),

Angry (F (1,51) = 6.77, p<.05), Sad (F (1,51) = 8.27, p<.05), and Overall mood (F (1,51) = 8.25, p<.01), indicating that participants across all three treatment groups experienced improvements with regard to these four measures of mood over the course of the intervention. A group main effect was found for Calm (F (2,51) = 6.06, p<.01) (See Table 7).

Post Hoc Analyses

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Following results of the planned analyses, post-hoc regression analyses were conducted with all criterion variables to explore whether spiritual intensity moderated the relationship between the treatment group and changes in the outcome measures. Spiritual intensity was defined as the sum of three items of the Religious Measures Questionnaire: church attendance, self-perceived level of religiousness, and self-perceived level of spirituality. These analyses were of particular interest due to the question of whether spiritual meditation was more effective for more spiritually-oriented participants than for less spiritually-oriented individuals.

Spirituality and Mood

Regression analyses were conducted in four steps for each criterion variable at both post- test and one month follow-up. At Step 1, each criterion measure at pre-test was entered. In Step

2, both the SP and SE groups were entered as dummy coded variables (the R group served as the base group). Spiritual intensity was entered in Step 3. In Step 4, the two interaction terms (SP group x spiritual intensity and SE x spiritual intensity) were entered. Analyses revealed that spiritual intensity moderated the relationship between treatment group and several measures of mood. More specifically, participants in the SP group with higher levels of spiritual intensity experienced greater improvements than participants in the SE and R groups with regard to items measuring Happy (∆R2=.11, F (2,47)=3.35, p<.05), Sad (∆R2=.12, F (2,47)=3.31, p<.05), and

Overall mood (∆R2=.12, F (2,47)=3.20, p=.05). Results of regression analyses are reported in

Tables 8 through 18.

Spirituality and Daily Spiritual Experiences

After controlling for the number of daily spiritual experiences at the outset of the study,

religious/spiritual intensity was found to moderate the relationship between treatment group and

daily spiritual experiences at both post-test (∆R2=.08, F (2,47)=3.90, p<.05) and one month

37 follow-up (∆R2=.09, F (2,47)=5.43, p<.01) (See Table 13). Higher levels of spiritual intensity

were related to greater improvement in the both the SP and SE groups is comparison to the R

group. These findings suggest that, as religious/spiritual intensity rose among participants of the

SP and SE groups, the more effective the meditation was in increasing daily spiritual experiences

at both post-test and one month follow-up.

38

DISCUSSION

The goal of the study was to determine whether spirituality is a critical ingredient in meditation. The primary research question was raised: Does adding an explicit spiritual component to concentration meditation enhance its impact on mood and spirituality in depressed college students? I tested the hypothesis that spiritual meditation is related to greater psychological and spiritual benefits than secular meditation and relaxation.

Overall, findings suggested that the addition of an explicitly spiritual component to the practice of meditation does not enhance the effectiveness of this technique among depressed college students. One exception is that spiritual meditation was shown to significantly improve positive mood. This finding, however, should be interpreted with caution as this was the only significant time x treatment group interaction effect. However, results do indicate that all three treatment groups showed improvement in psychological and spiritual variables across time. In addition, spiritual intensity appeared to moderate the relationship between treatment group and daily spiritual experiences and several measures of mood.

Mood and Meditation/Relaxation

Most relevant to this study were the results that pertained to negative mood. The findings did not confirm the hypothesis that spiritual meditation would be related to a greater decrease in negative mood than the other two group interventions. One potential explanation for this finding is that spiritual meditation may be particularly helpful to people who are feeling out of control.

Participants in the present study may not have been experiencing a strong sense of loss of control. Illustrative of this point is the work of Brenda Cole who evaluated Re-Creating Your

Life, a six session group intervention for individuals dealing with medical illnesses. Re-Creating

You Life examines spiritual resources and struggles related to several themes, including

39 meaning, identity, relationships, and control (Cole & Pargament, 1998). Cole evaluated the effectiveness of Re-Creating Your Life in female cancer patients (Cole, 2005), and patients with syncope, a heart condition which causes dizziness or loss of consciousness (Cole, 1999). The results of Cole’s studies were conflicting, such that the spiritual intervention was inconsistently more effective than the alternate forms of treatment or waitlist group. To make sense of her findings, Cole conducted further analyses and discovered that the syncope patients were not experiencing high levels of depression and anxiety, while the women with cancer were reporting high levels of distress. The syncope patients’ higher level of well-being may have been due to the fact that, unlike the cancer patients whose lives were at risk, the condition of the syncope patients was being successfully treated through the use of defibrillators and pacemakers. Cole

(1999) concluded that spiritual interventions may be most helpful to people in high stress situations in which they have little control. In light of Cole’s findings, if the present study’s participants experienced depression that was low-grade and chronic in nature, it is possible that they did not perceive their experience of depression as high-stress and out of control. Relevant to this possibility were the findings in this study that mean BDI scores at pre-test for all treatment groups fell within the “mild to moderate” range (Beck, Steer, & Garbin, 1988). Participants of the SP group, SE group, and R group reported mean BDI scores of 17.1 (SD=5.0), 16.8

(SD=5.1), 17.1 (4.8), respectively. According to Beck (1967), the mean BDI scores for minimal depression, mild depression, moderate depression, and severe depression are 10.9 (SD=8.1), 18.7

(SD=10.2), 25.4 (SD=9.6), and 30.0 (SD=10.4), respectively. Because participants’ BDI scores fall closest to the mean score for the mild classification, it is possible participants did not perceive their depressions as out of their control.

40

Another potential explanation for why the meditation and relaxation interventions did not lead to decreased negative mood is that participants’ depression may have interfered with their ability to learn and apply their assigned techniques in an effective manner. In this vein, researchers have suggested that mindfulness-based interventions (mindfulness-based cognitive therapy) are most effective when employed after individuals have recovered from depression, because their improved cognitive functioning puts them in the best position to learn cognitive techniques, such as meditation (Segal, Williams, & Teasdale, 2002; Teasdale, Segal, &

Williams, 1995). The goal of mindfulness-based cognitive therapy is for individuals to develop cognitive coping skills that reduce their cognitive vulnerability to stress, which ultimately prevents the recurrence of depression (Allen, 2006). According to this model, it is possible that participants’ cognitive functioning was impaired in such a way that they were unable to effectively learn or apply their assigned meditation or relaxation technique.

Although a significant treatment group x time interaction effect did not emerge for negative mood in this study, the findings did show that spiritual meditation was tied to a greater elevation in positive mood. Questions could be raised by this finding since it might be assumed that positive mood is inversely correlated with negative mood. In fact, positive and negative affect were not highly correlated (r’s from -.06 to -.34) in this study. This low correlation is consistent with other studies. According to Watson, Clark, and Tellegen, the originators of the

PANAS, the correlation between the positive affect and negative affect subscales is invariably low, ranging from -.12 to -.23 (Watson, Clark, & Tellegen, 1988). Over time, participants in the

SP group reported a larger increase in positive mood compared to participants in the other two groups. This finding is consistent with other research that has found that the use of spiritual techniques positively impacts psychological health (Wachholtz & Pargament, 2005). Previous

41 research suggests that nonspiritual forms of meditation can result in improved mood. Grossman,

Niemann, Schmidt, and Walach (2004) conducted a meta-analysis on 20 empirical studies that addressed the effects of mindfulness-based stress reduction (MBSR) on various dimensions of psychological and physical well-being. MBSR is considered a nonreligious and nonesoteric form of meditation, and was designed to enhance moment-to-moment awareness of mental processes. For the mental health variables (e.g., depression, anxiety), the meta-analysis yielded a significant medium strength effect size of d=.54 (95%-CI .39-.69, p<.001, two-tailed) for controlled studies and d=.50 for observational studies (95%-CI .43-.56, p<.0001). Adding an explicitly spiritual component to meditation in this study appeared to enhance its effectiveness among depressed college students in terms of positive mood. Some suggest that spiritual interventions are more effective than nonspiritual interventions because they help people view themselves and the world around them through a “spiritual lens” (Pargament, 2007). In his book

Spiritually Integrated Psychotherapy, Pargament (2007) writes:

Through the spiritual lens, people can see their lives in a broad, transcendent perspective;

they can discern deeper truths in ordinary and extraordinary experience and they can

locate timeless values that offer grounding and direction in shifting time and

circumstances. Through a spiritual lens, problems take on a different character and

distinctive solutions appear: answers to seemingly unanswerable questions, support when

other sources of support are unavailable, and new sources of value and significance when

old dreams are no longer viable. (p.12)

Various psychosocial explanations may also shed light on the question as to why spiritual meditation may have been more effective in increasing positive mood than secular meditation and relaxation. Pargament and Mahoney (2005) have suggested that spirituality induces positive

42 emotional states, such as love, adoration, and gratitude. Other research has focused on a variety of different emotions that seem to be deeply rooted in religion and spirituality, such as a sense of awe and elevation (Haidt & Keltner, 2004) and humility (Tangney, 2000). Second, spiritual meditation may have encouraged participants to attribute meaning and purpose to their experience of depression. Wachholtz, Pearce, and Koenig (2007) have suggested that religious or spiritual interventions may provide people with a rich resource of coping models from which to develop a positive religiously- or spiritually-based narrative in which to frame their experience of suffering. This framework, in turn, influences people’s ability and motivation to cope with pain. Placing their experience of depression in a larger benevolent context may have provided people with encouragement and comfort (e.g., my depression will strengthen me and bring me closer to God), and enhanced their sense of self-esteem and self-acceptance.

Another possible explanation for the change in positive affect is that participants experienced changes in neurotransmitter activity. Meditation has been shown to impact the function of serotonin and dopamine, two of the primary neurotransmitters that have been linked to depression. It is accepted among researchers that serotonergic and dopaminergic malfunction is linked to the presence of depression, and that when these neurotransmitters are available to neurons in higher concentrations depressive symptomatology tends to subside (Klein & Wender,

2005). Levitsky (1998) noted previous cross-sectional research that compared long-term practitioners of TM to matched control. Results indicated that practitioners of the TM program had increased urinary excretion 5-hydroxyindoleacetic acid (5-HIAA), the major metabolite of serotonin. Kjaer et al. (2002) examined the association of endogenous neurotransmitter release and meditation in eight healthy male meditation teachers who practiced meditation on a daily basis for 7 to 26 years. Results indicated a 65% increase in endogenous dopamine release during

43 the practice of meditation. It is possible that meditation’s effect on neurotransmitter activity is enhanced when an explicitly spiritual component is added to the meditative practice. However, in the case that neurotransmitter activity was affected by the meditation and/or relaxation techniques, it is likely that negative mood, in addition to positive mood, would have been affected.

Spirituality and Meditation/Relaxation

Results of the present study indicated that all three treatment groups showed improvements on nearly all of the spiritual criterion measures. Additionally, effects were sustained over the one month follow-up period with regard to several psychological and spiritual variables. These findings lead to an important question “How did the seemingly secular techniques of secular meditation and relaxation manage to significantly impact participants’ spiritual lives?” Meditators often report experiencing powerful emotions filled with sacred language, such as feelings of love and compassion, deep gratitude, a connectedness to the very core of their being or a transcendent entity outside themselves, and a sense of uplift and awe

(Astin, 1997; Shapiro, Schwartz, & Bonner, 1998). These sacred emotions may account for some of the beneficial spiritual effects of meditation, whether spiritual or secular, and relaxation.

Wachholtz and Pargament (2005) suggested that secular techniques enhance one’s spiritual well-being simply because they encourage the individual to set aside time on a daily basis to center the self and turn off the “noise” of everyday living. Their research raised the question of whether participants practicing secular meditation were injecting spirituality into the practice of secular meditation, or whether they were encountering a spiritual experience through the practice of a seemingly secular technique (Wachholtz & Pargament, 2005). The present study takes this one step farther by raising the possibility that relaxation produces similar spiritual

44 effects as both spiritual and secular meditation. The question now becomes whether all participants, including those who simply practiced relaxation, injected spirituality or encountered the spiritual in the practice of their assigned techniques.

Meditation has historically been grounded in a larger spiritual context. Results of this study suggest that it may be impossible to separate various meditative and relaxation techniques from this larger context. Perhaps drawing concise boundaries between spiritual meditation, secularly meditation, and relaxation is artificial and an oversimplification. Illustrative of this point, Mark Rye (Rye & Pargament, 2002; Rye et al., 2005) compared religious groups with secular forgiveness groups. Both the religious and secular forgiveness groups were developed from the same model of forgiveness (based on Worthington’s (1998) forgiveness intervention). The only distinction between the two treatment groups was that religious and spiritual resources were emphasized in the religious intervention, while these resources were not included in the secular intervention. Rye found that the religious and secular groups were equally successful in promoting forgiveness of romantic partners (Rye & Pargament, 2002) and ex- spouses (Rye et al., 2005). Upon further analysis, Rye discovered that participants in the secular intervention reported that religious and spiritual assets were two of the three most helpful resources they used to help them forgive. Although Rye’s intention was to compare the effects of spiritual vs. secular forgiveness programs, he was unable to “control” for spirituality in the secular intervention. Therefore, to call one form of treatment “spiritual” and another treatment

“secular” may be misleading. Pargament (2007) suggests that it might be more appropriate to label interventions as “explicitly spiritual” and “not explicitly spiritual.”

Results indicated that there was greater change with regard to spiritual variables than psychological variables. Regarding spiritual criterion measures, participants reported increases in

45 the areas of spiritual well being, daily spiritual experiences, and mystical experiences. It is widely accepted that religion and spirituality are linked to better functioning on a variety of mental health measures, (Koenig, McCullough, & Larson, 2001; McCullough, 1999). Religious involvement, including intrinsic religious motivation and positive religious attributions of major life stressors, have been positively correlated with various measures of mental health (Bergin,

1991; Bergin, et al., 1987; Larson, et al., 1992; Pargament, 1997; Schumaker, 1992;

Worthington, et al., 1996). For example, research suggests that various measures of religious involvement are related to decreased depression (Bienenfield, Koenig, Larson, & Sherill, 1997;

Ellison, 1995; Kendler, Gardner, & Prescott, 1997) and less suicide (Kark, et al., 1996). Religion and spirituality can serve as coping mechanisms, alleviating pain and distress by providing significance, meaning, and purpose to life in the face of stressors that are an inevitable part of the human experience (Pargament, 1997). Considering that participants in all treatment groups reported improved spirituality, it seems logical that they would have experienced psychological benefit in one way or another. It is possible, however, that the practice of meditation and relaxation directly effected participants’ spirituality, bypassing changes in psychological well- being. Another possibility is that the psychological measures used in this study were not sensitive to the psychological changes that may have been occurring over the course of the interventions. Perhaps measures of other dimensions of mental health (e.g., anxiety) would have captured changes in mental health.

Spiritual Intensity as a Moderating Variable

The findings from regression analyses provided some modest support for the idea that more spiritually oriented people may benefit from spiritual meditation more than less spiritually oriented people. Out of a total of 25 moderated regression analyses that were run to test for the

46 moderating effects of spirituality intensity, five were significant (daily spiritual experiences and four measures of mood), suggesting that these findings were not due to chance alone. Thus, the efficacy of spiritually integrated interventions may depend in part on the level of spirituality of the client. It seems logical that interventions of an explicitly spiritual nature would be more effective with spiritually oriented individuals (Pargament, 2007). In this vein, Wade,

Worthington, and Vogel (2007, worked with a sample of 271 clients who sought therapy at

Christian and secular counseling centers and found that, when religious models of treatment were used, more religious clients reported greater therapeutic change and greater closeness to their therapist than clients who were less religious.

Not all studies have yielded similar results. Other research has led to mixed findings on the value of matching spiritual clients with spiritual interventions (Worthington & Sandage,

2002). Cashwell, Young, Cashwell, and Belaire (2001) found that counselors who used a therapeutic intervention of a spiritual nature were viewed similarly as counselors who used a cognitive behavioral approach in terms of counselor Expertness, Trustworthiness, and

Attractiveness, and session Smoothness and Depth. This effect was not moderated by the respondent's reported level of spirituality. Therefore, participants perceived the two approaches similarly regardless of their reported level of spirituality.

Pargament (2007) has noted that spiritual interventions may, in fact, be quite relevant to nonspiritual individuals who may not recognize the role of spirituality in their lives.

Nevertheless, the spiritual dimension of a spiritual intervention may not always be relevant to an individual’s presenting problem. Further studies are needed to determine when the client’s level of spirituality plays a moderating role on the effects of spiritually integrated interventions.

Implications

47

Overall, the results of the study did not suggest that adding an explicitly spiritual component to meditation increased its effectiveness beyond that of secular meditation or relaxation. As previously mentioned, Cole (1999) has suggested that meditation may be most effective in situations that are perceived as high stress and uncontrollable. It is possible that spiritual meditation may be more relevant to the treatment of problems that are high stress in nature and perceived as uncontrollable, such as physical pain, genetic illnesses, criminal victimization (e.g., rape, domestic violence), and natural disasters. This may provide an explanation for the differing findings between the present study and Wachholtz’s research on pain tolerance and migraine headaches (Wachholtz & Pargament, 2005; Wachholtz, 2005). It is worth noting, however, that some depressed individuals may experience their depression as high stress and out of their control, while others experience a more chronic, low-grade depression.

Perhaps meditation is more effective for individuals with particular “types” of depression.

Having a clear understanding of participants’ perceptions of their depression would enable clinicians to identify situations in which meditation may be most helpful. In addition, some research suggests that the effectiveness of mindfulness meditation is most effective in preventing the relapse of depression. Perhaps then, a spiritual form of concentration meditation may be most helpful as a way of preventing future relapse following a depressive episode.

The findings of this study may have practical implications for mental health professionals. It is possible that these findings would generalize to populations with other forms of psychological distress (e.g., anxiety). This, however, awaits future research. Considering that spiritual meditation was linked to an elevation in positive mood but not a decrease in negative mood, a new question arises: what interventions will help decrease negative mood? In light of the fact that primary symptoms of depression include low energy, fatigue, and lack of motivation, it

48 seems logical that spiritual resources that serve to activate an individual may be most effective in improving negative mood. It is possible that the relaxing and introspective nature of meditation keeps individuals “stuck” in their depressed state. For example, it might be useful for depressed people to practice , a form of meditation that would serve to increase their physical activity and, as a result, their emotional energy. In addition, spiritual resources outside the realm of meditation could be explored, such as exercise (e.g., , pilates), walking, sacred music, religious/spiritual social support, journaling, and reading sacred literature.

Results may have important practical implications for those working with spiritually oriented individuals. Clinicians have varying degrees to which they are comfortable integrating spirituality in their clinical practice. However, clinicians must keep in mind that matching spiritual clients to spiritual interventions may be particularly effective.

Lastly, the study’s findings that secular meditation and relaxation result in improvements in spiritual outcome variables may have implications for the way in which mental health practitioners weave these techniques into their clinical practice. For individuals who do not view themselves as spiritual and are not interested in the development of a faith, it may be a misnomer to introduce nonspiritual meditation and relaxation techniques as “secular” as research has shown them to have spiritual implications (Wachholtz, 2005).

Limitations and Future Directions

While findings shed light on our understanding of the relationship between mood and various meditation and relaxation techniques, the study has several limitations. Because all participants were undergraduate college students, generalizability to other populations is limited.

Future studies should recruit participants from a broader age range and focus on other forms of

49 psychopathology. In addition, future research could focus on a clinical population by recruiting patients from hospitals or community mental health centers.

The study’s sample consisted of a total of 54 participants, who were then randomly assigned to three different treatment groups, This relatively small sample size resulted in limited statistical power to detect group differences in the efficacy of treatments.

Although the study design included a non-meditation group (the relaxation group) as a control group of sorts, it did not include a purely nontreatment group. Having a group of participants on a nontreatment waiting list would allow the researcher to tease out whether participants are improving over time on their own (i.e., regression to the mean) or whether they are benefiting from the actual meditation and relaxation techniques themselves.

While multiple measures of spirituality were included in the study, only one measure of mood was included (PANAS). Unfortunately, research suggests that some measures of mood, such as the BDI, may not be particularly sensitive to change. Nelson, Rensenbrink, and Kapp

(1995) assessed 25 psychiatrically hospitalized adolescents on three separate occasions using the

BDI, among other self-report measures. Results indicated that the BDI may not have been sensitive to clinical change until participants had been in treatment for five to six weeks and experienced perceptible relief in depressive symptoms. Future research should include a variety of change-sensitive scales assessing mood and depression.

Because the only form of accountability for verifying whether participants practiced their meditation or relaxation was online, it is unknown whether participants actually practiced their assigned technique as often as they reported. More frequent face-to-face contact between the researcher and participants would allow the researcher to more accurately track whether participants are practicing their assigned technique. For example, mandatory meetings could be

50 held to practice meditation or relaxation as a group. The online daily adherence diary was intended to serve the purposes of monitoring practice progress. It is possible, however, that students reported online that they practiced their technique each day in order to receive research credit.

Because of the biological basis of depression, it is important that future studies ask participants whether they are taking psychotropic medication, and if so, the type of meditation they are taking and whether there have been any changes in their medication during the course of the intervention. In addition to assessing psychiatric treatment, it is also important to ask participants whether they are receiving psychological services during the study.

Gathering qualitative data on how participants experience the practice of meditation or relaxation may help researchers understand the mechanisms by which these techniques affect psychological and spiritual well-being. Qualitative data may, for example, answer the question of whether participants are injecting spirituality into or encountering a spiritual experience through the practice of secular meditation and relaxation.

As previously mentioned, because depressed individuals tend to experience helplessness, powerlessness, and hopelessness, and often have little energy, the introspective and relaxed nature of meditation may be one of the reasons why meditation did not impact participants’ negative affect. Future research should focus on spiritual resources that might better activate and empower depressed individuals.

Conclusions

The addition of an explicitly spiritual component to the practice of meditation does not appear to add to the effectiveness of this technique among depressed college students. Although spiritual meditation was shown to significantly improve positive mood, this finding should be

51 interpreted with caution as this was the only significant time x treatment group interaction.

However, results do indicate that all three treatment groups showed improvement in psychological and spiritual variables across time. In addition, spiritual intensity appeared to moderate the relationship between treatment group and daily spiritual experiences and several measures of mood.

52

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APPENDIX A. POTENTIAL PATHWAYS BETWEEN SPIRITUAL MEDITATION AND

DECREASED DEPRESSION

• Increased "peak" and spiritual experiences

• Greater feelings of spiritual emotions Spiritual Decreased Meditation • Greater acceptance and Depression increased surrender to the divine

• Neuroendocrinological changes

Appendix B 69

This copy of the Beck Depression Index has been removed due to potential copyright issues. Appendix B 70

This copy of the Beck Depression Index has been removed due to potential copyright issues. Appendix B 71

This copy of the Beck Depression Index has been removed due to potential copyright issues. Appendix B 72

This copy of the Beck Depression Index has been removed due to potential copyright issues. 73

APPENDIX C. DAILY ADHERENCE DIARY

Daily Adherence Diary—Day # ____

Date ______ID # ______

Did you practice your meditation or relaxation technique for 20 minutes today? ___ Yes ___ No

Please circle the number that best describes how you currently feel.

Not at all Very Much Happy 1 2 3 4 5 6 7 Angry 1 2 3 4 5 6 7 Sad 1 2 3 4 5 6 7 Calm 1 2 3 4 5 6 7

Negative Positive__ General Mood 1 2 3 4 5 6 7

Additional Comments:

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APPENDIX D: RELIGIOUS MEASURES QUESTIONNAIRE

The following questionnaire consists of multiple choice and fill-in-the blank items. Please make an X next to your choice or provide the most accurate number for the fill-in-the-blank item.

1. How many times have you attended religious services during the past year? ____ times

2. Which of the following best describes your practice of prayer or religious meditation? _____a. Prayer is a regular part of my daily life. _____b. I usually pray in times of stress or need but rarely at any other time. _____c. I pray only for formal ceremonies. _____d. I never pray.

3. When you have a serious personal problem, how often do you take religious advice or teachings into consideration? _____a. Almost always _____b. Usually _____c. Sometimes _____d. Never

4. How much influence would you say that religion has on the way that you choose to act and the way that you choose to spend your time each day? _____a. No influence _____b. A small influence _____c. Some influence _____d. A fair amount of influence _____e. A large influence

5. During the past year, how often have you experienced a feeling of religious reverence or devotion? _____a. Almost daily _____b. Frequently _____c. Sometimes _____d. Rarely _____e. Never

6. To what extent do you consider yourself a religious person? _____a. Very religious _____b. Moderately religious _____c. Slightly religious _____d. Not religious at all

7. To what extent do you consider yourself a spiritual person? _____a. Very spiritual _____b. Moderately spiritual _____c. Slightly spiritual

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_____d. Not spiritual at all

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APPENDIX E: SPIRITUAL WELL-BEING SCALE

For each of the following statements, click on the circle that best indicates the extent of your agreement or disagreement as it describes your personal experience:

SA = Strongly Agree D = Disagree

MA = Moderately Agree MD = Moderately Disagree

A = Agree SD = Strongly Disagree

SA MA A D MD SD 1. I don’t find much satisfaction in private prayer with

God. 2. I don’t know who I am, where I came from, or where

I am going. 3. I believe that God loves me and cares about me. 4. I feel that life is a positive experience. 5. I believe that God is impersonal and not interested in

my daily situations. 6. I feel unsettled about my future. 7. I have a personally meaningful relationship with

God. 8. I feel very fulfilled and satisfied with life. 9. I don’t get much personal strength and support from

my God. 10. I feel a sense of well-being about the direction my

life is headed in. 11. I believe that God is concerned about my problems. 12. I don’t enjoy much about life. 13. I don’t have a personally satisfying relationship with

God. 14. I feel good about my future. 15. My relationship with God helps me not to feel

lonely. 16. I feel that life is full of conflict and unhappiness. 17. I feel most fulfilled when I’m in close communion

with God. 18. Life doesn’t have much meaning. 19. My relationship with God contributes to my sense of

well-being.

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20. I believe there is some real purpose for my life.

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APPENDIX F: DAILY SPIRITUAL EXPERIENCES The list that follows includes items you may or may not experience. Please consider if and how often you have these experiences, and try to disregard whether or not you feel you should or should not have them. A number of items use the word “God.” If this word is not a comfortable one, please substitute another idea that calls to mind the divine or holy for you.

How often did you experience the following while you practiced your technique?

Never/ Many Every Most Some Once in Almost times day days days a while never

1. I feel God’s presence. 1 2 3 4 5 6 2. I experience a connection to all of life. 1 2 3 4 5 6 3. During meditation, I feel joy which lifts me out of my daily concerns. 1 2 3 4 5 6 4. I find strength. 1 2 3 4 5 6 5. I find comfort. 1 2 3 4 5 6 6. I feel deep or harmony. 1 2 3 4 5 6 7. I find help in my daily activities. 1 2 3 4 5 6 8. I feel guided in my daily activities. 1 2 3 4 5 6 9. I feel God’s love for me, directly. 1 2 3 4 5 6 10. I feel God’s love for me, through others. 1 2 3 4 5 6 11. I am spiritually touched by the beauty of creation. 1 2 3 4 5 6 12. I feel thankful for my blessings. 1 2 3 4 5 6 13. I feel a selfless caring for others. 1 2 3 4 5 6 14. I feel an acceptance toward others. 1 2 3 4 5 6 15. I desire to be closer to God, or in union with God. 1 2 3 4 5 6

The following 2 items are scored differently.

In general, how close did you feel to God prior to beginning of this study? 1 – Not at all close 2 – Somewhat close 3 – Very close 4 – As close as possible

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In general, how close do you feel to God now? 1 – Not at all close 2 – Somewhat close 3 – Very close 4 – As close as possible

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APPENDIX G: MYSTICISM SCALE Below are brief descriptions of a number of experiences. Some descriptions refer to phenomenon that you may have experienced while others refer to phenomenon that you may not have experienced.

Please rate how each statement describes your experience during the course of the study.

In each case note the description carefully and then place a mark in the left margin according to how much the description applies to your own experience. Mark +2, +1, ?, -1, or -2 depending on how you feel in each case.

+2: This description is definitely true of my own experience or experiences. +1: This description is probably true of my own experience or experiences ?: I cannot decide. -1: This description is probably not true of my own experience or experiences. -2: This description is definitely not true of my own experience or experiences

_____1. I had an experience which was both timeless and spaceless. _____2. I never had an experience which was incapable of being expressed in words. _____3. I had an experience in which something greater than myself seemed to absorb me. _____4. I had an experience in which everything seemed to disappear from my mind until I was conscious only of a void. _____5. I experienced profound joy. _____6. I never had an experience in which I felt myself to be absorbed as one with all things. _____7. I never experienced a perfectly peaceful state. _____8. I never had an experience in which I felt as if all things were alive. _____9. I never had an experience which seemed holy to me. _____10. I never had an experience in which all things seemed to be aware. _____11. I had an experience in which I had no sense of time or space. _____12. I had an experience in which I realized the oneness of myself with all things. _____13. I had an experience in which a new view of was revealed to me. _____14. I never experienced anything to be divine. _____15. I never had an experience in which time and space were non-existent.

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_____16. I never experienced anything that I could call ultimate reality. _____17. I had an experience in which ultimate reality was revealed to me. _____18. I had an experience in which I felt that all was perfection at that time. _____19. I had an experience in which I felt everything in the world to be part of the same whole. _____20. I had an experience which I knew to be sacred. _____21. I never had an experience which I was unable to express adequately through language. _____22. I had an experience which left me with a feeling of awe. _____23. I had an experience that is impossible to communicate. _____24. I never had an experience in which my own self seemed to merge into something greater. _____25. I never had an experience which left me with a feeling of wonder. _____26. I never had an experience in which deeper aspects of reality were revealed to me. _____27. I never had an experience in which time, place, and distance were meaningless. _____28. I never had an experience in which I became aware of the unity of all things. _____29. I had an experience in which all things seemed to be conscious. _____30. I never had an experience in which all things seemed to be unified into a single whole. _____31. I had an experience in which I felt nothing is ever really dead. _____32. I had an experience that cannot be expressed in words.

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APPENDIX H. PROCEDURE

Face-to-face Training Session 1. Pass out informed consent forms 2. Provide a summary of the information of the consent forms. Answer participants’ questions and collect signed forms. 3. Randomly assign ID numbers 4. Participants complete surveys (either by hand or online—not yet determined) 5. Provide participants with instructions for their assigned technique. 6. Pass out meditation phrase forms (if applicable) and participants choose their focus phrase. 7. Each group practices its technique. 8. Answer questions. 9. Describe online diary. Explain how to use it and emphasize its importance. 10. Explain post-intervention procedures and how participants will be asked to complete two more full sets of all measures (BDI and religiousness/spirituality measures)—once immediately following the two week intervention period and one month post- intervention. 11. Collect meditation phrase forms. 12. Release participants.

One the 8th day of practicing the meditation or relaxation technique, participants will be individually emailed by the principal investigator or research assistant.

Email subject: Meditation and Relaxation Study Email content: “Hi (participant’s name). This is (researcher’s name) with the Meditation and Relaxation Study. Now that you have had a week of practice on your own, I am writing to see if you have any questions. If there’s anything you’re unsure about, please contact me at (RA’s email address) or the principal investigator, Meryl Reist, at [email protected]. Also, I want to remind you to complete the online forms for the study on (date) and to continue with the online diary until then. (Provide brief reminder instructions for how to access these measures online.) Thanks so much! (RA’s name)

One the final day of practicing the meditation or relaxation technique, participants will be individually contacted via email.

Email subject: Meditation and Relaxation Study Email content: “Hi (participant’s name). This is (researcher’s name) with the Meditation and Relaxation Study. Now that you have been practicing your technique for the full two weeks, I am writing to remind you to please complete the online forms today. (Provide brief reminder instructions for how to access these measures online.) If you have any trouble accessing the forms online, please call the principle investigator, Meryl Reist, immediately at (419)372-XXXX or (419)601-2415. For the sake of the project and in order to be rewarded with your research credits, it is very important that these forms are

83 completed on the last day of your practice! Again, if you have any difficulties, please contact Meryl. Thanks so much! (RA’s name)

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APPENDIX I. MEDITATION TRAINING SCRIPT

Hi! Thank you for coming in today to participate in this research project. (Review consent form) The next thing I would like everyone to do is complete a set of surveys on-line. Go ahead and get started with the surveys. We will wait until everyone is finished before moving on. (When everyone has completed the surveys) As you may or may not know, there is a great deal of research today that shows that individuals do not spend enough time in quiet, solitude activities. This lack of can result in decreased mood and feeling of spiritual isolation. Some research shows that certain types of relaxation and meditation can reduce the impact of negative emotions on people who practice these techniques. This project is comparing various forms of relaxation and meditation activities to see how these techniques affect people with mild levels of depression. I am hoping to teach individuals who experience mild depression some methods of dealing with negative mood.

Today you will be asked to begin to quietly meditate for twenty minutes a day. Twenty minutes a day for two weeks may not seem like very long, but you might be surprised. In order to get the most out of your meditation time, you should be alone. Your TV, radio, cell phone, and computer should be off. Your eyes are closed, but you aren’t asleep. You will be given a set of meditative phrases and asked to pick one to use while you are meditating. You begin by repeating the phrase out loud to focus your thinking. Once you feel focused, you can shift into silent about the phrase. Continue to think about the phrase and how you experience it in your life. Do this during the entire twenty minutes. If you find your mind slipping into other areas of thoughts, that’s okay. You don’t need to be upset or frustrated. Simply repeat your phrase out loud briefly to refocus your thoughts and then slip into silent meditation on the phrase.

(Hand out list of meditative phrases to both meditation groups) Let’s practice for a few minutes. Pick a meditative phrase from your list and close your eyes. Focus your attention on that phrase and try to maintain your concentration on the phrase. Remember, begin by repeating your phrase out loud to focus your attention on that phrase. Remember, it might be a little difficult at first, but if you lose your concentration, just return your

85 thoughts to the phrase and keep going. Let’s practice. (Five-minute meditation practice) Great, how did that feel? (Discuss the experience) Do you have any questions? You can meditate anytime during the day as long as you are able to find the quiet time to do it. People often find it helpful to pick one time during the day, but that isn’t required.

I want to briefly draw your attention to the online diary. (Provide instructions for how to access the on-line adherence diary) After you finish meditating everyday, please take a moment and fill out the short survey for the day. Are there any questions? So, you will practice your meditation for 20 minutes everyday for two weeks. Again, make sure you complete the diary everyday after you finish meditating. After two weeks, you will be instructed to complete the same set of online surveys that you completed just a bit ago. Then about one month after you have completed your two weeks of meditating, you’ll be asked to complete the surveys one last time.

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APPENDIX J. RELAXATION TRAINING SCRIPT

Hi! Thank you for coming in today to participate in this research project. (Review consent form) The next thing I would like everyone to do is complete a set of surveys on-line. Go ahead and get started with the surveys. We will wait until everyone is finished before moving on. (When everyone has completed the surveys) As you may or may not know, there is a great deal of research today that shows that individuals do not spend enough time in quiet, solitude activities. This lack of quiet time can result in decreased mood and feeling of spiritual isolation. Some research shows that certain types of relaxation and meditation can reduce the impact of negative emotions on people who practice these techniques. This project is comparing various forms of relaxation and meditation activities to see how these techniques affect people with mild levels of depression. I am hoping to teach individuals who experience mild depression some methods of dealing with negative mood.

Today you will be asked to begin to quietly relax for twenty minutes a day. Twenty minutes a day for two weeks may not seem like very long, but you might be surprised. In order to get the most out of your meditation time, you should be alone. Your TV, radio, cell phone, and computer should be off. Your eyes are closed, but you shouldn’t fall asleep. Continue to relax quietly for twenty minutes. You can do your relaxation time at anytime during the day, as long as you are able to find the quiet time to do it. People often find it helpful to pick one time during the day, but that isn’t required.

Let’s practice for a few minutes. Find a comfortable positive and close your eyes. Think about relaxing your body in a systematic way. Think about relaxing your feet. Relax all the muscles in your feet. Then move on to your calves and think about making your calves comfortable. Then think about the muscles in your thighs and concentrate on getting rid of any tension in your thighs. Next, move on to your hips and stomach. Think about relaxing those muscles until you are comfortable. After that, move on to your chest. Find all the tension in your chest and let it go. Then think about the muscles in your back. Relax those muscles until the tension is gone. Next, concentrate on the tension in your shoulders and neck. Work to release that tension until you feel your muscles loosen. Finally, think about the muscles in your face and head. Find all

87 the tension that might be residing there, and release it. Let’s practice (Five-minute relaxation practice). Great, how did that feel? (Discuss the experience) Do you have any questions?

I want to briefly draw your attention to the online diary. (Provide instructions for how to access the on-line adherence diary) After you finish relaxing everyday, please take a moment and fill out the short survey for the day. Are there any questions? So, you will practice your relaxation technique for 20 minutes everyday for two weeks. Again, make sure you complete the diary everyday after you finish relaxing. After two weeks, you will be instructed to complete the same set of online surveys that you completed just a bit ago. Then about one month after you have completed your two weeks of practicing relaxation, you’ll be asked to complete the surveys one last time.

88

Table 1

Demographics by Group

SP SE R Measure N (%) N (%) N (%)

Gender 15 (78.9%) 12 (70.6%) 16 (88.9%) Women 4 (21.1%) 5 (29.4%) 2 (11.1%) Men Prayer Frequency Regularly 7 (36.8%) 3 (17.6%) 10 (55.6%) During stress 8 (42.1%) 11 (64.7%) 4 (22.2%) Formal 1 (5.3%) 1 (5.9%) 4 (22.2%) Never 3 (15.8%) 2 (11.8%) 0 Meditation Frequency More than once per day 2 (10.5%) 1 (6.3%) 1 (5.6%) Several times per week 1 (5.3%) 2 (12.5%) 2 (11.1%) Once per week 1 (5.3%) 3 (18.8%) 1 (5.6%) Several times per month 0 0 1 (5.6%) Once per month 1 (5.3%) 1 (6.3%) 1 (5.6%) Less than once per month 2 (10.5%) 0 4 (22.2%) Not at all 12 (63.2%) 9 (56.3%) 8 (44.4%) Religious Person Very 1 (5.3%) 2 (11.8%) 1 (5.6%) Moderately 10 (52.6%) 4 (23.5%) 6 (33.3%) Slightly 5 (26.3%) 9 (52.9%) 11 (61.1%) Not at all 3 (15.8%) 2 (11.8%) 0 Spiritual Person Very 1 (5.3%) 3 (17.6%) 3 (16.7%) Moderately 10 (52.6%) 6 (35.3%) 7 (38.9%) Slightly 6 (31.6%) 7 (41.2%) 6 (33.3%) Not at all 2 (10.5%) 1 (5.9%) 2 (11.1%)

M (SD) M (SD) M (SD) Church Attendance/year 13.9 (15.1) 8.5 (11.4) 24.4 (26.4) BDI 17.1 (5.0) 16.8 (5.1) 17.1 (4.8) Days practiced meditation/ Relaxation 11.68 (1.57) 12.18 (1.29) 12.28 (1.45)

Note. SP = Spiritual Meditation; SE = Secular Meditation; R = Relaxation; BDI = Beck Depression Inventory

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Table 2

Cronbach’s Alphas for pre-intervention measures Scale Alpha

Screener

BDI .57

Spiritual Struggle .51

Religious Measures Questionnaire

Private Religious Activities .91

Religious/Spiritual Intensity .61 Note. BDI = Beck Depression Inventory

90

Table 3 Pre- and Post-Intervention Psychological and Spiritual Measures by Group SP SE R F-test (for group com- Alpha M (SD) M (SD) M (SD) parison at pre-test only) P-PANAS Pre .89 29.21 (8.21) 31.06 (6.09) 30.39 (7.53) F (2, 51) = 0.29, p=NS Post .88 37.95 (5.67) 32.71 (6.74) 36.28 (5.11) Follow-up .85 36.89 (5.59) 35.00 (6.19) 34.72 (5.12) N-PANAS Pre .80 25.42 (5.51) 25.00 (7.54) 24.06 (7.40) F (2, 51) = 0.19, p=NS Post .84 16.84 (3.85) 17.12 (6.43) 16.11 (4.60) Follow-up .88 18.21 (5.91) 18.65 (6.54) 19.06 (6.99) SWB Pre .91 83.11 (18.47) 80.35 (18.03) 89.39 (16.38) F (2, 51) = 1.22, p=NS Post .95 91.42 (21.20) 86.71 (16.50) 94.71 (14.04) Follow-up .95 87.11 (23.28) 86.81 (15.83) 93.11 (19.69) RWB Pre .96 40.84 (13.64) 37.88 (13.50) 44.00 (11.63) F (2, 51) = 0.98, p=NS Post .97 43.89 (14.36) 40.29 (12.85) 45.65 (11.17) Follow-up .96 42.32 (14.58) 40.63 (12.72) 46.11 (11.62) EWB Pre .84 42.26 (8.10) 42.47 (8.34) 45.39 (6.80) F (2, 51) = 0.91, p=NS Post .90 47.53 (8.53) 46.41 (6.43) 49.06 (6.51) Follow-up .92 44.79 (11.18) 46.19 (5.67) 47.00 (9.50) DSE Pre .87 52.32 (11.36) 54.12 (13.75) 52.06 (14.24) F (2, 51) = 0.13, p=NS Post .89 64.00 (14.90) 59.53 (15.33) 61.11 (10.87) Follow-up .89 62.42 (14.99) 59.41 (15.26) 60.61 (10.54) Mysticism Pre .93 111.05 (18.38) 106.47 (22.29) 114.22 (22.44) F (2, 51) = 0.60, p=NS Post .88 116.89 (19.48) 114.00 (15.64) 120.06 (15.46) Follow-up .94 123.37 (21.01) 118.18 (21.95) 124.67 (25.21) EM Pre .83 39.05 (7.54) 37.35 (9.59) 38.28 (9.80) F (2, 51) = 0.16, p=NS Post .78 40.11 (8.37) 40.59 (8.73) 41.72 (6.95) Follow-up .90 41.42 (10.07) 40.71 (8.96) 42.78 (11.14) RI Pre .86 44.79 (7.30) 43.29 (9.27) 48.00 (8.55) F (2, 51) = 1.46, p=NS Post .77 47.11 (8.73) 45.41 (5.94) 48.72 (5.94) Follow-up .85 47.84 (7.42) 45.65 (9.64) 47.72 (8.86) IM Pre .77 27.21 (6.35) 25.82 (6.29) 27.94 (7.21) F (2, 51) = 0.46, p=NS Post .55 29.68 (5.07) 28.00 (4.66) 29.61 (4.88) Follow-up .78 30.47 (5.46) 28.06 (6.06) 30.22 (6.34) Note. SP = Spiritual Meditation; SE = Secular Meditation; R = Relaxation; PPANAS = Positive Affect; NPANAS = Negative Affect; SWB = Spiritual Well Being; RWB = Religious Well Being; EWB = Existential Well Being; DSE = Daily Spiritual Experiences; EM = Existential Mysticism; RI = Religious Interpretation; IM = Introvertive Mysticism

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Table 4. Pearson r correlations for the primary psychological and spiritual variables in the Total Sample at Time 1 BDI PPANAS NPANAS SWB RWB EWB DSE M Total EM RI IM

BDI 1

PPANAS -.22 1

NPANAS .46a -.06 1

SWB .01 .26 -.03 1

Religious -.11 .09 -.10 .90a 1 Well-Being

Existential .19 .41a .12 .72a .35a 1 Well-Being

DSE -.12 .35a -.08 .70a .65a .49a 1

Mysticism -.03 .18 -.23 .42a .49a .14 .52a 1 Total

Extrovertive .03 .16 -.23 .30b .38a .06 .48a .93a 1 Mysticism

Religious -.02 .13 -.22 .52a .57a .22 .49a .90a .77a 1 Interpretation

Introvertive -.10 .18 -.15 .26 .30b .07 .40a .82a .69a .59a 1 Mysticism a p≤.01 b p≤.05

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Table 5

Pre- and Post- Adherence Diary Mood Ratings

Spir Sec Relax F-test M (SD) M (SD) M (SD) (for group comparison at pre-test only) Happy Pre 4.42 (1.11) 4.96 (1.11) 4.30 (1.13) F (2, 51) = 1.74, p=NS Post 5.54 (1.08) 5.28 (1.30) 5.15 (1.13) Angry Pre 2.00 (.92) 1.78 (.72) 2.09 (.77) F (2, 51) = 0.66, p=NS Post 1.35 (.71) 1.69 (1.43) 1.65 (.72) Sad Pre 2.54 (1.05) 2.14 (1.28) 2.17 (.64) F (2, 51) = 0.92, p=NS Post 1.54 (.64) 1.84 (1.45) 1.82 (.79) Calm Pre 4.96 (1.17) 5.16 (.85) 4.30 (1.06) F (2, 51) = 3.32, p<.05 Post 5.54 (1.18) 4.78 (1.35) 4.17 (1.17) Overall Mood Pre 4.65 (1.00) 4.69 (1.00) 4.70 (.84) F (2, 51) = 0.02, p=NS Post 5.51 (1.05) 5.22 (1.36) 5.08 (.87)

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Table 6

Main Effects and Interactions for 3x3 (time x group) Repeated Measures ANOVA

Group Main Effects Time Main Effects Interaction Psychological Measures

PPANAS F (2,51) = .57, p=.57 F (2,50) = 18.72, p<.05 F (4,100) = 2.82, p<.05

NPANAS F (2,51) = .06, p=NS F (2,50) = 40.61, p<.01 F (4,100) = .26, p=NS

Spiritual Measures

SWB F (2,49) = 1.16, p=NS F (1.47,71.95) = 6.21, F (2.94,71.95) = .38, p<.05 p=NS

RWB F (2,49) = 1.01, p=NS F (1.68,82.45) = 3.19, F (3.37,82.45) = .37, p=NS p=NS

EWB F (2,49) = .80, p=NS F (1.55,75.80) = 7.42, F (3.09,75.80) = .34, p<.005 p=NS

DSE F (2,51) = .07, p=NS F (2,50) = 11.92, F (4,100) = .72, p=NS p<.001

M F (2,51) = .62, p=NS F (2,50) = 15.02, F (4,100) = .08, p=NS p<.001

EM F (2,51) = .14, p=NS F (2,50) = 4.85, p<.05 F (4,100) = .27, p=NS

RI F (2,51) = 1.05, p=NS F (2,50) = 1.64, p=NS F (4,100) = .47, p=NS

IM F (2,51) = .75, p=NS F (2,50) = 12.55, F (4,100) = .24, p=NS p<.001

Note. PPANAS = Positive Affect; NPANAS = Negative Affect; SWB = Spiritual Well Being; RWB = Religious Well Being; EWB = Existential Well Being; DSE = Daily Spiritual Experiences; M = Mysticism; EM = Existential Mysticism; RI = Religious Interpretation; IM = Introvertive Mysticism

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Table 7

Main Effects and Interactions for 3x3 (time x group) Repeated Measures ANOVA

Adherence Diary Group Main Effects Time Main Effects Interaction

Happy F (2,51) = .88, p=NS F (1,51) = 15.74, F (2,51) = 1.51, p=NS p<.001

Angry F (2,51) = .36, p=NS F (1,51) = 6.77, p<.05 F (2,51) = 1.10, p=NS

Sad F (2,51) = .03, p=NS F (1,51) = 8.27, p<.05 F (2,51) = 1.45, p=NS

Calm F (2,51) = 6.06, p<.005 F (1,51) = .02, p=NS F (2,51) = 2.46, p=NS

Overall Mood F (2,51) = .35, p=NS F (1,51) = 8.25, p<.01 F (2,51) = .51, p=NS

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Table 8 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Positive Affect B SE t DEPENDEN VARIABLE: PPANAS at Time 2 Step 1: PPANAS at Time 1 0.37** 0.11 3.49

Incremental R2 = .19, F(1,52) = 12.15**

Step 2: SP 2.14 1.68 1.28

SE -3.84* 1.73 -2.23

Incremental R2 = .16, F(2,50) = 6.22**

Step 3: Spiritual Intensity 0.32 0.29 1.12

Incremental R2 = .02, F(1,49) = 1.25

Step 4: SP x Spiritual Intensity 0.84 0.68 1.24

SE x Secular Intensity 0.39 0.74 0.52

Incremental R2 = .02, F(2,47) = .76

DEPENDENT VARIABLE: PPANAS at Time 3 Step 1: PPANAS at Time 1 0.24* 0.10 2.33

Incremental R2 = .10, F(1,52) = 5.43*

Step 2: SP 2.47 1.77 1.40

SE 0.11 1.82 .06

Incremental R2 = .04, F(2,50) = 1.24

Step 3: Spiritual Intensity 0.71* 0.29 2.48

Incremental R2 = .10, F(1,49) = 6.13*

Step 4: SP x Spiritual Intensity 0.55 0.69 0.80

SE x Secular Intensity 0.58 0.75 0.78

Incremental R2 = .01, F(2,47) = .43 Note. PPANAS = Positive Affect; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

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Table 9 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Negative Affect B SE t DEPENDEN VARIABLE: NPANAS at Time 2 Step 1: NPANAS at Time 1 0.30** 0.09 3.24

Incremental R2 = .17, F(1,52) = 10.50**

Step 2: SP 0.32 1.53 0.21

SE 0.72 1.57 0.46

Incremental R2 = .00, F(2,50) = .11

Step 3: Spiritual Intensity 0.27 0.27 1.02

Incremental R2 = .02, F(1,49) = 1.04

Step 4: SP x Spiritual Intensity -0.65 0.65 -0.99

SE x Secular Intensity 0.28 0.67 0.41

Incremental R2 = .04, F(2,47) = 1.05

DEPENDENT VARIABLE: NPANAS at Time 3 Step 1: NPANAS at Time 1 0.39** 0.12 3.29

Incremental R2 = .17, F(1,52) = 10.81**

Step 2: SP -1.39 1.96 -0.71

SE -0.79 2.01 -0.39

Incremental R2 = .01, F(2,50) = .25

Step 3: Spiritual Intensity -0.05 0.34 -0.15

Incremental R2 = .00, F(1,49) = .02

Step 4: SP x Spiritual Intensity -0.38 0.86 -0.44

SE x Secular Intensity -0.04 0.88 -0.05

Incremental R2 = .00, F(2,47) = .12 Note. NPANAS = Negative Affect; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

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Table 10 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Spiritual Well Being B SE t DEPENDEN VARIABLE: SWB at Time 2 Step 1: SWB at Time 1 0.85** 0.07 12.77

Incremental R2 = .76, F(1,51) = 162.94**

Step 2: SP 2.52 2.94 0.86

SE 0.16 3.06 0.05

Incremental R2 = .01, F(2,49) = .48

Step 3: Spiritual Intensity 0.84 0.68 1.22

Incremental R2 = .01, F(1,48) = 1.50

Step 4: SP x Spiritual Intensity 2.35 1.18 1.99

SE x Secular Intensity 2.11 1.26 1.67

Incremental R2 = .02, F(2,46) = 2.26

DEPENDENT VARIABLE: SWB at Time 3 Step 1: SWB at Time 1 0.69** 0.12 5.74

Incremental R2 = .39, F(1,51) = 32.93**

Step 2: SP -1.65 5.28 -0.31

SE 0.43 5.59 0.08

Incremental R2 = .00, F(2,49) = .09

Step 3: Spiritual Intensity 1.79 1.19 1.50

Incremental R2 = .03, F(1,48) = 2.26

Step 4: SP x Spiritual Intensity -0.98 2.12 -0.46

SE x Secular Intensity -0.30 2.26 -0.13

Incremental R2 = .00, F(2,46) = .11 Note. SWB = Spiritual Well Being; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

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Table 11 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Religious Well Being B SE t DEPENDEN VARIABLE: RWB at Time 2 Step 1: RWB at Time 1 0.90** 0.06 15.62

Incremental R2 = .83, F(1,51) = 243.89**

Step 2: SP 1.51 1.84 0.82

SE 0.58 1.92 0.30

Incremental R2 = .00, F(2,49) = .35

Step 3: Spiritual Intensity 0.41 0.46 0.89

Incremental R2 = .00, F(1,48) = .79

Step 4: SP x Spiritual Intensity 1.15 0.76 1.52

SE x Secular Intensity 1.10 0.80 1.39

Incremental R2 = .01, F(2,46) = 1.41

DEPENDENT VARIABLE: RWB at Time 3 Step 1: RWB at Time 1 0.80** 0.08 9.58

Incremental R2 = .64, F(1,51) = 91.73**

Step 2: SP -1.28 2.65 -0.48

SE -0.41 2.80 -0.15

Incremental R2 = .00, F(2,49) = .12

Step 3: Spiritual Intensity 0.84 0.65 1.30

Incremental R2 = .01, F(1,48) = 1.68

Step 4: SP x Spiritual Intensity -0.41 1.08 -0.38

SE x Secular Intensity 0.27 1.13 0.24

Incremental R2 = .00, F(2,46) = .18 Note. RWB = Religious Well Being; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

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Table 12 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Existential Well Being B SE t DEPENDEN VARIABLE: EWB at Time 2 Step 1: EWB at Time 1 0.68** 0.09 7.73

Incremental R2 = .54, F(1,51) = 59.69**

Step 2: SP 0.60 1.70 0.35

SE -0.65 1.74 -0.37

Incremental R2 = .01, F(2,49) = .28

Step 3: Spiritual Intensity 0.31 0.31 1.01

Incremental R2 = .01, F(1,48) = 1.02

Step 4: SP x Spiritual Intensity 1.09 0.70 1.56

SE x Secular Intensity 0.77 0.75 1.02

Incremental R2 = .02, F(2,46) = 1.24

DEPENDENT VARIABLE: EWB at Time 3 Step 1: EWB at Time 1 0.45** 0.15 3.00

Incremental R2 = .15, F(1,51) = 8.99**

Step 2: SP -0.80 2.88 -0.28

SE 0.69 3.01 0.23

Incremental R2 = .01, F(2,49) = .13

Step 3: Spiritual Intensity 0.48 0.51 0.94

Incremental R2 = .02, F(1,48) = .88

Step 4: SP x Spiritual Intensity -0.65 1.17 -0.55

SE x Secular Intensity -0.72 1.26 -0.57

Incremental R2 = .01, F(2,46) = .22 Note. EWB = Existential Well Being; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

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Table 13 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Daily Spiritual Experiences B SE t DEPENDEN VARIABLE: DSE at Time 2 Step 1: DSE at Time 1 0.68** 0.11 6.02

Incremental R2 = .41, F(1,52) = 36.26**

Step 2: SP 2.71 3.47 0.78

SE -3.01 3.58 -0.84

Incremental R2 = .03, F(2,50) = 1.31

Step 3: Spiritual Intensity 1.23 0.74 1.67

Incremental R2 = .03, F(1,49) = 2.79

Step 4: SP x Spiritual Intensity 3.24* 1.32 2.45

SE x Secular Intensity 3.25* 1.39 2.34

Incremental R2 = .08, F(2,47) = 3.90*

DEPENDENT VARIABLE: DSE at Time 3 Step 1: DSE at Time 1 0.71** 0.11 6.68

Incremental R2 = .46, F(1,52) = 44.64**

Step 2: SP 1.62 3.31 0.49

SE -2.69 3.41 -0.79

Incremental R2 = .02, F(2,50) = .83

Step 3: Spiritual Intensity 1.38 0.69 1.98

Incremental R2 = .04, F(1,49) = 3.93

Step 4: SP x Spiritual Intensity 2.64* 1.21 2.17

SE x Secular Intensity -4.09** 1.27 3.22

Incremental R2 = .09, F(2,47) = 5.43** Note. DSE = Daily Spiritual Experiences; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

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Table 14 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Mysticism B SE t DEPENDEN VARIABLE: M at Time 2 Step 1: M at Time 1 0.50** 0.09 5.70

Incremental R2 = .39, F(1,52) = 32.51**

Step 2: SP -1.59 4.49 -0.36

SE -2.22 4..66 -0.48

Incremental R2 = .00, F(2,50) = .12

Step 3: Spiritual Intensity 0.60 0.79 0.75

Incremental R2 = .01, F(1,49) = .57

Step 4: SP x Spiritual Intensity 1.63 1.85 0.88

SE x Secular Intensity 0.75 1.95 0.39

Incremental R2 = .01, F(2,47) = .39

DEPENDENT VARIABLE: M at Time 3 Step 1: M at Time 1 0.83** 0.10 8.57

Incremental R2 = .59, F(1,52) = 73.38**

Step 2: SP 1.32 4.92 0.27

SE -0.10 5.11 -0.02

Incremental R2 = .00, F(2,50) = .05

Step 3: Spiritual Intensity 1.52 0.85 1.80

Incremental R2 = .03, F(1,49) = 3.23

Step 4: SP x Spiritual Intensity 0.25 1.99 0.13

SE x Secular Intensity -0.02 2.10 -0.01

Incremental R2 = .00, F(2,47) = .01 Note. M = Mysticism Scale; SP = Spiritual Meditation; SE = Secular Meditation *p<.05. **p<.01.

102

Table 15 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Extrovertive Mysticism B SE t DEPENDEN VARIABLE: EM at Time 2 Step 1: EM at Time 1 0.43** 0.11 3.98

Incremental R2 = .23, F(1,52) = 15.83**

Step 2: SP -1.96 2.33 -0.84

SE -0.73 2.40 -0.30

Incremental R2 = .01, F(2,50) = .36

Step 3: Spiritual Intensity 0.04 0.41 0.10

Incremental R2 = .00, F(1,49) = .01

Step 4: SP x Spiritual Intensity 1.07 0.97 1.10

SE x Secular Intensity 1.07 1.02 1.05

Incremental R2 = .02, F(2,47) = .78

DEPENDENT VARIABLE: EM at Time 3 Step 1: EM at Time 1 0.72** 0.12 6.01

Incremental R2 = .41, F(1,52) = 36.14**

Step 2: SP -1.92 2.58 -0.74

SE -1.40 2.65 -0.53

Incremental R2 = .01, F(2,50) = .29

Step 3: Spiritual Intensity 0.76 0.44 1.75

Incremental R2 = .03, F(1,49) = 3.05

Step 4: SP x Spiritual Intensity 0.08 1.06 0.07

SE x Secular Intensity 0.23 1.11 0.21

Incremental R2 = .00, F(2,47) = .02 Note. EM = Extrovertive Mysticism; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

103

Table 16 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Religious Interpretation B SE t DEPENDEN VARIABLE: RI at Time 2 Step 1: RI at Time 1 0.47** 0.10 4.86

Incremental R2 = .31, F(1,52) = 23.58**

Step 2: SP -0.16 2.00 -0.08

SE -1.17 2.08 -0.56

Incremental R2 = .01, F(2,50) = .19

Step 3: Spiritual Intensity 0.50 0.36 1.38

Incremental R2 = .03, F(1,49) = 1.91

Step 4: SP x Spiritual Intensity 0.95 0.80 1.19

SE x Secular Intensity 0.27 0.84 0.32

Incremental R2 = .02, F(2,47) = .74

DEPENDENT VARIABLE: RI at Time 3 Step 1: RI at Time 1 0.59** 0.11 5.20

Incremental R2 = .34, F(1,52) = 27.05**

Step 2: SP 2.06 2.35 0.88

SE 0.77 2.46 0.31

Incremental R2 = .01, F(2,50) = .40

Step 3: Spiritual Intensity 0.85* 0.42 2.03

Incremental R2 = .05, F(1,49) = 4.11*

Step 4: SP x Spiritual Intensity -0.10 0.93 -0.11

SE x Secular Intensity 0.23 0.98 0.24

Incremental R2 = .00, F(2,47) = .06 Note. RI = Religious Interpretation; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

104

Table 17 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Introvertive Mysticism B SE t DEPENDEN VARIABLE: IM at Time 2 Step 1: IM at Time 1 0.52** 0.07 7.24

Incremental R2 = .50, F(1,52) = 52.48**

Step 2: SP 0.45 1.15 0.39

SE -0.51 1.19 -0.43

Incremental R2 = .01, F(2,50) = .34

Step 3: Spiritual Intensity 0.18 0.20 0.89

Incremental R2 = .01, F(1,49) = .79

Step 4: SP x Spiritual Intensity -0.29 0.47 -0.60

SE x Secular Intensity -0.48 0.50 -0.97

Incremental R2 = .01, F(2,47) = .48

DEPENDENT VARIABLE: IM at Time 3 Step 1: IM at Time 1 0.74** 0.07 10.21

Incremental R2 = .67, F(1,52) = 104.26**

Step 2: SP 0.79 1.15 0.69

SE -0.61 1.19 -0.51

Incremental R2 = .01, F(2,50) = .73

Step 3: Spiritual Intensity 0.16 0.20 0.80

Incremental R2 = .00, F(1,49) = .63

Step 4: SP x Spiritual Intensity 0.43 0.47 0.91

SE x Secular Intensity -0.15 0.49 -0.30

Incremental R2 = .01, F(2,47) = .75 Note. IM = Introvertive Mysticism; SP = Spiritual Meditation; SE = Secular Meditation; *p<.05. **p<.01.

105

Table 18 Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Mood B SE t DEPENDEN VARIABLE: “Happy” at Time 2 Step 1: “Happy” at Time 1 0.23 0.14 1.68

Incremental R2 = .05, F(1,52) = 2.82

Step 2: SP 0.37 0.38 0.97

SE -0.04 0.40 -0.10

Incremental R2 = .03, F(2,50) = .69

Step 3: Spiritual Intensity -0.09 0.07 -1.31

Incremental R2 = .03, F(1,49) = 1.73

Step 4: SP x Spiritual Intensity 0.33* 0.15 2.20

SE x Secular Intensity -0.02 0.16 -0.11

Incremental R2 = .11, F(2,47) = 3.35*

DEPENDENT VARIABLE: “Angry” at Time 2 Step 1: “Angry” at Time 1 0.28 0.17 1.68

Incremental R2 = .05, F(1,52) = 2.82

Step 2: SP -0.27 0.32 -0.84

SE 0.13 0.33 0.39

Incremental R2 = .03, F(2,50) = .79

Step 3: Spiritual Intensity 0.06 0.06 1.11

Incremental R2 = .02, F(1,49) = 1.24

Step 4: SP x Spiritual Intensity -0.09 0.13 -0.71

SE x Secular Intensity 0.19 0.13 1.39

Incremental R2 = .07, F(2,47) = 2.09 Note. SP = Spiritual Meditation; SE = Secular Meditation *p<.05. **p<.01.

106

Table 18, continued Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Mood B SE t DEPENDEN VARIABLE: “Sad” at Time 2 Step 1: “Sad” at Time 1 0.01 0.14 0.10

Incremental R2 = .00, F(1,52) = .01

Step 2: SP -0.29 0.34 -0.85

SE 0.03 0.34 0.09

Incremental R2 = .02, F(2,50) = .53

Step 3: Spiritual Intensity 0.09 0.06 1.46

Incremental R2 = .04, F(1,49) = 2.12

Step 4: SP x Spiritual Intensity -0.21 0.13 -1.61

SE x Secular Intensity 0.14 0.14 1.02

Incremental R2 = .12, F(2,47) = 3.31*

DEPENDENT VARIABLE: “Calm” at Time 2 Step 1: “Calm” at Time 1 0.43* 0.16 2.66

Incremental R2 = .12, F(1,52) = 7.08*

Step 2: SP 1.15** 0.41 2.84

SE 0.32 0.43 0.76

Incremental R2 = .13, F(2,50) = 4.46*

Step 3: Spiritual Intensity 0.00 0.07 0.02

Incremental R2 = .00, F(1,49) = .00

Step 4: SP x Spiritual Intensity 0.26 0.17 1.57

SE x Secular Intensity -0.06 0.17 -0.38

Incremental R2 = .06, F(2,47) = 2.17 Note. SP = Spiritual Meditation; SE = Secular Meditation *p<.05. **p<.01.

107

Table 18, continued Hierarchical Regression Analysis of Treatment Group x Spiritual Intensity Predicting Mood B SE t DEPENDEN VARIABLE: “Overall Mood” at Time 2 Step 1: “Overall Mood” at Time 1 -0.08 0.16 -0.47

Incremental R2 = .00, F(1,52) = .22

Step 2: SP 0.43 0.37 1.18

SE 0.14 0.38 0.37

Incremental R2 = .03, F(2,50) = .72

Step 3: Spiritual Intensity -0.01 0.06 -0.14

Incremental R2 = .00, F(1,49) = .02

Step 4: SP x Spiritual Intensity 0.32* 0.15 2.22

SE x Secular Intensity 0.00 0.15 0.01

Incremental R2 = .12, F(2,47) = 3.20* Note. SP = Spiritual Meditation; SE = Secular Meditation *p<.05. **p<.01.

108

Figure 1 Positive Affect by Group and Time

38 Group Spiritual Secular 36 Relax

34

PPANAS 32

30

28

Pre Post Follow-up Time