6] Mantram Repetition: A “Portable Contemplative Practice” for Modern Times
Jill E. Bormann
Living in today’s world with a steady stream of interruptions from wire- less cell phones, iPods, and hand-held organizers, the notion of contem- plation seems nearly impossible. Yet, the ancient practice of silently repeating powerful, sacred words throughout the day to slow down and center oneself is truly a modern-day stress buster. This chapter will describe mantram repetition as a portable contemplative practice. Recommenda- tions for choosing and using a mantram will be described. Research sup- porting application of mantram repetition for managing stress in a variety of groups will also be presented. Family caregivers, women in labor, health care providers, adults living with HIV, and combat veterans coping with posttraumatic stress disorder (PTSD) will describe their experiences of using this simple tool that deepens spiritual and psycho- logical well-being.
Living in societies that value speed, productivity, and multitasking, leave very little room for thoughtful contemplation or reflection. What was once unavoidable “pause time,” such as waiting an hour to bake potatoes, is now a five-minute “zap” in the microwave. If we want or need to pause, we must plan for it. We feel stressed from the pressure of deadlines or the pace we believe is expected. With computers and
Sections of Chapter 6 are reprinted from Bormann, Jill, “Frequent, Silent Mantram Repetition: A Jacuzzi for the Mind,” Advanced Emergency Nursing Journal, Volume 27, Issue 2 (Wolters Kluwer Health, 2005). Reprinted with permission from Wolters Kluwer Health.
the Internet, there is a never-ending stream of perceived demands that all seem urgent. Nevertheless, throughout history, people have managed to survive the ever-changing challenges in their lives and have discovered ways to find inner peace. To do this today requires some innovative strategies. One of these strategies is Mantram Repetition.
WHAT IS MANTRAM REPETITION?
In this chapter, the guidelines and language of mantram repetition is taken from Eknath Easwaran, a spiritual teacher from India who came to the United States in 1959 and created the Eight-Point Program—a set of guidelines for living a spiritual life1 (see the chapter “Finding Balance in a Hurried World: The Eight-Point Program of Passage Meditation” by Flinders et al.). The word “mantram” originates from the Sanskrit words “manas” (mind) and “trai” (to set free or protect from). Thus, one traditional definition of the word is “to set free from the mind” (p. 39),2 and another is “the thought that liberates and protects” (p. 2).3
The word “mantram” does not differ in meaning from the word “mantra,” which is more familiar to Westerners. Easwaran’s preference for mantram is simply a reflection of the Sanskrit he studied as a boy, but the slight difference in spelling is helpful insofar as it underscores his understanding of the power of the mantram and the remarkable range of circumstances in which he suggests it be repeated.
In Easwaran’s Eight-Point Program of Passage Meditation, the mantram is one of eight points that are taught and practiced together as a comprehensive and integrated program for spiritual seekers. Even so, repetition of a mantram or sacred word is a practice that goes back thousands of years in virtually all faiths—it has a life of its own. While not all of us are willing or able to commit to a daily meditation prac- tice, repetition of a mantram may be the ideal portable contemplative practice for modern times.
Easwaran defined the mantram as a “short, powerful spiritual formula, for the highest power we can conceive of—whether we call it God, or the ultimate reality, or the Self within. Whatever name we use, with the mantram we are calling up what is best and deepest in ourselves” (p. 8).4 In Western culture, the word “mantra” is commonly used to mean any thought or phrase that is repeated (“I want to be a million- aire”). So another advantage of using Easwaran’s preferred term “man- tram” is that it preserves the traditional meaning: a sacred or holy word
or phrase chosen to be the object of one’s mental focus with the goal of connecting to inner positive resources that help in managing stress.
Mantram repetition is virtually available at any and every moment. Unlike a meditation practice such as bringing attention to one’s breath throughout the day, focusing on a mantram—a sacred name or exalted word—provides a more concrete, mental tool, which brings pause to the mind. The mantram can be described as a form of “divine communication” that opens us to the sacred Spirit within. Some call this Spirit their Higher Power, God, Mother Nature, Universal Con- sciousness, Heavenly Father, and so on. Mantram repetition has been described as a direct call to stillness. Regardless of the language used, the mantram repetition program is based on the assumption that human beings possess a mind, body and spirit. Attributes of the spirit include characteristics of goodness, compassion, well-being, peaceful- ness, and kindness. Unfortunately, most do not tap into these inner characteristics due to racing thoughts, unending interruptions, and a focus on past memories or future worries.
As a contemplative practice, mantram repetition is completely port- able, invisible, inexpensive, readily available, nontoxic, and nonpharma- cological. It can be repeated anywhere, anytime, and in any position with eyes open or closed. It can be repeated throughout the day to serve as a rapid focusing tool for the mind or even at night to help deal with insomnia or nightmares. For stress management, it is used to redirect attention away from intrusive, negative thoughts and allow observation and reflection. Thus, it provides “pause time” to reevaluate one’s behavior, habits, and addictions. It fosters equanimity, being able to stand in the middle of a situation and observe.
AUTHOR’S EXPERIENCE WITH MANTRAM REPETITION
Personally, this author has been repeating a mantram as part of the Eight-Point Program since 1988, when first introduced to the Blue Mountain Center of Meditation in Tomales, California. A greater sense of well-being and quality of life are benefits attributed to practic- ing the entire Eight-Point Program. However, some specific experien- ces related just to the mantram are noteworthy and may be helpful to readers.
Initially, it took some time to thoughtfully choose a mantram. A word or phrase related to my prior beliefs and religious upbringing was
preferred, but not a word associated with any negative personal memories. I chose a less familiar, non-English word with a neutral, sooth- ing sound and rhythm meaning “Lord of the Heart” or “Come, Lord.”
Then, I had some resistance to repeating the mantram, as it seemed too simplistic and mechanical. Over time and with persistence, however, I felt a growing sense of inner security and distinct feelings of safety when repeating it. Until then, I had little awareness of the chronic fear and anxiety I experienced daily. Over time, mantram repetition began to generate an increased awareness of emotional detachment and stability. An ability to watch the mind, to recognize automatic behaviors of reactiv- ity versus intentional, thoughtful action was cultivated. The mantram gradually became familiar, like an old friend. Amusingly, it became a game to see how long I could repeat the mantram without drifting away to other thoughts. I enhanced my ability to concentrate on tasks at hand and dismiss unwanted distractions.
After several years of consistent mantram practice, I experienced some mantram dreams. Such dreams are described as protecting people from nightmares,4 and they illustrate the depth at which the practice can impact a person. These nightmares consisted of being chased either by a large grizzly bear or by angry men with dangerous knives. In each dream, at the point of being overcome by enemies and unable to escape, I surrendered by repeating the mantram as sin- cerely and focused as possible. This freed me from feeling threatened and terrorized. Immediately, in the dream, I felt peacefulness. I was not harmed in the dream and upon waking, I felt relieved and secure.
DIMENSIONS OF THE PRACTICE
HOW TO CHOOSE A MANTRAM
There are specific guidelines for choosing and using a mantram that are highlighted here, but for more comprehensive instructions, see The Mantram Handbook4 by Easwaran. Choosing a mantram is not to be taken lightly. It is wise to take extra time and choose one that offers strength and support. Avoid words or phrases that evoke negative associations or bad memories. Do not make up your own. Mantrams are distinctive and time honored. They have been handed down from generation to generation and repeated by millions over time. Their power is not so much related to their concrete meaning, as it is to the resulting effects they have on individuals through repetition. Some people choose a
mantram because of the person who used it. Those who are inspired by Mahatma Gandhi, for example, may choose his mantram, which was “Rama” meaning “to rejoice.” A small list of recommended mantrams is shown in Table 6.1.
It is not necessary to be affiliated with a religion or have religious/ spiritual beliefs in order to benefit from mantram repetition. How- ever, those with strong religious and/or spiritual beliefs often choose a mantram that complements their beliefs. Others are surprised to find that a mantram from a different spiritual tradition may be more beneficial than one from their own tradition.
Some people have no difficulty choosing a mantram. A word or phrase jumps out at them immediately. Others have to try it on and practice repeating it silently for a few days, weeks, or months to see how it sounds and feels. From a psycho-spiritual perspective, the choice of a mantram is extremely important because “we are shaped by what gains our attention and occupies our thoughts.”5
Once chosen, keep the same mantram, despite any temptation to choose another. Unlike some traditions where a different mantram is recommended for different situations, in this practice one mantram fits all situations. One advantage of having only one mantram is its rapid accessibility when needed immediately. It becomes an automatic speed
Table 6.1. List of Common Mantrams from Traditional Sources
Sample Mantrams Common Meanings
Jesus, Jesus, or Lord Jesus Christ Savior or Son of God
Hail Mary or Ave Maria Mother of Jesus or Divine Mother
My God and my All Used by St. Francis of Assisi in his prayers
Om mani padme´ hum The jewel in the lotus of the heart
Namu Amidabutsu An invocation of the Buddha of Infinite Light
Rama Rama To rejoice or joy within
So Hum or So Ham I am That
Ribono shel olam Lord of the universe
Barukh attah Adonai Blessed art thou, O Lord
Bismilla¯h ir-rahma¯n ir-rahı¯m In the name of God, the merciful, the
compassionate
Allah One true God
Note: See other instructional resources at http://www.easwaran.org.
bump that slows reaction time in stressful moments. It is a doorway to equanimity.
HOW TO USE A MANTRAM
The mantram is to be repeated with sincerity, concentration, and intention as often as possible. “As with anything else in life, the more effort and concentration you give, the greater and more dramatic the results may be” (p. 58).2 For example, if the mind were analogous to a muscle that you wanted to strengthen, then repetition is the key. Just as an athlete lifts weights repetitively to build that muscle, we strengthen our ability to concentrate by repeating a mantram— returning our attention to it over and over. Moreover, the good news is that we can practice the mantram anytime, anywhere, without a gym, a trainer, a weight or a medicine ball, etc. It is important to repeat the mantram silently at every possible opportunity throughout the day, during routine activities such as washing dishes or when walk- ing to the car, and even during the night, particularly just before sleep. Even though the mantram can be chanted, spoken, sung out loud, whis- pered, hummed, or written, repeating it silently is highly recommended. Then it can be used rapidly when needed and when others are present. It is also helpful to repeat a mantram in times of distress or emo- tional upheaval such as anger, fear, panic, and/or grief. The mantram can be repeated intensely while walking briskly to transform unwanted emotions into positive energy. This is called a mantram walk. In addi- tion to eliciting the relaxation response, the mantram serves as an immediate connection to one’s higher Power, or inner, higher Self.
It is a shortcut to awareness of the present moment and one’s inner resources. Thus, it becomes a convenient form of contemplation.
The mantram can also be written, over and over, to capture one’s entire attention. Writing the mantram is particularly helpful when the mind is very scattered, when emotions are out of control, or when strug- gling with an addiction. Mantram writing in these situations serves as a pause button to allow space between thought and action.
Repeating a mantram involves two additional points of Easwaran’s program: skills of intentionally slowing down one’s thinking and engag- ing in one-pointedness or focused concentration. These three skills work together synergistically to create a quiet, contemplative state of mind.
USING A MANTRAM TO SLOW DOWN THINKING AND SET PRIORITIES
Our culture values speed and multitasking. Instant results are expected with the technology of computers, e-mail, cell phones, and fax machines. Although we benefit from these so called time-savers, they also create an enormous demand on our attention and energy. People groan that there are not enough hours in the day to accomplish all they want. Stress is felt when we perceive there is not enough time. Such thinking promotes a sense of urgency and the need to hurry through life.
Given our culture, it may seem ridiculous to even consider slowing down. After all, everyone and everything around us appears to be accel- erating at high speed. It seems as if we must hurry to survive. After awhile, most of us are not even aware we are hurrying. We become automatic robots with no time to reflect, to observe or examine our lives, and no time for contemplation.
One result of going faster and faster is that we become insensitive to others’ needs. Furthermore, speed fosters physical ailments that can be linked to stress and hurry. Easwaran claims, “If we want freedom of action, good relations with others, health and vitality, calmness of mind, and the ability to grow, we have to learn to slow down” (p. 102).1 This is an enormous task when everything around us is speeding up and making demands on us to do the same.
Slowing down involves discrimination. Discrimination means setting priorities and learning to let go of the nonessentials. Yes, there are many things to attend to—daily maintenance of household and career, caring for relationships with family and friends, etc. Discrimi- nation is needed to determine what is most important, and then to do those things at a moderate pace to avoid mistakes and error. Contrary to what most people believe, slowing down means greater efficiency! There are fewer mistakes, fewer accidents, and more creativity.
Repeating a mantram can actually help a person go slower and allows time for discrimination. Initially, it may feel threatening to evaluate one’s speed and realize the need to change and slow down. Nevertheless, slowing down has the reward of making a conscious effort to choose wisely each day in all aspects of life. The end result is living more fully, consciously, and intentionally.
USING A MANTRAM TO DEVELOP ONE-POINTED ATTENTION OR MINDFULNESS
Mantram repetition requires the mind to inherently become one- pointed with focused attention. Mantram repetition raises our aware- ness of the thinking process and how poor decisions and bad habits are fostered. The mantram is a very concrete, practical tool where you know when you are repeating it, and you know when you are not. Each time the mind wanders and you bring it back to focus and repeat the mantram, you have controlled your attention internally. Each time you pay attention to what you are doing, you control your attention externally. Attention is a valuable resource that often goes wasted. Just as sunlight can be focused through a magnifying glass to create a laser-sharp point capable of burning a leaf, attention that is focused on completing one task at a time creates efficiency and carefulness.
To summarize, all three skills are needed to be successful— mantram repetition, slowing down, and one-pointed attention. Repetition of each, especially mantram, is the key. Over time, repeti- tion of the mantram increases in its power and effectiveness. “One drop of water can accomplish very little, but hundreds of millions of drops can cut through rock or, indeed, change the face of the earth” (p. 4).3 Finally, the best way to evaluate the effectiveness of mantram practice, is to observe one’s reactivity to the usual, stressful things and to evaluate the time it takes to recover from such stressors. Usu- ally, the speed of reactivity is reduced and recovery time diminishes.
HISTORICAL PERSPECTIVES
Some form of word repetition has been discovered in nearly every culture and spiritual tradition throughout history. It has been docu- mented as early as the seventh or eighth century BCE in the Upanishads and from the fourth or fifth century BCE in Judaism. In Christianity, mantram repetition is a form of holy name repetition used for healing and devotional purposes.6
The practice may not necessarily be central to the religious institu- tions in which it is found. Catholics use the rosary but that is only one small part of the faith tradition. Many times, in contrast, lay persons have reported that they discovered, on their own, the benefit of
repeating a soothing word or phrase in times of distress. The practice appears to be universal, despite the many variations that can range from community vocal chanting or singing as a form of worship to quiet individual mental repetitions that some might call prayer.
REVIEW OF THEORETICAL AND EMPIRICAL LITERATURE
Theoretically, there are several explanations of how mantram rep- etition works to enhance health and well-being. These explanations are usually described using physical, mental/cognitive, psychological/ emotional, and religious/spiritual mechanisms. Some of these mecha- nisms are briefly summarized below. More research is needed, how- ever, to support these theories and address the impact of mantram repetition as a unique, portable practice.
PHYSICAL MECHANISMS
One of the earliest explanations for the health benefits of repeating a word, phrase, or sound is derived from research on the “relaxation response,” a term coined by cardiologist Dr. Herbert Benson and defined as the opposite of the stress response.7 The relaxation response is initiated by repeating a word, sound, prayer, phrase, or muscular activity and passively disregarding any intruding thoughts that come to mind. Ample research has been conducted on the effects of the relaxation response on anxiety, stress, cardiovascular, and neuroendocrine function.7
Benson recommends sitting with eyes closed repeating a chosen word or phrase for 20 minutes daily. This practice resembles Transcendental Meditation (TM), a form of sitting mantra meditation, which has also been studied in relation to health outcomes.8 TM, however, should not be confused with mantram repetition. It differs in that the TM man- tra is assigned by a paid TM practitioner rather than personally chosen. TM is a sitting meditation with eyes closed rather than a portable prac- tice. Its goal to “transcend” beyond conscious thought in contrast to training attention and remaining conscious.
But Benson also spoke of “mini’s” or brief moments throughout the day of repeating the word, sound or phrase and releasing tension while taking a deep breath. He suggested initiating the relaxation response
as often as possible throughout the day and even while exercising.7 This use most resembles mantram repetition.
Other mechanisms of mantram repetition are linked to the neural pathways in the brain. Such theories are based on preliminary data found using functional magnetic resonance imaging scans. With rep- etition, one is theoretically using the same neural networks over and over. This is believed to cause structural changes in the brain, particu- larly the structures involved with attention and control. Researchers have found that the cortical thickness in the brain is also thickened with long-term meditation practice.9
MENTAL/COGNITIVE
From a mental/cognitive perspective, mantram repetition works by interrupting negative, anxious, or irrational thoughts. For example, one way to restructure maladaptive thinking is by using the mnemonic acronym of the three C’s: “Catch it, Check it, Change it.” The mantram provides a tool or mechanism to “catch it” (meaning, recognize the unwanted thought). Then one can “check it” (assess if it is an irrational thought). This may be referred to as meta-cognitive awareness. Only when the thought is recognized can one “change it” (or replace it with a more realistic thought). Thus, mantram repetition may be a useful aid in teaching cognitive-behavioral skills.
This process has been explored in a study of positive reappraisal coping as it relates to anger in a sample of HIV+ persons. Using mixed model statistics, results suggested that the mechanism for reducing anger in the mantram group was increasing positive reappraisal cop- ing. Those who used their mantrams were better able to pause and reappraise the situation, which in turn, led to less anger over time.10
PSYCHOLOGICAL/EMOTIONAL MECHANISMS
A psychological explanation for mantram repetition is called the “associative network” theory of memory and emotions.6 Certain words generate either positive or negative feelings. Through associa- tions, the mantram fosters what is called a “spreading activation,” making related memories and emotions more mentally available. So when a mantram is paired with feelings of calm and peacefulness as in nonstressful times, such as before sleeping, it becomes associated
with positive mental and physical memories. These positive feelings are then more easily accessed when the mantram is repeated during stressful, annoying moments.
RELIGIOUS/SPIRITUAL MECHANISMS
Another mechanism explaining how mantram repetition works is related to spirituality. Existential spiritual well-being is defined as having meaning and purpose in life. Because the mantram helps us connect to our inner spiritual resources, it fosters a sense of well- being. In several mantram studies that measured spiritual well-being, the mantram groups improved significantly more than controls, supporting the notion that mantram repetition enhances spiritual well-being.
In the HIV study, there were 71 participants who gave saliva sam- ples for a secondary analysis to look at relationships between faith/ assurance and the stress hormone of salivary cortisol. The mantram group participants had significant improvements in faith/assurance from pre- to postmantram treatment. Faith/assurance, in turn, was found to be inversely associated with a lagged reduction in average salivary cortisol levels over time compared to the control group.11
MANTRAM REPETITION PROGRAM OF RESEARCH
A program of research, conducted by this author and colleagues, has been exploring the health benefits of a mantram-based group inter- vention since 2001. The program is now established as an eight- week (90 minutes per week) group course called “Mantram Repetition for Relaxation.” It has been adapted for a variety of audiences and con- sists of teaching mantram repetition, slowing down, and one-pointed attention. The textbook used is Strength in the Storm,12 along with a course manual that has recommended readings and exercises.
The following section describes a series of research studies that highlight the health benefits reported by various groups practicing mantram repetition. The groups include veterans with chronic illness and combat veterans coping with PTSD, health care providers, family caregivers of veterans with dementia, women in labor, and adults living with HIV disease. For an overview of these and other studies, see Table 6.2.
Table 6.2. Published Research Studies on Mantram Repetition
Reference Studies Findings
13 62 veterans in mantram group assessed at pre- and posttreatment (without comparison group)
16 29 combat veterans randomized to mantram (n = 14) and wait-list control (n = 15)
17 136 combat veterans with PTSD randomized to usual care with mantram group (n = 66) or usual care only (n = 70).
Health Care Provider and Veteran Qualitative Study
15 30 veterans and 36 health care employees were interviewed about mantram use at follow-up
Health Care Provider Studies
14 42 health care employees assessed at pre- and posttreatment (without comparison group)
Significant improvements were found in stress, anxiety, anger, spiritual well-being, quality of life, and PTSD.
Mantram practice fully mediated changes in anxiety and spiritual well-being, and partially mediated improvements in all other outcomes.
Mantram group (compared to controls) decreased PTSD symptom severity, psychological distress, and improved quality of life and spiritual well-being.
Mantram group had significant improvements in self- reported PTSD, spiritual well-being, quality of life, and mental health function compared to controls.
32% of veterans in mantram group were no longer classified by clinicians as having PTSD diagnosis at posttreatment compared to 15% of veterans in control group.
Most participants (83%) reported situations where the mantram was useful for managing stress, other negative emotions, sleep/insomnia, and unwanted thoughts.
Significant improvements in stress, anxiety, anger, spiritual well-being, and quality of life.
Mantram practice mediated favorable changes in anxiety and spiritual well-being.
(continued )
Table 6.2. (continued)
Reference Studies Findings
21 13 health care providers completed the entire Eight-Point Program and were interviewed on the impact of the pro- gram and its specific points, including mantram repetition.
Family Caregiver Study
18 16 family caregivers of Veterans with dementia completed a mantram program with added cognitive-behavioral skills and were assessed at pre-, post-, and 8 weeks posttreatment with phone interviews at 36-week follow-up (without com- parison group).
First-time Mothers During Labor
19 9 first-time mothers were randomized to childbirth classes plus mantram (n = 5) or childbirth class only controls (n = 4) and were telephone interviewed at 6 months postdelivery.
HIV Studies
20 93 HIV-infected adults randomized to mantram (n = 46) and educational controls (n = 47). Both groups had similar levels of attention and were followed for 22 weeks.
7 of 13 (54%) providers reported that use of mantram helped them slow down and focus attention on the tasks at hand.
Caregivers reported significant improvements in caregiver burden, perceived stress, rumination, depression, and quality of life.
94% of caregivers reported still using mantram at 36 weeks posttreatment and 100% reported that mantram repetition was helpful.
All 5 mothers in mantram group reported using mantram to manage pain and moments of uncertainty during complicated labors. One used mantram during delivery. All 5 reported still using mantram at 6 months postdelivery.
Mantram group (compared to controls) had favorable changes in anger, faith/assurance, and spiritual connectedness.
Mantram practice was associated with increased quality of life, faith/assurance, spiritual meaning/peace, and decreased non-HIV intrusive thoughts.
10 93 HIV-infected adults randomized to mantram (n = 46) and educational controls (n = 47) for a secondary analysis that examined positive reappraisal and distance coping as mediators of anger reduction.
11 71 HIV adults randomized to mantram (n = 36) and educational controls (n = 35) for a secondary analysis of relationships among faith/assurance and daily average salivary cortisol levels over time.
Community-Dwelling Adults
22 61 healthy community volunteers were randomized to mantram group (n = 23), placebo mantram group (n = 19), and no-treatment controls (n = 19).
Mantram group reported a 25% increase in positive reappraisal and 15% reduction in anger from baseline. Positive reappraisal appeared to mediate the effect of mantram on decreased anger at 22-week follow-up.
Controls reported decreased positive reappraisal coping. Distance coping was not related to anger reduction.
Faith/assurance increased among mantram group but not controls. There was a lagged relationship between faith/ assurance and average daily cortisol levels, which may have been enhanced by mantram use.
Maha mantra repetition was associated with significantly less stress and depression compared to active controls or no-treatment controls at posttreatment and even after
4- week follow-up.
Note: PTSD = posttraumatic stress disorder.
APPLICATIONS/INTERVENTIONS
Early research on the benefits of frequent, silent mantram repetition has shown improvements in lowering perceived stress, anxiety, and anger while increasing quality of life and spiritual well-being in veterans with chronic illnesses13 and in health care providers.14 In these first two pilot studies, participants who received the mantram program were self- selected (not randomly assigned) and were not compared to a control group. Therefore, these positive outcomes may have been related to the therapeutic effects of group social support. These studies did pro- vide, however, initial support needed to conduct larger, randomized controlled trials and qualitative research yet to be described.
Another group of veterans and health care providers (N = 66) were
interviewed approximately two months after completing the mantram course. They were asked about the kinds of situations in which they used mantram repetition and found it helpful. Fifty-five (83%) reported a total of 139 helpful incidents including (a) managing emo- tions (54% of incidents) such as impatience, anger, frustration, feeling upset, disgruntled, or out of control; (b) managing stress (25% of inci- dents); (c) managing sleep/insomnia (14% of incidents); and managing unwanted thoughts (7% of incidents).15 Some examples are provided below:
To manage grief:
I recently lost my father to cancer and I have found it [mantram repetition] very helpful in coping with his death.
—health care employee
To focus attention:
The mantram helps me slow down, helps me think and reason because it allows me to focus. And without that focus, I might be thinking three to four things at the same time.
—veteran with chronic illness
To find perspective:
The mind always blows things out of proportion and so my recit- ing the mantram, it seems to settle everything down and keep it in perspective, because again, reality is never as bad as what you imagine it to be.
—veteran with chronic illness
MANTRAM FOR COMBAT VETERANS WITH PTSD
While there have been numerous studies of pharmacological and cognitive-behavioral interventions for treating PTSD, little attention has been given to spiritually based approaches for managing symptoms of PTSD. Spirituality may be important to the treatment of PTSD because of research indicating that combat trauma may challenge veter- ans’ religious faith and beliefs about life’s meaning and purpose.
Because earlier research in veterans showed promising results, a feasibility study in a small sample of combat veterans was conducted. Thirty-three veterans with PTSD were recruited and 29 completed the study. They were randomly assigned to the mantram group (n = 14) or a wait-list control group (n = 15). Results demonstrated that mantram repetition was acceptable in this population and that the mantram group improved significantly more than controls in a number of psychological measures including a clinician assessment of having a PTSD diagnosis.16
These results supported a larger randomized trial testing the effects of the mantram program compared to usual care. A cohort of 136 outpatient veterans with PTSD were assigned to either the mantram program (n = 66) or the delayed-treatment control (n = 70). There were significant reductions in self-reported PTSD symptom severity in the mantram group compared to controls. Clinician assessment of PTSD diagnosis in the mantram group was reduced in 32 percent of the veterans compared to 15 percent in the control group. Mental health function and quality of life also improved in the mantram group. Spiritual well-being increased in the mantram group compared to a decrease in controls.17
Some examples of how veterans with PTSD used mantram are as follows:
To think clearly and rationally:
If I find myself getting into a bad mood or depressed .. . how can I say it ... when I have no patience with myself and I find myself going back and beat myself up over issues or whatever, I have to ... I do my mantram at that point in time. I get more relaxed where
I can start thinking other thoughts.
To manage anger:
—veteran with PTSD
I’m glad I learned the mantram. I don’t stay mad. I’m not angry. I’m not all stressed out. So I try and use the mantram the best
I can to relieve the pressure, you know, ’cause we’re like .. . steam, you know, once you turn the fire up .. . you got to get rid of it, you know, and the mantram really works well.
—veteran with PTSD
To manage various PTSD symptoms:
[I use mantram] any time I get agitated .. . any time I have any PTSD triggers .. . driving .. . situations in relationships .. . any- where I feel uncomfortable. Those types of things .. . in crowds when I am not comfortable in crowds .. . If I wake up in the night from a dream or nightmare .. . I wake up in sweat .. . I say my mantram and relax.
—veteran with PTSD
MANTRAM FOR FAMILY CAREGIVERS OF VETERANS
Family caregivers are another group who are in danger of poor health due to the stress of care giving. Caregivers frequently have total responsibility for their loved ones and are often unable to obtain support services because of their reluctance to leave care recipients alone. Therefore, a family caregiver support program was created using the structure of the mantram course and adding some cognitive behavioral skills. The program was delivered using teleconference calls in order to reach more caregivers, especially those from a distance.18
The caregiver study resulted in significant reductions in caregiver burden, depression, perceived stress, and rumination. There were sig- nificant improvements in quality of life satisfaction and enjoyment over time. The teleconference delivery of the mantram program was feasible, and improved access and participation for one caregiver who lived 160 miles away. All caregivers reported moderate to high satisfaction with the intervention.18 The following quotes were taken from telephone interviews to illustrate how mantram was used by caregivers:
To manage impatience:
I use mantram repetition during impatient incidences when my husband needs my attention.
—spouse as caregiver of veteran with dementia
To manage stressful situations:
Using my mantram has helped me to ward off any possible stress- ful situations, but when I do get stressed out over something, I concentrate on repeating my mantram numerous times .. . then I feel relaxed.
—family caregiver of veteran with dementia
MANTRAM REPETITION FOR MOTHERS IN LABOR
Another small pilot study was conducted to assess the effects of mantram repetition on labor in first-time pregnant women.19 Using mixed methods of quantitative and qualitative research, 9 out of 14 mothers (64%) completed the study. Five were assigned to the mantram group and four to the control group. Qualitative telephone interviews were conducted at six-month postdelivery with open- ended questions to assess mantram use.
Results of the interviews revealed that all five of the treatment group mothers had used mantram repetition during labor. They reported that mantram helped them clear their minds and not get con- sumed by experiences of pain, fear, stress, and anxiety. In return, they were able to use other measures such as deep breathing to help reduce the intensity of their physical and emotional experiences. The man- tram was also used to deal with moments of uncertainty. Mantram repetition gave them something “to do” during a time when they had no idea of what was going on. It also helped them be present to work with the doctors and the medical staff:
To manage labor:
The mantram has helped me make hard decisions .. . to think clearly and rationally. [It gave me] a platform to make good deci- sions and in return, know what is truly important.
—first-time mother during labor
ADULTS LIVING WITH HIV
The last study presented here provides the most rigorous test of ben- efits. With funding from the National Center of Complementary and Alternative Medicine, a randomized controlled trial of a mantram inter- vention on health outcomes in HIV-infected adults was conducted.20
Ninety-three participants interested in stress management were recruited using flyers distributed in the community. They were ran- domly assigned to either the mantram intervention (n = 46) or an educa- tional control group (n = 47) with equal group support. Questionnaires were administered before, during, and after the intervention and at three months follow-up. Compared to controls, the mantram group improved significantly more on anger, faith/assurance, and spiritual connectedness. Over time, both groups had significant reductions in perceived stress, anxiety, and depression.
As in earlier studies, mantram dose was measured using wrist coun- ters and logs. More frequent mantram practice was significantly asso- ciated with reduced non-HIV intrusive thoughts, increased quality of life enjoyment and satisfaction, faith/assurance, and sense of spiritual meaning/peace. Although these relationships could not be explained by demographics, baseline spiritual well-being, involvement in a religious group, or frequency of other religious practices, mantram prac- tice appeared to contribute to these improvements, but more research is needed. Examples of mantram practice include the following:
To help with nightmares or insomnia:
I was having trouble with nightmares .. . and those dreams were terrifying. I would wake up shaking and my hands would be clenching to my chest, stopping the blood circulation to my hands. And since I took the second week of class, the mantram started taking over and as of today, I no longer have those scary nightmares anymore.
—adult living with HIV
To manage frustration while waiting:
When I am really frustrated or in a line or something, I don’t let that bother me; I just say my mantram and before you know it, I am right up at the front of the line. It has really worked for me. I liked it. I really, really liked it.
—adult living with HIV
NEW RESEARCH DIRECTIONS
With findings that mantram repetition can enhance health and well-being in many people, new directions for research would be to examine the confidence one has in using a mantram for symptom
management, i.e., self-efficacy of mantram practice for various condi- tions. For example, there is no measure of self-efficacy for managing PTSD symptoms. Future research could assess the degree to which patients have confidence that mantram repetition can help them man- age their illness.
Another area for investigation is Comparative Effectiveness Research, a description used by the Institute of Medicine for research to improve the health care system in the United States. The Institute has published a list of research topics and priorities including complementary thera- pies. Although the mantram program is a complementary therapy and not a stand-alone treatment, the mantram program could be compared to the Mindfulness-Based Stress Reduction program by Jon Kabat- Zinn. Although both are meditative-related practices, there may be subtle differences in health outcomes between these interventions that would be interesting to identify.
CONCLUSIONS
Because mantram repetition is simple, inexpensive, and portable, it is an ideal contemplative practice for nearly everyone. It can be used actively with a mantram walk or quietly before sleep. Health-related outcomes from practicing mantram are most frequently reported as inner feelings of calm or peacefulness. Evenness of mind under stress and having more patience with others has been reported by many research participants. This is the trait of equanimity sought after by contemplatives. One final tip before sharing this technique with friends, family, patients, or students: make mantram repetition a regu- lar part of your life and test its benefits on your own.
ACKNOWLEDGMENTS
Studies cited in this chapter were conducted with support from the VA Office of Academic Affiliations; VA Office of Research and Devel- opment, Health Services Research and Development, Nursing Research Initiative (04-041-4); National Institutes of Health/National Center for Complementary and Alternative Medicine (R21AT01159); Gamma Gamma Chapter of Sigma Theta Tau International Research Award; Nurses of Veterans Affairs (NOVA) Foundation; and the San Diego State University School of Nursing’s Institute of Nursing Research (#900521). The views are those of the author and do not
necessarily represent the official views of the Department of Veterans Affairs, the U.S. government, or the National Center for Comple- mentary and Alternative Medicine.
REFERENCES
1. Easwaran, E. (2008a). Passage meditation: Bringing the deep wisdom of the heart into daily living (3rd ed.). Tomales, CA: Nilgiri Press.
2. Ashley-Farrand, T. (1999). Healing mantras. New York: Ballantine.
3. Radha, S. (1996). Mantras: Words of power (revised ed.). Spokane, WA: Timeless Books.
4. Easwaran, E. (2008b). The mantram handbook: A practical guide to choosing your mantram and calming your mind (5th ed.). Tomales, CA: Nilgiri Press.
5. Easwaran, E. (2005a). Words to live by. Tomales, CA: Nilgiri Press.
6. Oman, D., & Driskill, J. D. (2003). Holy name repetition as a spiritual exercise and therapeutic technique. Journal of Psychology and Christianity, 22(1), 5–19.
7. Benson, H. (1996). Timeless healing. New York: Scriber.
8. Walton, K. G., Cavanaugh, K. L., & Pugh, N. D. (2005). Effect of group practice of the Transcendental Meditation program on biochemical indicators of stress in non-meditators: A prospective time series study. Journal of Social Behavior and Personality, 17, 339–373.
9. Lazar, S. W., Kerr, C. E., & Wasserman, R. H., et al. (2005). Meditation experience is associated with increased cortical thickness. Neurological Report, 16(17), 1893–1897.
10. Bormann, J. E., & Carrico, A. W. (2009). Increases in positive reappraisal coping during a group-based mantram intervention mediate sus- tained reductions in anger in HIV-positive persons. International Journal of Behavioral Medicine, 16, 74–80.
11. Bormann, J. E., Aschbacher, K., Wetherell, J. L., Roesch, S., & Redwine, L. (2009). Effects of faith/assurance on cortisol levels are enhanced by a spiritual mantram intervention in adults with HIV: A randomized trial. Journal of Psychosomatic Research, 66(2), 161–171
12. Easwaran, E. (2005b). Strength in the storm: Creating calm in difficult times. Tomales, CA: Nilgiri Press.
13. Bormann, J. E., Smith, T. L., Becker, S., Gershwin, M., Pada, L., Grudzinski, A., et al. (2005). Efficacy of frequent mantram repetition on stress, quality of life, and spiritual well-being in veterans: A pilot study. Journal of Holistic Nursing, 23(4), 394–413.
14. Bormann, J. E., Becker, S., Gershwin, M., Kelly, A., Pada, L., Smith, T. L., et al. (2006). Relationship of frequent mantram repetition to emotional and spiritual well-being in healthcare workers. Journal of Continuing Education in Nursing, 37(5), 218–224.
15. Bormann, J. E., Oman, D., Kemppainen, J. K., Becker, S., Gershwin, M., & Kelly, A. (2006). Mantram repetition for stress management in veterans and employees: A critical incident study. Journal of Advanced Nursing, 53(5), 502–512.
16. Bormann, J., Thorp, S., Wetherell, J. L., & Golshan, S. (2008). A spir- itually based group intervention for combat veterans with posttraumatic stress disorder: Feasibility study. Journal of Holistic Nursing, 26(2), 109–116.
17. Bormann, J. E., Thorp, S., Wetherell, J. L., Golshan, S., Fellows, I., Lang, A., et al. (February 11–13, 2009). Efficacy of a spiritually-based mantram intervention on quality of life in veterans with military-related PTSD. Paper presented at the Health Services Research & Development 2009 National Meeting, Balitmore.
18. Bormann, J. E., Warren, K. A., Regalbuto, L., Glaser, D., Kelly, A., Schnack, J., et al. (in press). A spiritually-based caregiver intervention with telephone delivery for family caregivers of Veterans with dementia. Journal of Family and Community Health, 32(4), 345–353.
19. Hunter, L., Bormann, J., Belding, W., Sobo, E. J., Axman, L., Reseter,
B. K. Hanson, S. M., & Miranda, V. (in press). Satisfaction with the use of a spiritually–based mantram intervention for childbirth-related fears in couples, Journal of Applied Nursing Research, online: DOI:10.1016/j.apnr.2009.06.002.
20. Bormann, J. E., Gifford, A. L., Shively, M., Smith, T. L., Redwine, L., Kelly, A., et al. (2006). Effects of spiritual mantram repetition on HIV out- comes: A randomized controlled trial. Journal of Behavioral Medicine, 29(4), 359–376.
21. Richards, T. A., Oman, D., Hedberg, J., Thoresen, C. E., & Bowden, J. (2006). A qualitative examination of a spiritually-based intervention and self- management in the workplace. Nursing Science Quarterly, 19(3), 231–239.
22. Wolf, D. B., & Abell, N. (2003). Examining the effects of meditation techniques on psychosocial functioning. Research on Social Work Practice, 13(1), 27–42.
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PART TWO
CONTEMPLATIVE TRADITIONS
PREFACE TO PART TWO
Part Two, Contemplative Traditions, examines practice traditions that have been transmitted for many centuries or millennia within major faith traditions. The earlier chapter by Oman (Part One, Chapter 2) noted that four shared elements are present within many of these tradi- tions, as well as in the integrated systems described in Part One. What distinguishes the chapters in this part is that they emphasize traditions that are too vast and deep for any one person to practice them in their entirety. For example, each tradition may contain so many variants of sitting meditation, or of formalized prayer, that an individual would almost never seek to practice them all on a regular, ongoing basis. In some cases (e.g., yoga), many practices can be easily used by people outside of the original religious tradition, and perhaps combined with adherence to a different religious tradition.
In the four chapters in this section, we are treated to key elements and
highlights from the Jewish tradition (Weiss and Levy), Islam (Hamdan), the yoga school of practice that developed within Hinduism (Richards), and the Zen school within Buddhism (Tamayo-Moraga and Cohen Roshi).
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CHAPTER 7
