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Research Article
Effects of a Mindfulness Meditation Course on Learning and
Cognitive Performance among University Students in Taiwan
Ho-Hoi Ching,1Malcolm Koo,2,3 Tsung-Huang Tsai,4and Chiu-Yuan Chen1,5
1DepartmentofNaturalBiotechnology,NanhuaUniversity,Dalin,Chiayi62249,Taiwan
2Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin,
Chiayi 62247, Taiwan
3DallaLanaSchoolofPublicHealth,UniversityofToronto,Toronto,ON,CanadaM5T3M7
4Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 62247, Taiwan
5Research and Extension Center of Natural Healing Sciences, Nanhua University, Dalin, Chiayi 62249, Taiwan
Correspondence should be addressed to Chiu-Yuan Chen; chiuyuan@mail.nhu.edu.tw
Received September ; Revised October ; Accepted October
Academic Editor: Brett Froeliger
Copyright © Ho-Hoi Ching et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mindfulness training has recently gained much research interest because of its putative benets for both mental and physical
health. However, little is available in its eects on Asian students. erefore, a quasi-experimental pre/posttest design was used
to assess the eects of a one-semester mindfulness meditation course in rst-year Taiwanese university students and compared
with controls. e Chinese version of the College Learning Eectiveness Inventory (CLEI) and a computer soware program
focused on specic cognitive tasks were used for the evaluation. Results from the analysis of covariance revealed that while the
score of the full CLEI scale was signicantly higher in the intervention group compared with the control (𝑃 = 0.022), none of
the comparisons between the nine CLEI subscales were signicantly dierent between the two groups. For the computer cognitive
tasks, the intervention group exhibited signicantly better performance in the accuracy of the digital vigilance task (𝑃 = 0.048),
choice reaction time (𝑃 = 0.004), spatial working memory (𝑃 = 0.042), and digital vigilance task reaction time (𝑃 = 0.004). is
study showed that a one-semester mindfulness meditation course was able to improve learning eectiveness and both attention
and memory aspects of cognitive performance among Taiwanese university students.
1. Introduction
Mindfulness can be considered as a meditation practice that
cultivates present moment awareness []. e word mindful-
ness originates from the combination of two Pali words,
Sati which means “awareness” and Samprajanya, “clear com-
prehension.” Mindfulness meditation aims to foster inner
calmness and nonjudgment of the mind, which can help
individuals to “acknowledge and accept as it is” in all aspects
of daily life [, ]. A PubMed search of the term mindfulness
revealed the following trend: articles published between
and ; articles published between and ;
articles published between and ; and ,
articles published between and August . Mindful-
ness meditation has been studied in a broad range of mental
and physical health outcomes, such as major depression
[], cancer [], HIV pathogenesis [], multiple sclerosis [],
chronic low back pain [], chronic insomnia [], and chronic
kidney disease [].
In addition to its eects on pathogenesis, mindfulness
meditation has also been evaluated regarding its putative
benecial role in improving attention [, ], cognition [],
cognitive exibility [, ], and academic performance [].
Nevertheless, to our knowledge, no studies have evaluated
the eects of mindfulness meditation on Taiwanese university
students. We took advantage of a new curriculum oered by
auniversityinTaiwaninwhichamindfulnessmeditation
course is a mandatory credited course for all rst-year
students. e aim of this study was to explore the eects of
a mindfulness meditation course on learning and cognitive
performance among Taiwanese university students.
Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2015, Article ID 254358, 7 pages
http://dx.doi.org/10.1155/2015/254358
Evidence-Based Complementary and Alternative Medicine
2. Methods
2.1. Study Design and Participants. is study was carried out
in accordance with the protocol approved by the Institutional
Review Board of the Buddhist Dalin Tzu Chi Hospital,
Taiwan (number B).
is intervention study used a quasi-experimental
pre/posttest design. is study was conducted in a private
university in south Taiwan where a one-semester course in
mindfulness meditation is a part of the core curriculum for
all rst-year students. Since the course was oered in both
the rst and second semester and this study was conducted in
the rst semester of a school year, we recruited the students
whowereenrolledinthemindfulnessmeditationcourse(a
total of classes) as the intervention group and those who
wouldtakethecourse(anotherclasses)inthesecond
semester as the control group.
Aer obtaining the approval from the course instructor,
one of the study investigators (Ho-Hoi Ching) went to each
of the classes, that is, classes of mindfulness meditation
and classes of physical exercise, to explain the research and
invite participants.
A total of students, in the intervention group and
in the control group, consented to participate in the study.
During the study period, (%) and (%) students
in the intervention group and control group, respectively,
dropped out from the study. erefore, only (%) in the
intervention group and (%) controls were included in
the data analyses.
2.2. Intervention. e mindfulness meditation course con-
sisted of weekly -minute classes (a total of hours)
during September in and February . e course
content was modeled based on the concepts of mindfulness-
based meditations with reference to traditional Buddhists
context. Students in the mindfulness meditation course
engaged in formal meditation practices such as mindful
breathing, body scan, and eating and walking meditation.
During class time, the focus was on formal practice but
students were encouraged to apply mindfulness skills in their
everyday life. Students were required to attend classes, to
submit a practice diary, and to watch online course materials
outsideoftheclassesaspartoftheircourseassessment.
e outline of the mindfulness meditation intervention is
included in Table .
2.3. Measurement Tools. is study used the Chinese version
of the College Learning Eectiveness Inventory (CLEI) and
a set of computer cognitive tasks to measure the eects of
mindfulness meditation intervention on students’ learning
and cognition (attention and working memory), respectively.
e pretest and posttest were administrated to the students at
week and week , respectively.
2.4. College Learning Eectiveness Inventory. e College
Learning Eectiveness Inventory (CLEI) is a valid and reli-
able assessment tool designed to measure college students’
attitudes and behaviors that may impact learning and aca-
demic performance. e CLEI contains clearly denable and
T : Outline of the mindfulness meditation intervention.
Week Cont e n t
(i) Course orientation
(ii) Basics of body scan
(iii) Mindful eating
(i) Advanced body scan
(ii) -minute breathing meditation
(iii) Training attention and awareness through
mindful breathing
(iv) Basics of diary on mindfulness practice
(i) Walking meditation (live in the moment)
(ii) Breathing techniques
(iii) e classical basis of the mindfulness
meditation course
(iv) Administration of the pretest (College Learning
Eectiveness Inventory and computer cognitive
tasks)
Mindful meditations
(i) Mindfulness practice before sleeping
(ii) Nonjudgmental versus judgmental
Mindfulness and the Noble Eightfold Path
(i) From mindfulness to “fullness of
understanding”
(ii) Mindfulness diary writing skills
(i) How do we know the world
(ii) Mindfulness and health
(mid-term
exam) -minute mindfulness meditation practice
(i) e beginner’s mind
(ii) Benets of mindful speech
(i) Mindfulness interpersonal skills
(ii) Basic use of dialectical behavior therapy
(i) Mindfulness and scientic research
(ii) Mindfulness attitudes
Mindful living
(i) Purpose of behavior with “fullness of
understanding”
(ii) e use of the beginner’s mind
(iii) Balanced view of pros and cons
(i) Perspective views are decided by angles
(ii) Investigating the lters of knowing (cognition)
(iii) Administration of the posttest (College
Learning Eectiveness Inventory and computer
cognitive tasks)
Principle of not harming and principle of sincere
treating
(i) oughts as thoughts, not necessarily the
reality
(ii) e use of mindfulness-based cognitive
therapy
(iii) e origin of life dependent
(iv) Helpers also need mindfulness
-minute mindfulness meditation practice
operational items to measure psychosocial factors including
thoughts, feelings, or behaviors related to academic outcomes
[].
Evidence-Based Complementary and Alternative Medicine
e CLEI was previously translated into Chinese and its
psychometric properties were evaluated in Taiwanese
university students. A Cronbach alpha of . was obtained
for the Chinese version of CLEI, indicating a good internal
consistency. In addition, the -week test-retest study was con-
ducted on students and a test-retest reliability coecient
of . was obtained for the scale []. e scale consists of
nine subscales with questions using ve-point Likert-scale
responses from never to always. Negatively phrased items
were reverse scored. e total scores range from to with
a higher score representing better learning eectiveness.
e nine subscales of the Chinese version of CLEI are
as follows. () Emotional satisfaction: it reects the extent of
students’ interest in university life and emotional reactions,
including those towards people and to the environment on
campus. () Management (plan and time management): it
reveals the ability to organize and time management when
settinggoalsandmakeplanstocarryoutthenecessary
academic activities among college students. () Achieve-
ment: it reects the degree of students in actively setting
goals for themselves and trying to pursue success and also
reects students’ own expectations for success. () Stress:
it reects students perceived pressure from schoolwork and
time and whether they can properly handle stress from
the environment and the academic needs. () Attention
to study: it reveals the extent of university students for
learning and academic focus. () Class communication: it
includes communications between teachers and students in
classroom activities, including verbal and nonverbal part. ()
Condence: it reects the faith and condence demonstrated
by students for their academic ability. () Involvement with
college activity: it refers to belonging to certain organiza-
tions or participating in some activities within the campus
environment, including social and academic activities. ()
Friendship: it refers to the interaction and friendship with
friends, classmates, or other students when participating the
campus community or activities, such as group assignments
or studying together. In this study, the Chinese version of the
CLEI was administered online using an open-source learning
management system Moodle (https://moodle.org).
2.5. Computer Cognitive Tasks. e cognitive measurement
computersowareE-primewasusedinthisstudytoevaluate
cognitive performance of attention and working memory
[]. Students were asked to complete it aer they had nished
theCLEIsurveyatboththepretestandposttest.efour
cognitive tasks included in this study were digit vigilance
tasks, choice reaction times, spatial working memory, and
memory scanning tasks. e rst two tasks were used to
measure attention and the last two were used to measure
memory. A basic description of these four tasks is as follows.
() Digit vigilance task: a number (from to and ) was
displayed constantly on dierent places of the screen. If
the appearing number matched with the number in the
middle, the participant must press the “” button as quickly
as possible every time the digit in the center matched the
one constantly displayed. If the appearing number did not
matchwiththenumberinthemiddle,theparticipanthadto
press the “” button. Accuracy of response (%) and reaction
time (milliseconds) were recorded. A higher percentage in
accuracy and a lower value in reaction time represent better
performance.is task was designed to measure sustained
attention. () Choice reaction time: either the letter X or
the letter Y was presented on dierent parts of the screen.
e participant must press the “” for X or “” button for
Yasappropriateandasquicklyaspossible.erewere
trials and the interval varied randomly between and .
seconds. Accuracy (%) and reaction time (milliseconds) were
recorded. is task was designed to measure attention and
vigilance. In the posttest, X and Y were changed to U and
V to reduce learning eect. () Spatial working memory: a
schematic picture of a house was presented for seconds.
e house had nine windows in a ×pattern,ofwhich
were illuminated. A series of presentations of the same
house in which just one window was illuminated follow, and
the participant had to respond “” if the window was one
of the four lit in the original presentation or “” if it was
not. Reaction time and accuracy were recorded. is task was
designed to measure memory. In the pretest, the color of the
box was yellow and it was changed to red in the posttest. ()
Memory scanning task: ve digits were presented singly at
the rate of one per second for the participant to remember.
A series of thirty digits was then presented. For each, the
participant must press or according to whether the digit
was thought to be one of the ve presented initially. is was
repeated three times using a dierent set of digits on each
occasion. Reaction time and accuracy were recorded. is
task was also designed to measure memory.
2.6. Statistical Analysis. Descriptive statistics were used to
examine the sample demographic data, including sex, reli-
gious aliations, perceived health status, experience prac-
ticing mindfulness meditation, and college of study. e
distributions of these variables in the intervention group
and control were compared with chi-square test. Indepen-
dent 𝑡-test was used to compare the posttest minus pretest
(delta) scores between intervention group and control group.
Analysis of covariance (ANCOVA) was used to compare the
scores obtained from the full CLEI and each of its nine
subscales between intervention group and control group,
adjusted for the potential confounding eects of pretest
scores, sex, college, and experience with mindfulness medita-
tion. In addition, the accuracy and reaction time for the four
computer cognitive tasks between the intervention group and
control were each separately analyzed with ANCOVA. Least
square means and their associated % condence intervals
were presented. All analyses were conducted using IBM
SPSS Statistics soware package, version . (IBM Corp.,
Armonk, NY, USA). A 𝑃 < 0.05 was considered statistically
signicant.
3. Results
A total of students, in the intervention group and
inthecontrolgroup,wereincludedinthedataanalyses
of the study. All participants were between and years
of age and % were females. e distributions of their
sex, religious aliations, perceived health status, experience
Evidence-Based Complementary and Alternative Medicine
T : Characteristics of the study participants (𝑁 = 282).
Variabl e 𝑛(%)
Chi-square statistic 𝑃value
Total
()
Intervention group
(.)
Control group
(.)
Sex . <.
Males (.) (.) (.)
Females (.) (.) (.)
Religious aliation . .
None (.) (.) (.)
Buddhism (.) (.) (.)
Taoi s m (.) (.) (.)
Others (.) (.) (.)
Perceived health status . .
Healthy (.) (.) (.)
Neutral (.) (.) (.)
Unhealthy (.) (.) (.)
Experience practicing mindfulness meditation . <.
Ye s (.) (.) (.)
No (.) (.) (.)
College of study . <.
Management and social sciences (.) (.) (.)
Humanities and arts (.) (.) (.)
Science and technology (.) (.) (.)
with mindfulness mediation, and the college of study were
showninTable.Exceptreligiousaliationsandperceived
health status, the other factors were signicantly dierent
between the intervention group and control. ese factors
were included in the subsequent ANCOVA to adjust for their
potential confounding eects.
e unadjusted means of CLEI and computer cognitive
tasks at week and week for the intervention group and
control group are shown in Table . No signicant dierences
were observed in the delta scores of the scales between
intervention group and control group.
Table shows the least squares mean scores for the CLEI
andcomputercognitivetasks.Whilethescoreofthefull
CLEI scale was signicantly higher in the intervention group
compared with the control (𝑃 = 0.022), none of the com-
parisons between the nine CLEI subscales were signicantly
dierent between the two groups. For the computer cognitive
tasks, the intervention group exhibited signicantly better
performance in the accuracy of the digital vigilance task (𝑃=
0.048), choice reaction time (𝑃 = 0.004), and spatial working
memory (𝑃 = 0.042) and also in the reaction time of the
digital vigilance task (𝑃 = 0.004).
4. Discussion
In this quasi-experimental pre/posttest design study, the
eects of a curriculum-based mindfulness meditation course
on learning and cognitive performance among univer-
sity students were investigated. Overall, we found that a
one-semester mindfulness meditation course was able to
signicantly improve learning performance, as reected by
the least squares mean scores of the full CLEI scale (𝑃=
0.022). However, none of nine subscales showed signicant
dierences between the intervention group and control.
Based on the literature [], we anticipated that the stress
subscalewouldhaveshowedimprovementsamongstudents
with mindfulness meditation training. A literature review
of medical schools that taught mindfulness to medical
students and residents suggested that mindfulness programs
were able to decrease psychological distress []. A possible
reason for the lack of signicant eect on stress in the present
study could be a regression to the mean eect where stress
levels are high at the beginning of a school term but will
naturally regress to a low level once students are familiar with
university life, regardless of whether they have enrolled in the
mindfulness meditation program. Another possible reason
is that the mindfulness meditation program was oered as
a mandatory course. Not all students were interested and
engaged in using mindfulness meditation as a way to manage
their stress levels. Our ndings might be dierent if the
program was oered as an elective course where enrolled
students are more motivated. A -week mindfulness-based
curriculum on teacher-ratings of student classroom behavior
at a public elementary school showed improved classroom
behavior such as paying attention, self-control, participation
in activities, and caring/respect for others []. Nevertheless,
no control group was used for a comparison in the study.
e eects of mindfulness meditation on elementary school
students and university students may be dierent and will
require further research.
Evidence-Based Complementary and Alternative Medicine
T : Unadjusted means of College Learning Eectiveness Inventory (CLEI) and computer cognitive tasks at week and week for the
intervention group and control group (𝑁 = 282).
Variabl e
Mean (standard deviation)
Pvalue
Intervention Control
Pretest score
(week )
Posttest score
(week ) Δscore Pretest score
(week )
Posttest score
(week ) Δscore
College Learning Eectiveness
Inventory (CLEI) 𝑛 = 152 𝑛 = 130
Full scale score . ±. . ±. . ±. . ±. . ±. . ±. .
() Emotional satisfaction score . ±. . ±. . ±. . ±. . ±. . ±. .
() Management score . ±. . ±. . ±. . ±. . ±. −. ±. .
() Achievement . ±. . ±. . ±. . ±. . ±. . ±. .
() Stress . ±. . ±. −. ±. . ±. . ±. . ±. .
() Attention to study . ±. . ±. −. ±. . ±. . ±. . ±. .
() Class communication . ±. . ±. −. ±. . ±. . ±. . ±. .
() Condence . ±. . ±. −. ±. . ±. . ±. . ±. .
() Involvement with college activity . ±. . ±. . ±. . ±. . ±. −. ±. .
() Friendship . ±. . ±. −. ±. . ±. . ±. . ±. .
Computer cognitive task
() Digit vigilance task 𝑛 = 112 𝑛 = 66
Accuracy (%) . ±. . ±. . ±. . ±. . ±. . ±. .
Reaction time (msec) . ±. . ±. −. ±. . ±. . ±. −. ±. .
() Choice reaction time 𝑛 = 112 𝑛 = 66
Accuracy (%) . ±. . ±. . ±. . ±. . ±. . ±. .
Reaction time (msec) . ±. . ±. . ±. . ±. . ±. . ±. .
() Spatial working memory 𝑛 = 112 𝑛 = 66
Accuracy (%) . ±. . ±. . ±. . ±. . ±. −. ±. .
Reaction time (msec) . ±. . ±. −. ±. . ±. . ±. . ±. .
() Memory scanning task 𝑛 = 109 𝑛 = 64
Accuracy (%) . ±. . ±. . ±. . ±. . ±. . ±. .
Reaction time (msec) . ±. . ±. −. ±. . ±. . ±. −. ±. .
𝑃values were calculated by independent 𝑡-test comparing Δbetween intervention group and control group.
Δ: posttest values minus pretest values.
Regarding the eects on cognitive performance, the
mindfulness meditation course was able to signicantly
improve the accuracy of digital vigilance task, choice reaction
time, and spatial working memory as well as the reaction
time in digital vigilance task. Improvements in attentional
task performance were consistent with previous research [,
]. It is suggested that the process of mindfulness training
can promote attentional stability by promoting a balance
between a relaxed and vigilant state of mind and thereby
enhancing cognition through a better ability to self-regulate
emotions []. Moreover, mindfulness training may increase
participants’ cognitive performance by improving their mood
and reducing mind wandering. Mind wandering and mood
disturbances can negatively impact learning and memory
[]. A series of studies on short-term mindfulness-based
intervention on undergraduate students suggested that the
associated improvements in executive function are related to
the neural circuitry specic to the anterior cingulate cortex
and the autonomic nervous system [].
A few limitations should be noted when interpreting the
resultsofthisstudy.First,thegroupallocationwasnotbased
on random assignment. Although the factors with uneven
distribution between two groups were adjusted in ANCOVA,
other unmeasured factors such as sleep quality and usage
of caeine beverages could potentially aect the results.
Second, due to unforeseen computer issues, approximately
half of the controls and a quarter of the participants in the
intervention group were not able to complete the computer
cognitive tasks as expected. Nevertheless, the computer issues
shouldnotbeassociatedwiththeoutcome.Infact,weused
ANCOVA to compare the CLEI scores of the participants
with missing data with those of participants without missing
data on computer cognitive task. We found no signicant
dierences between the two groups (𝑃 = 0.653), implying
that the pattern of missing is random. ird, approximately
% of the initial participants dropped out from the study.
Fourth, we used a binary variable to adjust for the experi-
ence in practicing mindfulness meditation. Information on
Evidence-Based Complementary and Alternative Medicine
T : Analysis of covariance (ANCOVA) for the eects of mindfulness meditation on College Learning Eectiveness Inventory (CLEI)
andcomputercognitivetasks(𝑁 = 282).
Variabl e Least squares mean (% condence interval)a𝐹statistic (df) 𝑃value
Intervention Control
College Learning Eectiveness Inventory (CLEI) 𝑛 = 152 𝑛 = 130
Full scale score . (., .) . (., .) . (, ) .
() Emotional satisfaction score . (., .) . (., .) . (, ) .
() Management score . (., .) . (., .) . (, ) .
() Achievement . (., .) . (., .) . (, ) .
() Stress . (., .) . (., .) . (, ) .
() Attention to study . (., .) . (., .) . (, ) .
() Class communication . (., .) . (., .) . (, ) .
() Condence . (., .) . (., .) . (, ) .
() Involvement with college activity . (., .) . (., .) . (, ) .
() Friendship . (., .) . (., .) . (, ) .
Computer cognitive task
() Digit vigilance task 𝑛 = 112 𝑛 = 66
Accuracy (%) . (., .) . (., .) . (, ) .
Reaction time (msec) . (., .) . (., .) . (, ) .
() Choice reaction time 𝑛 = 112 𝑛 = 66
Accuracy (%) . (., .) . (., .) . (, ) .
Reaction time (msec) . (., .) . (., .) . (, ) .
() Spatial working memory 𝑛 = 112 𝑛 = 66
Accuracy (%) . (., .) . (., .) . (, ) .
Reaction time (msec) . (., .) . (., .) . (, ) .
() Memory scanning task 𝑛 = 109 𝑛 = 64
Accuracy (%) . (., .) . (., .) . (, ) .
Reaction time (msec) . (., .) . (., .) . (, ) .
aMeans were posttest scores adjusted for pretest scores, sex, college, and experience with mindfulness meditation.
msec: millisecond.
the length and frequency of practice was not ascertained
and therefore cannot be further adjusted. Fih, the 𝑃values
obtained should be interpreted in view of the increased
chance of type error as a result of multiple comparisons
of subscales of the CLEI and components of the computer
cognitive task. Finally, the possibility of a placebo eect
cannot be evaluated and future studies should consider the
use of a sham meditation group [].
In conclusion, ndings from this study are consistent
with the notion that attentional performance can be trained.
A one-semester mindfulness meditation course was able
to improve learning eectiveness and both attention and
memory aspects of cognitive performance among university
students. Eective learning and sustained attention and
memory are important requirements for success and well-
being in academic contexts. Incorporating a mindfulness
meditation course in the curriculum may be a feasible
approach to improve learning eectiveness and cognition
performance in university students.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
Authors’ Contribution
Ho-Hoi Ching and Malcolm Koo contributed equally to this
work. Ho-Hoi Ching and Chiu-Yuan Chen conceived and
designed the study, Ho-Hoi Ching conducted the study and
collectedthedata,Ho-HoiChingandMalcolmKooanalyzed
the data, Ho-Hoi Ching and Malcolm Koo wrote the paper,
and Ho-Hoi Ching, Malcolm Koo, and Chiu-Yuan Chen
interpretedthedata.Allauthorshavereadandapprovedthe
paper.
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