Relationship of Frequent Mantram Repetition to Emotional and Spiritual Well-Being in Healthcare Workers

Abstract

Healthcare workers report high levels of stress in the workplace. To determine how to reduce stress, the authors examined the effectiveness of frequently repeating a mantram (a word with spiritual meaning) on emotional and spiritual well-being.
A pretest-posttest design was used to measure stress, state/trait anxiety and anger, quality of life, and spiritual well-being in a convenience sample (N=42) of hospital workers completing a mantram intervention program.
Significant improvements were found in stress (p < .001), trait-anxiety (p = .002), trait-anger (p = .02), quality of life (p = .001), and spiritual well-being (p = .003). When examining the effects of mantram practice, trait-anxiety and religious and spiritual well-being were significant (p < .05).
Improvements in emotional and spiritual well-being may be mediated by frequent mantram repetition.

Full text

Relationship
of
Frequent
Mantram
Repetition
to
Emotional
and
Spiritual
Well-Being
in
Healthcare
Workers
Jill
E.
Bormann,
PhD,
RN,
Sheryl
Becker,
MN,
RN,
Madeline
Gershwin,
MA,
RN,
Ann
Kelly,
MSN,
APRN,
BC,
Laureen
Pada,
MSN/MBA,
RN,
Tom
L.
Smith,
PhD,
and
Allen
L.
Gifford,
MD
abstract
Background:
Healthcare
workers
report
high
levels
of
stress
in
the
workplace.
To
determine
how
to
reduce
stress,
the
authors
examined
the
effectiveness
of
frequently
repeat-
ing
a
mantram
(a
word
with
spiritual
meaning)
on
emotional
and
spiritual
well-being.
Methods:
A
pretest-posttest
design
was
used
to
mea-
sure
stress,
state/trait
anxiety
and
anger,
quality
of
life,
and
spiritual
well-being
in
a
convenience
sample
(N
=
42)
of
hos-
pital
workers
completing
a
mantram
intervention
program.
Results:
Significant
improvements
were
found
in
stress
(p
<
.001),
trait-anxiety
(p
=
.002),
trait-anger
(p
=
.02),
qual-
ity
of
life
(p
=
.001),
and
spiritual
well-being
(p
=
.003).
When
examining
the
effects
of
mantram
practice,
trait-anxiety
and
religious
and
spiritual
well-being
were
significant
(p
<
.05).
Conclusion:
Improvements
in
emotional
and
spiritual
well-
being
may
be
mediated
by
frequent
mantram
repetition.
H'ealthcare
workers,
particularly
nurses,
have
reported
.high
levels
of
stress
that
are
closely
linked
to
a
wide
range
of
health
outcomes
(Sullivan,
Kerr,
&
Ibrahim,
1999).
A
review
of
64
studies
on
stress
management
interventions
offered
in
the workplace
has
indicated
the
most
common
techniques
used
to
reduce
stress
are
progressive
muscle
re-
laxation
(DeBerry,
1981-1982;
Schneider
et
al.,
1995),
mind-
fulness
meditation
(Kabat-Zinn
&
Chapman-Waldrop,
1988;
Kabat-Zinn
et
al.,
1992),
transcendental
meditation
(Alexander,
Swanson,
Rainforth,
&
Carlisle,
1993;
Benson,
1983;
Jevning,
Anand,
Biedebach,
&
Fernando,
1996;
See-
man,
Dubin,
&
Seeman,
2003),
biofeedback
(Jacobs,
Ben-
son,
&
Friedman,
1996),
and
cognitive-behavioral
skills
(Murphy,
1996).
Other
examples
include
autogenic
train-
ing
(Takaishi,
2000),
hypnosis
(Bilkis
&
Mark,
1998;
Saletu,
1987),
and
guided
imagery
(Eller,
1999).
A combination
of
these
techniques
has
been
more
suc-
cessful
than
single
techniques
on
a
variety
of
physical
and
psychological
health
outcomes.
However,
these
traditional
meditative
and
relaxation
techniques
often
require
silence,
solitude,
and
interruption
in
daily
activity
to
be
practiced.
The
purpose
of
this
study
was
to
examine
the
feasi-
bility
and
effectiveness
of
frequently
repeating
a
silent
mantram
(a
word
or
phrase
with
spiritual
meaning)
on
stress,
quality
of
life,
and
measures
of
spiritual
well-be-
ing in
a
volunteer
group
of
healthcare
workers.
Unlike
other
forms
of
meditation
or
relaxation
techniques,
mantram
repetition
can be
used
throughout
the
workday
(Bormann,
2005).
It
offers
the
practical
advantage
of
be-
ing
implemented
any
time,
day
or
night,
without
special
equipment
or
need
for
a
quiet
environment
(Easwaran,
1998/2001;
Oman
&
Driskill,
2003).
This
is
especially
useful
to
healthcare
providers
who
routinely
deal
with
crises
and
who
may
benefit
from
a
portable,
easy,
and
inexpensive
tool
in
the
workplace
(Bormann,
2005).
In
addition,
mantram
repetition
incorporates
spiritu-
ality,
a
factor
that
is
becoming
recognized
as
a
vital
com-
ponent
in
health
and
well-being
(Hawks,
Hull,
Thalman,
Dr.
Bormann
is
Research
Nurse
Scientist,
VA
San
Diego
Healthcare
System,
and
Adjunct
Nursing
Research
Professor,
School
of
Nursing,
San
Diego
State University,
San
Diego,
California.
Ms.
Becker
and
Ms.
Ger-
shwin
are
Nurse
Case
Managers,
Nursing
Service,
and
Ms.
Pada
is
Patient
Health
Education
Coordinator,
VA
San
Diego
Healthcare
System,
San
Di-
ego,
California.
Ms.
Kelly
is
Nurse
Educator,
National
University
and
VA
San
Diego
Healthcare
System,
San
Diego,
California.
Dr.
Smith
is
Princi-
pal
Statistician,
University
of
California
San
Diego,
San
Diego,
California.
Dr.
Gifford
is
Associate
Professor
of
Public
Heath
and
Medicine,
Boston
University,
and
Associate
Director,
VA
Bedford
Centerfor
Health
Quality,
Outcomes
and
Economic
Research,
Boston,
Massachusetts.
The
views
expressed
in
this
article
are
those
of
the
authors
and
do not
necessarily
represent
the
views
of
the
Department
of
Veterans
Affairs.
Address
correspondence
to
Jill
E.
Bormann,
PhD,
RN,
VA
San
Diego
Healthcare
System
IIZN-1,
3350
La
Jolla
Village
Drive,
San
Diego,
CA
92161.
Email:
jilL
bormann@va.gov,
or
visit
http://jillbormann.com.
The Journal
of
Continuing
Education
in
Nursing
•
September/October
2006
•
Vol
37,
No
5
218

&
Richins,
1995;
Miller
&
Thoresen,
2003).
Research
has
shown
high
correlations
between
quality
of
life
and
spir-
itual
well-being
(Brady,
Peterman,
Fitchett,
Mo,
&
Celia,
1999;
Ellison
&
Jonker-Bakker,
1983;
Mytko
&
Knight,
1999;
Tuck,
McCain,
&
Elswick,
2001).
Mantram
repetition
is
actually
an
ancient
practice
found
in
nearly
all
spiritual
traditions that
has been
applied
to
modern
times
in
the
form
of
a
"rapid-focus
tool"
for
training
attention
and
calming
the
mind
(Eas-
waran,
2005;
Flinders, Flinders,
&
Gershwin,
1994).
As
a
mind-body
intervention,
it
is
not
considered
a
tra-
ditional
"relaxation
technique"
per
se,
although,
with
practice,
it
can
lead
to
a
physiological
state
of
relax-
ation.
Its
primary
mechanism
is
one
of
directing atten-
tion
away
from intrusive
thoughts
and
toward
a
cho-
sen
word
or
phrase
(often
with
spiritual
meaning)
that
provides
comfort.
Its
value and
benefits
are
believed
to
be
cumulative
with
consistent
practice.
Implementation
involves
the
same
two
basic
steps
as
Benson's
relaxation
response:
(1)
mentally
repeating
the
word
and
(2)
pas-
sively
disregarding
any
other
thoughts
that
intrude
(Benson,
1983, 1993,
1996).
METHODS
Design
A
non-experimental,
pretest-posttest
design
was
used
to
evaluate
the
intervention program,
which
was
taught
in
group
meetings
over
5
weeks
(90
minutes/
week).
Self-report
questionnaires
were
collected
in
the
first
and last
classes.
Mantram
practice
was
measured
using
wrist-worn
counters,
daily
tracking
sheets, and
a
self-report question.
Nurses
and
social
workers
earned
continuing
education
credit
for
attending.
Intervention
The program
was
based
on The
Mantram
Handbook
(Easwaran,
1998/2001),
which
was
provided
as
the
course
textbook.
The
curriculum
consisted
of
five
classes
employ-
ing
the
following
outline: Class
1-How
to
Choose
a
Man-
tram;
Class
2-How
to
Use
and
Track
Mantram
Practice;
Class
3-Developing
One-Pointed
Attention;
Class
4-Slow-
ing
Down;
and
Class
5-Putting
It
All
Together.
The
course
included
lectures,
group
discussions
on
how
to
incorporate
mantram
repetition
in
daily
life,
and
experiential
exercises,
including mantram
practice
during
classes.
Participants
received
a
manual
of
experiential
exercises
created
for
facilitating
mantram
practice
and
discussion.
They
were
asked
to
choose
a
mantram
from
a
list
of
rec-
ommended
sayings
from
several
major
spiritual
traditions
(Bormann,
2005;
Easwaran,
1998/2001).
For
example,
op-
tions
included
the
Hindu
sayings
"Rama
Rama,"
an
invo-
cation
for joy within,
and
"Om
Prema,"
a
call
for
univer-
sal
love;
the
Buddhist
phrase
"Om
Mani
Padme
Hum,"
a
blessing
of
the
heart;
the
mantram
of
St.
Francis
of
As-
sisi,
"My
God
and
My
All";
a
Native
American
prayer
to
the
Great
Spirit,
"0
Wanka
Tanka"; and
the
Judaic
say-
ings
"Barukh
Atah
Adonoi"
and
"Shalom,"
which
mean
"Blessed
are
you,
Lord"
and
"peace,"
respectively.
During
the
course,
the
concepts
of one-pointed
attention
and
slowing
down
were
taught
as
complementary
skills
for
enhancing
mantram
practice.
One-pointed
attention
is
de-
fined
as
focused
concentration
on
the
mantram
in
the
mind
or
on
a
selected
task
or
activity
of
one's
choice,
without
multi-tasking.
One-pointed
attention
is
necessary
to
men-
tally
repeat
a mantram.
Practicing
one-pointed
attention
as
frequently
as
possible
during
daily
activities
is
believed
to
enhance
mantram
repetition.
One
homework
assignment
was
to
practice
one-pointed
attention
by
choosing
to
do
only
one
thing
at
a
time
and
to
become
aware
of
the tenden-
cy
for
multi-tasking.
For
example,
preparing
medications
in
the workplace
requires
one-pointed attention.
Slowing
down
is
defined
as
living
intentionally
with-
out
hurry,
and may
require
resetting priorities
and
elimi-
nating
unnecessary
commitments.
American
culture
values
speed,
but hurrying
often
creates
time
pressure.
Becoming
aware
of
how
fast
paced
our
lives
are
allows
an
opportunity
to
slow
down
intentionally
and
priori-
tize
activities.
Within
the
mind,
mantram
repetition
aids
in
slowing
thoughts.
While
externally
engaged
in
an
ac-
tivity,
slowing
down
improves
efficiency
and
safety.
All
three
skills-mantram
repetition,
one-pointed attention,
and
slowing
down-work
together
synergistically
to
re-
duce stress
(Bormann,
2005;
Easwaran,
2005).
Throughout
the course,
practicing
mantram repetition
during
non-stressful
times
such
as
before
falling
asleep
or
while
waiting
in
lines
was
emphasized
to
promote
an
association
between
the
word
and
a
physiological
state
of
calm.
If
practiced
consistently
and
frequently,
man-
tram
repetition
is
believed
to
modify or
buffer
the
stress
response
because
of
this
mind-body
association.
Theoretical
Framework
and
Hypotheses
The
hypothesized
model
of
the stress
response
(Biondi
&
Picardi,
1999)
was
modified
by
Bormann
for
this
study.
In
this model,
work
demands
lead
to
in-
creased
symptoms
of
stress,
anxiety,
and
anger,
which
contribute
to
reductions
in
quality
of
life
and
spiri-
tual
well-being.
These
symptoms
of
stress
are
modi-
fied
when
using
mantram
repetition,
which
interrupts
intrusive
thoughts that
trigger
the
stress
response.
By
redirecting
negative
thoughts
to
a
mantram,
symp-
toms
of
stress, anxiety,
and
anger
are
modified
or
at-
tenuated.
When
stress
is
reduced,
quality
of
life and
spiritual
well-being
subsequently
improve.
Frequent
Mantram
Repetition
•
Bormann
et
aL
219

TABLE
1
OUTCOME
VARIABLES,
INSTRUMENTS,
AND
INTERNAL
CONSISTENCY RELIABILITIES
Format
Cronbach's
alpha
Stress
Anxiety
Anger
Quality
of
life
Spiritual
well-being
Perceived
Stress
Scale
Spielberger
State-Trait
Anxiety
Inventory
Spielberger
State-Trait
Anger
Inventory
Quality
of
Life
Enjoyment
&
Satisfaction
Short
Form
Total
Spiritual
Well-Being
Scale
Religious
Well-Being
Subscale
Existential
Well-Being
Subscale
10
items,
5-point
Likert
.88
40
items,
4-point
Likert
State-Anxiety
.93,
Trait-Anxiety
.91
20
items,
4-point
Likert
State-Anger
.91,
Trait-Anger .78
16
items,
5-point
Likert
20
items,
6-point
Likert
10
items
10
items
.88
.94
.95
.88
The
study
tested
the
following hypotheses:
workers
completing
the mantram
course
will
demonstrate
(1)
a
sig-
nificant
decrease
in
perceived
stress
and
state/trait
anxiety
and anger
scores
and
(2)
a
significant
increase
in
quality
of
life
and
spiritual
well-being between
pretest
and
posttest.
State
levels
of
anxiety
and
anger
refer
to how
par-
ticipants
feel
about questionnaire
items
right
now,
in
the
moment,
whereas
trait
levels
of
anxiety
and
anger
refer to
how
they
generally
feel.
Quality
of
life
refers
to
participants'
satisfaction
with
various
life
areas,
such
as
physical
and
mental
health status,
work,
fam-
ily
relationships,
leisure time,
economic status,
sexual
function,
and
living
situation.
Total
spiritual
well-be-
ing
consists
of
religious
well-being
with
items
related
to
one's
relationship
to
God
or
a
Higher
Power
and
existential
well-being
with
items
related
to
meaning
and
purpose
in life.
Sample
Institutional
review
board
approval
was
obtained
pri-
or
to enrolling
participants
in
the
program.
The
popula-
tion
consisted
of
employees
from the
Veterans
Affairs
San
Diego
Healthcare
System,
a
large
medical center
dedicated
to
the
care
of
veterans. E-mails and
flyers
were
used
to
promote
the
course
throughout
the
medical cen-
ter. The
classes
were
free
and
no
financial
incentives
for
participating
were
given.
The
same
two
psychiatric nurs-
es
taught
all
courses.
Data
were
collected
between
April
2001
and
December
2003.
Ninety-three
healthcare
workers
registered
for
the
course
and were
invited
by
the
instructors
to partici-
pate
in
the
research
at
the
end of
the
first
class;
62
gave
informed consent
and were
included
in
this
study.
Half
of
the
participants
were nurses
and half were
hospi-
tal
staff.
Participants'
ages
ranged
from
30
to
62
years,
with
a
mean
of
47.8
years (SD
=
8.33
years);
87.5%
were
women.
Of
the
33
participants
who
reported
ethnicity,
26
(79%)
were
white,
3
(9%) were
Asian,
2
(6%)
were
Hispanic,
1 (3%)
was
African
American,
and
1
(3%)
was
identified
as
Other.
Thirty-nine
participants
(62.9%)
had
perfect
attendance
and
the
rest
(37.1%)
attended
4
of
5
classes.
Of
the
total
participants,
42
(68%)
had
complete
sets
of
weekly
mantram
tracking
data
for
statistical
anal-
ysis.
Due
to
its
exploratory
nature, additional
measures
were
added
to
the
study,
creating
different
sample
sizes
for
each
outcome
measure.
Measures
Outcomes
were
measured
by the
following
in-
struments
that
have
reported
validity
and
reliability:
Cohen's
Perceived
Stress
Scale
(Cohen,
Kamarck,
&
Mermelstein,
1983;
Cohen,
Revicki,
Nabulsi,
Sarocco,
&
Jiang,
1998),
the
Spielberger
State/Trait
Anxiety
In-
ventory
and
the
Spielberger
State/Trait Anger
Inven-
tory
Short
Form
(Spielberger,
1972,
1983;
Spielberger,
Jacobs,
Russel,
&
Crane,
1983),
Endicott's
Quality
of
Life
Enjoyment
and
Satisfaction
Short
Form
(Endicott,
Nee,
Harrison,
&
Blumenthal,
1993),
and
the
Spiritual
Well-Being
Scale
(Ellison
&
Jonker-Bakker,
1983;
Life
Advance
Inc.,
n.d.;
Paloutzian
&
Ellison,
1982).
Inter-
nal
consistency reliability
was
determined
for
each
in-
strument
using
Cronbach's
alpha
(Table
1).
Mantram
usage
was
tallied
using
wrist-worn
counters
(golf
scorers)
to track
the
daily
frequency
of
mantram
repetition
from
week
2
through
week
5
outside of
class.
Because
it
is
impractical
to
count
each
repetition
of
a
word
or
phrase,
counters
were
used to track
the
num-
ber
of
times
participants
remembered to initiate
repeat-
ing
a
series
or
"session"
of
mantrams.
Participants
re-
corded
their
daily
totals
on
sheets
collected
weekly
by
instructors.
In
the
last
class,
participants
were
also
asked,
"During
the
past
week,
on the
days
you
repeated
your
mantram,
how
often
per
day
on
average
did
you
initiate
repeating
your
mantram?"
The
Journal
of
Continuing
Education
in
Nursing
•
September/October
2006
•
Vol
37,
No
5
Variable
Instrument
220

Analysis
To
test
the
hypotheses
of
the
effects
of
the
mantram
course
on
outcomes,
repeated
measures
analysis
of
variance
(ANOVA)
models
were
run
on
all
variables.
A
secondary
analysis
was
done
to
assess
the
specific
effect
of
mantram
practice
on
outcomes.
The
sample
was
divided
into
high
and
low
mantram
user
groups.
Then
2
group
(high
and
low
mantram
users)
by
2
time
(pre-intervention
and
post-in-
tervention)
repeated
measures
ANOVA
models
were
per-
formed
on
each
outcome.
The
relationship
between
self-
reported
mantram
practice
and
counter-tracked
mantram
practice
was
also assessed
using
a
Pearson
correlation.
RESULTS
Hypothesis
Testing
Results
of repeated
measures
ANOVA
models
dem-
onstrated
significant
pre-intervention
to
post-interven-
tion
reductions
in
perceived
stress,
trait-anxiety,
and
trait-anger,
but
not
in
state-anxiety
or
state-anger,
thus
partially
supporting
hypothesis
1.
There
were
signifi-
cant
increases
in
quality
of
life
and
existential
and
total
spiritual
well-being,
but
no
change
in
religious
well-be-
ing,
partially
supporting
hypothesis
2
(Bormann,
Beck-
er,
Gershwin,
&
Kelly,
2004). To
maintain
an
overall
alpha
value
of
.05
with
9
tests,
Bonferroni's
correction
with
an
a
value
of
.006
was
used.
Five of
six
outcomes
were
still
significant
at
a
p
level
of
less
than
.006.
These
data
are
presented
in
Table
2.
Not
surprisingly,
these healthcare
workers
had
high-
er levels
of
perceived
stress
(M
=
19.0;
SD
=
5.48)
than
the
general
population
(M
=
11.9;
SD
=
6.9)
(Cohen
&
Williamson,
1988).
On
measures
of
anxiety
and
anger,
this
sample
had
higher
levels
of
trait-anxiety
(M
=
38.5;
SD
=
9.76)
and
trait-anger
(M
=
16.2;
SD
=
3.15),
but
they
had
lower
levels
of
state-anxiety
(M
=
33.5;
SD
=
10.28)
and
state-anger
(M
=
10.8;
SD
=
1.80)
compared
to
the
population
norms for
trait-anxiety
(M
=
34.9;
SD
=
9.19),
trait-anger
(M
=
18.4;
SD
=
6.36),
state-anxiety
(M
=
35.7;
SD
=
10.40),
and
state-anger
(M
=
14.2;
SD
=
5.73)
(Spielberger,
1983;
Spielberger
et
al.,
1983;
Spiel-
berger,
Sydeman,
Owen,
&
Marsh,
1999).
Similarly,
this
sample
had
lower
levels
of
quality
of
life
(M
=
49.9;
SD
=
8.46)
and
total
spiritual
well-being
(M
=
90.0;
SD
=
19.30)
compared
to
the
population
norms
for
quality
of
life
(M
=
55.1;
SD
=
7.0)
(Gelfin,
Gorfine,
&
Lerer,
1998)
and
total
spiritual
well-being
(M
=
99.8;
SD
=
16.01)
(El-
lison,
Paloutzian,
&
Bufford,
1991).
In
the
secondary
analysis,
high
and
low
mantram
user
groups
were
created
by
dividing
mantram
practice
at
the
mean.
High
mantram
users
(n
=
24)
practiced
an
aver-
age
of
8.1
(SD
=
2.34)
sessions
per
day
compared
to
low
mantram
users
(n
=
18)
with
an
average
of
3.0
(SD
=
0.95)
sessions
per
day.
A
2
group
(high
and
low
mantram
us-
ers)
by
2
time
(pre-intervention
and
post-intervention)
ANOVA
demonstrated
significant
group
by
time
effects
for
trait-anxiety,
religious
well-being,
and
total
spiritual
well-being
(Figure).
This
provides
evidence
that
high
mantram
users
had
significant
reductions
in
trait-anxiety
and
increases
in
both
religious
and
total
spiritual
well-
being
compared
to
low
mantram
users.
Participants
verbally
reported
using
counters
to
track
their
mantram
practice.
To
further
assess
adherence
to
mantram
repetition,
a
Pearson
correlation
between
coun-
ter-tracked
mantrams
and
self-reported
mantram
practice
Frequent
Mantram
Repetition
-
Bormann
et
aL
TABLE
2
RESULTS
OF
MANTRAM
INTERVENTION
ON
OUTCOMES
USING
ANALYSIS
OF
VARIANCE
(ANOVA)
Time Effects
ANOVA
Outcomesa
Pretest
Mean
(SD)
Posttest
Mean
(SD)
F
(do
p
Perceived
stress
(n
=
42)
19.0
(5.48)
14.6
(6.34)
28.44
(1.41)
.001
State-anxiety
(n=
24)
33.5
(10.28)
29.7
(10.33)
2.44
(1.23)
.14
Trait-anxiety
(n
=
26)
38.5
(9.76)
34.6
(9.27)
11.70
(1.25)
.002
State-anger
(n
=
34)
10.8
(1.80)
10.3 (1.08)
3.29
(1.33)
.08
Trait-anger
(n
=
35)
16.2
(3.15)
15.3
(3.45)
5.94
(1.34)
.02
Quality
of
life
(n
=
36)
49.9
(8.46)
56.0
(5.78)
30.46
(1.35)
.001
Existential
well-being
(n
=
33)
46.8
(7.93)
50.0
(7.71)
14.54
(1.32)
.001
Religious
well-being
(n
=
33)
44.1
(13.05)
45.2 (13.15)
1.57
(1.32)
.22
Total
spiritual well-being
(n=
33)
90.9
(19.30)
94.9
(18.16)
10.09
(1.32)
.003
'Higher
scores
indicate
greater
amounts
of
the
variable.
221

Trait
Anxiety
F
(1,31)
=
4.41;
p
<
.05
0
U)
1
0
C)
0,
0
U)
46
44
42
40
38
36
34
32
30
Pretest
Posttest
Religious
Well
Being
F(1,31)
=
4.69;
p
<
.05
0)
U)
A-.
0
U)
C
cc
50
48
46
44
42
40
38
36
60
55
50
45
40
35
30
Pretest
Posttest
Total
Spiritual
Well
Being
F
(1,31)
=
7.57;
p
<
.01
AF-
A
Pretest
Posttest
-
High
Mantram
Users
---
-
Low
Mantram
Users
*
Higher
scores
=
greater
amounts
of
variable
Figure.
Pre-intervention
to
post-intervention
scores*
on
trait
anxiety, religious
well-being,
and
total spiritual
well-being
by
high
and
low
mantram
users.
during
the
last
week of
the
course
resulted
in
a
significant
positive relationship
(r
=
.
8 3
;p
<
.001;
n
=
31).
DISCUSSION
Results of
this
exploratory
study
demonstrate that
frequent
mantram
repetition
is a
feasible
and
effective
stress
management
strategy
for
use
in
the
workplace.
It
is
an
ancient
yet
innovative
technique
that
incorporates
a
spiritual
element,
which
was
shown
in
this
study
to
sup-
port
improvements
in
quality
of
life
and
spiritual
well-
being.
Classes
required
only
a
trained
facilitator,
text
materials,
and
classroom
space,
making this
educational
experience
convenient
and
practical
for
many
settings.
In
this
sample
of
primarily
female
healthcare
work-
ers,
there
were
significant
reductions
in perceived
stress
and
trait
scores
of anxiety
and
anger,
but not
state
scores.
One
explanation
for
no
difference in state scores
is
that
workers
filled
out
questionnaires
at
the
end of
class,
a
time
when
they
were
probably
less
anxious
or
angry.
In-
stead,
participants
reported
overall
general
reductions
of
perceived
stress,
trait-anxiety,
and
trait-anger,
indicating
that
the
effects
of
the
course
were experienced,
in
gen-
eral,
outside of
the
class.
These findings
support
using
trait
measures
for
future
research.
There
were
also
significant
pre-intervention
to post-
intervention
improvements
in
quality
of
life,
existential
spiritual
well-being,
and
total spiritual
well-being,
but
not
religious
well-being.
These
findings
may
be
explained
by
the
emphasis
on
the
spiritual,
rather
than
religious,
nature
of
the
course.
Participants
were encouraged
to
choose
their own
mantrams
with
a
spiritual
and
personal
mean-
ing.
Spirituality
was
discussed
as
a
coping
resource
with-
out
dependence
on
religious
dogma
or
church
doctrines.
One
strength
of
this
study
was
the
evaluation of
the
frequency
of
mantram
practice
using
both
real-time
as-
sessment
with
personal
counters
and
retrospective
as-
sessment of
mantram
use
with
a
self-report
question
in
the
last
week
of
the
course.
Despite
having
no
control
group,
interpretation
of
the
data
was
strengthened by
a
2
group
(high and
low
mantram
users)
by
2
time
(pre-
intervention
and
post-intervention)
analysis.
As
for
the
effects
of mantram
practice,
high
mantram
users
reported
significant
reductions
in
trait-anxiety
and
significant
increases
in
both
religious and
total
spiritual
well-being compared to
low mantram
users. This
finding
suggests
mantram
repetition
is
useful
for
managing
anxi-
ety
and
enhancing one's
spiritual
and
religious
resources.
This
finding
also
suggests
that
mantram
practice
in
itself
provides
a
unique
contribution
to
stress
reduction
be-
yond
the
group
intervention
experience.
This
study
evaluated the
overall
effect
of
a
mantram
group
intervention
and
examined
the
specific
effects
of
high
versus
low
mantram
repetition
or
practice.
Both
effects
were
not
consistently present
for
each
outcome.
For
example,
changes
in
trait-anxiety
and
total
spiritual
The Journal
of
Continuing
Education
in
Nursing
•
September/October
2006
•
Vol
37,
No
5
222

well-being
were
related
to
both
group
participation
and
high
mantram
practice.
Changes
over
time
for
perceived
stress,
trait-anger,
quality
of
life,
and
existential
spiritual
well-being
were
related
to
group
participation
but
not
to
high
mantram
practice.
Change
in
religious
well-being
was
related
to
high
mantram
practice
but
not
to
group
participation.
These
discrepancies
might
be
explained
as
a
lack
of
power
due
to
small
sample
size,
or
perhaps
the
sample
actually
received
uniquely
different
benefits
from
the
group
experience
and
amount
of
mantram
practice.
There
are
several
limitations
to
this
study,
indicat-
ing
the
need
for
further
research.
There
was
no
control
group
and
the
sample
was
small,
non-random,
and
pri-
marily
female.
We
also
did
not
identify
the
words
chosen
by
participants.
Attending
a
weekly
support
group
alone
may
have
contributed
to improvements
and
there
was
no
follow-up.
More
research
using
larger,
more
diverse
samples
and
experimental
designs
is
warranted.
CONCLUSIONS
Findings
provide
preliminary
support
that
a
5-week
mantram
intervention
program
for
hospital
workers
results
in
significant
improvements
in
measures
of
perceived
stress,
trait-anxiety,
trait-anger,
quality
of
life,
existential
spiritual
well-being,
and
total
spiritual
well-being.
Results
showed
that
for
some
outcomes,
after
dividing
the
sample
into
high
and
low
mantram
users,
changes
over
time
from
pre-inter-
vention
to
post-intervention
were
mediated
by
mantram
practice.
These
findings
are
consistent
with
the
literature,
indicating
that
mind-body-spiritual
therapies
provide
mul-
tiple benefits
and
increase
the
feeling
of
well-being
(Astin,
Shapiro,
Eisenberg,
&
Forys,
2003;
Bormann,
Gifford,
et
al.,
2006;
Bormann,
Oman,
et
al.,
2006;
Jacobs,
2001).
Implications
Healthcare
workers
are
a
highly
stressed
population.
It
is
not
surprising
to
find
that
healthcare
worker
stress
contributes
to
poor
health
outcomes
and
impairs
qual-
ity
of
life
(Murphy,
1996).
Innovative
stress
management
programs,
especially
those
acknowledging
aspects
of
one's
spirituality,
could
be
offered
as
continuing
educa-
tion
in
the
workplace,
making
them
convenient
and
ac-
cessible.
Stress
management
interventions
with
a
spiritual
component
may
enhance
workers'
psychological
health
and
improve
spiritual
well-being
(Bormann,
2005).
Mantram
repetition
is
an
innovative
strategy
that
is
portable,
easy
to
implement,
and
inexpensive.
Results
of
this
preliminary
study
suggest
mantram
repetition
may
be
an
effective
intervention
strategy
for
use
among
health-
care
workers,
and
more
research
is
warranted.
Mantram
group
intervention
in
the
form
of
continuing
education
and
mantram
practice
shows
promise
for
reducing
anxiety
key
points
Frequent
Mantram
Repetition
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.
The
Journal
of
Continuing
Education
in
Nursing,
37(5),
218-224.
1Healthcare
worker
stress
contributes
to
poor
health
outcomes
and
impairs
quality
of
life,
leading
to
reduced
quality
of
care.
2
Mantram
repetition
is
an
innovative
stress
reduction
strategy
that
is
portable,
convenient,
easy
to
implement,
and
inexpensive.
3
Mantram
repetition
is
useful
for
managing
anxiety
and
enhancing
spiritual
and
religious
resources
to
reduce
stress
among
healthcare
workers.
in
the
workplace
and
for
deepening
spirituality
in
health-
care
workers-all
of
which
may
improve
quality
of
life.
ACKNOWLEDGMENTS
The
authors
thank
the
Department
of
Veterans
Affairs
in
San
Di-
ego,
California,
and
the
VA
Office
of
Academic Affiliation
for
support;
the
Institute
of
Nursing
Research
at
San
Diego
State University
School
of
Nursing
and
the
Gamma
Gamma
Chapter
of
Sigma
Theta
Tau
In-
ternational
Honor
Society
for
partial
funding;
and
the
UCSD
Clinical
Research
Center
NIH
grant
M01
RR0087
for
infrastructure
support.
We
acknowledge
the
contributions
of
Eknath
Easwaran
from
the
Blue
Mountain
Center
of
Meditation,
and
Nilgiri
Press
(www.easwaran.org),
Tomales,
CA;
also,
special
thanks
to
Walter
Boyle,
ITS,
and
computer
support.
Portions
of
this
paper
were
presented
at
the State
of
Science
Con-
gress
2002
in
Washington,
DC;
the
Western
Institute
of
Nursing
Confer-
ence
2002
in
Palm
Springs,
CA;
and
the
Western
Institute
of
Nursing
Conference
2004
in
Portland,
OR.
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