1. Introduction

Meditation practice is increasingly becoming utilized as a means for stress reduction among college students. [1-6]^[1] Meditation practices can be oriented around formal or informal meditation (sitting meditation, as opposed to developing awareness of the present moment in daily life). The words meditation, mindfulness, and mindfulness meditation tend to be used in the field interchangeably. ^[7] In this article all three are used, and any use of the word meditation is intended to incorporate the mindfulness components of awareness in the present moment. ^{[8, 9]} If mindfulness is used by itself, it is to differentiate between mindfulness in everyday life, as opposed to its use in meditation.

The purpose of the study was to identify barriers, opportunities and variables involved in promoting use of meditation in college students for stress reduction. College students have a high burden of stress resulting from balancing college life, academic studies, work, and family. ^[10] A first step in this direction, and the purpose of this study is a Knowledge, Attitudes, and Beliefs (KAB) survey of college students regarding their interest and understanding of meditation. Just as it is important to identify how to encourage exercise among sedentary individuals who are disinterested in exercise, it would be important to discover current KAB, to overcome barriers and determine what would motivate people to learn meditation and mindfulness techniques.

The Health Belief Model (HBM) is a conceptual framework used as a guideline for developing health behavior interventions. ^[11] The key constructs are: Perceived Susceptibility (perception of one’s degree of susceptibility to a health concern) and Perceived Severity (perceptions regarding the seriousness of the health concern) which can be grouped together as “Perceived Threat,” Perceived Benefits (Belief of potential benefits of a health practice), Perceived Barriers (Moderating elements that inhibit undertaking a desired behavior), as well as Self-Efficacy (Belief in one’s ability to carry out a health intervention). Cues to Action is a sixth variable that relates to cues that can trigger action. This framework is used to identify and discuss elements relating to the use of meditation for behavioral health, as well as to categorize the responses from the survey regarding meditation KAB of college students in a general education class on personal and family health at a major university.

2. Review of Literature

Germer and others ^[7] note that formal mindfulness meditation, using the example of 45 minutes each day, can be challenging to those who do not come specifically for therapy utilizing mindfulness training. Germer and colleagues state however, that any person can benefit from stopping activity for a few minutes and being mindful of their current state and thoughts. It is suggested that informal, everyday mindfulness exercises are the most easily integrated into psychotherapy. It may be that for people not predisposed towards meditation, informal momentary mindfulness may be the most effective method for incorporating the principles of meditation (awareness, stopping of incessant and destructive thoughts, and the development of an ever-present sense of peace). Informal momentary meditation would also help to overcome the barrier of time.

Germer and others ^[7] noted that only 54% of outpatients continued concentration (more formal) meditation, and that those who where in distress, or expected benefits, were the most likely to continue. The latter further supports the need to understand the KAB of meditation. A Mindfulness Based Stress Reduction (MBSR) program conducted by Jon Kabat-Zinn, one of the pioneers of MBSR, is presented by Germer and colleagues as an example. 75% of chronic pain patients were still practicing meditation up to four years after the end of the program, due to health threats. From the perspective of the HBM, perceived threat to one’s health is a major factor in health practice motivation, stressing the importance of educating people with severe health concerns on meditation benefits.

Jon Kabatt-Zinn ^[12] notes that he is frequently asked if anyone can meditate, further supporting a strong need for educating the public on the basics and benefits of meditation. He observed that many people feel they are incapable of meditation, that if they do not get immediate benefits from attempts to meditate, that it must not work for them. Educating potential meditators on the process of meditation, from early stages to the benefits experienced by long-term meditators, would help to address this barrier. The same would be true of the benefits of mindfulness.

Ironically, it may be the very awareness raising element of mindfulness and meditation (the increased awareness of threats and uncertainty), that may be the reason behind resistance to meditation – essentially a resistance to awareness of what is actually going on in one’s life. In other words, ignorance is bliss. David Brazier, a therapist specializing in Zen therapy, addresses this as dissimulation of the unconscious. ^[13] Increased awareness may exacerbate cognitive dissonance by “throwing in your face” contradictions in behavior, inabilities to deal with difficult situations, or even awareness that a person is in a destructive situation. A subconscious awareness of this may cause a person to actively resist any activity that causes them to look within and become more aware of one’s inner state and outer circumstance.

Brazier states that a therapist who attempts too quickly to lay a clients soul bare may cause more damage than good. He stresses the need for patience and the utilization of mindfulness to first ground the client in a more powerful life, which ultimately may even negate the necessity for facing one’s inner demons. Brazier further states that the goal of Zen is not an attempt at complete congruency and integration, but rather a return to original nature. In Zen philosophy, original nature refers to the ideal self before the influence of negative and destructive elements of socialization. From a Zen perspective, to become an empty vessel, taking in and seeing each new experience as it is, in the moment, unburdened by the past. As stated in the “Tao Te Ching,” to become an “Uncarved Block.” ^[14].

Germer and colleagues ^[7] also addresses the barrier of not wanting to dwell on one’s flaws and incongruencies, stating the need to focus on the present moment, empty of the past, and just remembering to “Be.” He states that a changed relationship to experiences is necessary to reduce or even eliminate fixation with past problems or future worries. Resistance to meditation may very well come from what the authors identify as the “fear of stopping the striving in life, even for a moment.”

But by focusing on just “Being,” rather than opening a door to destructive thoughts and emotions, such emotions may be circumvented with peaceful and healthy living following naturally. For the college student, this may mean learning to be more focused on the tasks of academia at hand, rather than the distractions of college life or the stress of approaching deadlines. Being focused “in the moment” while working on a paper can create a more positive state of mind from which to work more efficiently.

Various forms of mindfulness practices can result in benefits among college students. Caldwell and others ^[1] studied 166 college students enrolled in 15-week classes of consisting of Gyrokinesis, Pilates, and Taiji quan. The Pilates and Gyrokinesis classes met twice a week for 75 minutes or three times a week for 50 minutes, and the Taiji quan met twice a week for 50 minutes. The authors found that total mindfulness scores were significantly higher at the end of the semester compared to measurements taken at the beginning and in the middle of the semester. Not only did mindfulness scores increase but better sleep quality was also reported. In looking at how meditation not only affects stress but also forgiveness among college students, Oman and colleagues ^[2] found that after an eight week 90-minute per session intervention, college students in the treatment group demonstrated lower levels of stress and ruminations and higher levels of forgiveness.

A study by Decrko and colleagues ^[3] found that 90% of college students who completed the program demonstrated significant reduction of psychological distress and anxiety compared to the control group, after a 6-week mind/body intervention comprised of six 90-minute group training sessions focusing on the relaxation response (RR) and cognitive behavioral therapy (CBT). Rosenzweig and others ^[4] used MBSR (mindfulness-based stress reduction) to aid in total mood disturbance (TMD), finding that second year medical students had significantly lower TMD scores than the control group, as well as improved scores on the subscales measuring bewilderment, confusion, fatigue, inertia, tension-anxiety, and vigor-activity. This study also concluded that meditation, specifically MBSR can be an effecting tool in reducing stress among college students.

Other benefits reported from meditation by college students includes a study by Hall ^[5] on the effects of meditation on GPA. Of the 56 African American undergraduate students who participated in this study, those who were randomly selected to the meditation group had higher GPAs in the psychology course they were recruited from, as well as a higher cumulative GPAs for that spring semester. Students practiced meditation at least two times a week for 10 minutes per day for the duration of the semester.

Shapiro et al. ^[6] found significant changes in pre-medical and medical students in psychological distress, increased empathy, and increased spirituality, as well as reduced self-reported and trait anxiety The program consisted of an eight week meditation and stress reduction intervention, with a total of seven 2.5 hour sessions provided, while encouraging both home practices and daily journaling. This study then replicated the 8-week intervention with those in the control group to also compare the effects of this intervention. No changes were found in the control group.

3. Methods

The above studies indicate a significant benefit for a variety of concerns for college students. But if students are resistant towards meditation practice, they are unlikely to participate in meditation programs or use meditation techniques. To gather data to evaluate KAB regarding meditation, and to identify potential barriers to meditation, an open-ended questionnaire was administered to a group of 72 college students in a general education class on personal and family health. The Health Belief Model was utilized to categorize responses according to Perceived Barriers, Perceived Benefits, Perceived Threats, and Self-Efficacy components. Students were asked to express their views and understanding of meditation, conditions under which students might consider trying meditation (related to perceived threats), what aspects of meditation appealed to them (related to perceived benefits), and what aspects of meditation did not appeal (perceived barriers). One student was excluded due to having previous experience with meditation. Refer to table one for survey results and categorization of responses based on thematic analysis.

4. Results and Discussion

Almost half of the students responded that time was a major barrier (n=32). Another potential barrier identified by 13 respondents (18%), related to lack of knowledge or potential misperceptions regarding meditation, particularly in viewing meditation as “new age.” Another barrier, related to the self-efficacy beliefs component of the Health Belief Model, is the number of respondents (n= 9; 12.6%) who made statements indicating that lack of knowledge and lack of confidence were a barrier to trying meditation. This relates to Kabatt-Zinns ^[12] observations commented on above, regarding “can anyone meditate?” Only six respondents (8%) expressed no interest in meditation, stating that meditation was a waste of time.

These barriers might be addressed through education on proven values and benefits of meditation, particularly mindfulness meditation. For those people seeing time as a barrier, it might be pointed out what mindfulness is, and that mindfulness techniques can be incorporated into daily life, enhancing time management and a sense of time relaxation. People might be encouraged to try five minutes of meditation two to three times a day, and note after a one month period if they feel more in control of their lives and more effective in their use of time. As for the barrier of viewing meditation as “new age” (that is, as an alternative view of life, or as one respondent stated; “trying to find one’s “Own God” in themselves”), education on the daily direct practical benefits of mindfulness would be beneficial. As identified by Milroy and O’Neil ^[15], ignorance of the benefits of chiropractic home exercises can be a major barrier to adoption, which may be alleviated with a brochure on the benefits for the patient. The creation of a brochure detailing meditation, mindfulness, techniques, and resources, would ensure people have a grasp on what meditation actually is, as well as its many benefits. Such a brochure would act as a “Cue to Action,” another component of the HBM. It might be considered whether some people relate or benefit more from sitting meditation, mindfulness techniques, moving meditation such as tai chi or kinhin (walking meditation), or other forms of mindful practice (Zen Archery, Tea Ceremony, or even traditional martial training) ^[16].

Table 1. Responses Related to Perceived Barriers, Threats and Benefits

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Three Perceived Benefits of meditation were identified by the participants: Calmness/Relaxation/Stress reduction (n=61; 86%), Focus (n=7; 10%), and Reflection (n=9; 12.5%). These results are significant in that one of the main benefits and purpose of mindfulness and meditation, (enhanced awareness and mindfulness of one’s actions, behaviors, and relationships) was not identified. If the general population thinks of meditation as no more than an aid to relaxation, then a good nap would do as well. What is more, in the fast paced productivity oriented society of the modern world, relaxation, although valuable, is too often seen as an unrealistic luxury (after all, “things must get done!”).

More people might be willing to practice meditation, and even make it a priority in their lives, if the true value of meditation and mindfulness was understood. Aside from promoting the effectiveness of meditation for reducing college stress, it would also be important to create awareness of the benefits of meditation for enabling students to deal better with life problems and difficulties (including exams), for understanding moments of self-sabotage (i.e., all night parties before an exam), and to enhance awareness of all elements of living.

The lack of proper marketing of the true nature and benefits of meditation and mindfulness may be the key barrier to its effective use. The history of Zen as an obscure mystic practice (characterized by what is often viewed as nonsensical riddles, or Koans) rather than as stimulating out of the box thinking, may in the modern world obscure the power of Zen. The crazy stories and bizarre Koans that were key in promoting inspired thought may be a barrier to everyday use. It may be time to translate “What is the sound of one hand clapping” to the everyday verbiage of “people need community.”

Related to the variable of Perceived Threats, 32 individuals (45%) stated that they would practice meditation if they were dealing with large amounts of stress. Identifying and promoting how meditation and mindfulness can benefit mental health and reduce stress may also help in the promotion of these practices. Sometimes it takes the threat of stressful situation to bring about a change in lifestyle. As stated in the Tao Te Ching: “Sick of being sick, so no longer sick.” ^[14].

Guidelines and detailed descriptions of mindful states and benefits, and the process for developing mindfulness, would predispose more people to look into the practice of mindful living. From the perspective of the Health Belief Model, this would address barriers due to ignorance, while increasing likelihood of participation due to enhanced awareness of perceived benefits. Targeting the benefits of meditation for efficient time management for college students, to deal with the chaotic and random life that can arise from unaware living, may also enhance interest in meditation by enhancing awareness of perceived threats and benefits.

To effectively promote meditation and related practices among college students and in society, it is necessary to identify and clarify barriers to these practices, and identify solutions to these barriers, particularly in regards to time. Mindfulness practice apart from meditation was identified as one possible solution by Germer ^[7]. It would also be worth investigating the actual time commitment and structure necessary to reap the benefits of mindfulness practice.

5. Conclusion

Overall, as exemplified in the review of literature, meditative practices may offer a multitude of benefits for college students beyond the common perception of meditation for calmness, relaxation, and stress reduction. These benefits included increase mindfulness scores, better sleep quality, and enhanced forgiveness ^[1]; reduced total mood disturbance, including reduced fatigue and confusion ^[4]; lower levels of rumination and higher levels of forgiveness ^[3]; higher GPA ^[5]; and increased awareness and stopping of incessant and destructive thoughts ^[7].

Ignorance of the benefits of meditative practices can be a major barrier, and was reflected in the responses of the survey participants. To address this issue, education into the benefits and methods of meditation would be paramount, to enhance knowledge and interest in meditation, as well as to create an awareness of the importance of creating time for meditation. It would also be important to clarify how time spent in meditation can lead to reduced stress and increased productivity, and more efficient time management, as well as creating a more time rich life and enhanced sense of temporal well-being.

Other avenues of developing mindfulness, apart from sitting meditation, would also be worth pursuing, to address different personality types and interests. Is tai chi, walking, running, painting, or gardening as effective in promoting mindfulness as is sitting meditation? Zen practice has a long history of association with various physical arts, or Ways, as means of training the mind through focused activity in the present moment.^[16] If the end goal is mindful awareness and an empowered life, various means to this goal may be worth pursuing, to examine effectiveness of the different modalities, as well as to provide options for a diverse population.

Statement of Competing Interests:

No Competing Interests Exist.

References

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