|Year : 2022 | Volume
| Issue : 1 | Page : 24-30
A cross-sectional study on impulsiveness, mindfulness, and World Health Organization quality of life in heartfulness meditators
Dwivedi Krishna1, Deepeshwar Singh1, Krishna Prasanna2
1 Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India
2 Welfare Harvesters, Bengaluru, Karnataka, India
|Date of Submission||31-Jan-2022|
|Date of Decision||03-Apr-2022|
|Date of Acceptance||11-Apr-2022|
|Date of Web Publication||30-Jun-2022|
Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, No. 19, Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Heartfulness meditation (HM) is a heart-based meditation with its unique feature of transmitting energy which may have an impact on mental health and well-being. The present study intends to compare the mental health-related outcomes in long-term HM meditators (LTM), short-term HM meditators (STM), and control groups (CTL).
Materials and Methods: The self-reported measures of mental health and well-being are reported by using State Trait Anxiety Inventory-II, Barratt Impulsive Scale-11, Mindfulness Attention Awareness Scale, Meditation Depth Questionnaire, and World Health Organization Quality of life-BREF. A total of 79 participants (29 females) participated in LTM (n = 28), STM (n = 26), and CTL (n = 25) with age range 30.09 ± 6.3 years.
Results: The LTM and STM groups showed higher mindfulness along with the depth of meditation, quality of life, and lower anxiety and impulsivity than to CTL group. Our findings suggest that the HM practice enhances mindfulness, reduces anxiety, and regulates impulsivity. The LTM and STM groups showed significant positive trends of mindfulness as compared to CTL.
Conclusion: The results indicated that HM practice could be an effective intervention for reducing anxious and impulsive behavior by subsequently improving mindfulness-related mental health and well-being.
Keywords: Anxiety, heartfulness meditation, impulsivity, mental well-being, mindfulness, quality of life
|How to cite this article:|
Krishna D, Singh D, Prasanna K. A cross-sectional study on impulsiveness, mindfulness, and World Health Organization quality of life in heartfulness meditators. Yoga Mimamsa 2022;54:24-30
|How to cite this URL:|
Krishna D, Singh D, Prasanna K. A cross-sectional study on impulsiveness, mindfulness, and World Health Organization quality of life in heartfulness meditators. Yoga Mimamsa [serial online] 2022 [cited 2023 Jun 7];54:24-30. Available from: https://www.ym-kdham.in/text.asp?2022/54/1/24/348200
| Introduction|| |
Meditation is a self-regulated contemplative practice that helps to improve mental functioning and well-being. Patanjali yoga sutra, the ancient yogic text compiled by sage Patanjali defines “meditation as a balanced, continuous and natural flow of attention directed towards the one point or region of meditation” (Chapter III verses 2; PSY). Later, meditation has categorized into different types of meditative practices as described elsewhere., However, in any meditation technique, the practitioner tends to continuously focus on the chosen object for a considerable amount of time and that leads to a focused attentive state of mind. Once the practitioner becomes experienced enough to avoid mind wandering and maintain sustained attention for a considerable amount of time, the practitioner gradually enters the state of deep meditation. Last two decades, researchers have observed that meditation is capable of promoting mental health and wellbeing. Scientific investigations reported that the meditation practice helps to reduce anxiety, depression, and emotional dysregulation.,,,,
In recent years, meditation has emerged as a preventive and potential therapeutic tool for psychiatric and psychosomatic problems due to the resultant outcome of meditation techniques for reducing stress, anxiety, and depression.,, A disturbed mental state is associated with an inability to regulate an emotional response to perceived threats, and meditation practice strengthens a person's mental ability to control emotions when anxious. The scientific investigations on meditation have focused on outcome measures such as cognitive functions, health behaviors, psychological effects, and synchronicities. Previous studies have reported that the mindfulness meditation improves behavior control, quality of life, and reduced impulsivity., There is a vast literature on mindfulness meditation concerning mental health issues such as impulsive behavior or distress, and emphasis on protective capacities for distress tolerance and resilience., Today, meditation is acceptable and readily adaptable to daily lives to promote mental health and well-being., However, more research is needed to understand the relationship between various mental health with duration and quality of meditation practice.
The practice of heart-based meditation has been tested as a potential preventive intervention for a wide range of clinical and psychological issues., HM practice is a modified form of Raja Yoga meditation consisted of meditation, cleaning, and prayer. Empirical evidence suggests that Raja yoga has a positive influence on physiological, emotional, and psychological wellbeing. Further, it has a beneficial effect on emotional regulation, pro-social behavior, positive health, and quality of life.,,, However, there is no study, to our knowledge, that examined the different duration of HM experience on mental health-related outcomes and quality of life. Hence, we aimed to check the effect of HM on mindfulness, anxiety, impulsiveness, depth of meditation, and quality of life in long-term and short-term meditators with reference to nonmeditators.
| Materials and Methods|| |
In the cross-sectional study, 79 participants (29 females) with age ranged between 25 and 45 years were recruited from heartfulness meditation (HM) centers (long-term HM meditators [LTM]: n = 28, short-term HM meditators [STM]: n = 26) and nearby areas (control [CTL]: n = 25). The inclusion criteria were (a) in the LTM group, the participant should have had more than 3 years of HM experience, (b) in the STM group, the participant should have had at least 6–36 months of HM experience, (c) control participants never had the experience of HM in their total life span. The exclusion criteria were (a) presence of any illness, particularly psychiatric disorders, (b) person on any medication, and (c) history of smoking or alcohol. None of the participants were involved in any other ongoing research activity.
All participants were asked to provide their demographic information such as age, gender, occupation, education attainment, meditation experience (in years), frequency of meditation practices (every day, 2–4 times a week, once or twice every week, once every week, or rarely), years of meditation, and the average duration of each meditation session in minutes. The characteristics of the participants are given in [Table 1].
This study was approved by the Ethics Committee of the Institution (RES/IEC-SVYASA/164/1/2020). Written informed consent was obtained from each participant after explaining the design and assessment tools of the study.
The trait anxiety of the participants was assessed using the State-Trait Anxiety Inventory (STAI-II). The trait anxiety STAI-II (how individual generally feels-Trait). It consists of 20 items emphasizing the intensity of anxiety symptoms. These questionnaires contain excellent psychometric properties. Each question is rated on a 4-point scale (i) almost never, (ii) sometimes, (iii) often, and (iv) almost always. Reversed scoring items are: 1, 2, 5, 8, 10, 11, 15, 16, 19, and 20. Scores range from 20 to 90, and the cutoff for high anxiety is 48. The median alpha reliability coefficient for the trait scale is 0.81.
The dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS). This tool measures the general tendency to be attentive and aware of present moment experiences in daily life. It measures a unique quality of consciousness related to a variety of well-being constructs, differentiates mindfulness practitioners from others, and is associated with enhanced self-awareness. MAAS has been used for several studies and reported mental health indicators positively associated with mental and physical health. It contains a 15-item self-reported single-factor scale to assess a core characteristic of mindfulness. It is collected on a 6-point Likert scale; (i) Almost always, (ii) Very frequently, (iii) Somewhat infrequently, (iv) Very infrequently, and (v) Almost never. To score the scale, simply compute a mean of the 15 items. Higher scores reflect higher levels of dispositional mindfulness. The internal consistency reliability is 0.74.
The quality of life of recruited participants was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF). It is a self-assessment tool to measure the individual's perceptions in the context of their culture and value systems and their personal goals, standards, and concerns. The WHOQOL-BREF instrument comprises 26 items; first, two questions contain overall all quality of life and General Health, 24 items are divided into four domains: (i) physical health with 7 items-explaining about pain and discomfort, energy and fatigue, sleep and relaxation, mobility, and daily life activity; (ii) psychological health with 6 items-focusing on positive and negative feelings, thinking, learning, memory and concentration, self-esteem, personal beliefs, and spirituality; (iii) social domain-with 3 items-addressing personal relationships, support, social and sexual activity; and (iv) the environment with eight items detecting the physical safety and protection, home environment, financial resources, health, and social care, seeking for wisdom and skill. Each item is rated on a 5-point Likert scale scored from 1 to 5 on a response scale. Each item of the WHOQO-BREF is scored from 0 (worse) and 156 (best) on a response scale. Its good internal consistency is α = 0.63.
Barratt Impulsiveness Scale-11 (BIS-11) was used to assess the personality/behavioral construct of impulsiveness. There are 30-items self-reported scales divided into three primary factors of scale: (1) attentional impulsivity (BIS-A) with 8 items; (2) Motor impulsivity (BIS-M) with 11 items; (3) nonplanning (BIS-NP) with 11 items. Participants respond to each item using a 4-point Likert scale: 1 (rarely/never), 2 (occasionally), 3 (often), and 4 (almost always/always). Reversed scoring items are: 1, 7, 8, 9, 10, 12 13, 15, 20, 29, and 30. The total score ranges from 30 to 120 and higher scores indicate greater impulsivity. BIS-11 internal consistency coefficient is 0.74.
The depth of meditative experiences was assessed using Meditation Depth Questionnaire (MEDEQ). It contains 30 items in five different subdomains; (a) hindrance (MEDEQ-H)-assesses the boredom, impatience, and problem with motivation and concentration, (b) Relaxation (MEDEQ-R)-emphasizing comfortable feeling, inner peace, and calmness, (c) personal-self (MEDEQ-PS)-explains the experience of being detached from thoughts, having a deep understanding or insight and feeling centred, (d) Transpersonal qualities (MEDEQ-TPQ)-include emotion such as love, devotion, thankfulness, and connectedness, and (e) Transpersonal-self (MEDEQ-TPS)-interprets the disappearance of cognitive process and the experience of the unity of everything. Each item is rated with the scale ranging from 0 (not at all) to 4 (very much). Responses are summed up to a total score for the dimension of meditation depth. The internal consistency of MEDEQ is = 0.81.
Heartfulness meditation practice
It is a unique heart-based practice consisting of cleaning, prayer, and meditation is aided by yogic transmission. Meditation is done preferably in the morning on the source of light within the heart. Cleaning is performed in the evening to rejuvenate oneself from the effects of impressions created by the activities during the day. Prayer is silently offered before going to bed connecting ourselves with our inner-self to reinforce the goal of our life. The entire system becomes pure and more capable of receiving yogic transmission which improves the effectiveness of meditation. The process of transmission is facilitated by meditating with the global guide or certified HM trainer.
Control group participants who had no experience of any form of meditation were asked to complete the same questionnaires.
Statistical analysis was done using the SPSS software version, 20 Inc. (Chicago, IL, USA) in Windows. The data were checked for normal distribution and homogeneity of variance by applying the Shapiro-Wilk test and Levene test. One-way analysis of variance (ANOVA) was performed between group analysis for each psychological assessment. This was followed by post hoc analysis with Bonferroni adjustment for multiple comparisons. Statistical significance was considered at p < 0.05. The descriptive statistics included mean values, standard deviations (SDs), significant values, F-value, partial eta square is given in [Table 2] and [Table 3]. The relationship between the scores of trait anxiety (STAI-II) and trait mindfulness (MAAS) with other outcomes was analyzed using Pearson's correlation, as shown in [Table 4].
|Table 2: Analysis of variance results of mental outcomes among three different groups|
Click here to view
|Table 3: Mean and standard deviation of mental health.related outcome measures of participants in three groups|
Click here to view
|Table 4: Relation of mindfulness with anxiety, impulsivity, depth of meditation, and quality of life|
Click here to view
| Results|| |
The Shapiro–Wilk test showed that data were homogeneous and normally distributed (p > 0.05). The results of one-way ANOVA for all the variables are reported in [Table 2].
The mean and SD values of self-reported questionnaires are given in [Table 3]. The post hoc analysis with Bonferroni adjustment showed a significant higher scores of MAAS (p < 0.001; p < 0.001), MEDEQ-R (p < 0.05; p < 0.001), MEDEQ-PS (p < 0.01; p < 0.001), MEDEQ-TPQ (p < 0.001; p < 0.001), MEDEQ-TPS (p < 0.001; p < 0.001), WHOQOL-Physical (p < 0.05), WHOQOL-psychological (p < 0.01) and lower score of STAI-II (p < 0.001; p < 0.001), BIS-A (p < 0.05; p < 0.001), BIS-M (p > 0.05; p < 0.001), BIS-NP (p < 0.05; p < 0.001), BIS-T (p < 0.001; p < 0.001) and hindrances of meditation depth scale (p < 0.01; p < 0.001) in the LTM as compared to STM and CTL, respectively. Moreover, the STM group has shown significant higher scores in MAAS (p < 0.01), MEDEQ-PS (p < 0.05), MEDEQ-TPQ (p < 0.05), MEDEQ-TPS (p < 0.05) and lower cores in STAI-II (p < 0.05), BIS-A p < 0.05), BIS-M (p < 0.05), BIS-T (p < 0.01), and MEDEQ-H (p < 0.05) compared to CTL.
Pearson's correlation [Table 4] shows a significant negative correlation of MAAS with trait anxiety (LTM [r = −0.38, p < 0.05] and STM [r = −0.47, p < 0.05]); BIS-A (r = −39, p < 0.05), BIS-M (r = −0.51, p < 0.01), BIS-NP (r = −0.54, p < 0.01), BIS-T (r = −0.64, p < 0.001), hindrance (LTM [r = −41, p < 0.05], and STM [r = −0.41, p < 0.05]). Moreover, MAAS showed positive correlation with relaxation (r = 0.48, p < 0.01), transpersonal qualities (r = 0.38, p < 0.05), QOL-Physical (r = 0.44, p < 0.05), QOL-Psychological (r = 0.46, p < 0.05), and meditation experience (r = 0.37, p < 0.05) in LTM group. Whereas, STAI-II has shown negative correlation with meditation experience (r = −0.41, p < 0.05), relaxation (r = −0.5, p < 0.01), and positive correlation with hindrance (r = 0.45, p < 0.05) in LTM group and positive correlation with hindrance (r = 0.42, p < 0.05) in STM group. A heatmap of Person's correlation between mindfulness and other outcome measures of LTM group is presented in [Figure 1].
|Figure 1: Graphical representation of correlation between mindfulness with anxiety, impulsivity, depth of meditation, and quality of life in LTM group. The Pearson's correlation showed a significant positive relation of mindfulness with relaxation, meditation depth, and quality of life, whereas the negative relation of mindfulness with anxiety and impulsivity. MAAS, Mindful Attention Awareness Scale; STAI-II, State-Trait Anxiety Inventory; BIS, Barratt Impulsive Scale; BIS-A, BIS-Attentional impulsivity; BIS-M, BIS-Motor impulsivity; BIS-NP, BIS-Nonplanning; MEDEQ, Meditation Depth Questionnaire; MEDEQ-H, MEDEQ-Hindrance; MEDEQ-R, MEDEQ-Relaxation; MEDEQ-PS, MEDEQ-Personal-Self; MEDEQ-TPQ, MEDEQ-Transpersonal Qualities; MEDEQ-TPS, MEDEQ-Transpersonal-Self; QOL, Quality of life|
Click here to view
| Discussion|| |
The primary aim of the study was to compare the mindfulness and anxiety among HM meditators and nonmeditators. Moreover, we also assessed other mental health-related outcomes such as impulsivity, trait anxiety, meditation depth, and quality of life. As expected, we found trait mindfulness was higher and anxiety was lower in the LTM group as compared to the CTL group. Similarly, other mental health-related outcomes showed lower impulsive behavior and higher depth of meditation and quality of life in HM practitioners. It indicates that the frequency of meditation is associated with improvement in alertness, attentiveness, mindful state, and also enhance the ability to cope with anxiety efficiently., These outcomes are inferred from the potential differences in LTM when compared to STM and CTL groups. Moreover, significant associations were observed between meditation experience, mindfulness, anxiety, impulsive behavior, and quality of life in LTM and STM groups. The meditation experience is positively associated with mindfulness and meditation depth and negatively correlated with anxiety and impulsiveness. These results support the previous studies on HM and enhance the evidence of HM practice's effect on mental health and well-being. The experienced HM practitioners showed lower impulsiveness in attention, motor, and nonplanning behavior. It indicates that HM practice may have preventive and therapeutic potentials to reduce impulsivity among individuals. The trait anxiety also showed a lower score in experienced HM practitioners which indicate that HM controls not only impulsive behavior but also anxiety. The previous study supports our findings that meditation increases subjects' ability to improve motor responses. It was found that lower BIS-11 motor impulsivity and nonplanning impulsivity subscale scores were associated with the medial orbitofrontal cortex and paracingulate gyrus. These brain areas are associated with a mindfulness practice that is negatively correlated with impulsiveness and anxiety in meditators. HM could be a useful therapeutic technique to treat conditions having features of impulsiveness such as attention deficit hyperactive disorders, obsessive-compulsive disorder, and substance abuse., Moreover, the depth of meditation was assessed, and meditators reported higher scores for relaxation, personal self, transpersonal qualities, and transpersonal-self with lower hindrances which suggests that the intense meditation may reduce mental fluctuations and improve self-perception. A previous study reported that cognitive function, attention, and self-awareness are enhanced by mindfulness meditation that showed greater cortical thickness in anterior insular cortex. This study is the first to examine the effect of HM on self-reported dispositional mindfulness and other psychological health outcomes. The quality of life particularly, the physical and psychological domain of life, was higher in the meditators group. Moreover, other studies reported that higher self-reported mindfulness was positively correlated with better quality of life and psychological well-being., The lower trait anxiety of experienced meditators may be due to reduction in hindrances and enhanced relaxation and personal self, as reported in the MEDEQ. Previous mindfulness meditation studies also found significantly lower STAI-II scores., Reduced STAI-II scores are principally attributed to the anterior cingulate cortex, a brain region that controls thinking and emotion and is functionally tied with the amygdala reactivity to explicit and implicit emotional processing, which could reduce anxiety. The current finding suggests that HM meditation helped to reduce anxiety by regulating self-referential thoughts. Further, higher trait mindfulness is related to lower neuroticism, depression, anxiety, and higher life satisfaction, optimism, and self-esteem. In line with this, we also observed a negative correlation between trait mindfulness with lower anxiety among meditators. The HM practice has potential to influence breathing rhythm and suppress global vagal modulation and enhance sympathetic and baroreflex activity during deep meditation. These outcomes indicated that HM could be considered a therapeutic tool for healthcare providers to ameliorate health-related issues, and enhance wellness.
Although HM showed significant change among the practitioners, there are limitations to the study. The limitations of the study are (i) the broad age range of the participants, (ii) the data is a self-reported subjective assessment, (iii) the duration of heartfulness practice was self-reported by meditators, and lack of supervision may have its repercussions, and (iv) there is a need to study a more heterogeneous meditation groups with diverse cultures and societies. Finally, the present study paves a path for future exploration with neuroimaging techniques such as electroencephalogram, electrocardiogram, functional magnetic resonance imaging (fMRI), or positron emission tomography to study the structure or functional and cognitive domains of the brain among long-term, novice, and naïve heartfulness practitioners.
| Conclusion|| |
The results indicated that HM practice could be an effective and promising intervention to enhance mindfulness, depth of meditation, and quality of life with reduction of impulsivity and anxiety. The regular practice of this meditation technique may improve the personal self and transpersonal qualities that promote positive emotions and quality of life. Finally, the outcome of the study highlights the preventive and therapeutic potentials of HM for regulating anxiety and impulsiveness in behavioral disorders.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Taimni K. The Science of Yoga. United States: Quest Books. 1961.
Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention regulation and monitoring in meditation. Trends Cogn Sci 2008;12:163-9.
Travis F, Shear J. Focused attention, open monitoring and automatic self-transcending: Categories to organize meditations from Vedic, Buddhist and Chinese traditions. Conscious Cogn 2010;19:1110-8.
Leung PC. Rehabilitation training in artificially heated environment. J Exerc Rehabil 2017;13:546-9.
Schoormans D, Nyklíček I. Mindfulness and psychologic well-being: Are they related to type of meditation technique practiced? J Altern Complement Med 2011;17:629-34.
Krisanaprakornkit T, Ngamjarus C, Witoonchart C, Piyavhatkul N. Meditation therapies for attention-deficit/hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2010;2010
Schlechta Portella CF, Ghelman R, Abdala V, Schveitzer MC, Afonso RF. Meditation: Evidence map of systematic reviews. Front Public Health 2021;9:742715.
Black DS, Sussman S, Johnson CA, Milam J. Psychometric assessment of the Mindful Attention Awareness Scale (MAAS) among Chinese adolescents. Assessment 2012;19:42-52.
González-Valero G, Zurita-Ortega F, Ubago-Jiménez JL, Puertas-Molero P. Use of meditation and cognitive behavioral therapies for the treatment of stress, depression and anxiety in students. A systematic review and meta-analysis. Int J Environ Res Public Health 2019;16:E4394.
Kang YS, Choi SY, Ryu E. The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Educ Today 2009;29:538-43.
Lemay V, Hoolahan J, Buchanan A. Impact of a yoga and meditation intervention on students' stress and anxiety levels. Am J Pharm Educ 2019;83:7001.
Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database Syst Rev 2006;25:CD004998. [doi: 10.1002/14651858.CD004998.pub2].
Vieten C, Wahbeh H, Cahn BR, MacLean K, Estrada M, Mills P, et al.
Future directions in meditation research: Recommendations for expanding the field of contemplative science. PLoS One 2018;13:e0205740.
Korponay C, Dentico D, Kral TR, Ly M, Kruis A, Davis K, et al.
The effect of mindfulness meditation on impulsivity and its neurobiological correlates in healthy adults. Sci Rep 2019;9:11963.
Joshi AM, Mehta SA, Pande N, Mehta AO, Randhe KS. Effect of Mindfulness-Based Art Therapy (MBAT) on psychological distress and spiritual wellbeing in breast cancer patients undergoing chemotherapy. Indian J Palliat Care 2021;27:552-60.
Nila K, Holt DV, Ditzen B, Aguilar-Raab C. Mindfulness-based stress reduction (MBSR) enhances distress tolerance and resilience through changes in mindfulness. Ment Health Prev 2016;4:36-41.
Duprey EB, McKee LG, O'Neal CW, Algoe SB. Stressful life events and internalizing symptoms in emerging adults: The roles of mindfulness and gratitude. Ment Health Prev 2018;12:1-9. [doi: 10.1016/j.mhp.2018.08.003].
Beccia AL, Dunlap C, Hanes DA, Courneene BJ, Zwickey HL. Mindfulness-based eating disorder prevention programs: A systematic review and meta-analysis. Ment Health Prev 2018;9:1-12.
Arya NK, Singh K, Malik A, Mehrotra R. Effect of Heartfulness cleaning and meditation on heart rate variability. Indian Heart J 2018;70 Suppl 3:S50-5.
Desai K, Gupta P, Parikh P, Desai A. Impact of virtual heartfulness meditation program on stress, quality of sleep, and psychological wellbeing during the COVID-19 pandemic: A mixed-method study. Int J Environ Res Public Health 2021;18:11114.
Soriano-Ayala E, Amutio A, Franco C, Mañas I. Promoting a healthy lifestyle through mindfulness in university students: A randomized controlled trial. Nutrients 2020;12:2450.
Sipe WE, Eisendrath SJ. Mindfulness-based cognitive therapy: Theory and practice. Can J Psychiatry 2012;57:63-9.
Yadav GS, Cidral-Filho FJ, Iyer RB. Using heartfulness meditation and brainwave entrainment to improve teenage mental wellbeing. Front Psychol 2021;12:742892.
Spielberger CD. State-trait anxiety inventory. In: The Corsini Encyclopedia of Psychology. Hoboken: John Wiley & Sons, Inc.,; 2010. p. 1.
Field T, Diego M, Delgado J, Medina L. Tai chi/yoga reduces prenatal depression, anxiety and sleep disturbances. Complement Ther Clin Pract 2013;19:6-10.
Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Pers Soc Psychol 2003;84:822-48.
Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial a Report from the WHOQOL Group. Qual Life Res 2004;13:299-310.
Andrade EM, Geha LM, Duran P, Suwwan R, Machado F, do Rosário MC. Quality of life in caregivers of ADHD children and diabetes patients. Front Psychiatry 2016;7:127.
Piron H. The Meditation Depth Index (MEDI) and the Meditation Depth Questionnaire (MEDEQ) by Harald Piron Summary The Meditation Depth Index ( MEDI ) and the Meditation Depth Questionnaire (MEDEQ). J Medit Medit Res 2001;1:69-92.
Thimmapuram J, Pargament R, Sibliss K, Grim R, Risques R, Toorens E. Effect of heartfulness meditation on burnout, emotional wellness, and telomere length in health care professionals. J Community Hosp Intern Med Perspect 2017;7:21-7.
Ferrarelli F, Smith R, Dentico D, Riedner BA, Zennig C, Benca RM, et al.
Experienced mindfulness meditators exhibit higher parietal-occipital EEG gamma activity during NREM sleep. PLoS One 2013;8:e73417.
Heeren A, Van Broeck N, Philippot P. The effects of mindfulness on executive processes and autobiographical memory specificity. Behav Res Ther 2009;47:403-9.
Xiao Q, Yue C, He W, Yu JY. The mindful self: A mindfulness-enlightened self-view. Front Psychol 2017;8:1752.
Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, et al.
Meditation experience is associated with increased cortical thickness. Neuroreport 2005;16:1893-7.
Pagnini F, Bercovitz KE, Phillips D. Langerian mindfulness, quality of life and psychological symptoms in a sample of Italian students. Health Qual Life Outcomes 2018;16:29.
Falsafi N. A randomized controlled trial of mindfulness versus yoga: Effects on depression and/or anxiety in college students. J Am Psychiatr Nurses Assoc 2016;22:483-97.
Ratanasiripong P, Park JF, Ratanasiripong N, Kathalae D. Stress and anxiety management in nursing students: Biofeedback and mindfulness meditation. J Nurs Educ 2015;54:520-4.
Chen C, Chen YC, Chen KL, Cheng Y. Atypical anxiety-related amygdala reactivity and functional connectivity in sant mat meditation. Front Behav Neurosci 2018;12:298.
de Bruin EI, Zijlstra BJ, van de Weijer-Bergsma E, Bögels SM. The Mindful Attention Awareness Scale for Adolescents (MAAS-A): Psychometric properties in a Dutch sample. Mindfulness (N Y) 2011;2:201-11.
Léonard A, Clément S, Kuo CD, Manto M. Changes in heart rate variability during heartfulness meditation: A power spectral analysis including the residual spectrum. Front Cardiovasc Med 2019;6:62.
[Table 1], [Table 2], [Table 3], [Table 4]