The influence of mindfulness meditation on angry emotions and violent behavior on Thai technical college students

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1 The influence of mindfulness meditation on angry emotions and violent behavior on Thai technical college students This is the peer reviewed author accepted manuscript (post print) version of a published work that appeared in final form in: Wongtongkam, Nualnong, Day, Andrew, Ward, Paul Russell & Winefield, Anthony Harold 2015 'The influence of mindfulness meditation on angry emotions and violent behavior on Thai technical college students' European Journal of Integrative Medicine, vol. 7, no. 2, pp This output may not exactly replicate the final published authoritative version for which the publisher owns copyright. It is not the copy of record. This output may be used for non-commercial purposes. This version is licensed under a Creative Commons CC-BY-NC-ND 4.0 license ( The final definitive published version (version of record) is available at: Persistent link to the Research Outputs Repository record: General Rights: Copyright and moral rights for the publications made accessible in the Research Outputs Repository are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights. Users may download and print one copy for the purpose of private study or research. You may not further distribute the material or use it for any profit-making activity or commercial gain You may freely distribute the persistent link identifying the publication in the Research Outputs Repository If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

2 The Library Educating Professionals, Creating and Applying Knowledge, Engaging our Communities NOTICE: this is the accepted author manuscript (AAM) or post print which was accepted for publication in [European Journal of Integrative Medicine]. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms are reflected in this document. A definitive version was subsequently published in [European Journal of Integrative Medicine] vol. 7, no. 2 pp , 2015, DOI: dx.doi.org/ /j.eujim

3 The Influence of Mindfulness Meditation on Angry Emotion and Violent Behavior in Thai Technical College Students Nualnong Wongtongkam a, Andrew Day b, Paul Russell Ward c, Anthony Harold Winefield d,e a School of Biomedical Sciences, Charles Sturt University, New South Wales, Australia. b School of Psychology, Faculty of Health, Deakin University, Victoria, Australia. c School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, South Australia, Australia. d School of Psychology, Social Work and Social Policy, University of South Australia, South Australia, Australia. e School of Psychology, The University of Adelaide, South Australia, Australia *Corresponding Author: Nualnong Wongtongkam Address: School of Biomedical Sciences, Building N8 (B-1448), Charles Sturt University, Bathurst, New South Wales, Australia, 2795 Tel ; Fax ; address nwongtongkam@csu.edu.au 1

4 The Influence of Mindfulness Meditation on Angry Emotion and Violent Behavior on Thai Technical College Students Abstract Introduction: Violence among technical college students is a significant issue in Thailand, South East Asia, and yet few interventions are available for use with this group. In this study the outcomes of a culturally appropriate intervention, mindfulness meditation (MM), on anger and violent behavior are reported. The MM intervention was delivered over three consecutive weeks to technical college students (n=40) and the effects compared to a comparison group (n=56) who attend classes as usual. Methods: Both the intervention and comparison group completed a series of self-report measures of aggressive and violent behavior perpetration and victimization on three occasions (preintervention and 1 month and 3 month post-intervention). Results: Program participants reported lower levels of anger expression at one month followup, but there were no observed group x time interactions for self-reported violent behavior. The direct victimisation rates ( being pushed, being yelled at and asked to fights ) were declined across group and time periods. Conclusions: MM may have the potential to improve emotional self-control, but is likely to only impact on violent behavior when this is anger mediated. Keywords. Anger, Mindfulness Meditation, Thailand, Technical College 2

5 Introduction Youth violence is a major public health issue in Thailand, a low-middle income country in South-East Asia [1], where particular concerns have been expressed about violence in students who attend vocational training institutes, particularly technical colleges [2]. In response, the Minister of Education has announced plans to send delinquent students to boot camps, a proposal which has triggered public debate about the effectiveness of this, and other, interventions for youth. The Secretary General Office of the Vocational Educational Commission has also proposed a number of new regulations to control violence in vocational colleges. These include increased policing of the streets adjacent to colleges, the use of surveillance cameras in public locations, prohibiting students leaving the colleges during school hours, and improving student enrolment screening processes [3]. These initiatives, however, focus on the monitoring of student behavior rather than implementing interventions that have the potential to address the causes of violence in this population. The aim of this study, then, is to investigate the effect of one particular type of intervention, mindfulness meditation (MM), on aggressive and violent behavior in Thai technical college students. While a number of alternative interventions are potentially available, the evidence base to support their effectiveness outside of the United States is somewhat limited [4], and many employ methods that cannot be assumed to be culturally appropriate. MM, on the other hand is increasingly being incorporated into a range of different health care treatments [11] and particularly valued in a country in which more than 90% of the population are Buddhist. The rationale to support the use of MM as a means to reduce aggressive and violent behavior has been articulated by both Baer (2003) and Wright, Howells and Day (2009). They identify a number of different mechanisms by which mindfulness-based interventions might improve emotional control [5, 6], suggesting, for example, that mindfulness improves 3

6 an individual's ability to tolerate negative emotional states and the ability to cope with them effectively. Related to this is the idea that mindfulness training interferes with those ruminative patterns that are believed to be characteristic of negative emotional arousal [7]. Applying mindfulness skills permits the individual to step back from the emotional disturbance, and to see it clearly as an emotional state that will, in time, pass. Improved selfnoticing may thus allow the individual to make more informed, wiser, behavioral choices as he or she develops a higher level of tolerance for unpleasant internal states. Finally, the ability of various meditation strategies to induce physiological relaxation has been welldocumented. Gillespie et al. (2012) have further discussed the neurobiological and cardiorespiratory mechanisms associated with controlled breathing, which is thought to be conducive to a state of mindfulness [8]. They argue that these techniques, considered key components of many meditational practices, have been shown to affect the functioning of those neural circuits involved in the regulation of emotional states, including the prefrontal cortex and the amygdala. The aim of this exploratory study, then, is to investigate the effects of MM in a high-risk cohort of Thai technical college students. Materials and Methods Participants Ninety six students from seven departments, across various year levels (shown in Table 1). volunteered to participate in the study, from the 600 students at the college. Forty of these were invited to participate in the MM intervention, with 56 acting as a non-intervention comparison group. These students attended normal classes throughout the study. Self-reported data were collected from both groups on three occasions (preintervention, and at 1 month and 3 month post-intervention). There was some attrition from 4

7 the study, resulting in a total of 77 participants at the 1-month follow-up (MM = 29, control group = 48) and 3-month follow-up (MM = 32, control group = 45). Insert Table 1 Procedure The MM intervention was delivered in a technical college in Bangkok with the agreement of the College Director. Interested students were given an information package (consent form and program outline) by their teachers and invited to meet the principal researcher to discuss participation. Informed consent was provided by the students parents. Each participant was reimbursed the equivalent of US $10 for his or her time and expertise. Intervention: Mindfulness Meditation The MM intervention in the study was a modification of the Mindfulness-Based Stress Reduction (MBSR) program developed by the University of Massachusetts Medical Center [9] and similar to Vipassana meditation that is practiced in Theravada Buddhism. It did not, however, include the somatic relaxation technique (a body scan or yoga). It focused on the objective observation and awareness of the breath in order to concentrate attention, a technique that is used in both sitting and walking meditations. The intervention was delivered by Buddhist monks who had at least 5 years of meditation and teaching experience. Participants attended daily for three consecutive weeks from 9.00 a.m. to 5.00 p.m. The day started with communal chanting and liturgical services, followed by meditation until noon. Students sat quietly with their eyes closed and placed their attention on breathing either at the tip of the nose or the diaphragm. If participants drifted away or were distracted by thoughts they were encouraged gently to bring the focus back to their breathing and acknowledge the thought without judging. The monks 5

8 guided participants until they were able to do this properly before joining the meditation. After, a walking meditation was used. To begin walking meditation, participants simply stood, and then began to walk at a fairly slow walking pace and in a normal manner around garden paths in the college, approximately 2 hours with 5-minute break in every a half-hour. The monks practiced walking meditation with the participants. In the afternoon, participants attended lectures on how to behave towards parents, teachers, seniors, and friends, and discussed the consequences of antisocial behavior. The final session each day involved 1 2 hours of communal chanting and sitting meditation until 5 p.m. Participants attended all exercises every day during the intervention. Measures Victims, Witnesses and Perpetrators All of the self-report questionnaires used in this study have been shown to have high validity and reliability when used with Thai youth [10]. Victimization. A self-report measure, based on the Social Experience Questionnaire- Self Report [11] was used to assess victimization. Items in the original scale which related to pro-social behaviors were removed as they were not considered to be culturally suitable. The resulting scale comprised 11 items (direct and indirect victimization) which wereee rated on a 6-point Likert-type scale ranging from never (0) to 20 or more times (5). Witnessing violence was assessed using 6 items which asked respondents if they had seen someone being beaten up or mugged, threatened with serious physical harm by someone, shot, or shot at with a gun, attacked or stabbed with a knife, chased by gangs or individuals, or seriously wounded in a violent incident, using a 6-point Likert-type scale ranging from never (0) to 20 or more times (5). 6

9 Violent offenses. Participants were then asked whether they had been involved in attempting to cause harm to others [12] and to complete a slightly modified version of the overt victimization subscale of the Problem Behavior Frequency Scale [13]. Respondents were asked whether they had ever hit, pushed or shoved, threatened to hit, yelled or called mean names, threatened or injured someone with a weapon (gun, knife, club, etc.) in the previous 6 months. The responses were coded on a 6-point Likert-type scale ranging from never (0) to 20 or more times (5). Anger. The State-Trait Anger Expression Inventory (STAXI-2) scale is a 32-item questionnaire developed to measure characteristic styles of coping with anger arousal [14]. Participants were asked to rate the frequency with which they engaged in the items when feeling angry across a 4-point Likert-type scale ranging from 1 ( almost never ) to 4 ( almost always ). Four 8-item subscales assess different aspects of anger as conceptualized by Spielberger (1999) (anger-in, anger-out, anger control-in, and anger control-out). The scale has been widely used to measure anger in college students and has been shown to have acceptable reliability and validity [15, 16]. Finally, participants were asked about their age, gender, years of education, family income and parent s job. Results Two-way repeated-measured ANOVAs 1 were used to examine whether average levels of behaviors as offenders, direct and indirect victims, and witnesses differed for the comparison and intervention groups over time (pre- and post-intervention). 1 Although the dependent variables (violence classifications) were categorical scales, they were treated as continuous data. Kruskal Wallis methods produced similar results to ANOVA [21]. 7

10 Offender behaviors. At baseline (pre-intervention), the mean scores for self-reported offending behavior were similar for both groups (except for one item, yelling at someone ). There were no significant differences between the groups, or time effects, and interactions (see Table 2). Insert Table 2 Direct victim behaviors. There were significant differences for three of items which assessed victimization ( being pushed F (1, 28) = 10.26, p <.05, being yelled at F (1, 28) = 8.19, p <.05, and being injured with weapons F (1, 28) = 4.43, p <.05). Similarly, scores on three victimization items changed significantly over time ( being pushed, F (2, 56) = 4.70, p <.05, being yelled at F (2, 56) = 18.36, and being asked to fight F (2, 56) = 5.26, p <.05), although the time x group interaction was significant only for one item ( being threatened, F (2, 56) = 4.36, p <.05) (see Table 3). Insert Table 3 Indirect victim behaviors. The groups different on almost all of indirect victimization items ( spreading a false rumor F (1, 28) = 10.01, p <.05, being left out on purpose F (1, 28) = 9.08, p <.05, keeping others from liking you F (1, 28) = 6.48, p <.05, and told lies about you F (1, 28) = 6.09, p <.05). One item, told lies about you, changed significantly over time (F (2, 56) = 3.28, p <.05), but there were no interaction effects for any of the indirect victim behaviors, as shown in Table 4. Insert Table 4 Witness behaviors. There was a significant difference between the groups effect on two items ( seeing someone hit ; F (1, 28) = 10.09, p <.05; seeing someone pushed F (1, 28) = 7.30, 8

11 p <.05), and an interaction effect for the items seeing someone hit (F (2, 56) = 6.00, p<.05) and seeing someone threatened with weapons (F (2, 56) = 3.26, p <.05) (see Table 5). Insert Table 5 Anger scales. There were group differences for anger expression and anger control. Anger expression ( anger-out ) did not change across time for the control group, but decreased by approximately 9% at the 1-month follow-up for the MM group before returning to the preintervention level at 3 months post-intervention (pre-intervention mean = 17.52; 1-month post-intervention mean = 15.96; 3-month post-intervention mean = 17.74). Anger control ( control-in ) reduced by 13% at 3 months post-intervention for both groups. There were no significant differences across time or r interaction effects (Table 6). Insert Table 6 Discussion The harmful effects of aggressive and violent behavior on young people have been well documented [17], highlighting the need to identify and deliver effective prevention programs. These not only include the psychological harm associated with victimization, such as high levels insecurity, low-self-esteem, anxiety, and depression, but also academic difficulties, school failure, and school drop-out [18, 19]. College-based Mindfulness Meditation (MM) training is one intervention which may be considered for use with populations that are considered to be at risk of acting violently or being victimized. It is likely to be particularly relevant for youth who come from cultural backgrounds in which meditation is both recognized and valued. MM aims to improve selfcontrol by training participants to intentionally focus attention on the moment-by-moment experience with an attitude of acceptance [20, 21] and is thought to assist with the regulation 9

12 of negative emotions, such as anger, which trigger aggression. In this study, MM was shown to have some impact on anger expression, although there were no observed behavioral differences between the comparison and intervention groups across time. This may be because the intervention has only limited impact (and should be used as part of a broader intervention) or because much of vocational college violence is not anger-mediated. Indeed, one recent study has suggested that Thai college violence is often instrumental in nature and motivated by group rivalry between different colleges [22]. However, these findings require replication given the small sample sizes, the lack of random allocation or matching, and the potential confound (Buddhist teachings on how to behave properly to people) introduced by the lectures delivered as part of the MM program. Competing Interests The authors declare that they have no competing interests of this article. Acknowledgements The authors would like to thank a director and teachers at a technical college in Bangkok for supporting the study and providing facilities for the research, and all participants in the college for their willing participation over three weeks. References [1] World Health Organization-Kobe Centre. National Report on Violence and Health Thailand. In: Kobe, Japan: World Healh Organization Centre for Health Development, WHO/WKC/Tech.Ser./05.4; [2] Royal Thai Police. Conference on prevention of students' fights ( Report on July, 2009: Thai version). In: Bangkok: Bureau of Royal Thai Police, Thailand;

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15 [22] Wongtongkam N, Ward PR, Day A, Winefield AH. Student perspectives on the reasons for physical violence in a Thai Vocational College:An exploratory study 2014, in press. 13