This file contains handouts to accompany the paper entitled:
A Randomized Controlled Trial of a Spiritual-Wisdom-Based Program
To Enhance
Caregiving Self-Efficacy and Reduce Stress and Burnout
Reporting on work by
Doug Oman, PhD
(presenter)
John Hedberg, MD
Carl E Thoresen, PhD
Presented at
131st Annual Meeting of the
American Public Health Association
San Francisco, California, USA
November 18, 2003
Online Abstract
(http://apha.confex.com/apha/131am/techprogram/paper_60781.htm
accessed December 26, 2003)
131st Annual Meetings of the American Public Health Association
4021.0: Tuesday, November 18, 2003 - 8:50 AM
A randomized controlled trial of a spiritual-wisdom-based program to enhance caregiving self-efficacy and reduce stress and burnout
Doug Oman, PhD1, John Hedberg, MD2, Carl E Thoresen, PhD3.
(1) Public Health Institute, 2001 Addison Street, Second Floor, Berkeley, CA 94704-1103, 707-878-2573, .
(2) University of Colorado Health Sciences Center, Denver, CO.
(3) Stanford University, Stanford, CA.
BACKGROUND AND PURPOSE:
To evaluate the effects on caregiving self-efficacy, stress and burnout of an eight week, 2 hour per week training for health professionals in spiritual-wisdom-based self-management tools. Drawing extensively on spiritual wisdom traditions, the program may be practiced by adherents to any major religious faith, as well as those outside of all traditions.
DESIGN AND METHODS:
Participants (N=61) were recruited through hospitals in Colorado, and included physicians, nurses, chaplains and other health professionals actively involved in patient care. After a pretest, participants were randomly allocated to an intervention condition (n=30) and a wait-list comparison group (n=31). The training program was based on a previously researched adaptation for health professionals of a comprehensive nonsectarian program from Easwaran (1991/1978). Participants were offered continuing professional education credits through the host hospital education department. Pretest, posttest, and 8-week followup data were gathered on spirituality, caregiving self-efficacy, perceived stress, and burnout (emotional exhaustion, depersonalization, and personal accomplishment).
RESULTS:
Beneficial treatment effects trends were observed at posttest for all measures except depersonalization, and were statistically significant for increased caregiving self-efficacy (p<0.05) and reduced stress (p<0.05). Beneficial effects became even stronger and more statistically significant at followup for increased caregiving self-efficacy (p<0.01), reduced stress (p<0.001), reduced emotional exhaustion (p<0.05), and increased personal accomplishment (p<0.05). Participants also reported increases at posttest and followup in self-reported spirituality (p<0.05).
CONCLUSION:
Evidence suggests this program enhances caregiving self-efficacy, reduces stress and burnout, and may merit inclusion in continuing education curricula for healthcare professionals.
______COMMENT______
A pilot study describing this program and the caregiving self-efficacy measure is available (Oman, Hedberg, Downs, & Parsons, 2003). In comparison with other nonsectarian programs, this program is seen as more systematically including a wider range of material from the “wisdom traditions” of the great religions, especially through promoting observational learning from spiritual exemplars, which has been suggested as a major source of spiritual and religious growth (Bandura, 2003; Oman & Thoresen, 2003). According to Bandura’s highly influential social cognitive theory, observational learning of all types of human skills and behaviors typically involves the four processes of attention, retention, reproduction, and motivation (Bandura, 2003). By memorizing and meditating upon the words of spiritual exemplars who have composed such passages, practitioners give attention to pertinent modeling information (i.e., information about the lives and thought processes of the authors of the passages). Meditating upon the information in these passages fosters its retention, thereby facilitating its reproduction in behavior later during the day (e.g., when a meditator remembers St. Francis’ words “where there is hatred let me sow love”). Since passages are selected to inspire and motivate (Easwaran, 1991/1978), this form of meditation is hypothesized to foster all four of the processes that are theorized as central to spiritual modeling (Oman & Thoresen, 2003). Other components of the EPP, such as spiritual fellowship (Point 7), spiritual reading (Point 8), and frequent repetition of a sacred/holy name or mantram (Point 2 – see also Oman & Driskill, 2003) are also likely to foster spiritual modeling experiences, either by providing additional modeling information, or by facilitating its assimilation.
REFERENCE LIST:
Bandura, A. (2003). On the psychosocial impact and mechanisms of spiritual modeling. The International Journal for the Psychology of Religion 13 (3), 167-174.
Easwaran, E. (1991/1978). Meditation: A simple eight-point program for translating spiritual ideals into daily life, 2nd ed. Tomales, CA: Nilgiri Press (full text: http://www.nilgiri.org).
Oman, D., & Driskill, J.D. (2003). Holy name repetition as a spiritual exercise and therapeutic technique. Journal of Psychology and Christianity 22 (1), 5-19.
Oman, D., Hedberg, J., Downs, D., & Parsons, D. (2003). A transcultural spiritually-based program to enhance caregiving self-efficacy: Findings of a pilot study. Complementary Health Practice Review. 8 (3), 201-224.
Oman, D., & Thoresen, C.E. (2003b). Spiritual modeling : A key to spiritual and religious growth? The International Journal for the Psychology of Religion 13 (3), 149-165.
CONTACT INFORMATION:
E
APHA 2003 Meetings - Primary Handouts
Intervention
Eight Point Program (EPP)
(Easwaran, 1991/1978; introduced 1960)
* / 1. / “Passage” Meditation / } / FoundationSee Oman & Driskill (2003)
* / 2. / Holy Name / Mantram Repetition / }
3. / Slowing Down / } / Mindful-ness
4. / One-Pointed Attention
5. / Training the Senses
6. / Putting Others First
7. / Spiritual Association / B Everyday Exemplars
* / 8. / Inspirational Reading
*Points 1, 2, 8 foster daily attention to
C Exalted Exemplars from
Spiritual Wisdom Traditions;
Point 1 fosters retention
Several points foster reproduction in behavior
Points 1, 7, 8 foster motivation
Inspirational Passages for Meditation
23rd PsalmThe Lord is my shepherd
I shall not want....
Prayer of Saint Francis:
Lord, make me an Instrument of Thy peace;
Where there is hatred, let me sow love...
Discourse on Good Will:
May all beings be filled with joy and peace...
More information: http://www.nilgiri.org
Self-Tailoring
Individual selects meditation passages and other materials
C nonbelievers often use passages from Buddhism, Taoism
Corollary:
EPP usable in any religious tradition
or outside all traditions
Grassroots Multicultural Interest
Independent Publication 20+ languages
Black: Countries of Independent Publication
(Gray: Available in official language)
Info. for health practitioners
Hedberg, J., Bowden, J., & Oman, D. (2002). A comprehensive non-sectarian program for integrating spirituality into health practice. (Materials prepared for workshop at Conference on Spirituality, Culture and End-of-Life in Medical Education, sponsored by the Association of American Medical Colleges, Kansas City, MO, September 14); Available online
E
APHA 2003 Meetings - Primary Handouts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
E
APHA 2003 Meetings - Primary Handouts
A Comprehensive Non-Sectarian Program for Integrating Spirituality into Health Practice
John Hedberg, M.A., M.D.
University of Colorado Health Sciences Center, Denver
Jeanne Bowden, Ph.D., R.N., M.P.H., F.A.A.N.
Oregon Health Sciences University, La Grande
Doug Oman, Ph.D.
School of Public Health, University of California, Berkeley
Pre-Printed Materials for Workshop to be presented at
Spirituality, Culture and End-of-Life in Medical Education Conference
Jointly sponsored by the Association of American Medical Colleges,
George Washington University School of Medicine, and
Harvard Medical School, Department of Continuing Education
Kansas City, Missouri
September 14, 2002
Contents
Section / Description / PageContents / 1
1 / Introduction / 2
2 / Unusual Features of EPP / 5
3 / Description of the Eight Points / 6
4 / Examples of Meditation Passages / 10
5 / Examples of Mantrams / Prayer Words / 12
6 / Similar Practices in Well-Known Health Interventions and Religious Traditions / 13
7 / Research Bibliography / 14
8 / Adapting EPP to Specific Spiritual / Religious Groups / 21
9 / Support Systems for using EPP / 22
10 / Applying the EPP to Healthcare Practice / 24
11 / Examples of Potential EPP Course Uses / 29
12 / Appreciations of the EPP / 30
______
Acknowledgements: Dr. Oman’s contribution to the workshop was supported in part by Grant T32 HL07365-21 (U.S. NIH/NHLBI).
1
13
§1 Introduction
The Eight Point Program developed by Easwaran (1991/1978) is completely nonsectarian, yet brings participants into close daily contact with the spiritual ‘wisdom traditions’ of the great religions, providing a fully integrated program for daily living that can be practiced within any major religion or no religion at all.
These eight points offer an affirming set of experiences that evidence suggests promote improved quality of life and foster subjective well-being, i.e., perceived life satisfaction, increased positive emotions, and reduced negative emotions (Diener, 1999). Because of its comprehensiveness and other special features (see section 2), this program may have advantages over widely used spiritual practices and interventions for improving health and quality of life.
Originally developed for spiritual and religious purposes, the Eight Point Program (EPP) was introduced to the United States in 1959 by its developer, Eknath Easwaran (1911-1999), at that time a visiting Fulbright scholar from India. Later, the program was the focus of what was perhaps the first course in the theory and practice of meditation to be offered for credit at a major American university (Easwaran, 1991/1978, p. 3). More recently the program has also been used for a variety of health-related purposes.
Applications in Medicine and Medical Education
What?
The Eight Point Program has been found useful for...
· Managing Stress
· Managing Caregiver Burden
· Coping with Chronic and Life-Threatening Diseases
· Coping with End-of-Life Issues
Who?
The Eight Point Program has been found useful by...
· Physicians / · Psychologists / · Medical Educators / · Hospice Workers· Nurses / · Social Workers / · Healthcare Administrators / · Patients
(continued)
How?
The Eight Point Program has been...
· Taught to groups of patients
· Incorporated in professional and staff training (hospitals, universities, long-term-care facilities)
· Shared informally with patients and colleagues
· Used personally by health professionals to improve professional effectiveness
Why?
According to its developer...
· The Eight Point Program operates by training attention.
· Through refocusing attention, all eight points converge in helping a person become more concentrated, empowered, and guided by uplifting spiritual wisdom.
Where?
The wide cross-cultural appeal of the Eight Point Program is demonstrated by its
international dissemination by mutually independent publishers in 20 European, Asian, and Middle Eastern languages (see figure, next page).
References
Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125(2), 276-302.
Easwaran, E. (1991/1978). Meditation: A simple eight-point program for translating spiritual ideals into daily life (2nd ed.). Tomales, CA: Nilgiri Press.
______
This section (text & graphic) adapted from Oman, D. (2000), A comprehensive non-sectarian program to promote spirituality and health. (poster presented at Conference on Spirituality in Health Care: Issues of Culture and End of Life in Medical Education, Dallas, TX: Sep. 16, 2000); additional information used from Nilgiri Press (August 2001), Foreign editions of the books of Eknath Easwaran [annually prepared for distribution at Frankfurt book faire - available upon request], Tomales, CA: Nilgiri Press.
(A Comprehensive Non-Sectarian Program for Integrating Spirituality into Health Practice, 2002: John Hedberg,
; Jeanne Bowden, ; Doug Oman, )
13
World-Wide Cross-Cultural Interest
The wide cross-cultural appeal of the Eight Point Program is demonstrated by its
international dissemination by mutually independent publishers in 20 European, Asian, and Middle Eastern languages .
Figure:
Countries in which books describing how and why to practice the Eight Point Program are...
black - Published within the country by an indigenous publishing houseor / gray - Published (somewhere in the world) in the country’s official language
European languages:
Dutch
English
French
German
Greek
Hungarian
Italian
Lithuanian
Portuguese
Russian
Slovenian
Spanish / Middle Eastern languages:
Hebrew
Asian languages:
Bahasa Indonesian
Chinese (PRC)
Chinese (Taiwan)
Japanese
Korean
Malayalam (India)
Marathi (India)
Telugu (India)
Works published independently in multiple languages include more than one dozen supportive texts in addition to the basic instructional text (Easwaran, 1991/1978, Meditation).
(A Comprehensive Non-Sectarian Program for Integrating Spirituality into Health Practice, 2002: John Hedberg,
; Jeanne Bowden, ; Doug Oman, )
13
§2 Unusual Features of EPP
The EPP has several features that make it broadly applicable across cultures and religions, and allow it to be embraced without having to alter one’s religious views (or lack of religious views).
(A Comprehensive Non-Sectarian Program for Integrating Spirituality into Health Practice, 2002: John Hedberg,
; Jeanne Bowden, ; Doug Oman, )
13
§3 Description of the Eight Points
The following information is adapted from Easwaran (1991a, 1998) and from Oman (2000). Fuller information can be found in EPP publications (Easwaran, 1991a, 1991b/1978).
Brief Description of the Eight Point Program (EPP)
1. “Passage” Meditation.
Memorize an “inspirational passage” such as the 23rd Psalm, the Prayer of Saint Francis, or the Discourse on Good Will of the Buddha’s Sutta Nipata (see below). Meditate for a half an hour each day, preferably in the morning. Meditate by sitting with back straight, eyes closed, and reciting the passage slowly in one’s mind with concentration. Focus the mind as completely as possible on the words of the passage; when distractions come, do not resist them, but give more attention to the words of the passage. If the mind strays from the passage entirely, bring it back gently to the beginning and start again. When the passage is completed, begin another memorized passage or slowly and silently repeat the same passage until the time for meditation is completed.
2. Repetition of a Holy Word or Mantram.
Each practitioner selects a single short word or phrase from a major religious tradition. Suitable words or phrases include “Jesus”, “Ave Maria”, “Om mani padmé hum” (a Buddhist mantram referring to the “jewel in the lotus of the heart”), “Barukh attah Adonai” (means “Blessed art thou, O Lord” in Jewish tradition), “Allah”, or “Rama” (which was Mahatma Gandhi’s mantram). The chosen holy word is to be repeated as often as possible at spare moments during the day (e.g., when walking, waiting, or doing mechanical chores like dishwashing), and, once decided on, is not to be changed.