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Introducing Qigong Meditation into Residential Addiction Treatment: A Pilot Study Where Gender Makes a Difference Article in Journal of alternative and complementary medicine (New York, N.Y.) · August 2010 DOI: 10.1089/acm.2009.0443 · Source: PubMed
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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 16, Number 8, 2010, pp. 875–882 ª Mary Ann Liebert, Inc. DOI: 10.1089/acm.2009.0443
Introducing Qigong Meditation into Residential Addiction Treatment: A Pilot Study Where Gender Makes a Difference Kevin W Chen, PhD, MPH,1 Anthony Comerford, PhD,2 Phillip Shinnick, PhD,3 and Douglas M. Ziedonis, MD, MPH 4
Abstract
Objective: The objective of this study was to explore the feasibility and efficacy of adding integrative qigong meditation to residential treatment for substance abuse. Methods: Qigong meditation, which blends relaxation, breathing, guided imagery, inward attention, and mindfulness to elicit a tranquil state, was introduced into a short-term residential treatment program. At first clients chose to participate in qigong meditation on a voluntary basis during their evening break. Later they chose to participate in either meditation or Stress Management and Relaxation Training (SMART) twice a day as part of the scheduled treatment. Weekly questionnaires were completed by 248 participants for up to 4 weeks to assess their changes in treatment outcomes. Participants in the meditation group were also assessed for quality of meditation to evaluate the association between quality and treatment outcome. Results: Most clients were amenable to meditation as part of the treatment program, and two thirds chose to participate in daily meditation. While both groups reported significant improvement in treatment outcome, the meditation group reported a significantly higher treatment completion rate (92% versus 78%, p < 01) and more reduction in craving than did the SMART group. Participants whose meditation was of acceptable quality reported greater reductions in craving, anxiety, and withdrawal symptoms than did those whose meditation was of low quality. Female meditation participants reported significantly more reduction in anxiety and withdrawal symptoms than did any other group. Conclusions: Qigong meditation appears to contribute positively to addiction treatment outcomes, with results at least as good as those of an established stress management program. Results for those who meditate adequately are especially encouraging. Meditative therapy may be more effective or acceptable for female drug abusers than for males. Further study is needed to assess ways to improve substance abusers’ engagement and proficiency in meditation.
Introduction
C
omplementary and integrative medicine approaches are finding their way into treatment of substance use disorders as both clinicians and clients become more open to and interested in alternative approaches. Therapies such as yoga,1 qigong,2 relaxation techniques,3 therapeutic touch,4 meditation,5–7 guided imagery,8 biofeedback,9 and acupuncture10,11 have been reported as having varying but low levels of effectiveness in reducing withdrawal and craving and in improving client retention in treatment. Complementary ap-
proaches also support the inclusion of spirituality, self-care, mind–body integration, and other engagement-support elements that may be missing from typical cognitive and behavior therapy approaches. While this is the case, there are few studies on the acceptability, feasibility, and effectiveness of complementary approaches to substance abuse treatment. Meditation and related approaches are at the core of many complementary therapies that are finding their way into regular treatment programs.12 Since these are consistent with the literature of Alcoholics Anonymous and other 12-step approaches that include spiritual elements in their recovery
1
Center for Integrative Medicine and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD. New Hope Foundation, Marlboro, NJ. 3 Research Institute of Global Physiology, Behavior and Treatment, Inc., New York, NY. 4 Department of Psychiatry, University of Massachusetts Medical School, Boston, NY. 2
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876 process models and recommendations,13 acceptability is relatively high. Our clinical experience suggests that most 12step based clinicians are open to exploring the role that meditation might play in improving treatment outcomes, and integrating meditation and relaxation therapies with other evidence-based practices has yielded some promising results.14,15 For example, Layman16 summarized studies applying Zen meditation to addiction treatment and reported that 99% of patients who chose to practice meditation stopped drug use because of a change in perspective. The more general literature17–19 documents the positive effects of meditation on anxiety and depression, improvement in physical health, concentration, and sense of purpose, all of which are relevant to early and sustained recovery from substance abuse. A recent systematic review of meditation for health17 included substance abuse as one of three clinical applications where meditation practice can make a positive contribution to recovery. Although 17 of the controlled trials reviewed suffered from inadequate research design, in combination they suggest a positive trend of improved treatment outcome. Tension-reduction theories of addiction also support the potential benefit of the meditation effect. Meditation may be especially useful in strengthening neural networks that improve the focus of attention and management of withdrawal symptoms.20,21 While many variables must be understood before meditation can be accepted as standard protocol, the research to date points to the potential efficacy and cost-effectiveness of integrating this practice into more traditional substance abuse programs.18 Integrative qigong meditation Qigong (pronounced as Chi Kung), or qi meditation, is an ancient Chinese health practice that is believed to have special therapeutic effects.22 Qigong is a general term for a wide variety of traditional Chinese energy exercises and therapies, and it refers to all mind–body operational skills or techniques that integrate body, breath, and mind adjustments into Oneness.22 Such exercises or meditations as yoga, Reiki, Zen, Vipassana, and Transcendental Meditation, all better known in the West, are considered forms of qigong in China. There are no known studies on the application of qigong meditation to drug addiction treatment in the United States. There are, however, reports of successful applications of qigong to addiction treatment in China. Yan et al.23 treated 1403 drug addicts with Zhineng qigong in the Lanzhou Drug Treatment Center, combining group qigong practice with individual external qi healing to achieve improvements significantly better than those of conventional treatment alone. Xu24 reported that qigong therapy was somewhat effective in smoking cessation treatment, and Li and colleagues applied qigong meditation in their clinical trials with heroin addicts and demonstrated that qigong practice accelerates body detoxification, relieves withdrawal symptoms, and reduces anxiety symptoms.2 While their findings are impressive, most of these studies have methodological weaknesses. Moreover, it is not clear how much Chinese culture contributes to these outcomes or whether the benefits of qigong can be realized in an American population. To answer these questions, we conducted a series of pilot studies to introduce a specific form of qigong meditation to clients at a residential addiction treatment
CHEN ET AL. program. The objectives of this pilot study include (1) exploring the feasibility and acceptability of adding integrative qigong meditation to the regular residential treatment for addiction; (2) examining the primary effectiveness of the qigong meditation on addiction-related outcomes in a drug treatment facility; and (3) assessing potential differences in completion rate and effects on craving, withdrawal, depression, and anxiety in clients practicing qigong and those practicing Stress Management and Relaxation Training (SMART),3 a standardized relaxation program. Methods Treatment facility and subjects The study took place in the adult rehabilitation unit of a residential addiction treatment facility in New Jersey, where length of stay ranges from 14 to 28 days. The comprehensive program includes individual and group counseling based on motivational enhancement, cognitive behavior, and 12step facilitation therapies that are integrated into the daily schedule. All clients in the adult rehab unit, with no exclusions, were invited to participate in the pilot study. At the first stage, a feasibility trial, the clients were offered training and practice in qigong meditation in the evening of each day on a voluntary basis. At the second stage, all clients were offered a choice of qigong meditation or SMART twice daily, 5 or more days a week. Due to the pilot nature of this study and the fact that meditation is not an approved therapy in standard treatment, clients were allowed to switch programs during the course of treatment so that they would be more likely to give meditation a try. During the winter of 2004 and the summer of 2005, about 350 clients participated in the study and completed weekly questionnaires. Excluding those who dropped out of the study or treatment or had incomplete data or invalid responses, 248 participants completed the questionnaires with at least 2 weeks of useable data. Design The study protocol was approved by Board of Trustees at the treatment center and the Institutional Review Board of the Robert Wood Johnson Medical School. Two (2) daily periods were scheduled for clients to practice either qigong meditation or SMART. Random assignment was not used in this pilot study since it would be inappropriate to force clients to meditate. Feasibility and acceptance of meditation were important components of this pilot study. Each participant was informed of the study purpose and signed a consent form during the admission process. Changes in key outcomes were monitored with identical questionnaires, administered at entry and weekly during the entire stay. Procedure At the first stage, the clients were offered practice in qigong meditation in the evening of each day on a voluntary basis. At the second stage, all clients were given the choice of practicing qigong meditation or SMART twice a day. In addition to daily participation in either meditation or SMART, all participants were exposed to weekly, 90-minute mixed-gender educational seminars offering an introduction
INTEGRATIVE MEDITATION FOR ADDICTION to qigong meditation, information on stress management, self-healing, and the application of meditation for health. These seminars were attended by all participants and served as motivational and cognitive components. Participants completed the weekly questionnaires during the seminar periods. The qigong meditation was adapted from the Taiji FiveElement Medical Qigong25 and included two short forms: meditation for detoxification and classical meditation. This practice encompasses the following qigong techniques or elements: (1) slow abdominal breathing to relax the entire body and mind; (2) focused inward attention to warm up the lower abdomen; (3) breathing through the skin to absorb universal energy; (4) cleansing the body and brain with ‘‘sacred water’’ through guided imagery; (5) integrating breath–mind–body into Oneness and maintaining emptymindedness; and (f ) a closing procedure. There was no facilitation manual for this pilot study, but the meditation instructions were recorded on a 25-minute audio CD with soothing background music. Participants followed the recorded instructions and were told that the key to quality meditation lies in ‘‘relaxation, tranquility, and naturalness,’’ and ‘‘following the flow.’’ If they had difficulty following the instruction, they might simply rest the awareness at the lower abdomen and observe slow abdominal breathing. On most days, participants practiced meditation for detoxification in the morning, focusing on guided imagery for cleansing, and classical meditation in the evening, focusing on relaxation and gathering energy, under the supervision of a trained instructor. While the meditation group practiced qigong meditation with a CD player, a trained counselor facilitated the alternative program, SMART, which incorporates standard relaxation training and education to help people develop stress resistance skills. SMART was developed to give the participants the skills to reduce somatic anxiety arousal and form effective coping strategies. It had been used previously in this treatment facility for standard stress management. Measurements The instruments used in the study include (1) Readiness to change ruler26 (initial survey only) for alcohol, marijuana, cocaine, and opiates; (2) Adjective Rating Scale for Withdrawal27 (16 items), a symptom checklist ranging from muscle cramps to watery eyes and scaled from 0 (never) to 10 (severe) (a ¼ 0.92); (3) Voris craving/negative-mood scale28 (4 items; a ¼ 0.74); (4) CES Depression Scale29 (20 items, a ¼ 0.93); (5) Spielberger State–Trait Anxiety Inventory–State only30 (20 items; a ¼ 0.89); and (6) Substance-specific craving scale31 (10 items, a ¼ 0.82). All instruments have been used in previous studies and have good validity and reliability. To take quality of meditation into consideration, we created a four-item index to assess relaxation, tranquility, naturalness, and peacefulness/calmness during and after meditation. All items were rated from 1 ¼ low to 7 ¼ high. A score of 4 or more on each item at week 2 was considered acceptable; otherwise, we considered that the meditation was of low quality or that the participant was noncompliant. Each questionnaire was carefully checked for quality and completeness before data entry. Subjects who left too many questions unanswered or had an obvious response pattern
877 such as a ceiling or zigzag effect were excluded from the data analysis. No data were collected on substance use on the assumption that no one should have access to any substance during residential care. Analytic strategy Baseline group differences were analyzed with a w2 test for categorical variables and an F-test for continuous variables to assess compatibility. To examine significant changes over time and possible group differences in key outcomes, repeated-measure analysis of variance (ANOVA) with control for covariants was applied. Analysis was performed in two stages. First we analyzed the data of the meditation and SMART groups to determine any significant differences at baseline or follow-up. Then based on the observation that not all participants practiced meditation the same way, we subdivided the meditation group into two groups in order to determine whether quality of meditation affects treatment outcome. Participants did not achieve the same quality of meditation. Some acknowledged that they chose the meditation group in order to socialize with the opposite sex or have some quiet time, since the SMART program requires active participation in discussion. Of the 126 clients in daily meditation, 82 (65%) met the criteria of acceptable quality and 44 (35%) were classified as having low quality or low compliance. The subgroups were compared for both baseline and subsequent outcomes. Most key outcome measures had normal distribution with little skewing, so parametric statistics ( p < 0.05) were used in data analyses with SPSS-window software (Version 12). Results At the beginning we attempted to introduce qigong meditation as an optional activity for clients during their evening break time. During the 2 months of this open trial, about half of the clients came to try the qigong meditation, but only a small portion (n ¼ 7) continued with meditation daily during their stay. We found that those who chose to participate in daily meditation tended to have more severe withdrawal symptoms and craving at baseline and experienced significantly greater improvement than those in the treatmentas-usual group. A focus group was conducted at the close of the first stage to learn more about the barriers that clients faced in committing to meditation. Eleven (11) clients who had participated in at least one meditation session joined in this discussion. Questions related to their feelings and perceptions of meditation as an addition to their treatment were openly discussed. Surprisingly, most participants claimed that they liked qigong meditation and enjoyed the CD recording very much. They indicated that they did not continue the practice for a variety of reasons. The most frequent were: (1) ‘‘Too much for me, too much on my mind, I cannot concentrate or relax during qigong.’’ (2) ‘‘I don’t understand how it can help.’’ (3) ‘‘Should not occur in our free time but be part of the regular program.’’ (4) ‘‘May not have much benefit in such a short time.’’ (5) ‘‘Problems with the schedule; the afternoon or evening is for finishing assignments or other personal things.’’ (6) ‘‘Did not go back because nobody
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else went; I thought this was a group activity.’’ Nine (9) indicated that they would like to practice meditation as part of their regular program. This was one of the main findings taken into consideration when planning the schedule of the second pilot trial. During the second stage of the trial, in which all clients were offered a choice of qigong meditation or SMART twice a day as part of scheduled treatment, general acceptance of meditation was high. About two thirds of all clients chose qigong meditation as a component of their program after listening to the weekly seminars. Some clients offered very positive feedback on meditation. About one third of those in the meditation group asked for a copy of the meditation CD before they left treatment in order to continue practicing by themselves. As a result of positive outcomes and feedback from both clients and counselors, the treatment facility continued daily qigong meditation as a component of regular treatment even after our study was complete. Of the 248 participants with effective data, 207 are included in the final analysis: 81 (33%) chose SMART as their daily stress management program, and 126 (51%) chose qigong meditation. The 41 (16.5%) who switched between the two programs have been excluded from the data presentation, although analysis shows no significant difference be-
tween this group and other two. Table 1 presents the basic demographics and key outcomes at baseline of the 2 groups. Although there was no random assignment, Table 1 shows that there was no significant difference between the two groups in most of the demographic and outcome measures, which suggests no large self-selection bias in the natural grouping. However, some group differences in age, gender composition, and previous experience with meditation should be taken into consideration when looking at the outcomes. No significant group differences were found in baseline outcome measures. We examined the outcome measures for changes over time and found no significant differences between the 2 groups except in craving. The meditation group reported more reduction in craving than did the SMART group in weeks 1 ( p ¼ 0.054) and week 2 ( p ¼ 0.065). All participants, regardless of group, reported significant reductions in craving, sleep problems, anxiety, depression, and withdrawal symptoms during the treatment ( p < 0.01). Repeated-measure ANOVA by group and gender was applied to further examine group differences over time. Table 2 shows the summary results in terms of F statistics from these repeated-measure ANOVA models during the first 2 weeks of treatment.
Table 1. Description and Comparison of Baseline Information by Group Group Baseline measures N Demographics % of female Age: mean (SD) % of white % Never married % Unemployed or laid-off % Ever meditated before % Alcohol as main problem % Drugs as main addiction issue % Some college or college degree % Ever used nontraditional therapies Social perception Consider themselves religious (%) Ever prayed for health (%) Degree of religiosity/spirituality: mean (SD) General feeling about life (1 ¼ terrible to 7 ¼ delighted) Readiness for change Importance of planned changes Confidence in planned changes Outcome measures Voris craving/negative mood scale Withdrawal symptom checklist Drug/Alcohol Craving index VAS craving for drug or alcohol Spielberger Anxiety State scale CES Depression scale
Range of measure
Total 207
SMART 81
QM
Group diff (p-Value)
126
27.1 33.6 (10.4) 74.8 64.1 69.9 20.5 32.4 55.1 36.9 6.4
22.2 30.7 (8.9) 77.8 72.8 74.1 13.6 22.2 60.5 34.6 9.0
30.2 35.9 (10.9) 72.8 58.4 67.2 25.0 38.9 51.6 38.4 2.5
0.69 0.06
1–10
68.3 42.4 5.24 (2.4)
64.2 37.5 4.78 (2.4)
71.0 45.5 5.54 (2.4)
0.31 0.26 0.03
1–7
3.60
3.46
3.70
0.22
1–10 0–100 0–100
8.93 93.5 81.7
8.84 92.4 79.7
8.98 94.3 83.1
0.61 0.21 0.25
0–100 0–144 10–70 0–100 20–80 20–80
42.3 33.8 20.6 23.3 44.5 42.1
40.5 32.8 21.2 22.4 44.1 41.5
43.3 34.5 20.2 23.9 44.7 42.4
0.41 0.66 0.43 0.69 0.76 0.61
18–65
0.21 0.01 n.s. 0.05 0.21 0.05 0.03
SMART, Stress Management and Relaxation Training; QM, qigong meditation; SD, standard deviation; VAS, visual analog scale.
INTEGRATIVE MEDITATION FOR ADDICTION
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Table 2. Summary Results (F Statistics) from Repeated Measures Analysis of Variance for Major Outcomes Over 2 Weeks by Group (2) and Gender (2) Source\outcome measures
N
Time
Group
Gender
Time * group
Time * gender
Time * group*gender
(df ¼) Voris negative mood VAS craving score Drug/Alc craving scale Withdrawal index STAI Anxiety state CES Depression scale
202 189 202 204 199 190
2 23.8** 9.6** 18.0** 32.3** 42.5** 42.4**
1 1.49 2.13 2.75{ 0.01 0.05 0.16
1 0.03 0.24 0.43 7.83** 0.51 0.02
2 0.20 0.44 0.09 1.76 0.64 0.46
2 1.98 1.13 3.07* 0.26 4.01* 1.71
2 0.07 2.00 0.59 2.53{ 0.07 0.43
{ p 0.10; *p 0.05; **p 0.01. The 2 groups are qigong meditation and Stress Management and Relaxation Training. VAS, visual analog scale; STAI, State–Trait Anxiety Inventory.
These models confirm significant changes for all main outcomes with no significant between-group differences over time: The 2 groups did similarly well in most areas. There were significant gender differences in the reduction of craving and anxiety ( p < 0.05). Females reported higher craving and anxiety scores than did males at baseline and showed significantly more reduction in both variables by week 2. A similar gender difference was found in withdrawal symptoms. When we further classified meditation participants into subgroups to assess the effect of quality meditation on the outcomes, we found that participants in the low-compliance meditation group had significantly more problems with craving and withdrawal symptoms at baseline ( p < 0.05). These addiction-related symptoms improved significantly, but not as much as those of other groups. The exception is in the visual analog scale (VAS) craving scale, where the lowquality group reported higher craving at baseline but lower than that of the SMART group after 2 weeks. The multivariate ANOVA models in Table 3 confirm these findings. There were significant differences in main outcome measures among three groups at baseline except in withdrawal symptoms. In the course of treatment, all groups showed significant improvement ( p < 0.01). There were significant interaction effects between gender and time for negative mood, craving, anxiety, and depression, confirming that females tended to report worse symptoms at baseline but achieved more improvement than did males by the end of
the 2-week treatment. Figure 1 presents the means and changes in key outcomes of the SMART, low-quality/lowcompliance meditation, and acceptable meditation groups. Table 3 presents the results of repeated-measure ANOVA for these outcomes, with effects by time, group, gender, and their interactions. When we directly compared SMART participants with those in the quality meditation group (N ¼ 82), we found greater but not statistically significant improvement in the qigong group. Group differences did reach significant levels at week 2 for VAS craving ( p < 0.05), drug craving scale ( p < 0.01), anxiety ( p < 0.01), and depression ( p < 0.10; detailed data not shown due to space limitations). At the follow-up data examination, which included those who had dropped out of treatment early or for whom we had incomplete data, we found that those in the meditation group were more likely to have completed the scheduled treatment than were those in SMART. The completion rate for the meditation group averaged 92% (94.5% for quality meditation and 88.2% for low quality), while the rate for the SMART group was 78%. Group difference is statistically significant ( p < 0.01). Discussion These preliminary results suggest that acceptance of meditation as a component of treatment is high. More than two thirds of the clients chose qigong meditation as a component
Table 3. Summary Results (F Statistics) from Repeated Measures Analysis of Variance for Major Outcomes Over 2 Weeks by Group (3) and Gender (2) Outcome measures\source
N¼
Time
Group
Gender
Time * group
Time * gender
Time * group*gender
(df ¼) Voris negative mood VAS craving score Drug/Alc craving scale Withdrawal index STAI Anxiety state CES Depression scale
202 189 202 204 199 190
2 31.0** 17.1** 18.1** 50.5** 57.4** 62.8**
2 9.05** 4.65* 3.22* 2.23 10.5** 6.39**
1 0.08 0.15 0.11 8.65** 0.60 0.03
4 1.81 0.99 0.65 1.76 1.03 0.40
2 3.69* 0.70 2.54{ 1.11 7.61** 3.04*
4 0.23 2.28{ 0.73 2.70* 3.34** 1.06
{ p 0.10; *p 0.05; **p 0.01. The 3 groups are quality qigong meditation, low-compliance meditation, and Stress Management and Relaxation Training. VAS, visual analog scale; STAI, State–Trait Anxiety Inventory.
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CHEN ET AL.
FIG. 1. Mean group outcome measures over 2 weeks. (A) Negative Mood Index. (B) VAS Craving Score. (C) Anxiety State Score. (D) CES Depression Score. VAS, visual analog scale; SMART, Stress Management and Relaxation Training; QM, qigong meditation.
of their treatment program. While the qigong meditation and SMART groups reported similarly significant improvement after 2 weeks of treatment, subjects who attained an acceptable quality of mediation reported greater reductions in craving, anxiety, and withdrawal symptoms than did those with low-quality meditation. In general, the meditation group achieved a higher treatment completion rate (92%) than did the SMART group (78%, p < 0.01), suggesting that qigong meditation contributed positively to this commonly reported addiction treatment outcome. There are significant correlations between severity of negative mood or withdrawal symptoms and the quality of meditation practice. Those who reported more severe addiction-related symptoms at baseline tended to have more difficulty practicing meditation with the relaxation and calmness that is required, and thus they experienced less improvement than did those who were able to meet the basic requirements for quality meditation. This finding suggests the need for more practical methods or training to help clients better engage in breathing-based meditation and manage the frustration and restlessness blocking useful practice. While the results of this pilot study are informative, they are far from conclusive. Our procedural assessments and data suggest that clients in addiction treatment are highly receptive to meditation for stress management and that it is feasible to add group meditation to regular treatment. We received much positive written feedback from meditation participants, and about one third of participants requested copies of the meditation CD to continue practice after leaving the treatment. Our data show that female clients had higher addictionrelated symptoms when entering treatment, and that the females in the qigong meditation group reported significantly
greater reductions in anxiety and withdrawal symptoms than did any other group. This suggests that meditative therapy may be more effective (or acceptable) for female drug abusers than for males. It appears that including qigong meditation as a component of residential substance abuse treatment is feasible with appropriate supervision. About one third of meditation participants were unable to achieve quality meditation; some of these had chosen meditation over SMART because it required less active participation. Although the index of quality meditation was able to effectively identify these participants, the experience posits a not uncommon problem for substance abuse treatment in general (i.e., the problem of identifying ways to inspire clients who are not sufficiently motivated to commit to treatment and selfcare). It is not clear from this pilot study whether qigong meditation would benefit all clients in substance abuse treatment since clients self-selected into the two approaches. One third chose not to participate in meditation from the beginning, and another quarter left the meditation program. Of most interest are the low-compliance meditation subjects, who appeared to have had more problems at baseline, were present in the meditation room, but did not meditate as instructed. Since meditation is a self-care therapy based on selfawareness and inward attention, there are limited resources for checking and reinforcing quality of practice. It will be a challenge to apply randomized control to this type of study since only those who are willing to be randomized to a meditation group and practice meditation will be qualified for such a study. It is not clear what proportion of clients might be willing and able to engage in quality meditation under randomization conditions.
INTEGRATIVE MEDITATION FOR ADDICTION The limitations of this pilot study include (1) self-selection bias due to the lack of random assignment. Future studies call for a more sophisticated design with more compatible controls. (2) Unlike SMART, the qigong program lacked a detailed facilitation procedure or manual, making it difficult to assist clients in achieving acceptable quality and commitment. (3) This study did not measure possible effects on physical and spiritual health or long-term effects on general well being. (4) The study did not provide adequate training for the counseling staff to appropriately integrate this selfcare therapy into their interactions with clients. Such lack of training and support limits the benefits of this self-care therapy. While far from conclusive, our preliminary evidence suggests that qigong meditation might be a valuable and beneficial treatment supplement for some patients. In comparison with the SMART group, those who practiced daily, acceptablequality qigong reported greater reductions in craving, anxiety, and withdrawal symptoms. As meditation introduces elements of self-responsibility to substance abuse treatment that complement standard therapies and programs, it is a promising approach that warrants further exploration. Our preliminary results encourage further study, including longitudinal follow-up, in order to identify the potential benefits of integrative qigong meditation that is readily available for use in substance abuse treatment and recovery programs. Acknowledgments This study was partially supported by a research grant from the Research Institute of Global Physiology, Behavior and Treatment, Inc., New York. The authors would like to thank Lei Zhong, Cindy Tow-Eng, Edward Chu, Kate Kapner, Kara Moeller, and Joy Stellar for their assistance in the data collection and delivery of the integrative qigong meditation in this study. We also appreciate the comments and suggestions made by Joy Stellar, Christine C. Berger, and Lyn Lowry on prior versions of this article.
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Disclosure Statement No competing financial interests exist. 21.
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CHEN ET AL. Address correspondence to: Kevin W Chen, PhD, MPH Center for Integrative Medicine University of Maryland School of Medicine 520 Lombard Street, Room 101C Baltimore, MD 21201 E-mail:
[email protected] 