A Randomized Controlled Trial of Awareness Training Program (ATP), a Group-Based Mahayana Buddhist Intervention

Mindfulness https://doi.org/10.1007/s12671-018-1082-1 ORIGINAL PAPER A Randomized Controlled Trial of Awareness Training Program (ATP), a Group-Based Mahayana Buddhist Intervention Bonnie Wai Yan Wu 1 & Junling Gao 1 & Hang Kin Leung 1 & Hin Hung Sik 1 # The Author(s) 2019 Abstract Objectives This study evaluated the effectiveness of a Mahayana Buddhist teaching- and group-based intervention, the Awareness Training Program (ATP), which is textually aligned to a Mahayana Sūtra so that its theory and practice are coherent. The ATP aims to alleviate stress by enhancing participant’s compassion and wisdom of nonattachment. Methods Middle-aged working adults (n = 122) in Hong Kong participated in this randomized waiting-list controlled trial. Selfreported psychological questionnaires were used to assess the participants’ level of stress (PSS), sense of coherence (SOC), psychological well-being (GHQ), and nonattachment (NAS) at pretest, posttest, and 3 months later. Results The data showed significant improvements in the intervention group over the controls for all outcome measures at posttest and 3 months later (post and post-3 PSS: ηp 2 = .15 and .16; post and post-3 SOC: ηp 2 = .05 and .10; post and post3 GHQ: ηp 2 = .16 and .13; post and post-3 NAS: ηp 2 = .17 and .14). A mediation analysis demonstrated that nonattachment mediated both the treatment and the maintenance effects for all outcome variables (post and post-3 PSS: indirect effect ab = − 1.50 and − 1.70; post and post-3 SOC: ab = 2.48 and 3.61; post and post-3 GHQ: ab = − 1.65 and − 1.56; bootstrap 95% confidence interval (CI), CI does not include zero). Conclusions The ATP may effectively reduce stress and improve a sense of coherence and psychological well-being by enhancing participants’ wisdom of nonattachment. This study provides promising evidence that the ATP could be an effective intervention for middle-aged working adults. Keywords Awareness Training Program . Mahayana Buddhism . Meditation . Stress . Nonattachment . Wisdom of nonattachment . Compassion Over the past few decades, there has been increasing interest in incorporating Buddhist practices into group-based interventions for treating various psychological problems in the behavioral, social, and health sciences. The Buddhist practice of mindfulness has been incorporated into many of these groupbased interventions as a key component. Such practices are generally known as Bmindfulness-based interventions^ (MBIs). Scholars have demonstrated the efficacy and effectiveness of many of these MBIs in improving participants’ psychological and physical health. However, some scholars have shown that many MBIs vary in the type of mindfulness practice and in the manner that is incorporated into the interventions (Chiesa and Malinowski 2011; Singh et al. 2008; Van Gordon et al. 2015). Many * Hin Hung Sik 1 Buddhism and Science Research Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong, Hong Kong scholars have also noted that one possible issue with these MBIs is that they may have applied mindfulness practice in an out-of-context manner (Bodhi 2011b; Shonin et al. 2013b; Singh et al. 2008) that Bdivorces it from its profoundly transformative potential^ (Kabat-Zinn 2015). Another possible issue with these interventions is that they may have incorporated components from various Buddhist models of the elimination of suffering without considering if they are coherent. As Bodhi (2011a) has noted, there is a danger in creating Bcognitive dissonance^ by merging theories and/or techniques from different schools and/or traditions. The reason for this argument is that each individual school and/or tradition has its own theoretical model and assumptions, which guide and dictate the development of the corresponding system of practice. Nevertheless, Shonin and Van Gordon (2015) have a different perspective on this discussion of lineages and traditions. They argued that Bthe Buddha wasn’t concerned with endorsements or lineages, he was only interested in whether a meditation teacher had tamed their mind^ (Shonin and Van Gordon 2015, p. 143) and Blineage is a means of guiding Mindfulness people to enlightenment, but it is not enlightenment itself^ (Shonin and Van Gordon 2015, p. 143). Therefore, it is argued that authentic Dharma lineages and traditions must be open to evolution and not become attached to whatever guiding principles they deem define them. Despite these differing views, some scholars still believe that building an intervention that systematically incorporates a coherent Buddhist model of the elimination of suffering into its theoretical model and program content is a logical development given that many of these MBIs have been shown to be efficacious by incorporating only part of the Buddhist system of eliminating suffering (Sik 2010; Teasdale et al. 2003; Van Gordon et al. 2014). According to Van Gordon et al. (2015), these MBIs could be regarded as Bsecond-generation MBIs,^ and when compared to first-generation MBIs, such as Mindfulness-Based Stress Reduction (MBSR), these Bsecond-generation MBIs, such as Meditation Awareness Training (MAT), have integrated a greater range of meditation techniques and subscribe to a definition of mindfulness that is arguable to be more congruent with the traditional Buddhist construction^ (Van Gordon et al. 2016, p. 364). This could be further developed by formulating an intervention that systematically combines a Buddhist theoretical model with a compatible meditation practice. Recent examples of second-generation MBIs include Mindfulness-Based Positive Behavior Support (Singh et al. 2013, 2014, 2018) which includes the four immeasurables, compassion, attachment, and the five hindrances, and explicit teachings on Buddhist ethics, and Mindfulness-Based Symptom Management (Monteiro et al. 2018) which includes the Five Skilful Habits—the five lay Buddhist precepts—presented as ethical themes. However, current second-generation MBIs do not explicitly include Mahayana Buddhist teachings or groupbased interventions that adopt a textually aligned approach, and that has a coherent theory and praxis. BMahayana Buddhist teaching,^ Btextually aligned,^ and Bcoherent theory and praxis^ are important components to consider when formulating an MBI for the following reason: Mahayana Buddhism, unlike the more classical Theravada Buddhism that focuses on eliminating suffering, emphasizes the cultivation of compassion and wisdom to develop spiritual advancement, which will eventually lead to the attainment of Buddhahood. In a way, Mahayana Buddhism’s emphasis of the cultivation of compassion and wisdom follows a Bwellness model,^ whereas Theravada Buddhism’s focus on the elimination of suffering is more consistent with a Bmedical model.^ The importance of being Btextually aligned^ concerns tracing back to the source of the teachings, thereby avoiding the potential danger of inconsistency between theory and p (...truncated)