From the Heart: Comparing the Effects of Spiritual and Secular Meditation on Psychophysiology, Cognition, Mental Health, and Social Functioning in Healthy Adults

Study Overview
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Brief Summary
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The purpose of this study is to investigate and compare the effects of Christian and Islamic heart-centred spiritual meditation to mindfulness meditation and waitlist control conditions, respectively, in healthy adults. The potential effects will be studied at multiple levels, with a focus on psychophysiology, cognition, mental health, and social functioning.

Detailed Description
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Background Secular forms of meditation have been widely accepted as an effective tool to promote well-being and as therapeutic strategies. The popularity of such practices, most notably mindfulness meditation, can be attributed to the substantial body of research on their beneficial effects in the past few decades. While these practices are loosely based on Eastern traditions, and actively reduce emotional reactivity, some Western spiritual meditations have retained their God-centred focus and aim to elicit strong emotions. The current study aims to examine the effects of heart-centred contemplation based on Christian and Islamic traditions on mental, physical, cognitive, and social well-being, compare the outcomes of these exercises to mindfulness meditation, and investigate the external correlates of the outcomes. Aims The present study aims to recruit healthy adults to investigate and compare the effects of Christian and Islamic heart-centred spiritual meditation to mindfulness meditation (Mindfulness-based stress reduction; MBSR) and waitlist control, respectively. The potential effects will be examined using measures from multiple domains, with a focus on psychophysiology, cognition, mental health, and social functioning. Additionally, the study aims to examine the possible external correlates of the outcomes by testing perspective-taking, affect, religiosity, spiritual experiences, closeness to God, closeness to the offender, and credibility/expectancies about the spiritual meditation program. The study seeks to understand the impact of different types of meditation practices on the well-being of individuals. Participants This study will apply a mixed method repeated measures design to examine a three-arm stratified randomised control trial with healthy samples of Christians and Muslims in multiple testing centres, including Hong Kong and India. Assessments will be conducted at three time points: pre-intervention (T1), after intervention (T2), and at a 3-month follow-up (T3). Eligible participants will be first stratified into Christian and Islamic samples and then randomly allocated to one of the three conditions: religious contemplation (either Christian or Islamic spiritual meditation based on their religions), mindfulness meditation, or waitlist control. Administration of intervention The intervention will consist of an 8-week app-based program, including approximately 20-minute daily audio-guided instructions of either one of the spiritual meditations or mindfulness meditation. Participants from the waitlist control will not receive any intervention, but they will be given access to Christian or Islamic meditation app after the experiment is completed. Outcome measures Outcome measures consist of domains related to interpersonal functioning, physiology, attention, mental health, spirituality. Primary outcomes will be the interpersonal functioning domain including measures of prosociality, forgiveness, empathy, and perspective taking. Secondary outcomes include domains concerning physiology, attention, and mental health. Physiology domain encompasses pain threshold, pain intensity, stress reactivity (heart rate and heart rate variability), psychophysiological reactivity associated with forgiveness (heart rate and heart rate variability). Attention domain includes measures of alerting attention, orienting attention, and executive attention networks. Mental health domain involves self-reported stress, depression, anxiety, subjective welling, and positive and negative affect.

Official Title
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From the Heart Multi-Centre Study: Comparing the Effects of Spiritual and Secular Meditation on Psychophysiology, Cognition, Mental Health, and Social Functioning in Healthy Adults

Conditions
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Prosocial Behavior, Forgiveness, Empathy, Pain, Attention, Depression, Stress, Anxiety, Mental Well-being

Intervention / Treatment
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* Behavioral: Arm 1 - Heart-Centred Spiritual Meditation: Christian contemplation
* Behavioral: Arm 1 - Heart-Centred Spiritual Meditation: Islamic contemplation
* Behavioral: Arm 2 - Action Control: Mindfulness Meditation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 to 60 years old able to read, speak and understand English willing to be randomly assigned to all the conditions, with religious affiliation restricting allocation to either the Christian or Islamic type of spiritual meditation conditions consider oneself to be a Christian or Muslim and pray at least weekly Exclusion Criteria: currently suffer from any mental health conditions or use medication to manage mental health conditions long-term serious physical medical problems, such as liver, brain, kidney, or other life-threatening chronic diseases a history of a heart condition, high blood pressure, Raynaud syndrome, diabetes, or musculoskeletal condition the current use of anxiolytics/mood stabilizers.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The study consists of 3 arms, including: Arm 1 - experimental groups: Heart-Centred Spiritual Meditation. Within this arm, the interventions encompass Islamic heart-centred contemplation and Christian heart-centred contemplation. Participants allocated to the spiritual meditation groups will receive either Islamic or Christian heart-centred contemplation intervention, depending on their respective religious affiliations. Arm 2 - active control group: Mindfulness-based Stress Reduction. Participants assigned to the active control group will receive mindfulness intervention. This arm mirrors the time commitment and level of engagement of the contemplation interventions. Arm 3 - passive control group: Waitlist control. Participants assigned to the waitlist control group will not receive any intervention.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Heart-centred spiritual meditation<br>Intervention 1: Christian contemplation and Intervention 2: Islamic contemplation | Behavioral: Arm 1 - Heart-Centred Spiritual Meditation: Christian contemplation<br>* Participants assigned to this condition will receive daily audio instructions of approximately 20 minutes daily over the course of 8 weeks focused on Christian contemplation delivered through a mobile app. The intervention will consist of a core contemplative practice focused on heart visualisation based on Christian tradition and prayer recitation with breathing to focus their attention on and connection to God.<br>Behavioral: Arm 1 - Heart-Centred Spiritual Meditation: Islamic contemplation<br>* Participants assigned to this condition will receive daily audio instructions of approximately 20 minutes daily over the course of 8 weeks, focused on Islamic contemplation delivered through a mobile app. The intervention will consist of a core contemplative practice focused on heart visualisation based on Islamic tradition and prayer recitation with breathing to focus attention on and connection to God.<br>|
| Active Comparator: Mindfulness Meditation (MBRS)<br>Intervention 3: Mindfulness Meditation (MBRS) | Behavioral: Arm 2 - Action Control: Mindfulness Meditation<br>* Participants assigned to this condition will receive daily audio instructions of approximately 20 minutes daily over the course of 8 week, focused on mindfulness meditation delivered through a mobile app. The intervention will consist of the mindfulness-based stress reduction program which emphasizes focused attention on breathing and sensations as well as the practice of non-judgemental acceptance of the present experience.<br>|
| No Intervention: Waitlist control<br>No Intervention: Participants in this condition will not receive any intervention and the outcome measures will be only collected at time points T1 and T2. After T2 testing, they will be given access to either the Christian or Islamic intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Interpersonal functioning: Change in Prosociality (1) | The number of game points (0-10) that a participant is willing to allocate to another individual as measured by the Dictator Game | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Interpersonal functioning: Change in Prosociality (2) | Social value orientation scores as measured by the social value orientation slider measure. The higher scores represent greater prosocial preferences while lower scores represent greater self-interest preferences | Pre-intervention (collected up to 1 week before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Interpersonal functioning: Change in Prosociality (3) | The percentage of compensation fees that participants are willing to donate to a charity | Post-intervention (collected up to two weeks after the 8-week intervention) | 
| Interpersonal functioning: Changes in self-reported Forgiveness | A self-reported forgiveness scale assessed within a forgiveness task, ranging from 0 (Not at all) to 20 (Completely). High scores reflect a higher level of forgiveness, while lower scores indicate a lower level of forgiveness | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Interpersonal functioning: Changes in self-reported Empathy | A self-reported empathy scale assessed within a forgiveness task, ranging from 0 (Not at all) to 20 (Completely). High scores reflect a higher level of empathy, while lower scores indicate a lower level of empathy. | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Interpersonal functioning: Change in Perspective Taking | Interpersonal Reactivity Index (IRI) - Perspective Taking scale. The 7-item Perspective Taking scale from IRI measures one's tendency to take the point of view of others. Participants are asked to rate how closely the statements describe them on a 5-point Likert scale ranging from A (Does not describe me well) to E (Describes me very well). The total scores range from 0 - 28. Higher scores indicate greater perspective-taking | Pre-intervention (collected up to 1 week before the intervention), post-intervention (collected up to 2 weeks after the intervention), and at 3-month follow-up (collected up to 2 weeks following 3 months after the end of the intervention) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physiology: Change in Pain Tolerance | The duration (in seconds) that a participant endures painful stimulation assessed during an endurance task | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Physiology: Change in Pain Intensity | 0-10 Numerical Rating Scale | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Physiology: Change in Stress Reactivity (1) | Heart rate | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Physiology: Change in Stress Reactivity (2) | Heart rate variability | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Physiology: Change in psychophysiological reactivity associated with forgiveness (1) | Heart rate assessed during a forgiveness task. | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Physiology: Change in psychophysiological reactivity associated with forgiveness (2) | Heart rate variability assessed during a forgiveness task | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Attention: Change in Alerting Attention network | Reaction time assessed through a 10-minute version of Attentional Network Task (CRSD-ANT) | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Attention: Change in Orienting Attention network | Reaction time assessed through a 10-minute version of Attentional Network Task (CRSD-ANT) | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Attention: Change in Executive Attention network | Reaction time assessed through a 10-minute version of Attentional Network Task (CRSD-ANT) | Pre-intervention (collected up to 3 hours before the intervention), and post-intervention (collected up to two weeks after the 8-week intervention) | 
| Mental health: Change in self-reported Stress | The Depression, Anxiety and Stress Scale - 21 Items (DASS-21) is a 21-item self-report questionnaire that comprises three distinct subscales: depression, anxiety, and stress, with each containing 7 items. Participants are asked to rate the extent of the statements applied to them over the past week using a 4-point rating scale, ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Higher scores on stress scale reflect a greater severity of the stress symptoms, whereas lower scores indicate a milder experience of these symptoms | Pre-intervention (collected up to 1 week before the intervention), post-intervention (collected up to 2 weeks after the 8-week intervention), and at 3-month follow-up (collected up to 2 weeks following 3 months after the end of the intervention) | 
| Mental health: Change in self-reported Depression | The Depression, Anxiety and Stress Scale - 21 Items (DASS-21): Depression subscale, ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Higher scores on depression scale reflect a greater severity of the depression symptoms, whereas lower scores indicate a milder experience of these symptoms | Pre-intervention (collected up to 1 week before the intervention), post-intervention (collected up to 2 weeks after the 8-week intervention), and at 3-month follow-up (collected up to 2 weeks following 3 months after the end of the intervention) | 
| Mental health: Change in self-reported Anxiety | The Depression, Anxiety and Stress Scale - 21 Items (DASS-21): Anxiety subscale, ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). Higher scores on anxiety scale reflect a greater severity of the anxiety symptoms, whereas lower scores indicate a milder experience of these symptoms | Pre-intervention (collected up to 1 week before the intervention), post-intervention (collected up to 2 weeks after the 8-week intervention), and at 3-month follow-up (collected up to 2 weeks following 3 months after the end of the intervention) | 
| Mental health: Change in Subjective Wellbeing | Well-Being Index (WHO-5). WHO-5 is a 5-item self-report questionnaire measuring subjective wellbeing. Participants are asked to rate their feelings in the past 2 weeks using a 6-Likert scale, ranging from 0 (At no time) to 5 (All of the time). The raw score is multiplied by 4 and the final scores range from 0-100. A score of 0 indicates the lowest possible level of wellbeing, whereas a score of 100 reflects the highest possible level of wellbeing | Pre-intervention (collected up to 1 week before the intervention), post-intervention (collected up to 2 weeks after the 8-week intervention), and at 3-month follow-up (collected up to 2 weeks following 3 months after the end of the intervention) | 
| Mental health: Change in self-report Positive and Negative Affect (1) | International Positive and Negative Affect Schedule (PANAS) Short Form (I-PANAS-SF). I-PANAS-SF is a 10-item self-report questionnaire measuring 5 items of positive affect and 5 items of negative affect. Participants are asked to rate their general feelings and emotions on a 5-point Likert scale ranging from 1 (Never) to 5 (Always). Higher scores indicate a greater level of positive affect, and lower scores represent a lower level of negative affect | Pre-intervention (collected up to 1 week before the intervention), post-intervention (collected up to 2 weeks after the 8-week intervention), and at 3-month follow-up (collected up to 2 weeks following 3 months after the end of the intervention) | 
| Mental health: Change in self-report Positive and Negative Affect (2) | 5-item Smiley Face Likert scale within the meditation app. The scale assesses participants' feelings before and after their daily contemplative / mindfulness practices. Participants are asked to choose one out of the five emoji faces on the scale to indicate their current feelings ranging from a very sad face to a very happy face | Throughout the 8 weeks intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Christian spiritual meditation, Islamic spiritual meditation, Mindfulness, Prosociality, Forgiveness, Empathy, Pain, Attention, Depression, Stress, Anxiety, Well-being, Heart-centred spirituality