THE EFFECT OF TRANSCENDENTAL MEDITATION UPON MODIFYING THE CIGARETTE SMOKING HABIT

Allen J. Ottens, Ph.D

Allen J Ottens, PhD. Department of Social and I’rerlentirie Medicine, University of Maryland School of Mrdicine, Aaltimore, Maryland.

INTRODUCTION Within the past several years, there has been

increased interest in, and investigation of, the effects attribut,ed to the practice of various medit,ative techniques. One meditative technique, in part,icular, that is arousing a good deal of interest and stimulating a growing body of research is Transcendental Meditation (TM). Unlike other, more “esoteric” or austere techniques, T M appears to be more suited for t,he typical Western life style: i t is easily learned and practiced, involves no mental control or physical manipulation, and demands no great changes in one’s daily routine. 1‘M is practiced twice daily for fifteen or twenty minutes. During meditation, the practitioner is instructed to think the sound of a rnantm, a melodious Sanskrit syllable which is assigned individually to each T M student. The proponents of Transcendental Meditation claim that T M provides i t s practitioners with a relaxing, tension-reducing experience.

Preliminary investigations have pointed to a number of salutary effects apparently resulting from TM practice. Certain positive physiological changes (eg., Wallace and Benson, 1972; Wallace, 1970) and psychological changes ( e.g, Nidich, Seeman, and Dreskin, 1973; Seeman, Nidich, and Banta, 1972) have been attributed to TM, as well as positive changes of addictive behavior involving the use of nonprescription drugs, alcohol, and cigarettes (Henson and Wallace, 1972). Moreover, such physiological, psychological, a n d behavioral changes are claimed to be more profound over time, as one continues to practice the technique.

One finding from the Benson and Wallace (1972) survey is especially interesting. Benson and Wallace

li This paper was presented a t the Scientific Forum of the ASHA Research Council, 1974 Convention of the American School Health Association in New York City.

surveyed a sample of 1,862 TM practitioners. Of this number, 976 or 52.4 percent were originally non-smokers. It was discovered that after a maximum of three months of meditation, the number of non-smokers increased to 1,197 or 64.2 percent of the total sample. Thus, more than 25 percent of the cigarette smokers within this sample had quit using cigarettes. After a maximum of nine months of meditation, more than 38 percent of the smokers had quit. These da ta show a substantial decrease in cigarette smoking dependency as experience in practicing T M increased.

I t is intriguing to note in the Benson and Wallace (1972) survey, the practice of T M had not necessarily been a specific treatment, per se, tor abandoning the use of cigarettes-the subjects in the sample gave up such usage seemingly of their own accord sometime after beginning TM. However, i t was not known from this survey whether o r not the cigarette usage was discontinued independently of meditation. No control group had been used to gauge the relative effectiveness of TM. However, the encouraging statistics reported by Benson and Wallace (1972) argued for increased investigation o f T M practice as a n alternative to cigarette use.

The purpose of the present study was to expand upon the Benson and Wallace survey da ta by monitoring the cigarette consumption of smoker- subjects in Transcendental Meditation and control groups. It was hypothesized a t the close of an appropriate treatment period (ten weeks) subjects within the T M group would be smoking significantly fewer cigarettes than subjects within the control groups.

SUBJECTS The subjects for this study were recruited through

a n advertisement in the University of 1llinoi.s (Champaign-Urbana) campus newspaper and through notices placed in various buildings in and around the campus area. Almost all subjects were University of Illinois students. Subjects were randomly assigned to one of three groups: ( a ) Transcendental Meditation ( T M ) group; ( b ) s e l f -

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'I'ABLI' I

SLJIIJISC'I ( ' O M P O S I ' I ' I O N 0 1 : I I<ANSCL"DI:NTAL MEDITATION (TM 1, SI1LI.'<'ON'I'ROL ( S O , A N I ) NO '1KI:ATMI:NT ( N T ) GROCJPS

~~. __ __ _l____l__

M e a n I,.stirnate M a l e / { ) I Cigarettes Mean No. of

bernale Mean Age SL) Smoked Per Day SD Years Smoking SL) .- __ - ~ ___I__ ___I__-

Group . ~-

' I M* 12 M, 6 I , ' 22.50 4.98 21.11 6.32 4.44 2.46 S ( ' * * 9M,91. ' 22.11 3.04 22.94 8.86 4.84 1.53 "1. 10 M , 8 1: 20.50 4.39 23.50 9.38 4.00 3.05

\ t ) i \ f r o I (SC) group and (c ) no treatment ( N T ) group !'he (omposi t ion of the three groups a re iirinniariLed i n Table I.

PROCEDURES Each group met separately a t an initial meeting

to receivtb instructions about i t s role in the study 'wihjects were informed the duration of the study \ $ o d d I ) c a approximately 11 weeks, consisting of a tivv-da\ baseline period and 10 treatment weeks

\ I I s u b p ts were instructed to record the number of b rgirrettes smoked during a five-day period prior to 1 Iriset 01 treatment. At this initial meeting, subjects ,ilho w t w instructed to keep daily accounts of the iiumbei ( I f cigarettes smoked during the ten week i ieatrncmt phase of the study. These cigarettes were I tv ordetl on log sheets provided for this purpose. At ilw end o f each treatment week of the study, these ~ i , i i l y log sheets were mailed back to the I IiLestigator in stamped, addressed envelopes ywcific procedures for each group are outlined 1 bt. lo w

1"11/1 G I o i l p

Subjec 1.4 in the Transcendental Meditation group if ere told the study would be investigating the effect

'I'M on cigarette smoking. Subjects were informed IIitby w i ~ u l d be t a u g h t t h e t echn ique of I I iinscendental Meditation by qualified instructors

i r om the local Student International Meditation "-locwty (SIMS). The TM subjects were told after t / w five-rl,iy baseline period, they would be expected 1 4 8 learri 'ind to practice T M as taught to them. ~ ~ l ~ l i t i o r ~ a l l y , TM group members were instructed

1 4 ) ( a ) practice TM twice daily over the ten weeks of ( t i c & stud\?, and (b ) to smoke according to their need lor cigarettes.

i'o i i ~ cArtain whether all subjects were practicing i M as iristructed, a question to this effect was

I I H luded t i n each of the subject's daily log sheets. I irrt herinore, to insure all subjects of the TM group r l l t h t the rtasponsibilities of the study outlined, a $25

y ti

TABLE I I

HASI<LINI. TOTAL A N D BASF,LINI' MI:ANS I,OK T K A NSC I: NI) ENT A L. M I : I) I TAT10 N, Sl< LF-CO NT K O I , ,

A N D NO TRI,:ATMENT GROCII'S - _ ~ _ _

Five-day Total 0 1 Group n Cigarettes Smoked X SI)

TM 18 1637 90.94 33.115 SC 18 1703 94.61 43.12 NT 18 1751 97.28 42.70

deposit was requested of each subject to be refunded upon satisfactory completion of the study's requirements. In return for completing the necessary requirements demanded of them, the total cost of receiving TM instruction ($45) would be paid for each subject. All subjects made this $25 deposit, and this deposit was returned to all TM group participants a t the end of the study.

A t the TM group's initial meeting, subjects received the first introductory instruction lecture on TM by a qualified T M teacher. Questions about TM and the nature of the study were answered a t the initial meeting.

One stipulation for learning T M involves abstaining from nonprescription drugs for a 15-day period prior to actually beginning meditation. I t was necessary to identify those subjects within the TM group who failed to meet this criterion. Nine subjects were identified a s having used such drugs within this time. These subjects were held in abeyance for two weeks and received complete instruction in TM practice. Five days before these nine subjects began their meditation instruction, they were contacted to begin keeping the baseline cigarette consumption da ta . The other nine qualified students received customary TM lectures and instruction over the next several days after this initial meeting. After the initial meeting and instruction sessions, subjects in the T M group were instructed to practice the technique on their own for the remaining ten weeks; no further meetings were

DECEMBER 1975 VOLUME X L V NO. 10

held during the treatment period with T M group mern hers.

s(' Group

,The self-control group was told the investigator was devising a group discussion format intended to help individuals quit smoking. I t was explained there would be s ix group meetings, one about every 1 % days. This number of meetings was chosen to caonform to the number of instruction sessions required of the subjects who learned TM. At these meetings, subjects i n the SC group were given handouts that were developed to focus on various motivational and psychological aspects for giving up cigarettes. A separate handout was distributed a t each meeting. SC subjects were instructed to attend all meetings, to read the handouts, to refer to them a s aids in quitting smoking, and to use the handouts as springboards for di.scussion during each SC meeting.

Again, subjects in the SC group kept account of all cigarettes smoked during the five-day period prior to treatment and kept daily log sheets of cigarette consumption during the ten-week treatment period. To insure subjects in this group maintained motivation to continue to participate in the study, a $20 payment was given a t the end of the study to each subject who satisfactorily completed the study's requirements. At the end of the study, this pa,yment was made to 18 subjects in the SC grn u p .

A t the s ix discussion meetings, subjects talked about the various aspects of their smoking habit with other group members; they shared their own "tips" and techniques for giving up cigarettes; they explained and described personal successes and failures in quitting; and they discussed the ideas presented in the handouts and attempted to implement some of the handouts methods for qui t t ing smoking. T h e invest igator allowed discussion to flow in the directions that appeared most relevant for the SC group members. Subjects were strongly encouraged to develop for themselves whatever method was most personally effective to stop smoking.

NT Group Subjects in the no treatment group were told a

study was being conducted on the effects of a special treatment on cigarette smoking. At the NT group's initial meeting, i t was explained this group would represent the control group for this experiment. The importance of the N T group's participation in this study was stressed.

The N T group was instructed to keep daily accounts of the number of cigarettes smoked during the course of the study. I t was explained during the study, N T subjects could choose to continue to smoke a t their present rate, decrease or increase cigarette consumption, or to quit altogether. The choice was theirs, so long as they actually recorded the number of cigarettes they smoked.

For their participation in the study, subjects in the NT group were told they would receive a $10 payment for satisfactory completion of the study's requirements. This payment was made to subjects a t the end of the study's eleventh week.

I t is known nonspecific factors can have an influence on smoking reduction (McFall and Hammen, 197 1). One prominent nonspecific factor operating in many smoking-reduction studies is the act of self-monitoring cigarette consumption. Consequently, it was necessary to include in the study a no treatment (NT) control group whose task was simply to log the number of cigarettes smoked in order to allow for any deviance in the smoking patterns of the T M and SC groups due to the self- monitoring effect.

RESULTS All subjects in each of the three groups,

Transcendental Meditation (TM), self-control (SC), and no treatment (NT), kept records of the number of cigarettes smoked over a five-day baseline period prior to the beginning of treatment. The total number of cigarettes smoked by each group over these five-days and the mean number of cigaretteh smoked by the subjects in each group for the fivc. days a re summarized in Table 11.

A one-way analysis of variance was computed to determine whether or not the baseline data for the

TABLE 111

ANALYSIS 01: VARIANCE SUMMARY 01: CIGARETTES SMOKED FOR THREE TREATMENT GROUPS DURING BASELINE PERIOD

Source of Variation Sum of Squares d.f. Mean Square 1:

Between 367.33 2 183.67 0.12 Wit hi n 81,179.50 51 1591.75

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I'ABLE IV

ANAl YFlS 0 1 V A K I A N ( I 01 TO1 AL NUMHL I< 01 CI(rAKI I I1 S TMOKI I) PI K w i I K I OK I A( ii S U H J I ( ' I I N r m i I

TRI ATMI N r (3KOCII'5 OVI K I 1 N W I I K L Y OBSLRVA IIONS

I -

Mean Square ~

Source of Variation Sum o f Squares d.f .

Treatment ( A ) 327,891.7 2 163.945.9 x . z x * 1,009,034.7 5 1 19,802.6 Icrror (a)

Observations (ti) R ,65 ( I . 5 9 96 I .2 1 .69 rreatinent X 49,680.5 18 2,7 6 0.0 4.844

observations (AXH) Imor (b) 26 1.495.2 45 9 569.7

three groups differed significantly. These results are sumniwrized in Table 111.

I t ('an be seen from Table I11 that there was no significant difference between the three groups on the rriean number of cigarettes smoked by each group over the baseline period.

An atialysis of variance was performed on the cigarette consumption da ta which covered the ten- week t.reatment period of the study. These dat.a cmsisteci of each week's total cigarette consumption li)r eac4i subject in the three treatment groups. This malysis is summarized in Table IV.

For t,reatment (A) effect, means from the three IrtJatnient groups have been averaged over ten observations, representing a general over-all iiieasurc. of cigarette consumption for each trt~atnwnt. Since A mean square was significant ( 1 1 ~ 0 1 I , it can be concluded the treatment groups' i I Ira ns differed significantly.

For (he rva t ion ( B ) effect, means of the ten wrekly observations were averaged over three I reatments, but it cannot be concluded the means of i he ten observations differed significantly.

'I'he significant Treatment X Observation (AXB) iiitrractron ( p <01) indicated cigarette consumption (~irves lot- the three treatment groups were not of tlw sanw form. Put another way, the trend of the ttliwrvatton means was not the same for the three ti,c*at,merrt levels. Figure 1 represents the AXB Irlteract,iotr curve.

1'0 detvrmine if cigarette consumption of the three g,i I J I I ~ S showed a decline over ten weeks of the study, ,-t;itistic;il technique of trend analysis was utilized 1 0 study the trend of the three group means over ten ,t1w(vssive weekly observations. Trend analysis can

i 9 t 5 rtnploytd to reveal either upward or downward .t.t.n(ls in the data. In addition to the upward or tf~,wriwar(l 1 linear) trend, it is possible to determine *tlicJther tlie dat,a show a significant degree of

4 !ii\riiturt. o r a quadratic trend (Edwards, 1960). II will tw recalled the treatment period for this

study was a total of 70 days ( ten weeks). 7'0 make the trend analysis of the data extremely more concise and interpretable, the 70 days were collapsed into a total of ten weekly observations. Thus, a group member's weekly, rather than daily, cigarette consumption was used for the trend analysis. The total weekly number of cigarettes smoked by each group over ten weeks (observations) are given in Table V.

An analysis of over-all observation means was computed on data in Table V. The cell totals in

I- z

i;; I I I I 1

z I

FIGURE 1

TOTAL WEEKLY CIGARETTII CONSUMPIION PLOTTED FOR 'TKIIATMIiNT CROUPS

ACROSS TEN WEEKLY OBSLRVATIONS Original data given in Table V

\ \ \

I I

I I I

I I

I I

I I I

1 I

I I

I I

, I , I I

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 w l n d m m - 2 2 23613c1=: r I w m m m r a 2 Q I 2

101 A L N L l M B I I< 0 1 CIbARI TI I 'i 5MOKI 1) PI I< WI I K I O K (,KOllI '4

DECEMBER 1975 VOLUME XLV NO 10

TABLE V

TABLE VI

ANALYSIS 01" OVI:R-hLL OHSI<RVAI'ION MLANS, LINEAR COMPONENT

1) I Linear component= (- 1 I684)'= 7660.82 __- ( ; roup

' I M -14738 S( -2352 N'I' +5406 569.7 *p <.() I . 1l.t: i atid 4.59

(54) (330)

I:= 7660.82 = 13.45* ___ - _._____

~- .

Table V were multiplied by the corresponding linear coefficient ( -9, -7, -5, -3, -1, + 1 , +3, +5 , +7, + 9 ) appropriate for a n experimental design

employing ten observations. The figures in D, c.olumn of Table VI represent the row totals obtained by multiplying Table V cell totals by the linear coefficient and summing.

Since F = 13.45 with 1 and 459 d.f., we can conclude that the over-all observation means showed a significant linear trend. Moreover, the direction of this trend is downward as indicated by the large negative number appearing in the numerator of the linear component. Thus, the trend of the three treatment groups' means, taken together, is essentially l inear a n d negative (downward).

To test for curvature of the over-all trend, the weekly cell totals (from Table V) were multiplied hy the corresponding quadratic coefficient (t 6, +2 , I , - 3 , -4, -4, -3, -1 , +2 , +6). The figures in the DL column of Table VII represents the row totals obtained by multiplying Table V cell totals hy the quadratic coefficients and summing. Table VI I summarizes the quadratic component calcula- tions.

Since F = 0.50 with 1 and 459 d.f., we can conclude the over-all observation means do not show a significant curvature. The two orthogonal comparisons regarding the trend of the ten observation means indicated a significant linear comparison (downward trend) with no significant curvature.

The difference between the linear components of the trend for the three treatment groups can now be

examined. The analysis of the linear component o f this interaction is summarized in Table VIII.

Since F = 30.65 with 2 and 459 d.f., we can conclude the linear components of the trends for the three groups differed significantly.

The da ta in Table IX outline the calculations to test for differences in the curvature of the trends.

Since F = 0.61 with 2 and 459 d.f., we caii conclude the differences in curvature of the trends were not significant.

DISCUSSION Cigarette consumption of the SC group dropped

most sharply from the end of the baseline period through the first treatment week, and then leveled off. Cigarette consumption of the T M group, as can be seen in Figure 1, showed a gradual decline a c n m the treatment weeks.

The significant Treatment X Observations linear interaction indicated the cigarette consumption curves for the three groups were not of the saint. form. This is apparent in Figure 1 which shows a decline in cigarette consumption for the SC and 'I'M groups and a gradual increase for the NT group. The different D, totals (Table VI), large negative ( -14738) for the T M group, smaller negative ( -2352) for the SC group, and positive ( +540fi) tor the N T group indicated these cumes would differ Since the trend of trial means for the T M group decreased more gradually than for the SC grouj), these D, totals for the T M group would C O ~ S C ' -

quently result in a larger negative figure. Although the cigarette consumption curves were of

different forms, inspection of Figure 1 indicated

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TABLE V I I

TABLE Vl l l

TliE A7 M I NT X OUSI K V A I IONS I N 1 I IlACI ION. LINLAR COMI'ONI N I

2 1,: Linear Component -~ d.t. Mean Squarc 1) I u: x I), -14738 217208644 11684 136515856 34925.95 2 17462.98 -2352 5531904 +5406 29224836 I - 17462.98 = 30.65* ___-

569 7

that from the seventh through the tenth treatment weeks, the consumption curves for the T M and SC groups almost overlap. Analysis of the baseline data showed prior to t reatment , mean cigarette consumption of the T M and SC groups were statistically similar. At the end of treatment, cigarette consumption totals for these two groups again showed little difference.

The significant over-all linear trend indicated the trend of over-all treatment means was essentially linear and negative. Thus, a significant decrease in cigarette consumption for the combined TM and SC group means was obtained. However, despite the significant over-all linear trend and the significant Treatment X Observations linear interaction, inspection of Figure 1 indicated it cannot be concluded that Transcendental Meditation was a more effective treatment approach for reducing cigarettt. smoking than the traditional group discussicin method used with the self-control group. Both 'I'M and SC groups significantly decreased their cigarette consumption but it was not possible to concslude one treatment approach was more effective than the other.

I t must be emphasized this present study represents only a preliminary effort in determining the effect of Transcendental Meditation on cigarette smoking. Although cigarette consumption of the T M group i r i this study did decrease, this decrease was no more pronounced than evidenced by the se l f - control group. Additional research is needed to better gauge the effectiveness of T M a s a viable treatment approach.

If the subjects in the T M group followed specific instructions to smoke as they felt the need to smoke,

reducing cigarette consumption may have been easier for the T M subjects than for the SC subjects. However, this degree of personal difficulty encountered in giving up cigarettes was not measured in this present study. I t may be useful to determine if the practice of Transcendental Meditation could prove to be an easier method than others for cutting down or giving u p cigarettes.

A further research possibility could include using other subjects who have longer smoking careers than the typical college-age student. I t still needs to be determined if T M can help the older, inveterate smokers to reduce their dependency on cigarettes.

It, has been recognized (Ikard & Tomkins, 1973; Tomkins, 1966 and 1968) that one important smoking behavior is negative affect smoking. Characteristically, this type of smoking behavior often occurs when the individual is experiencing tension or anxiety. With increasing evidence of Transcendental Meditation a s a tension-reducing or relaxation technique, areas for future research could include investigating the effect of TM upon reducing the incidence of negat,ive affect smoking.

Finally, a more ambitious research er:deavor might involve investigating the practice of T M as a possible smoking preventive. A follow-up study of students, perhaps of early high school age, who practice T M could be conducted to determine if fewer of these individuals would be cigarette smokers than individuals in a corresponding control group. I t has been reported (Driscoll, 1972) that 'I'M has been introduced into a high school to combat drug abuse. Perhaps introduction of T M into a high school as a cigarette smoking preventive could prove effective.

582 DECEMBER 1975 VOLUME X L V NO. 10

54 3 294849 +I431 2047761

ACKNOWLEDGMENT Thr riuthor, wishes to thank the members of his doctoral

r,ommittre, Urn. Robert Linn, Harold Moses, Jean Phillips, cintl Domlrl Stone for their help in completing this study.

BIBLIOGRAPHY Henson H, Wallace RK: Decreased drug abuse with

'Transcendental Meditation: a study of 1,862 subject,s. In Zarafonetis CJD (ed): Drug Abuse, Proceedings of the International Conference. Philadelphia, Lea and Febiger, 1972.

Ihiscoll FG: 'I'M as a secondary school subject. Phi Delta Kappan, 54:236-237, 1972.

Edwards AL: Experimental Design in Psychological Research, New York, Holt, Rinehart and Winston, 1960.

Ikard FF, Tomkins S: The experience of affect as a determinant of smoking behavior: a series of validity st.udies. J Abnorm Psycho1 81: 172-181, 1973.

McFall RM, Hammen CL: Motivation, structure, and

689.82 2 344.9 I

I:= 344.91 = 0.61; d.f. 2 and 459 569.7

self-monitoring: role of nonspecific factors in smoking reduction. J Consult Clin Psychol 37:80-86, 1971.

Nidich S, Seeman W, Dreskin T: Influence of Transcendental Meditation: a replication. J Couns Psychol 20:565-566, 1973.

Seeman W, Nidich S, Banta T: Influence of Transcendental Meditation on a measure of self- actualization. J Couns Psychol 19:184-187, 1972.

Tomkins SS: A modified model of smoking behavior. In Borgatta EF, Evans RR (eds): Smoking, Health, Behavior. Chicago, Aldine Publishing Co, 1968.

Tomkins SS: Psychological model for smoking behavior. American Journal of Public Health, 1966, 12, 17-20.

Wallace RK: Physiological effects of Transcendental Meditation, Science 167:1751-1754, 1970.

Wallace RK, Benson H: The physiology of meditation. Sci Amer 22684-90, 1972.

The author of this article is Allen d Ottens, PhU., Assistant Professor, Social and Preventive Medicinr, University of Maryland School of Medicine, Baltimore, MD 21201.

SIECUS ANNOUNCES NEW PRESIDENT AND EXECUTIVE DIRECTOR

T h e Board of Directors of the Sex Information and Education Council of the U.S. today announced tha t Mary S. Calderone, MD, MPH, noted authority on sexual health and education, has been appointed President of the nonprofit organization she helped to establish in 1964. Board Chairman, Wardell B. Pomeroy, PhD, announced simultaneously the appointment of Joyce Dudney Fleming, PhD, to the post of Executive Director.

Dr. Fleming, a cum laude graduate of Ohio Wesleyan, received her doctorate in philosophy from the University of California for a special study program in the psychological and the biological aspects of sexual behavior. She comes to SIECUS from Psychology Today.

THE JOURNAL OF SCHOOL HEALTH