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THE EFFECTS
PSYCHOLOGICAL
Eric Smernoff, PhD,1 Inbal Mitnik, MA,1 Ken Kolodner, ScD,2 and Shahar Lev-ari, PhD1#
INTRODUCTION
Mental disorders, in particular depression and anxiety, are
associated with impairment in physical, social, and role
functioning, as well as in health-related quality of life. They
are also associated with increased prevalence of chronic
diseases and increased mortality and morbidity, such as in
coronary heart diseases.13 Mental disorders account for 13%
of the global disease burden, and their economic effect is
24
Results: A mixed models analysis revealed signicant positive changes between baseline compared to the end of the
intervention and six-month follow-up in all measures: BDI-II
(t 10.24, P o .0001), SHS (t 9.07, P o.0001), QOLI
(t 5.69, P o .0001), QIDS-SR16 (t 9.35, P o .0001),
OQ-45.2 (t 11.74, P o .0001), STAXI-2 (State) (t 3.69,
P .0003), STAXI-2 (Trait) (t 7.8, P o .0001), STAI (State)
(t 11.46, P o .0001), and STAI (Trait) (t 10.75,
P o .0001).
Conclusions: The promising results of this pilot study
warrant randomized clinical trials to validate The Work
meditation technique as an effective intervention for
improvement in psychological state and quality of life in
the general population.
Key words: The Work, meditation, psychological symptoms, quality of life
(Explore 2015; 11:24-31 & 2015 Elsevier Inc. All rights reserved.)
METHODS
Participants
The sample included individuals self-enrolled in a nine-day
workshop entitled The School for The Work at Los Angeles,
CA, USA, in November 2008. All the participants signed an
informed consent form prior to enrollment in the research study.
Due to the samples characteristics, minimal exclusion criteria of
ability to read English at a ninth grade level or higher (as judged
by successful completion of a battery of self-reported measures)
and willing to sign an informed consent were employed.
Data Collection
Each participant was assigned a number that was used on all
test materials in order to ensure condentiality. All the subjects
lled in seven self-administered questionnaires on three occasions: at the beginning of the training course (T1), at the
completion of the training course (T2), and at six months after
completing the training course (T3). The forms were returned
by mail at T3. The research staff was available at all times to
answer questions. Questionnaires were scored according to the
standard procedures of each instruments instruction manual.
Intervention Method
The participants attended a nine-day workshop guided by
Byron Katie and assisted by a staff of facilitators who were
trained in the authorized certication program at The
Institute of the Work (ITW), an international learning
center13 based in the USA. All sessions followed the
guidelines of the training manual that was developed in
order to maintain consistency in the program. This manual
is based on the instructions of Judge-your-neighbor (JYN)
worksheet (Appendix 1) and the inquiry technique detailed in
Loving what is.14 The subjects received a training manual to
serve as a guideline for performing the various forms of the
inquiry practice.
During the sessions, the participants were encouraged to explore
their stressful thoughts using The Work technique, which is based
on identifying and investigating the thoughts that cause distress and
suffering. This process is divided into two parts. The rst part is to
identify the stressful thoughts in a systematic and comprehensive way
and to write down the thoughts about various situations perceived
by the person as being stressful.
JYN worksheet is the main tool for systematically identifying
stressful thoughts in The Work technique.
The participant is instructed to think of a reoccurring stressful
situation, a situation that is reliably stressful even though it may
have only happened once and reoccurs only in your mind. Before
answering each of the questions below, allow yourselves to mentally
revisit the time and place of the stressful occurrence. The participant
then writes down all the thoughts and beliefs regarding the stressful
situation as he/she perceives them according to the worksheet
format.13,14
25
26
RESULTS
All 197 participants who were initially recruited to this study
completed the initial surveys (T1), 164 completed the surveys
immediately after the intervention (T2), and 102 completed
the surveys at the six-month follow-up after the intervention
(T3). Table 1 provides the demographic characteristics of the
participants. A total of 168 subjects completed one of the two
follow-ups. Overall, 68% were females (mean age 48.27
9.05 years) and 31% were males (mean age 46.83 12.28
years). Most of the participants were married, employed full
time, and had a college degree.
Mixed models revealed a signicant positive change in all
measures when comparing the baseline to T2 and T3
(Table 2). There were no differences in any measures from
Table 1. Demographic
(n 197)
Characteristic
Characteristics
of
the
Participants
Sex
Female
Male
Missing
Age (years)
Women
Men
134 (68.37%)
62 (31.63%)
1
48.27 (9.05)
46.83 (12.28)
Marital status
Single
Married
Divorced
Separated
Widowed
Missing
55 (32.16%)
59 (34.50%)
41 (23.98%)
13 (7.6%)
3 (1.75%)
26
Employment status
Full time
Part time
Self-employed
Unemployed
Retired
Missing
73 (42.20%)
12 (6.94%)
68 (39.31%)
6 (3.47%)
14 (8.09%)
24
Education level
o12 Years
Good enough diplomab
High school
1315 Years
Bachelor's degree
Master's degree
Doctorate degree
Missing
1 (0.54%)
0
9 (4.86%)
32 (17.30%)
74 (40%)
47 (25.41%)
22 (11.89%)
12
DISCUSSION
This pilot study assessed the effectiveness of The Work
intervention in a non-clinical sample, and its preliminary
results indicated a signicant improvement in psychological
state and quality of life after the intervention, as measured by
a range of well-established psychometric assessment tools.
This effect lasted six months after the intervention. The
selected sample represents a non-clinical cohort with depression scores within the normal range according to Becks
depression scale.21 Likewise, the StateTrait Anger scores24
and the Subjective Happiness Scale28 were not signicantly
different from the published norms. The Quality of Life
scales further conrmed that this cohort was mentally healthy
and relatively satised with their lives.32 Levels of Trait
Anxiety, which were higher than the normal population,23
decreased signicantly after the intervention, and this effect
persisted for six months after it.
27
Table 2. Comparison of Outcomes for the Baseline Versus Post-Intervention (n 197) Using Mixed Models
Before Intervention (T1) After Intervention (T2) After Six Months (T3)
P
Instrument
Mean (SD)
Mean (SD)
Mean (SD)
t Valuea
Beck Depression Inventory (BDI)
11.89 (10.42)
4.01 (5.16)
3.86 (5.29)
10.24 o.0001
Subjective Happiness Scale (SHS)
4.71 (1.37)
5.49 (1.18)
5.50 (1.21)
9.07 o.0001
Quality of Life Inventory (QOLI)
1.95 (1.1.73)
2.89 (1.17)
2.67 (1.27)
5.69 o.0001
Quick Inventory of Depressive
7.30 (4.76)
4.28 (2.90)
3.73 (2.66)
9.35 o.0001
Symptomatology-Self Report (QIDS-SR)
Outcome Questionnaire (OQ)
61.17 (24.46)
41.52 (20.58)
41.47 (22.00)
11.74 o.0001
StateTrait Anger Expression InventoryState
18.48 (5.63)
16.40 (4.28)
16.36 (4.70)
3.69 0.0003
(STAXI)
StateTrait Anger Expression InventoryTrait
18.13 (5.53)
15.36 (4.07)
14.64 (3.78)
7.80 o.0001
(STAXI)
StateTrait Anxiety ScaleState (STAI)
40.29 (13.05)
27.69 (8.53)
31.23 (11.28)
11.46 o.0001
StateTrait Anxiety ScaleTrait (STAI)
42.22 (11.67)
34.37 (10.88)
33.10 (10.60)
10.75 o.0001
SD, standard deviation.
a
The t value represents a contrast using mixed models of the baseline versus the pooled phase average of both follow-up time periods.
28
APPENDIX 1
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