Qigong: Acute Affective Responses

Qigong: Acute affective responses
“Qigong and emotion/mood”.

Örebro Studies in Sport Sciences 4
Mattias Johansson
Qigong: Acute affective responses

in a group of regular exercisers
© Mattias Johansson, 2009
Title: Qigong: Acute affective responses

in a group of regular exercisers
Publisher: Örebro University 2009
www.publications.oru.se
Editor: Heinz Merten
heinz.merten@oru.se
Printer: Intellecta Infolog, V Frölunda 04 /2009
issn 1654-7535
isbn 978-91-7668-665-2
ABSTRACT
Qigong is a Chinese mind-body therapy that aims to, through the use of movements,
relaxed breathing and relaxation/meditation, create a healthy flow of life force, qi, in
the body, and consequently improve health. A growing number of Qigong studies
report beneficial effects on health and well-being. However, little attention has fo-
cused on the acute affective responses that accompany single sessions of Qigong ex-
ercise. The aim of the present thesis was therefore to study affective reactions to
Qigong exercise. In Study I, the effects of Qigong exercise on mood and anxiety were
compared to a control group. Results showed partial support for the superiority of
Qigong exercise compared to controls. In Study II, different lengths of session time
were compared, resulting in similar affective benefits for the 30 and 60-minute ses-
sions. In Study III, affective responses were also assessed during the session, using
mean scores and individual responses. Results showed an increase toward greater
Activated and Deactivated Pleasantness during the session, with the greatest changes
at the end of the bout. The majority of individuals reported increased Pleasantness
during the Qigong session. Expectations of positive outcomes were significantly as-
sociated with only few affective responses. Responses to open-ended questions of af-
fective experiences displayed affective reactions mostly toward greater Deactivated
Pleasantness. This thesis contributes to a greater understanding of the limited area of
Qigong-related affective responses. For the exercisers, Qigong is associated with a
greater momentary emotional state. However, due to the highly select group of regu-
lar Qigong exercisers, generalizing the results outside the sample population is lim-
ited. Theories on active mechanisms in the Qigong-affect relationship, and results
from studies of affective responses to similar activities, suggest that other groups of
people would also benefit affectively from Qigong exercise. Given the many benefits
of positive affect, Qigong exercise may also pose great promises for the enhancement
of other areas related to health and well-being. This calls for additional studies.
Key words: Qigong, affective responses, mind-body therapy, low-intensive physical

activity, affect regulation
3
ACKNOWLEDGEMENT
Writing a doctoral thesis is like climbing a mountain. Starting out easily, it then
gradually becomes steeper and more difficult, until you are finally standing on top of
the mountain. You sit down and feel proud of yourself, having managed to reach the
top. Then you look up and see that what you thought was the top of the mountain
was just a cliff, and that the mountain continues further and further up into the sky.
So you have to keep on climbing… During my years of PhD work, there have been
hardships and struggles, followed by times of accomplishments and relaxation, then
again followed by new difficult challenges… These cycles are repeated (like in all
parts of life), but gradually it does get easier – you find new tools that simplify the
tasks, and the times of struggle don’t last as long as they used to. Having reached
one of the tops (still not aware of the next top!), I feel proud and satisfied. But no
matter whether you choose to climb a mountain or write a PhD thesis, you always
need friends and colleagues who support and encourage you to keep going. Without
them, the task would be nearly impossible and much less fun.
First I would like to thank my supervisor, Peter Hassmén, who has continuously
supported me, giving me instant feedback on my work, challenging me, and pushing
me into becoming an independent researcher. Peter, I am grateful for your encour-
agement and support when I was struggling, and for you believing in me when I
couldn’t find the way up the mountain.
I would also like to thank my assistant supervisor, Anna Hertting, who has shared
her knowledge and supported me in the latter part of my studies. Returning from our
talks I always feel inspired, full of new ideas, and happy about being a researcher.
Anna, I have especially enjoyed our talks on mind-body therapies, where you have
shared your knowledge.
Naturally, the thesis could not have been completed without the participants in the
three studies. Thank you for taking part in my studies. I am also grateful to the
4
Green Dragon, the member association of Biyun Qigong in Sweden. First I thank
Qigong master Fan Xiulan for sharing her great knowledge of Qigong, and letting
me conduct research on her method. I am also grateful to Niko Nygren, Ewa Den-
ward-Olah, Göran Jacobson, and Helena Norman, who have been of valuable assis-
tance and who have shared their knowledge of Qigong.
Being part of the PhD student group in Sport Sciences at Örebro University has been
so much fun. Thank you Henrik Gustafsson, Helena Andersson, John Jouper, Jenny
Isberg, Anders Heden, Jing Li (thank you for the beautiful calligraphy), John Hell-
ström, Sören Hjälm, Lina Wahlgren, Peter Mattsson, Mattias Folkesson, and Karin
Andersson, for making these years such a memorable experience. I would especially
like to mention John Jouper who inspired me to begin doing research on Qigong,
Helena Andersson for many inspiring talks about music and life, and Henrik
Gustafsson, who with his humor and friendship has made life and work especially
enjoyable.
I have also had the pleasure of working as a teacher in Sport Sciences. I feel grateful
to have had the opportunity to work, learn from, and enjoy the positive, humorous,
and warm atmosphere of the people in “the corridor”. In addition, I have also had
the opportunity to broaden my skills and knowledge by teaching in Public Health. It
has been great to be part of this small but warm, hard-working, enthusiastic and
creative group of people. From Sport Sciences and Public Health, I would particu-
larly like to mention Hanna Arneson, Jeanette Åkerström, Nathalie Hassmén, He-
lena Sjöberg, Peter Marklund, Stephan Svenning, Helena Ragnarsson, Elisabeth
Solin, Anita Cierzniewski and Kerstin Norman for making each day at work a warm
and meaningful experience.
I am grateful to Magnus Lindwall and Petra Lindfors, who read and gave me valu-
able criticism on earlier versions of the present thesis. Thank you also, Stig Wenne-
berg, for sharing your knowledge of research on meditation and related areas. Over
the years I have also had the pleasure to chat with, learn from, and enjoy the com-
pany of other people in the Sport psychology area: Carolina Lundqvist, Hansi Hinic
Urban Johnson, Göran Kenttä, and Johan Fallby.
During my PhD student time I have also taken many interesting courses. I especially
think of Professional Communication with Margaret Kerr, and the Exercise Psychol-
ogy workshop at Exeter University with Adrian Taylor, Panteleimon Ekkekakis, and
Elaine Rose, for its high quality and high value for me as a researcher.
I feel blessed to have so many wonderful friends. In their company I have been able
to rest from the hardships of PhD work. Thank you Tomas Engström, Mattias
Danielsson, Christer Rangefil, Hanna Forsgärde, Anna Sandberg, Alice Hartmann,
Nathalie Runeborg, Rie Hjorth, Paul Nowak, Anna Solgevik, Carlos Wedin, An-
dreas Holmquist, Klaus Nesse, Anna Krafft, Helena Edman, Eva Gustafsson, and
My Rådmark – you are fantastic!
As I’ve survived and enjoyed these years, the list of thanks wouldn’t be complete if I
didn’t mention my experiences and friends from the alternative communities around
Sweden, who have deeply enriched my life. I especially think of the courses Passion
For Life and The Five Rhythms©.
Life does not wait on you while you write your PhD! Over the years I have experi-
enced times of hardship, sorrow, strain, happiness, joy, gratefulness and lots of other
emotions. I would like to express my deep gratitude to life – which although it is
sometimes tough, keeps expressing itself in ways that challenge me and enable me to
grow – for sharing its many wonders and mysteries.
I am eternally grateful for the endless love and support I have received from my par-
ents, Kerstin and Per-Olof, and my sister Maria. You have always wanted the best
for me. My warm thoughts also go to Daniel and Sanna, and my immediate family.
6
Finally, my dearest Anna, you challenge and support me with your love and honesty,
and remind me of what is truly important in life.
7
The thesis is based on the following three studies, which are referred to in the text by
their Roman numerals:
I. Johansson, M., Hassmén, P., & Jouper, J. (2008). Acute effects of qigong exer-
cise on mood and anxiety. International Journal of Stress Management, 15,
199-207.
Re-produced with permission by The American Psychological Association
II. Johansson, M., & Hassmén, P. (2008). Acute psychological responses to qigong
exercise of varying durations. The American Journal of Chinese Medicine, 36,
449-458.
Re-produced with permission by World Scientific Publishing Company.
III. Johansson, M., Hassmén, P., & Hertting, A. Affective responses to qigong ex-
ercise: A pilot study. Submitted for publication.
8
TABLE OF CONTENTS
SVENSK SAMMANFATTNING AV AVHANDLINGEN .........................................15
INTRODUCTION .................................................................................................19
QIGONG ..........................................................................................................21
Chinese philosophy and medicine ...................................................................21
History and defi nitions ..................................................................................23
Different styles of Qigong .............................................................................. 24
Research on Qigong exercise...........................................................................25
BIYUN QIGONG ..............................................................................................28
Biyun Qigong ..................................................................................................28
Physical activity ..............................................................................................29
Relaxation .......................................................................................................31
Attentional regulation (meditation).................................................................32
Imagery ...........................................................................................................33
Respiration ......................................................................................................34
Self-massage .................................................................................................... 35
STUDYING AFFECTIVE RESPONSES ............................................................36
Differentiating between affect, mood and emotion.........................................36
Regulating affective states...............................................................................41
Antecedents and dynamics of affective states .................................................42
Measuring affective responses ........................................................................43
A framework for the study of affective responses .......................................... 44
ACUTE AFFECTIVE RESPONSES ..................................................................46
Suggested mechanisms for acute affective benefits ..........................................46
Acute affective responses to physical activity ..................................................51
Acute affective responses to mind-body therapies ...........................................52
Acute affective responses to Qigong exercise ..................................................54
UNANSWERED QUESTIONS IN THE QIGONG-AFFECT
RELATIONSHIP ..............................................................................................55
RATIONALE FOR THE PRESENT THESIS .....................................................56
AIM OF THE THESIS .........................................................................................59
STUDIES ............................................................................................................61
STUDY I ..........................................................................................................61
Introduction ....................................................................................................61
Method ...........................................................................................................61
Results and discussion ....................................................................................62
STUDY II ........................................................................................................63
Introduction ....................................................................................................63
Method ...........................................................................................................64
STUDY III ........................................................................................................66
Introduction ....................................................................................................66
Method ...........................................................................................................66
GENERAL DISCUSSION ....................................................................................73
MAIN FINDINGS.............................................................................................73
RESEARCH QUESTIONS ...............................................................................73
Are the affective responses associated with Qigong exercise
significantly different from a control condition? .............................................73
Are the affective responses associated with Qigong exercise
dependent on length of session? ......................................................................74
Is there a relationship between affective responses and expectations
of affective benefits? ........................................................................................75
How do affective responses display themselves and change, from pre-,
to during, to post-exercise, using mean averages and individual scores? ........76
How do the exercisers describe the experience associated with
Qigong exercise, during and after the session? ................................................77
METHODOLOGICAL ISSUES .........................................................................78
Participants .....................................................................................................78
Design .............................................................................................................79
Procedure ........................................................................................................80
Measures ........................................................................................................81
Statistical analysis ...........................................................................................85
Ethical considerations .....................................................................................85
CONCLUDING DISCUSSIONS ........................................................................87
Affective changes associated with Qigong exercise .........................................87
A proposed model of mechanisms of affective benefits ...................................90
Causality in the Qigong-affect relationship ...................................................94
Is Qigong beneficial for everybody? ................................................................96
Qigong – affective regulation and alleviation of physiological arousal? .........97
Long-term benefits of regular Qigong exercise................................................98
Future studies .................................................................................................99
CONCLUSIONS ...............................................................................................103
REFERENCES .................................................................................................105
SVENSK SAMMANFATTNING AV AVHANDLINGEN
Qigong är en kinesisk kroppsrörelse och meditationsform (mind-body therapy) som
har utövats i årtusenden för dess hälsofrämjande effekter. Qi kan översättas med
livskraft och gong med arbete. Grundprinciperna för qigong är att genom avspän-
ning och naturlig andning fokusera på och inhämta qi (livskraft) till kroppens alla
delar, och få till stånd ett hälsosamt flöde av qi. Många människor upplever positiva
effekter i samband med qigongträning.
Sedan några årtionden har qigong blivit föremål för ökat intresse från forsknings-
världen. Trots att vissa studier lider av bristande vetenskaplig kvalitet ökar antalet
studier av god kvalitet. Den samlade forskningen pekar på hälsofrämjande effekter
inom områden som stresshantering, ökad livskvalitet, känslomässig balans, en för-
bättrad förmåga att hantera negativa symtom av och leva med kronisk sjukdom,
samt ökad motståndskraft vid sjukdom.
Även om forskningen på qigong ökar har studier av akuta känslomässiga effekter
av enstaka qigongpass varit få. Det affektiva området inkluderar emotioner, sinnes-
stämningar och känslor, dvs. känslomässiga reaktioner. Mer kunskap om aktiviteter
som får människor att må bra är av stor vikt då många människor lider av såväl fy-
sisk som psykisk ohälsa. Även om ökat känslomässigt välmående i stunden är viktigt
i sig, klingar känslomässiga reaktioner efter ett tag av. Det har emellertid visats att
personer som regelbundet aktiverar sig också kan få mer långvariga effekter. Ett po-
sitivt känslomässigt tillstånd påverkar exempelvis hur vi ser på oss själva och livet i
stort. Vi tolkar omgivningen mer positivt, minns fler positiva minnen och möter oss
själva och andra mer positivt. Positiva känslotillstånd kan också göra att negativa
fysiologiska reaktioner i samband med stress och negativa känslor snabbare klingar
av. Känslomässiga effekter som är kopplade till en viss aktivitet påverkar också om
vi väljer att fortsätta att engagera oss i aktiviteten.
Syftet med avhandlingen var att studera känslomässiga reaktioner av enstaka qi-
gongpass. Studiedeltagarna rekryterades i samband med qigongläger; majoriteten var
högutbildade medelålders (55 år) kvinnor som under några år regelbundet tränat qi-
gong. I Studie I, var syftet att jämföra effekterna av ett enstaka qigongpass med en
11
Qigong: Acute affective responses ✍ mattias johansson I 15

kontrollgrupp som fick lyssna på ett föredrag av grundaren av Biyunmetoden (själv-
skattningsinstrumenten Profile of Mood States, POMS, och state-versionen av State
and Trait Anxiety Inventory, STAI användes). Resultatet visade att oro/ängslan, de-
pression, ilska och utmattning minskade signifikant i qigonggruppen jämfört med
kontrollgruppen. Denna skillnad var dock inte synlig i självskattad spändhet, förvir-
ring och vigör. Att jämföra känslotillståndet efter qigong med det efter ett föredrag
av grundaren av den aktuella qigongformen är inte optimalt; de något varierande re-
sultaten kan möjligtvis förklaras av detta. En bättre kontrollbetingelse skulle ha varit
en grupp som satt och läste en bok.
I Studie II, jämfördes känslomässiga reaktioner efter ett qigongpass på 30 minuter
respektive efter ett på 60 minuter. Det visades sig att båda passen förbättrade det
känslomässiga tillståndet lika mycket (POMS, STAI och självkonstruerade skatt-
ningsskalor för upplevd aktivering och välmående användes). Detta resultat är vik-
tigt för dem som inte har tid att träna längre pass, vilket är ett vanligt skäl till att inte
engagera sig i fysisk aktivitet. En viss försiktighet med denna slutsats är dock nöd-
vändig sett ur ett qigongperspektiv. Trettiominuterspasset bestod nämligen av Jichu
gong och 60-minuterspasset av Jichu gong och Dong gong tillsammans. Jichu gong
är den första formen i Biyunqigong och Dong gong den nästkommande. De två for-
merna har olika mål. Medan Jichu gong fokuserar på att mjuka upp kroppens leder
och skapa förutsättning för qi-flödet syftar Dong gong till att inhämta qi från om-
givningen.
I Studie III fick qigongutövarna även skatta sitt känslomässiga tillstånd under qi-
gongpasset. De nomotetiska mätningarna kompletterades med individuella beskriv-
ningar av stämningsläget. Resultaten visade att de känslomässiga förbättringarna
startar efter 10-20 minuters qigong och ökar i styrka under resterande del av passet.
Qigongutövarna rapporterar skönare känslomässiga tillstånd som både är mer akti-
verande och avslappnande. Den stora majoriteten av utövarna upplever att det känns
behagligt under tiden de tränar qigong. Utövarna fick också fylla i en enkät om deras
förväntningar om positiva känslomässiga förbättringar i samband med qigongpas-
sen. Få signifikanta samband återfanns i relation till de verkliga känslomässiga reak-
tionerna. Slutligen fick också utövarna beskriva den qigongrelaterade känslomässiga
12
16 I mattias johansson ✍ Qigong: Acute affective responses

upplevelsen i ord. I motsats till resultaten på självskattningsinstrumentet (Swedish
Core Affect Scale) beskrev majoriteten endast avslappnande sköna känslotillstånd
(och inte också aktiverande känslotillstånd).
Sammantaget bidrar avhandlingen till en större förståelse av den tidigare begrän-
sade kunskapen om qigongrelaterade känslomässiga reaktioner av akut slag. Utövar-
na upplever att deras känslomässiga välmående förbättras i samband med qigongt-
räning. Då urvalet består av självvalda, regelbundna utövare på qigongläger, begrän-
sas möjligheten att generalisera resultatet till andra grupper av människor. Resulta-
ten stämmer dock överens med liknande studier av tai chi, meditation och promena-
der vilket indikerar att också andra grupper av människor skulle kunna uppleva
känslomässiga förbättringar i samband med qigong. Fortsatt forskning kring dessa
frågor är därmed motiverad.
13

INTRODUCTION
In recent decades people have shown a growing interest in alternative and comple-
mentary medicine (Kelner & Wellman, 2000). Many individuals have been attracted
to mind-body therapies (relaxation techniques, Yoga, meditation, hypnosis, guided
imagery, Tai Chi, Qigong, etc.). In an American survey, 20% of the respondents had
some experience of mind-body therapies (Wolsko, Eisenberg, Davis, & Phillips,
2004). Reasons for use were to treat medical conditions, general prevention and
wellness promotion, and as leisure use. In our own country, activities ranging from
mindfulness meditation (Åsberg, Wahlberg, Sköld, & Nygren, 2006), relaxation and
somatic awareness training (Blomberg, 2004) to physical exercise (FYSS, 2008) are
on the rise and pose great promise for living associated with balance, reduced stress,
and well-being. Goldstein (2000) argues that the recent increased interest in alterna-
tive and complementary medicine is related to a greater interest in fitness. He pro-
poses that this increased interest is connected to people viewing health as wellness
(not only the absence of disease), health becoming more our own responsibility, a
greater belief in the mind-body connection, skepticism toward the modern techno-
logical world, and people regarding health as a search for the natural. Frisk (1998)
argues in a similar vein when describing the interest in new religious movements
(New Age) in Sweden. Modern medicine may successfully treat more disease symp-
toms of than ever before in history, but it cannot give the individual answers related
to the meaningfulness of disease, health, suffering, or life and death. Thus, mind-
body therapies may provide a means to greater meaningfulness, health and healing,
which may be pursued through different kinds of belief systems and activities, as well
as personal and spiritual development.
The present thesis discusses Qigong exercise, a mind-body therapy that originated
in China some thousands of years ago. I chose to study a group of regular exercisers
at the Biyun School of Qigong (Medical Qigong), because it is one of the larger
Qigong schools in Sweden. Since the end of the 80s, a growing number of studies on
Qigong reporting health-enhancing effects can be found. However, little focus has
been placed on the momentary/acute affective (affect, mood, & emotion) responses
14

associated with qigong exercise. Studying Qigong associated responses in the affec-
tive domain may have a number of benefits. Experiencing positive affect is of course
a positive end in itself and important for subjective well-being. Positive affect may
also lead to other health benefits (e.g., a more positive outlook on life). Many indi-
viduals (e.g., the elderly) may not be able to adhere to higher intensity exercise and
may miss out on the beneficial psychological benefits associated with these activities.
The main purpose of the present thesis is the investigation of acute affective re-
sponses associated with Qigong exercise. Affective responses (See also affective
states; Scherer, 1984) is used here as a generic term referring to any affective re-
sponse (be it a mood state, an emotion or on the level of basic affect). As such, it is
focused on the conscious feeling aspect of the affective domain and not on the
physiological changes (facial, autonomic, brain-based, vocal, and other physiological
changes; Larsen & Fredrickson, 1999) that accompany any subjective affective ex-
perience. Acute refers to the responses specifically associated with a single session of
Qigong, in contrast to chronic, which refers to the effects of a series of sessions over
a longer time (e.g., a few months). Given that new mind-body therapies are being
used by more individuals and are also in demand by health care consumers
(Landstingsförbundet, 2001), it is necessary to know more about their possible bene-
fits as well as when caution is warranted in their use.
A number of Qigong forms exist. Biyun Qigong and the forms discussed by the
majority of studies mentioned may be classified as Medical Qigong; hence their main
focus is on prevention of disease and enhancement of health (although spiritual
characteristics may also exist). When Qigong is mentioned in the present thesis, it is
mainly the medical form that is referred to.
15

Qigong
Chinese philosophy and medicine
Qigong is an integrated part of Traditional Chinese Medicine (TCM). In order to

understand Qigong one also needs to understand the traditional medicine and phi-
losophy from which Qigong originated. A main difference between Western and
Eastern philosophy is grounded in basic ontological and epistemological assump-
tions (Ames, 1993). Western philosophical perspectives, influenced by Greek and
Christian traditions as well as the Scientific Revolution, focus on strict distinctions
between concepts, such as body/soul, beginning/end, open/closed, subject/object,
birth/death, etc. Eastern philosophical perspectives, influenced by Asian religions
and philosophies such as Taoism, Confucianism, Buddhism and Hinduism, instead
view the world in terms of dynamic processes that are complementary, co-
dependent, cyclical and non-linear, and a more holistic view of mind and body. The
yin and yang symbol can illustrate this perspective. Composed of a dark and a white
side of a circle, the two sides are co-dependent on, and also part of, each other. A
very important aspect of the co-dependency view in relation to TCM is that humans
are like a microcosm and are influenced by everything in the cosmos. This is in stark
contrast to the reductionist scientific medical view, in which humans are to some
extent viewed as a machine with parts that can be fixed and exchanged if necessary
(O’Connor, 2000).
Yin-Yang theory is essential to the understanding of TCM and Chinese philoso-
phy. First mentioned in Tao Te Ching, 300 BC, yin and yang were the names used
in the ancient interpretation that all manifestations of the world could be grouped
into two opposites. At the same time, these two opposites are dependent on each
other and contain each other. This illustrates the view that all aspects of life are in-
terrelated with everything else. Yin and yang are visible in all aspects of Chinese life.
Yin can be described as shadow, passivity, female, the moon, while Yang is light,
activity, male, the sun. In the context of TCM, all the body’s organs are grouped
into yin or yang. Too much yin or yang in the body is seen as an imbalance and can
16

lead to disease (Kaptchuk, 2000). In the context of Qigong, yin and yang can be il-
lustrated as being in a state of simultaneous stillness and change (Cohen, 1997).
An essential characteristic of Chinese philosophy and medicine that does not exist
in the West is the concept of qi. Qi can be described as “a type of energy or dy-
namic force that sustains and nourishes life” (Dorcas & Yung, 2003, p. 198). It is
also sometimes referred to as vital force or life force. Similar concepts of life energy
exist around the world, for example as prana in the Yoga tradition of India (Cohen,
1997). Qi may stem from different sources, coming from our parents, food and
drink, and by way of our breath through the air. According to TCM, energy chan-
nels or meridians cover our inner bodies. Qi, the life force, flows through specific
meridians. There are twelve regular meridians that are connected to the bodily or-
gans, and eight extraordinary meridians that are not connected to the organs. A
steady flow of qi through the meridians is vital to one’s health. It can be compared
to a river in which there is a constant flow of water. Stagnation or a flow that is too
wild is considered unhealthy (Kaptchuk, 2000).
According to TCM, the flow of qi may be regulated by way of different medical
modalities. Acupuncture uses needles to treat special points on the meridians, acu-
points. Specific acupoints have different functions and affect the flow of qi and the
health of the individual in specific ways. Depending on the imbalance or disease the
individual is experiencing, needles are inserted at certain acupoints. Acupressure and
Qigong also directly aim to affect the flow of qi in the meridians, by way of massage
and mental focusing to direct the flow of qi (Tse, 1998).
Emotions play a significant role in relation to health and well-being in TCM.
Health is related to a healthy balance of different emotions, and overly strong emo-
tions may cause disturbances and even disease. All emotions – not only anger, for
example, which people in the West may find counterproductive to health (e.g., car-
diovascular disorders) but also joy – in extremes may affect our health. According to
TCM, strong emotions like anger can cause disturbances in the liver, joy can be
negative for the heart, and sadness can be negative for the lungs (Fan, 2000).
17

History and definitions
Qigong belongs to a group of exercises called mind-body therapies (See also mind-
body medicine, NCCAM, 2007; mindful exercise, Chow & Tsang, 2007; meditative
movement, Larkey, Jahnke, Etnier, & Gonzales, in press; and meditation, Ospina et
al., 2007), to which meditation, Yoga, Tai Chi, dancing, etc., also belong. These
methods date back to prehistoric times and have religious connotations. Mind-body
therapies have sprung out of repetitive, rhythmic chants and offerings to appease the
gods (Joseph, 1998), and written records of them and their predecessors can be
found in Hindu, Taoist, Buddhist, Christian, and Moslem scriptures (Everly & Lat-
ing, 2002). The goal of mind-body therapies can be therapeutic (health and well-
being) as well as spiritual (finding peace and tranquility and transcending normal
consciousness; Ospina et al., 2007).
Qigong originated in China, but it is possible that it has been influenced by In-
dian Yoga (Cohen, 1997) as the two traditions share some characteristics. Its earli-
est records date back some 3000 years (Chen, 2007). Qi is translated as life force
and gong as work (Cohen, 1997). Qigong can be seen as a generic term referring to
methods, “… working with the life energy, learning how to control the flow and
distribution of qi to improve the health and harmony of mind and body. “ (Cohen,
1997, p. 4). The name Qigong was introduced in the 1950s and it was originally
known as Dao-yin (Cohen, 1997). It is suggested (Cohen, 1997) that the core of
Qigong exercise originated from farmers observing the cycles of planting and har-
vesting, and of life and death (other Qigong origins come from mimicking the
movements of animals, e.g. the Five Animal Frolics). To ensure the growth of seeds
it is important to establish strong, healthy roots for the plant to find a good support
for growth; also important is daily care through optimal watering and sunshine.
Many Qigong forms therefore advocate first creating a strong foundation/roots to
build upon. Plants need water to grow, but in optimal doses. Qigong exercise is
therefore recommended in daily optimal doses for a particular individual. Too little
training may be insufficient to have any effect, and too much training may not cre-
ate better health but might instead have negative effects for the individual (Ng,
18

1999). By further observing the effects of water resources (Cohen, 1997), people liv-
ing at the time Qigong developed came to the conclusion that a healthy, steady flow
of clean water was important: Too much causes flooding, too little causes drought,
and stagnant water can cause disease. This may have influenced the view on qi (life
force), which flows in the meridians of the body, by way of Qigong exercises being
enhanced and creating a healthy flow throughout all parts of the body. Through the
performance of Qigong, the flow of qi can be optimized. Thus, one may illustrate a
healthy human being with the example of a plant: A healthy plant is strong yet soft,
swaying with the wind but not breaking. However, when the plant is sick it becomes
stiff and rigid and easily breaks (Cohen, 1997).
Different styles of Qigong
Over the years the principals of Qigong exercise have been used in different forms
and settings and for different aims. It can be divided into Active Qigong (Dong
Gong), which includes slow movements and postures, and Passive Qigong (Jing
Gong), which focuses more on mental concentration, visualization, and breathing.
Active Qigong is the more popular form, in both China and the West. Most Qigong
forms do, however, include both active and passive aspects, reflecting the impor-
tance of the yin and yang philosophy, encompassing the contrasting aspects of life
(Cohen, 1997).
Today, Qigong is mostly known for its health-promoting characteristics, but it
was initially created for the cultivation of the mind and spirituality (Chen, 2007).
Historically it has had many different focuses, such as promoting moral develop-
ment (Confucian Qigong) and spiritual development (Buddhist and Taoist Qigong),
and preparing the body for combat and healing wounds (Martial Arts Qigong), in
addition to Medical Qigong (Chen, 2007).
Qigong may also be grouped into Internal and External Qigong (Chen, 2007). In-
ternal Qigong refers to the activity described above, carried out by the exerciser in-
dividually. External Qigong is a form of healing. According to TCM, the cultivation
of qi and the ability to move it to different parts of the body thanks to many years
19

of Qigong practice may also create an ability to emit qi, break qi blockages, and re-
move sick qi from another person’s body. Many Qigong clinics in China provide
External Qigong.
Although different Qigong forms may differ, most include adjusting the mind,
body and breathing (Chen, 2008). Some forms may include actively performing spe-
cific movements (Dong Gong), standing like a pole (Zhuang Gong), and static forms
of meditation (Jing Gong). The dynamic forms of Qigong that include movements
are sometimes introductory forms, with the movements guiding and helping the ex-
erciser to better concentrate on their internal body and induce qi flow. Static forms
of Qigong include meditation (concentrative and mindfulness), relaxation, breathing
manipulation, guided imagery, and incantation. Static forms are supposed to train
intentional power (consciousness stability) while cultivating qi flow, and by way of
the mind guide the flow of qi in the body. Standing like a pole refers to when an ex-
erciser is in a standing up position, and spontaneous movements may occur. Thus,
although different forms of Qigong exist, generally the exerciser first tries to attain a
state of mind that is quiet and calm. When this is accomplished, the exerciser’s next
goal is the cultivation of an awareness of experiencing qi and its movements through
the body. Finally, different paths of cultivation can be followed such as gathering qi
in the body, cultivating qi circulation, and other forms of guiding the flow of qi us-
ing the mind (Zhang & Rose, 2001).
Research on Qigong exercise
Qigong exercise has been shown to positively affect the psychological, neuroendo-
crine, and immune systems (Ryu et al., 1995). Interventions involving Qigong exer-
cise have been found to reduce blood pressure and triglycerides as well as increase
high-density lipoprotein (HDL) cholesterol (Lee, Lee, & Kim, 2004), and to reduce
work-related stress (heart rate, noradrenalin urine excretion, finger temperature,
and subjective experienced stress reactions) significantly more than controls
(Skoglund & Jansson, 2007). In a psychological vein, cross-sectional studies show a
20

significant negative relationship between Qigong (length of practice) and neuroti-
cism (Leung and Singhal, 2004) and perceived stress (Lee, Ryu, & Chung, 2000).
Qigong has also been used as an intervention (two to three months) for coping
with and alleviating symptoms of diseases. Multiple sclerosis patients showed sig-
nificant improvements in depression and balance (Mills, Allen, & Morgan, 2000),
and fibromyalgia patients improved on measures of pain, physical and psychological
functioning, anxiety and depression (Astin et al., 2003), and enhanced movement
harmony (Mannerkorpi & Arndorw, 2004). Muscular dystrophy patients main-
tained perceived general health when performing Qigong while the control group
deteriorated (Wenneberg, Gunnarsson, & Ahlström, 2004b). Hypertension patients
reduced their blood pressure (and norepinephrine, epinephrine, cortisol, and per-
ceived stress) significantly more than a control group did (Lee, Lee, Kim, and Moon,
2003). In a similar study, self-efficacy and self-esteem increased and blood pressure
decreased (Lee, Lim, & Lee, 2004). Negative symptoms in cancer patients receiving
chemotherapy were reduced and improvements in pain, numbness, heartburn and
dizziness, as well as a greater will to live, were found (Lee, Chen, & Yeh, 2006). A
randomized controlled trial including depressed elderly found improvements in
mood, self-efficacy, and personal well-being (Tsang, Fung, Chan, Lee, & Chan,
2006). Thus, the increasing support for the benefits of Qigong seems promising in
many ways.
Acute physiological responses to Qigong exercise have been predominantly stud-
ied by a group of Korean researchers. In their studies they have used the Chun Do
Sun Bop style of Qigong, which in addition to the common characteristics of Qigong
(e.g., relaxation and slow movements) also uses sounds. The Chun Do Sun Bop style
is performed for 60 minutes, and a majority of fairly young male participants have
been studied. Training background ranges from beginners having learned the proce-
dure on certain occasions before the experiment to regular exercisers (up to a year).
Studies show an increased secretion of growth hormone (Lee, Kang, Ryu, & Moon,
2004; Ryu, Lee, Jeong, Lee, Kang, Lee et al., 2000), improved immune function (Lee,
Kang, & Ryu, 2005; Lee, Kang, Ryu, & Moon, 2004; Lee, Kim, & Ryu, 2005), and
decreased breathing and heart rate during qigong (Lee, Kim, Huh, Ryu, Lee, &
21

Chung, 2000) – promising acute results, indeed; however, control groups were used
only in the Lee, Kang, and Ryu study (2005).
Negative health effects of Qigong exercise are also reported. Ng (1999) reports in-
creased psychiatric symptoms in some individuals, Qigong deviation syndrome. This
may be associated with an extra sensitivity to the effects of relaxation: relaxation-
induced anxiety (Heide & Borkovec, 1984), which may cause an individual to dis-
play increased anxiety. Detrimental effects may also stem from faulty training, such
as overly long sessions (Ng, 1999). Fan Xiulan of the Biyun School states that when
training recommendations have been followed, no detrimental effects have been seen.
However, there are some conditions under which Qigong training should be avoided:
epilepsy, serious psychiatric illnesses, and when under the influence of drugs or
strong emotions. Special training precautions are also cited for menstruating and
pregnant women (Fan, 2000).
Research on Qigong exercise highlights promising health-related benefits in many
areas, such as the management and reduction of symptoms of diseases (fibromyalgia,
hypertension, multiple sclerosis, and cancer), improved psychological and physical
well-being, and a positive acute affect on the psychological, neuroendocrine, and
immune systems. Some caution is warranted on scientific rigor grounds (e.g., use of
control groups in only some of the studies).
22

Biyun Qigong
Biyun Qigong
Biyun Qigong is one of the most widespread Qigong styles in Sweden, and was cre-
ated and developed by Qigong master Fan Xiulan (Fan, 2000). Biyun Qigong can be
described as a Medical Qigong style. Thereby, the focus is on the flow of blood and
qi in the body, strengthening the function of the lungs, digestion, and other bodily
functions. Biyun also focuses on strengthening muscles and joints that easily get
worn out and exhausted. Yet, as TCM and qigong are holistic in perspective, typical
spiritual elements are also included in Biyun Qigong, including the intention to raise
consciousness (insight and a greater understanding of consciousness) by way of
mindfulness (accepting and not clinging to emotions) and living in harmony with
oneself, other people, and nature. By way of Qigong exercise, in which typical medi-
cal and spiritual perspectives are equally important, intentions of spiritual growth
(de) and naturalness (wu wei) may lead to Tao, a state of harmony, peace and free-
dom. Fan describes Biyun Qigong as a “focused mindful concentration on the physi-
cal body to systematically increase qi in the body and to develop its ability to gather
natural qi from the universe” [translated from the Swedish] (Fan, 2000, p. 31).
The Biyun School of Qigong consists of a number of specific forms of Qigong ex-
ercise. These range from beginner forms (Jichu Gong) to more advanced ones (Dong
Gong, Five Elements Qigong, and Wai Chi). The beginner forms focus on softening
the joints and opening up for the life force (qi) to flow in the body. The exerciser
later focuses on gathering qi from the environment and cleansing the body of bad qi
(Dong Gong). The more advanced forms focus on moving qi through the body, get-
ting more attuned to the flow of qi and letting the body move spontaneously, and
creating one’s own individual form of Qigong (Fan, 2000). All forms stress the im-
portance of concluding by gathering qi by way of visualization as well as physically
(by way of arm movements) and directing it into the Dantien (an energy center, a
few centimeters below the navel).
23

Characteristics of Biyun Qigong, as well as those of many other forms of Qigong,
include slow movements (physical activity), relaxation, concentration/meditation,
imagery, natural breathing, and self-massage. These methods will be presented and
discussed below, with a focus on their possible positive influences on affective states.
Physical activity
Qigong also includes physical activity in the form of slow movements. Physical ac-
tivity refers to the movement of the body produced by the skeletal muscles, resulting
in energy expenditure, which varies from low to high, and a positive correlation
with physical fitness. In addition to what is stated regarding physical activity, exer-
cise also includes planned, structured and repetitive bodily movements and the ob-
jective to maintain or improve physical fitness (Caspersen, Powel, & Christenson,
1985). Qigong exercise can be defined as a low-intensity physical activity and exer-
cise (in addition to its mindful aspects), although its influence on physical fitness
may be limited compared to jogging.
It is sometimes stated that the human body is designed for physical activity. Al-
though this statement is difficult to test in an experimental setting, three lines of evi-
dence support it (Bouchard, Blair, & Haskell, 2007). Firstly, the human body can
adapt to the metabolic demands of its environment. Secondly, a low level of physical
activity is associated with increased frequency of disease, loss of functional capacity,
and premature death. Thirdly, without the ability to perform demanding physical
work, early humans would not have been able to survive. Thus, we can conclude
that being physically active lies inherent in us, and that the sedentary lifestyle of to-
day have negative physical and mental effects (Bouchard et al., 2007). There is now
a large body of evidence linking physical activity with the prevention of poor health,
as well as the enhancement of health and well-being. The Surgeon General’s Report
on Physical Activity and Health (USDHHS,1996) cites numerous diseases and
health-related aspects of life that are affected by physical activity, like lower mortal-
ity rates, decreased risk of cardio-respiratory disease, reduced risk of some forms of
cancer, reduced risk of developing non-insulin-dependent diabetes mellitus, mainte-
24

nance of normal muscle strength, normal skeletal development during childhood,
reduction of risk of falling among the elderly, lower rates of obesity and mainte-
nance of a healthy diet, relief from symptoms of depression and anxiety, reduced
risk of developing depression, improved health-related quality of life such as psycho-
logical well-being, and improved physical functioning.
A growing body of evidence from reviews of the literature supports the impor-
tance of physical activity for psychological health (Biddle & Ekkekakis, 2005;
Biddle & Mutrie, 2001; Berger & Tobar, 2006; Landers & Arent, 2006; Mutrie &
Faulkner, 2004; Scully, Kremer, Meade, Graham, & Dudgeon, 1998; Warburton,
2006). Physical activity is associated with reduced state and trait (acute and chronic)
anxiety (Landers & Arent, 2006, Petruzzello et al., 1991; Scully et al., 1998; Taylor,
2000). Individuals suffering from clinical and non-clinical anxiety may benefit from
physical activity (Landers & Arent, 2006; Taylor, 2000). Further, physical activity
also has positive effects on psychosocial stress. Bouts of physical activity can reduce
stress, and improved fitness is also associated with reduced stress reactivity and bet-
ter coping (Berger & Tobar, 2006; Landers & Arent, 2006; Scully et al., 1998; Tay-
lor, 2000).
Studies also show beneficial effects associated with physical activity on those suf-
fering from depression (Paluska & Schwenk, 2000; Scully et al., 1998), and physical
activity is also associated with a decreased risk of developing clinical depression
(Mutrie, 2000). The effect of physical activity on depression is comparable to that of
psychotherapy (Mutrie & Faulkner, 2000; Paluska & Schwenk, 2000).
A physically active lifestyle is associated with increased self-esteem (Biddle &
Mutrie, 2000), improved cognitive functioning (Landers & Arent, 2006), and im-
proved health-related quality of life, including physical functioning, physical symp-
toms, and emotional, social and cognitive functioning (Berger & Tobar, 2006; Re-
jeski, Brawley, & Shumaker, 1996). Thus, a large body of evidence now supports
the relationship between a physically active life and improved psychological health.
Acute affective benefits of single bouts of exercise also show promising results; this
will be dealt with in a later section.
25

Relaxation
Biyun Qigong sessions begin with a few minutes of relaxation. Although the term
relaxation techniques often includes a large number of relaxation-associated tech-
niques like progressive relaxation, self-hypnosis, autogenic training, meditation, im-
agery, and biofeedback-assisted relaxation (Orne & Whitehouse, 2000; Poppen,
1998), relaxation may be a sole intervention in itself, sometimes being used in
preparation or in combination with other techniques (Lichstein, 2000) like in
qigong. Contrasting relaxation and meditation, relaxation is used primarily to re-
duce physiological arousal whereas meditation is more focused on directing one’s
attention to the present moment (and not directly trying to change the level of
arousal; Shapiro, Schwartz, & Santerre, 2005).
According to Biyun Qigong, relaxation training entails a systematic, mental
screening of the inner and outer parts of the body, inducing relaxation. Qigong fo-
cuses on an optimal state in which we can gather qi from the environment. Relaxa-
tion is therefore stressed before beginning Qigong exercise, and when one is experi-
encing strong emotions Qigong exercise is not recommended (Fan, 2000). Also,
through relaxing, thoughts and emotions can be prevented from interfering with our
concentration and we may even forget ourselves (Fan, 2000). As no muscular activ-
ity is carried out (as it is in progressive relaxation, in which the muscles are first
tensed and then relaxed), the form of relaxation in Biyun Qigong is associated with
autogenic training, in which the practitioner by way of mental focus induces states
of warmth and heaviness in different body parts (Sadigh, 2001). Words like warm
and nice feeling, relaxation and pleasantness are used to induce relaxation in audio-
recorded instructions in Jichu gong and Dong gong in the Biyun School (Fan, 2001,
2004). The exerciser is instructed to let go of all tension, irritation, and worries
(Fan, 2000). Relaxation has been found to reduce physiological arousal (Scheufele,
2000) and emotional distress symptoms (Farné & Gnugnoli, 2000), and improve the
capacity for control over imagery (Singer, 2006). Relaxation is also used in prepara-
tion for meditation to reduce arousal (Girdano, Everly, & Dusek, 2001). Qigong
26

exercisers may benefit from relaxation training before actual Qigong, making it eas-
ier to relax and direct their attention to the body and mental imagery.
Attentional regulation (meditation)
The next phase in Biyun Qigong (Jichu Gong) refers to the actual Qigong activity.
Systematically softening the joints from feet to head, the practitioner also focuses on
the corresponding body part. This entails holding the attention at the specific area
of focus. For example, when slowly rotating the ankle joint, focus is directed at the
foot and the joint. Words like strengthening and promoting (Fan, 2001, 2004) as
well as “thinking positively of the body part performing the movement” (Fan, 2000,
p. 41) are employed. The concentrative/focusing techniques used are meditative
methods. One definition of meditation refers to “… a family of self-regulation prac-
tices that focus on training attention and awareness in order to bring mental proc-
esses under greater voluntary control and thereby foster general mental well-being
and development and/or specific capacities such as calm, clarity, and consciousness”
(Walsh & Shapiro, 2006, pp. 229). Meditative disciplines are usually divided into
concentrative and mindfulness forms of meditation (Carrington, 2008). In concen-
trative meditation, attention is focused on a specific object like the breath, a mantra,
sounds, or different parts of the body like in Qigong exercise. If the mind wanders,
thoughts come into one’s awareness or other stimuli interrupt, the exerciser is in-
structed to ignore these and return to focusing on the object of choice. Mindfulness
meditation entails opening one’s attention to all kinds of stimuli, inside and outside,
witnessing all the contents of consciousness, accepting everything. Qigong exercise
according to the Biyun School is primarily focused concentrative meditation, but
there are also examples of mindfulness meditation (Fan, 2000). The exerciser directs
her attention/concentrates on specific body parts, in a relaxed and balanced manner.
She may become unaffected of the things going on around her, and may even forget
herself (Fan, 2000). In this state (the Qigong state) “… a new state of awareness
that is not contaminated, tinted or distorted by the contents and processes of con-
27

sciousness comes into being, and the natural forces or energies of life (qi) are able to
freely flow.” (Dorcas & Yung, 2003, p. 200). This state of consciousness is what
most meditative traditions attempt to attain (Dorcas & Yung, 2003). It is the bal-
ance point between yin and yang (Fan, 2000), where the division between subject
(me) and object (not me) disappear, and one may feel at one with the entire universe
(Dorcas & Yung, 2003). Concentrative meditative practice may “allow the partici-
pant to feel inner balance, calm, and the ability to transcend the continuous flow of
cognitions and emotions” whereas mindfulness meditation “may encourage insights
into the maladaptive cognitive, emotional, and behavioral patterns” (Deikman,
1982). Meditation may improve well-being and stress management, and provide for
important insights into one’s own life (Bogart, 1991), reduce state and trait anxiety
and psychological distress (Shapiro, Schwartz, & Bonner, 1998), offer some support
for the alleviation of anxiety disorders (although the small number of studies limit
conclusions; Krisanaprakornkit, Krisanaprakornkit, Piyavhatkul, & Laopaiboon,
2006), and help the fostering and cultivation of positive emotions (Fredrickson,
Coh, Coffey, Pek, & Finkel, 2008). Fan Xiulan stresses the importance of focusing
(Fan, 2000). The ability to concentrate during Qigong exercise is its single most im-
portant feature. Support for the importance of concentrative ability has been found
empirically (Jouper, Hassmén, & Johansson, 2006).
Imagery
Several forms of Biyun Qigong include forms of imagery. Imagery can be provided
from verbal suggestions in recorded instructions (it is common to use recorded in-
structions when performing Biyun Qigong). Verbal instructions (Fan, 2001, 2004)
include thinking about an inner smile and imagining taking in positive, energizing
life energy from the environment and directing it into the head, through the body,
and down into the energy center of the body (the Dantien), a few centimeters below
the navel. Further suggestions include focusing on health, strength, feelings of
warmth, harmony, positive emotions and positive aspects of one’s life. These sugges-
tions are examples of guided imagery. The aim of guided imagery is to affect one’s
28

physical, emotional or spiritual state by way of visualization (Barrows & Jacobs,
2002). Reviews of guided imagery show its beneficial effects on mood and well-
being, and as a means of coping with stress (Astin, Shapiro, Eisenberg, & Forys,
2003; Gruzelier, 2002; Luskin et al., 1998). Visualizing pleasurable, relaxing images
has been used to counteract anxiety (Singer, 2002). Through repetition, individuals
may also learn to distract themselves from negative images (by replacing them with
more positive ones) of consciousness, which may lead to an increased sense of mas-
tery of internal experiences (Singer, 2002). The use of guided imagery in Qigong ex-
ercise may contribute to acute beneficial affective changes.
Respiration
Breath training is a part of many cognitive-behavioral, somatic, and mind-body

therapies (Wilhelm, Gevirtz, & Roth, 2001). Whereas some mind-body therapies
advocate controlling and changing the breath (e.g. Yoga; Brown & Gerbarg, 2005),
as do some forms of Qigong (Cohen, 1997), Fan Xiulan, founder of Biyun Qigong,
recommends natural breathing. This means letting go of one’s breath and not trying
to control it. It is also common for the exerciser to use different breathing patterns
during the Qigong session, as respiration is influenced by the different movements
(Fan, 2000). Respiration is essential for maintaining life, and its regulation includes
complex homeostatic interactions. It is central for emotion, health, and conscious-
ness. Dysregulation of respiration may therefore have severe health consequences
(Wilhelm et al., 2001). Different patterns of respiration affect individuals in specific
ways. Shallow breathing may make people more anxious (Conrad et al., 2007),
slowing down breathing frequency can reduce state anxiety (Han, Stegen, Valck, &
Clément, 1996), and different emotions can be experienced through the induction of
different breathing patterns (e.g. joy through regular, slow, deep breathing through
the nose (Philippot, Chapelle, & Blairy, 2002). Physiologically, the slowing down of
breathing frequency is associated with increased parasympathetic activity (Bernardi
et al., 2002; Recordati, 2003). Patients are taught to use slow diaphragmatic breath-
ing to manage and reduce anxiety disorders; through practice they may gain a
29

greater understanding of their symptoms and thereby reduce their fears (Wilhelm et
al., 2001). In addition, when one gains feelings of mastery over one’s mental states,
self-efficacy may increase (Bandura, 1982), followed by a reduction in anxiety.
Self-massage
Oxytocin has been shown to be associated with the pleasurable responses found in
breast feeding, sexual activities, social interaction and massage (Uvnäs-Moberg,
Arn, & Magnusson, 2005). It has been suggested as a vital part of the calm and
connection system; a relaxed growth, a restorative processes system, and a counter-
part to the fight or flight stress response. Massage has been shown to reduce anxiety
(Moyer, Rounds, & Hannum, 2004), and self-massage has led to anxiety reduction
in cigarette cravings (Hernendez-Reif, Field, Hart, 1999). It has also been suggested
as an active mechanism providing the positive effects of mind-body therapies (Uv-
näs-Moberg, 2000). In Biyun Qigong, most forms end with a number of minutes of
self-massage (sometimes clapping) all over the body.
30

Studying affective responses
Psychological responses to Qigong exercise can include several aspects. Human
mental functioning is generally divided into cognition, conation (e.g. motivation),
and affect (Parkinson, Totterdell, Briner, & Reynolds, 1996). The aim of the present
thesis is focused on affective responses. Below, the affective domain will be dis-
cussed. Affect and cognition are generally viewed as separate constructs (or as repre-
senting the opposite ends of a continuum; Panksepp, 2003). On a fundamental level,
“cognition refers to representation of knowledge (truth and falsity)” whereas “affec-
tive refers to representations of value (goodness and badness)” (Clore et al., 2001, p.
29). Cognitive and affective processes are, however, seldom completely separate
from each other, and are instead intertwined in each other’s processes; both are es-
sential to basic human functioning (Forgas, 2008).
Affect influences cognition in many ways. Affect may influence “how people re-
member, perceive, and interpret social situations and execute interpersonal behav-
iors” (Forgas, 2008, p. 99). When we consciously experience a mood, it influences
not only how we interpret our situation, but also how we see our relation to that
situation, and our affective reactions to it (Parkinson et al., 1996). Affect may func-
tion as conscious information, helping our rational thinking make choices (Schwarz
& Clore, 1983). It may be interconnected with ideas and memories and may auto-
matically prime cognitions – mood congruency (Parkinson et al., 1996), and it may
influence cognition through different ways of information processing. When in a
happy mood people tend to remember happy memories, and vice versa (Eich &
Macauley, 2006); happy people perceive more happy behaviors in themselves and
others (Forgas, Bower, Krantz, 1984), and think happier thoughts (Parkinson et al.,
1996).
Differentiating between affect, mood and emotion
The study of affective responses to physical activity and Qigong exercise pose some
basic problems as no consensus exists regarding what an emotion is, several con-
31

structs coexist side by side (Russell & Feldman Barrett, 1997), and affect, mood, and
emotion are used interchangeably, which creates confusion (Ekkekakis &
Petruzzello, 2000). See Figure 1, for a simplified summary of affective states.
32

The difference between affect, mood, and emotion (See Figure 3) can be seen from an
evolutionary perspective, by which affect is considered the most basic, mood on an
intermediate level, and emotion as a later stage of human evolutionary development,
including cognitive components, and therefore a more complex phenomenon (Ek-
kekakis & Petruzzello, 1999). Affect refers to “the irreducible aspect that gives feel-
ings their emotional noncognitive character” (Frijda, 1993, s. 383). Affect is re-
garded as all valenced (“good-bad”) responses, including emotions and moods (Fri-
jda, 1994; Gross, 1999; Scherer, 1984. It colors our experiences, and without it they
would be a neutral gray (Batson, Shaw, & Oleson, 1992). The word feeling is syn-
onymous with affect (Berkowitz, 2000) and refers to conscious experience.
Moving on to emotion, most theorists agree that in addition to affect, which is
probably the most essential component (Feldman Barrett & Russell, 1999), emotion
also includes appraisals/cognitions, action tendencies and physiological responses
(Frijda, 1994). Although some argue that mood is made up of the same components
as emotion is (Frijda, 1994), it is the conscious, subjective experience – affect – that
is the focus in mood research (Watson, 2000). Some even consider mood to be an
extended form of affect (or core affect; Russell & Feldman Barrett, 1999).
Although they display some similar characteristics, emotion and mood differ on
some important issues, making them related yet separate constructs. An emotion is
considered a short (a few seconds), highly intensive affective state. It also has a clear
object that sets it off (Frijda, 1994). “They are about something. One is happy about
something, angry at someone, afraid of something” (p. 381). In contrast, moods are
of longer duration (from hours to days) and are milder than emotions. Emotions can
be viewed as occupying the foreground of consciousness, whereas moods occupy the
background (Rosenberg, 1998). Another distinguishing characteristic is the absence
of a clear object eliciting the moods. Moods are therefore more diffuse compared to
emotions (Ekkekakis & Petruzzello, 2000). External stimuli may induce moods, but
whereas emotions indicate “reactions to specific affectively important events” mood
is “a cue to one’s current global state of action readiness and/or evaluation of the life
situation” (Morris, 1999, p. 171). Emotions influence action, while moods influence
cognitions (Davidson, 1994; Frijda, 1994). Emotions and moods may influence each
33

other. Moods may modulate the threshold for eliciting an emotion (Frijda, 1994).
Being in an irritated mood may, for example, lower one’s threshold for anger (emo-
tion). Conversely, some emotional episodes may combine into a mood state (Parkin-
son et al., 1996).
The issue of defining affective states has created many different conceptualiza-
tions, the two main groups of which are the discrete/categorical view and the dimen-
sional view. Proponents of the discrete/categorical view argue for the existence of a
number of distinct categories of emotions. This is supported by research that shows
that people around the world display similar facial expressions related to a number
of specific emotions, including fear, anger, sadness, enjoyment, and disgust (Ekman,
1992).
Conversely, proponents of the dimensional view of emotion (affect) argue that af-
fective states can be described as two or three dimensions. One such example, the
circumplex model of affect (Russell, 1980), is represented by “two orthogonal and
bipolar dimensions, valence (pleasure-displeasure) and activation (low-high; see Fig-
ure 2). Specific affective states are considered combinations of the two dimensions”
(Rose & Parfitt, 2007, p. 282). A few different variations of this structure, the cir-
cumplex structure of affect, exist (Larsen & Diener, 1992; Russell, 1980; Thayer,
1996; Watson & Tellegen, 1985). Russell’s circumplex structure of affect has also
been found across different cultures (Russell, Lewicka, & Niit, 1989).
Watson and Tellegen (1985) emerged with a different variation of Russell’s cir-
cumplex structure. Instead of separate valence and activation constructs (Russell,
1980), Positive Affect (high Positive Affect is Pleasant Activation in Figure 1) and
Negative Affect (high Negative Affect is Unpleasant Activation in Figure 1) inter-
twined (rotational variant; Feldman Barrett & Russell, 1999). Yik and colleagues
(Yik, Russell, & Feldman Barrett, 1999) showed that the four different views of the
affect circumplex (Larsen & Diener, 1992; Russell, 1980; Thayer, 1996; Watson &
Tellegen, 1985) are actually the same structure viewed from different angles. These
different views can be grouped into un-rotated and rotated variations. Biological cor-
relates exist for both perspectives (Ekkekakis & Petruzzello, 2002).
34

There has been a debate between those who advocate that positive and negative af-
fect are independent of each other – unipolar scales (e.g. Watson & Tellegen, 1985),
and those who argue that they are poles on a continuum – bipolar scales (e.g. Rus-
sell, 1980). There is still some controversy around this issue, but one could conclude
(Berkowitz, 2000) that when looking at a narrow time span (the experience of mo-
ment-to-moment affective states) we sometimes have a mixture of affective states,
but when we are having one very strong positive feeling it is unlikely that we will
also report a very strong negative feeling. When reporting milder affective states, in-
dividuals may report a mix of both positive and negative feelings.
So which view best describes affective states, the discrete/categorical view or the
dimensional view? They complement each other. The categorical view is preferred
for studying specific emotions (which can be done in great detail), while the dimen-
35

sional view is preferred when the focus of study is feelings on a more basic level (e.g.,
pleasantness-unpleasantness), and less is known about the area of focus (Ekkekakis
& Petruzzello, 2000; Larsen & Diener, 1992).
Regulating affective states
Affect regulation is defined as “any process directed at modifying or maintaining

moods or emotions whose operation depends on monitoring of affective informa-
tion” (Parkinson et al., 1996). Affect regulation includes coping, emotion regula-
tion, mood regulation, and psychological defenses (Gross & Thompson, 2007).
Reasons for regulating affective states are many: adapting to challenges in life,
health and relationships, and maintaining a global sense of subjective well-being
(Larsen & Prizmic, 2004). The inability to regulate affective states (particularly
emotion) is related to a large number of psychiatric disorders and reduced mental
health (Gross, 1999).
Gross (1999) makes distinctions between where in the emotional process the regu-
lating intention is directed. Focus may be directed at the situation. We can choose
situations that will provide us with desirable emotions – situation selection. We can
also try to modify the situation, acting in a way that causes us to receive desirable
emotions. In the specific situation we may also modify what we attend to (distraction
& concentration). As the emotional response is building up in us, we may also cogni-
tively change by way of reappraisal. A situation that was earlier appraised as fright-
ening may now be appraised differently. Finally, we may deal with emotions (re-
sponse modulation) by way of drugs, exercise or relaxation (Gross, 1999). How we
attend to affective states may also be different based on whether they are negative or
positive (Larsen & Prizmic, 2004). Behaviors often used to regulate negative affective
states include distraction, venting (expressing the negative affect), suppression, cogni-
tive reappraisal, self-reward, exercise, relaxation, eating and other physical manipu-
lations, socializing, and withdrawal (spending time alone), while behaviors to in-
crease positive affect instead include gratitude, helping others, and humor. Some re-
searchers argue for the benefits of accepting the emotional content without doing
36

anything with it (Fruzzetti, Shenk, Mosco, & Lowry, 2003), like in mindfulness
meditation. Thayer and colleagues (Thayer, Newman, & McClain, 1994) report that
the most effective way to change a bad mood is a combination of relaxation, stress
management, and cognitive and exercise techniques. In this context, Qigong may
also serve as a tool for regulating affect (reducing negative affect and enhancing posi-
tive affect).
Antecedents and dynamics of affective states

What determines our affective states? Is it as simple as feeling good when we do
something we like and feeling bad when we do something we do not like (Parkinson
et al., 1996)? A great number of antecedents that influence our affective states are
always present. Watson (2000) suggests that moods are influenced by affective traits
(personality traits like neuroticism have been associated with negative affect; Larsen
& Diener, 1992), situational/environmental factors (activities, food and drink, physi-
cal aspects of the environment, and hassles), endogenous/sociocultural rhythms (cir-
cadian rhythms may influence during the day, menstrual cycles in women during the
month, and seasonal changes), and individual characteristics. Further, research
shows that positive mood is usually low at the beginning and the end of the day
(peaking around midday). People generally report better mood during the weekend
than on weekdays, and from April to September than from October to March (in the
northern hemisphere). He concludes that positive moods are associated with active
behavior (doing) and negative moods are more associated with thoughts (thinking)
(Watson, 2000). It is also important to consider what state the individual was in be-
fore he/she assessed his/her affective state. A pleasant mood may not be exceptionally
high, but may rather be a consequence of feeling less bad (Parkinson et al., 1996).
Determinants may not only influence the individual from outside in a causal rela-
tionship uniform to all individuals. A different perspective entails the person-
environment fit, or the transactional perspective (Parkinson et al., 1996). A conse-
quence of the transactional approach is not what kind of antecedents influence af-
fective states, but how we interpret them. In the context of Qigong exercise, there
37

may be characteristics in the regimen (e.g., slow movements and relaxation) that are
known to influence affective states positively; additionally (from a transactional per-
spective), it is important that the exerciser experience enjoyment (Motl, Berger, &
Leuschen, 2000) for the benefits to occur. Thus, cause and effect and transactional
approaches may work at different times or simultaneously (Parkinson et al., 1996)
to influence affective states.
Measuring affective responses

A number of self-report measures have been created to assess affective responses (af-
fect, mood, and emotion) associated with exercise. The assessment of affect, based
on (or in concordance with) Russell’s (1980) view of affect (pleasantness and activa-
tion) can be made with one-item scales, like the Affect Grid (Russell, Weiss, & Men-
delsohn, 1989), the Self Assessment Manikin (SAM; Bradley & Young, 1994), and
the Feeling Scale (Hardy & Rejeski, 1989) together with the Felt Arousal Scale of the
Telic State Measure (Svebak & Murgatroyd, 1985). An example of a multi-item
scale is the Activation Deactivation Adjective Check List (AD ACL), which is based
on Thayer’s view of affect (consisting of tense and energetic arousal; Thayer, 1989).
Another multi-item scale is the Positive And Negative Affect Scale, based on Watson
and colleagues’ conceptualization (PANAS; Watson, Clark, & Tellegen, 1988). Af-
fect measures have also been created in Swedish: Sjöberg, Svensson, & Persson
(1979), the Swedish Core Affect Scale (SCAS; Västfjäll, Friman, Gärling, & Kleiner,
2002) and Knez and Hygge (2001). Several of the above-mentioned affect scales are
often also defined as mood measures (AD ACL, PANAS, and SCAS), given that some
researchers view mood as an extended form of affect (Russell, 1999) or as similar to
affect (Watson, 2000).
The Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1981) is the
most widely used measure in Sport and Exercise Psychology (LeUnes & Burger,
1998). Another very common measure is the State and Trait Anxiety Inventory
(STAI; Spielberger, Gorsuch, Luschene, Vagg, & Jacobs, 1983). The POMS assesses
six mood states and is considered a mood questionnaire (Gauvin & Spence, 1998).
38

The STAI measures anxiety and is considered to assess emotion anxiety (Gauvin &
Spence, 1988).
A group of measures are based on the idea that exercise-induced affective
changes are specific to that context. Self-report measures have therefore been cre-
ated to assess the specific affective changes taking place when exercising. These in-
struments include the Exercise-induced Feeling Inventory (EFI; Gauvin & Rejeski,
1993), the Subjective Exercise Experience Scale (SEES; McAuley & Corneya, 1994),
and the Physical Activity Affect Scale (PAAS; Lox, Jackson, Tuholski, Wasley, &
Treasure, 2000).
A framework for the study of affective responses
As the area of affective sciences includes several different views of affect, there is a
need to decide how to view affective responses in the context of Qigong exercise. I
have adopted the view presented by Ekkekakis and Petruzzello (2000), who advo-
cate a functionalist view of affect in which all kinds of information processing (emo-
tional and cognitive) are adaptational to the demands of the environment through
pairing survival and well-being with survival and well-being-enhancing behavior
(Keltner & Gross, 1999). The functionalist perspective view distinguishes between
affect and emotion, on different levels of information processing, stemming from
earlier and later stages of human evolution, cognition being a later development in
consciousness than affect (Panksepp, 2003). Emotions, which include cognitive (and
other) components, therefore comprise a later and more complex structure than af-
fect (Izard, 1993; Leventhal & Scherer, 1987). Leventhal and Scherer’s model
(1987) spans from sensory-motor levels (automatic and reflex-like) to more complex
levels of information processing: schematic (more cognitive level, integration be-
tween automatic processes and feelings) and conceptual levels (highly cognitive level
with abstract rules about emotions). Ekkekakis and Petruzzello (2000) suggest that
exercise affects the exerciser on all levels (from basic to more complex). The state-
ment about vigorous exercise that “it hurts so good” may therefore be interpreted
from different levels of processing (Ekkekakis, 2003, p. 217): On a more basic level,
39

the signals of exhaustion and depletion of energy from the body may signal negative
effects, while on a more complex level, the fact that one is engaging in an exercise
regimen may induce feelings of pride and satisfaction. Similarly, in a Qigong con-
text, the slow movements may be experienced as pleasant, and on a higher level as
joy or happiness for some or as boring for others as the movements may make them
feel restless and wish they were doing something “more useful”.
40

Acute affective responses
Suggested mechanisms for acute affective benefits
Given that Qigong exercise constitutes a number of different characteristics, includ-

ing slow movements, relaxation, meditation, imagery, natural breathing and self-
massage, a number of different theories on active mechanisms may work simultane-
ously and interactionally to affect the exerciser’s affective state. Below are some
suggestions and theories that intend to explain the Qigong exercise-affect relation-
ship. Chen (2008) speculates on how Qigong may enhance health and healing from
a TCM perspective: 1) First, vital qi may flow more strongly through the meridians
after Qigong practice and enhance health; 2) The cultivation of consciousness and
intention (yi) may release suppressed emotions and resolve mental disturbances. Fan
(2000) states that emotional disturbances may be cleared by Qigong exercise. Fur-
ther, it may release the individual from the socialized self (determinant of stress) and
allow him/her to return to a more natural original self. 3) Finally, Qigong exercise
may uncover the body’s self-healing capabilities by strengthening the immune sys-
tem.
From a Western scientific point of view, Qigong exercise may affect the exerciser
in a number of different ways, including the nervous system, by way of the relaxa-
tion response, placebo/positive expectations, cultivation of positive emotions, al-
tered states of consciousness, and other suggestions and theories related to physical
activity and exercise science. The autonomic nervous system consists of two parts,
the sympathetic (mobilizes and utilizes energy) and the parasympathetic (promotes
restorative processes), which enables the body to adapt to different environmental
situations and secure the individual’s survival. Certain behavioral conditions are
more prevalent in one or the other of the two systems (Recordati, 2003). Sympa-
thetic behaviors include the transition from sleep to wakefulness, muscle exercises
and mental arousal. Among conditions such as sleep, hibernation and post-exercise,
the voluntary control of breathing, grooming and repetition of a stimulus seem es-
pecially relevant as they are important aspects of Qigong exercise. Grooming refers
41

to activities concerned with the primary biological functions of caring for the body
surface, and may in this case be related to self-massage and clapping of the body, as
well as the focus on the inner body which are performed during qigong. Also, the
repetition of a stimulus is evident in Qigong activities in the repetitive, slow move-
ments. Finally, slow, deep breathing increases parasympathetic activity (Bernardi,
2002), also a vital part of Qigong exercise. It is suggested that sympathetic activity
focuses on work related to the external environment, while parasympathetic activity
instead focuses on work related to the internal environment, self-protection and re-
covery (Recordati, 2003).
Research on meditation at the beginning of the 70s led to the suggestion that
mind-body therapies share specific characteristics that may elicit the Relaxation Re-
sponse (Benson, 1983; Esch, Fricchione, & Stefano, 2003). These characteristics in-
clude a mental device (a sound, a word, or some other object for mental focus), a
passive attitude (not worrying about how well one is performing, or if distracting
thoughts occur, redirecting one’s attention to the repetition of the mental device),
decreased muscle tonus (a comfortable posture or sitting position), and a quiet envi-
ronment (Benson, Greenwood, & Klemchuk, 1975). The Relaxation Response is
associated with decreased sympathetic nervous system activity, reduced oxygen con-
sumption, reduction in heart and respiratory rates, decreased blood lactate concen-
tration, increased alpha-wave activity, and stabilization of muscle blood flow (Ben-
son, 1983; Benson et al., 1975; Levander, Benson, Wheeler, & Wallace, 1972).
Mind-body therapies (Jin, 1992) and physical activity (O’Halloran, Murphy, &
Webster, 2002, 2005) have been associated with the placebo effect or positive ex-
pectations. A number of theories attempt to explain how placebo may affect psycho-
logical and physiological health: Expectancy Theory, classical conditioning, and
Emotional Change Theory (Catanzaro & Mearns, 1999; Olson, Roese, & Zanna,
1996). In the context of the Schematic Processing Approach, Lund (1987) suggests
that by taking a placebo or engaging in something one believes will lead to a posi-
tive outcome, a cognitive schema of expected effects is activated. When activated,
individuals are more likely to recall and notice information or experiences that are
consistent with that schema, interpret ambiguous information consistent with the
42

schema, and overlook mildly inconsistent information or dismiss it as invalid. Given
that the placebo effect is enhanced when one has an inner bodily focus (Geers,
Helfer, Weiland, & Kosbab, 2006), it is likely that positive expectations and affec-
tive Qigong outcomes will be associated (or perhaps also have an influence), as the
qigong exerciser focuses on the inner body.
Qigong exercise and similar relaxation techniques may enable the cultivation of
positive emotions (Fredrickson, 2000). While negative emotions may narrow the
thought-action repertoire (e.g., fear is linked with the need to escape), positive emo-
tions may work and function in a different way. In her Broaden-and-Build Model of
positive emotions (1998), Fredrickson suggests that positive emotions may broaden
an individual’s thought-action repertoire so that it is incompatible with that of nega-
tive emotions. This can loosen the hold that negative emotions such as depression or
anxiety may have over the individual’s psychological and physiological responses
(the Undoing Hypothesis). Specifically, Qigong exercise may cultivate positive emo-
tions like contentment (an appreciation for the present moment and also integrating
those experiences to better appreciate one’s place in the world). Relaxation tech-
niques are often multicomponental (Qigong consists of relaxation, visualization, re-
laxed breathing, etc.). They may focus on one component that is included in the
emotion. The relaxation of muscles in relaxation training may be associated with
the physiological relaxed state of the body that is associated with experiencing posi-
tive emotions. Inducing one component of the emotion may jump-start other com-
ponents of the same emotion (e.g., cognitions and facial expressions).
Qigong exercise may also induce an Altered State of Consciousness (ASC; Vaitl,
Birbaumer, Gruzelier, Jamieson, Kotchoubey, Kübler et al., 2005) by way of respira-
tory maneuvers, relaxation, etc. These states are associated with changes in activa-
tion, awareness span, self-awareness (e.g., absorption in the activity and forgetting
the self), the experience of sensations, body image, suggestibility, time experience,
emotions, self control, and sense of personal identity (Farthing, 1992; Vaitl et al.,
2005). One example of ASC is Flow or Optimal Experience (Nakamura & Csik-
szentmihalyi, 2002). The Flow state may be induced when the individual’s ability
matches the demands of the activity and when goals and feedback are clearly visible.
43

The Flow state is characterized by great focus on the present moment, a merging of
action and awareness, a loss of reflective self-consciousness, a sense of control and
of time distortion, and is rewarding in itself (intrinsic). A related concept is absorp-
tion, in which an individual forgets everything else except the focus of attention.
Whereas absorption is characterized by passivity, concentration or attention is more
active, although they are related (Davidson & Schwartz, 1976). The ability to con-
centrate has been associated with perceived health in the context of Qigong (Jouper,
Hassmén, & Johansson, 2006) and is very important in Qigong practice (Fan,
2000). In his cognitive-behavioral model of relaxation, Smith (1990) stresses the
importance of focusing, passivity, and receptivity for inducing a relaxed state, sug-
gesting an optimal level between activity and passivity for relaxation. A suggestion
was recently presented for biological correlates of ASC experiences: The Transient
Hypofrontality Hypothesis (Dietrich, 2003). This theory states that by narrowing
attention (through focusing on the body, breathing, or a mantra), higher cortical
functions (the prefrontal cortex) responsible for analyzing, differentiating, and logi-
cal reasoning may be down-regulated, leading to a state of unity, timelessness, ab-
sence of reflection, and reduced depression and anxiety. Thus, because of the char-
acteristics of Qigong an altered state of consciousness can be induced, which can be
experienced as a pleasant affective state.
Leaving the more general suggestions for the Qigong-affect relationship, I now
turn to those that are specific to physical activity and the area of exercise science.
Although it is only one component of Qigong, the role of low-intensity physical ac-
tivity is important. By engaging in an activity the exerciser can feel good about
him/herself for being able to adhere to the regimen, master difficult movements, or
reduce arousal (mastery/self-efficacy; Bandura, 1982). This may lead to a sense of
accomplishment affecting physical self-efficacy and self-concept, which may lead to
increased global self-esteem (Sonstroem & Morgan, 1989). The Time-Out Hypothe-
sis (Bahrke & Morgan, 1978) suggests that anxiety may be reduced due to a leaving
behind of, or taking a time-out from, worries. The activity in itself does not lead to
a better affective state, but instead simply distracts the exerciser from the stressors
of daily life. The secretion of endorphins (Hoffman, 1997) and neurotransmitters
44

(serotonin, dopamine, epinephrine, etc.) as the biological correlate of value for well-
being (Chaouloff, 1997; Dishman, 1997) has been suggested as the reason for the
emotional benefits associated with physical exercise. The affective benefits of exer-
cise may also be influenced by increased body temperature (Thermogenic Hypothe-
sis; Petruzzello, Landers, & Salazar, 1993), by being regularly influenced by the
stress of physical activity (Physiological Toughness Model; Dienstbier, 1989), the
fact that being physically active is inherent in our genetic makeup (living a sedentary
life therefore creates negative mental health; Anthropological Hypothesis, Martin-
sen, 2002), and by socially interacting with other people. All the suggestions men-
tioned may provide for affective responses in the context of Qigong (except perhaps
the Thermogenic Hypothesis and the Physiological Toughness Model), and social
interaction may not be solely responsible, as solitaire exercise has led to improved
affective states (Szabo, 2003).
The Opponent Process Theory (Solomon & Corbit, 1973) has been associated
with physical activity-associated affective benefits. This theory is based on the as-
sumption that the brain is organized to oppose both pleasurable and aversive emo-
tional states, by creating a countering reaction. As the body is greatly activated dur-
ing exercise, upon extinction of the bout, the opponent process, a pleasant deacti-
vated state will follow. Extending the Opponent Process Theory, Bixby and collabo-
rators suggest that the intensity level of the exercise influences the affective change
(Bixby, Spalding, & Hatfield, 2001). Affective changes of high intensities, the Re-
bound Model, are characterized by an initial decline in perceived affect (aversive)
and later an increase in affect reaching higher affective levels (than baseline) at post-
measurements. At low intensities, the affective change is characterized by an eleva-
tion of affect until it reaches a plateau, referred to as the Maintenance Model. Both
high and low intensities lead to post-exercise elevation of affect, but affective
changes during exercise take different pathways.
A recent important suggestion is the Dual-Mode Model (Ekkekakis, 2004), which
is based on the assumption that physical activity is an essential component of hu-
man evolution. Affective responses are evolved psychological mechanisms that are
adaptational in that they promote health and well-being by way of pleasure (utility)
45

and displeasure (danger). Affective responses are dependent on a hierarchically or-
ganized system with different controlled components and encompass functions from
primitive ones that show little inter-individual variability to more advanced ones
that show greater variability. Further, the affective responses to physical activity are
dependent on the interplay between two factors: cognitive processes (meaning of ex-
ercise, goals, self-perceptions) and interoceptive cues (exercise-induced physiological
changes). Low intensities are proposed to be characterized by a low influence of
cognitive factors and most individuals experiencing pleasure during the bout. Me-
dium intensities display a strong influence of cognitive factors and great variability
between individuals; some experience more pleasantness, some more unpleasantness
(during). Finally, high intensity levels of exercise are instead theorized as displaying
a strong influence of interoceptive factors and with most individuals experiencing
displeasure. The majority of individuals are proposed to experience pleasantness
post-exercise.
Acute affective responses to physical activity
Reviews of the literature show that affective improvements accompany the termina-
tion of most forms of physical activity (Biddle, 2000; Ekkekakis & Petruzzello,
1999; Reed & Ones, 2006; Yeung, 1996). Focusing on low and moderate-intensity
exercise, a number of studies on walking display acute affective benefits. Five min-
utes of walking was associated with increased energy post-exercise (Thayer, Peters,
Takashi, & Birkhead-Flight, 1993) and perceived energy and tension reduction
(Thayer, 1987). State anxiety was reduced after a 40-minute walk on a treadmill
(Porcari, et al., 1998). Ekkekakis and colleagues (Ekkekakis, Hall, Van Landuyt, &
Petruzzello, 1999) found that short walks (10-15 minutes) were associated with in-
creased activation and more positive affective valence during the bout. Recovery
from walking was associated with calmness and relaxation. Further, active middle-
aged and elderly individuals were prescribed 15 minutes of walking or silent read-
ing. Results displayed increased self-reported energy during and post-exercise (Ek-
kekakis, Backhouse, Gray, & Lind, 2008) significantly better than the control con-
46

dition. The above studies show that low-intensity exercise of short duration may
also provide for a better affective state.
Other variables important for the improvement of affective reactions in relation
to physical exercise include self-selected intensity (Parfitt, Rose, & Marklund,
2000), the activity being enjoyable (Daley & Maynard, 2003; Lane, Jackson, &
Terry, 2005, Parfitt & Gledhill, 2004), similar affective benefits independent of du-
ration (Daley & Welch, 2004; Hansen, Stevens, & Coast, 2001; Petruzzello &
Landers, 1994), the bout not exceeding 75 minutes (Reed & Ones, 2006), cogni-
tions during the bout (Blanchard, Rodgers, & Gavin, 2004), and the affective state
before the bout (more negative affective state before is associated with more positive
state after (Reed et al., 2004)).
For a long time, the recommended intensity level of physical activity for optimal
affective benefits was that of moderate levels (cf. Berger, 2001), and it was suggested
that a certain intensity threshold was necessary for the provision of these benefits
(Kikcaldy & Shephard, 1990). In his Dual-Mode Model (described elsewhere), Ek-
kekakis (2004) posits that pleasurable responses can be found at all intensities ex-
cept high intensity. This model has some support (Ekkekakis, Hall, & Petruzzello,
2005; Welch, Hulley, Ferguson, & Beauchamp, 2007), and from the discussion
above about investigations of activities ranging from low intensities like walking to
higher intensities, many levels of intensity are associated with affective benefits.
Acute affective responses to mind-body therapies
Investigations of specific mind-body therapies show affective benefits in a number of

studies. Yoga is related to a predominantly sympathetic tone of the nervous system
during the activity and parasympathetic after (Savang & Telles, 2006). Negative
mood and anxiety were reduced after a Yoga session, but there was no increase in
Vigor (positive mood; Berger & Owen, 1992). Tai Chi showed a reduction in sympa-
thetic nervous system activity and an increase in parasympathetic activity after a
bout (Lu & Kuo, 2003). In another study, at post-measures, Tai Chi displayed in-
creased heartbeat, increased urinary noradrenalin, decreased salivary cortisol, and
47

increased positive mood (Vigor) as well as decreased negative mood (anxiety, ten-
sion, depression; Jin, 1989). Relaxation was associated with a reduction in arousal
and distress (Peveler & Johnston, 1986) and an alleviation of somatic and cognitive
anxiety (Gill, Kolt, & Keating, 2004).
Comparing the effects of different mind-body therapies and other activities, both
relaxation and short walks were associated with a reduction in tense arousal, but
only walks were associated with feeling energized afterwards (Saklofske, Blomme, &
Kelly, 1997). Yoga was associated with increased perceived physical energy and feel-
ing alert, while relaxation increased sluggishness (Wood, 1998). Studies by Berger
and associates (Berger, Friedmann, & Eaton, 1988; Berger & Owen, 1992) display
similar post-exercise effects (reduction in negative mood) that were significantly dif-
ferent from controls. Low-intensity mindful activities (Feldenkreis & Yoga) were su-
perior in enhancing subjective well-being and reducing state anxiety and depression
compared to a high-intensity non-mindful activity (dance aerobics; Netz & Lidor,
2003). Finally, Tai Chi, Yoga and Martial Arts were associated with a reduction in
psychological distress, fatigue and exhaustion to the same extent, however only the
Tai Chi and Yoga displayed increased tranquility (Szabo, Meskó, Caputo, & Gill,
1998).
Mind-body therapies show changes comparable to other physical activities, as
they share similar characteristics. However, when they lack the physically active as-
pect, like in relaxation, people generally do not feel activated like they do in Yoga
and Tai Chi. Feeling activated is probably associated with the intensity of the activ-
ity. Naruse and Hirai (2000) showed a positive relationship between exercise inten-
sity and arousal level (lower intensity and lower arousal). It has been proposed that
mind-body methods may reduce negative mood while not enhancing positive mood
(Yeung, 1996). Few results of the above-mentioned studies show increased positive
mood; however, this may be due to the use of scales predominantly covering nega-
tive aspects of mood, such as the POMS (five negative subscales and one positive).
Mind-body therapies seem to affect the exerciser in ways that stabilize the nervous
system and provide a reduction in negative mood and sometimes an increase in posi-
tive mood.
48

Acute affective responses to Qigong exercise
Qigong studies have also focused on acute psychological responses to single ses-
sions. Qi-training (Qigong) of a group of male beginners (having learned the form
prior to the study) was studied, comparing an actual session with a sham-control
(movements without mindful intention) qi session (Lee, Kang, Lim, & Lee, 2004).
State anxiety (STAI) was reduced significantly more (26% to 9%) in the actual Qi-
training session. Also, plasma concentration of ACTH, cortisol, and aldosterone de-
creased in the Qi-training condition but not in the sham session. It is concluded that
Qigong has effects on the hypothalamic-pituitary-adrenal axis. Kjos and Etnier
(2006) used the PANAS (Watson, 1988) to study affect before, after and at three
15-minute intervals pre-exercise, for a group of older (mean age 65 years) female
beginners who had learned Qigong prior to the study. The effects of Qigong were
compared to walking. There was a significant increase in Positive Affect from pre-
exercise to post-exercise (similar to Pleasant Activation in Figure 2) that was compa-
rable to walking. Positive Affect rapidly decreased after the bout to below pre-
exercise levels at the post-15-minute assessment. No significant change was found
for Negative affect (similar to Unpleasant Activation of Figure 2). Qigong was con-
sidered a moderate-intensity activity that was comparable to walking.
The above two sole studies of acute affective responses to Qigong exercise display
promising benefits. However, in the context of Unpleasant Activation (Figure 2),
where anxiety and Negative Affect can be found, contrasting results are found:; a
reduction in anxiety in the Lee et al. (2004) study, and no significant reduction in
Negative Affect in the Kjos and Etnier (2006) study. The reasons for this difference
are not known, but there were only men in the Lee et al. (2004) study and only
women in the Kjos and Etnier (2006) study. This also shows the limitations associ-
ated with using the PANAS (restricted to only the high activated poles of the cir-
cumplex structure of affect) in the context of Qigong. It seems reasonable that
Qigong is also associated with the deactivated poles of the circumplex (e.g., Un-
pleasant Deactivation).
49

Unanswered questions in the Qigong-affect relationship
When work was commenced on the first study of the present thesis, Qigong exercise
had only been found to reduce state anxiety (Lee et al., 2004). However, anecdotal
reports, a master’s thesis (Brinker, 1998), and studies of mind-body therapies (Berger
et al., 1988; Berger & Owen, 1992; Jin, 1992; Gill et al., 2004; Peveler & Johnston,
1986; Saklofske et al., 1997; Szabo et al., 1998) and low-intensity physical activity
(Ekkekakis et al., 1999; Porcari et al., 1998; Thayer, 1987; Thayer et al., 1993) also
suggested that Qigong exercise would perhaps display an association with affective
benefits.
The continued study of Qigong-related affective responses is important for a
number of reasons. In addition to commencing studies in a new field of research, the
increasing interest from the public in mind-body therapies (Kelner & Wellman,
2000; Landstingsförbundet, 2000; Wolsko et al., 2004) is indeed an important incen-
tive for further study. Studying acute (positive) affective responses appeals to re-
searchers, because most people want to be happy or experience subjective well-being.
Physical activity is often recommended for the enhancement of mental health (FYSS,
2008). However, not everyone (e.g. the elderly) is able to engage in higher-intensity
activities, and some may not like it. In studying affective responses to Qigong exer-
cise we may find new ways for people to increase their health and well-being. From a
theoretical standpoint, studying Qigong, which includes both mindful (relaxation
and meditation) characteristics and physical activity, is a fascinating prospect. Thus,
the continued study of the acute affective responses to qigong exercise may provide
promising benefits in the areas of positive affect and subjective well-being
(Fredrickson, 2000), affect regulation (Wallace & Shapiro, 2006), and managing and
reducing physiological and psychological arousal (e.g., stress; Gunnarsson, 2004).
50

Rationale for the present thesis
The study of Qigong-related acute affective responses is a fairly new avenue of re-
search. A very limited number of studies had been carried out prior to the present
thesis. Given the similar research context, I chose to study Qigong from an exercise
psychology perspective. Although there may be some dissimilarities between, for ex-
ample, jogging and Qigong (the foremost being the focus on the mindful intention in
Qigong), the physical activity part is included in both exercises and may allow for
the use of similar ways of study. Perspectives and methodologies in the present the-
sis are therefore influenced by the area of exercise psychology.
Given the rather broad population of Biyun Qigong exercisers in Sweden, I chose
to commence my investigations at the annual Biyun Qigong training camp, which
takes place a few days every summer. This meant having the opportunity to meet up
to a hundred Qigong exercisers at the same time and place. All members of the
Green Dragon (the member association of Biyun Qigong in Sweden) who have taken
a course in the basic qigong form (Jichu Gong) are welcome to attend the camp,
which includes lectures on Qigong and TCM, Qigong exercise, and meeting others
interested in Qigong.
Jouper and colleagues published a study on the demographics of the members of
the Green Dragon (Jouper et al., 2006), showing a majority of women in the associa-
tion: In 2007 there were 102 men and 1348 women (G. Jacobson, personal commu-
nication). The majority of members have a university degree (57%), and have com-
pleted an average of four (SD = 4) qigong courses. At the time, 44% were employed,
45% retired, and 11% students. They are an active group, engaging in other physical
activities 4.2 (SD = 2.9) times a week. The reasons for beginning Qigong exercise are
mainly curiosity, but also to find a means of promoting personal health and recuper-
ating from illness. Reasons for continuing to practice include feelings of personal
well-being and physical health preservation (Jouper et al., 2006). The members of
the Green Dragon display means in the middle range (unpublished data) compared
to norm means for Antonovsky’s Sense of Coherence Scale (Antonovsky, 1991), and
51

Ryff’s Psychological Well-Being Scales (Lindfors, Berntsson, & Lundberg, 2006; Ryff
& Keyes, 1995).
52

AIM OF THE THESIS
The aim of the present thesis is to study Qigong-related acute affective responses in
a group of regular exercisers. Affective responses will be assessed on different levels
of the affective hierarchy: from the level of affect to moods and emotions, using cor-
responding self-report measures. Further, through the use of mean scores, individual
responses, and open-ended questions, the affective Qigong experience will also be
studied. Assessments will be made before, during, and after the Qigong bout. Spe-
cifically, the following research questions are posed in the thesis:
Are the acute affective responses associated with Qigong exercise signifi-
cantly different from a control condition?
Are the acute affective responses associated with Qigong exercise dependent
on the length of the session?
Is there a relationship between acute affective responses and positive expecta-
tions of affective benefits?
How are affective responses displayed and how do they change, from pre-, to
during, to post-exercise, using means and individual responses?
How do the exercisers describe their experience associated with Qigong exer-
cise, during and after the session?
53

STUDIES
Study I
Johansson M., Hassmén, P., & Jouper, J. (2008). Acute effects of qigong exercise on
mood and anxiety. International Journal of Stress Management, 15, 199-207.
Introduction
Today, stress causes widespread ill health, demonstrated by increased rates of mus-
culoskeletal disorders, anxiety, and depression (Bergdahl & Bergdahl, 2002; Krantz,
& Lundberg, 2006; Ursin, 2000). Increasing evidence points to the benefits of using
physical activity and mind-body therapies (e.g. Yoga, Tai Chi, and Qigong) as a
means for managing and alleviating stress by improving mood and reducing anxiety
(Berger & Motl, 2001; Granath, Ingvarsson, von Thiele, & Lundberg, 2006;
Petruzzello, Landers, Hatfield, Kubitz, & Salazar, 1991; Wolsko et al., 2004). Chi-
nese traditions have emerged with a method, Qigong, which combines slow move-
ments, relaxed breathing, and deep mental focusing. Studies show that Qigong may
increase the overall health and well-being of the exerciser (Lee, Ryu, & Chung,
2000; Mayer, 1999; Ryu et al., 1995). Acute affective (mood and emotional) re-
sponses to single sessions of Qigong exercise are fairly limited, yet one study (Lee,
Kang, Lim, Lee, 2004) reported reduced anxiety after one hour of Qigong exercise.
Given that everyone does not have the time to engage in an hourly Qigong bout, it
would be interesting to investigate whether a 30-minute bout would also yield posi-
tive affective benefits. The aim of the present study was therefore to study the acute
effects on mood and anxiety after 30 minutes of Qigong exercise, compared with a
control condition.
Method
Participants at a Qigong camp were asked to participate, and those willing (59 indi-
viduals, 8 men and 51 women; 50.8 years of age, SD = 3.1) were consequently first
54

matched according to age, instructor versus exerciser, and gender, and were later
randomized to a Qigong group or a control group (attending a lecture on Tradi-
tional Chinese Medicine by Biyun founder and Qigong master Fan Xiulan).
Mood and anxiety were measured using the Profile of Mood States (POMS;
McNair et al., 1992) and the state form of the State and Trait Anxiety Inventory
(STAI; Spielberger et al., 1983). The POMS consists of 65 items assessing six affec-
tive states: tension/anxiety, depression/dejection, anger/hostility, vigor/activity, and
confusion/bewilderment. The respondents rate their feelings on a five-point (0-4) in-
tensity scale; the question “How are you feeling right now?” was chosen. The POMS
has been validated by different groups of individuals: psychiatric outpatients and col-
lege groups (McNair et al., 1992), and adult and geriatric populations (Nyenhuis,
Yamamoto, Luchetta, Terrien, & Permentier, 1999).
The STAI has been validated in a number of college student samples (Spielberger
et al., 1970) and has strong psychometric qualities (Gauvin & Spence, 1998). The
STAI comes in two versions, a trait and a state version. The state version (SAI) was
used here. Respondents assess their level of anxiety on a four-point (1-4) intensity
scale, ranging from Not at all to Very much so. The state version of the STAI con-
sists of 20 statements.
Before and after the Qigong and control intervention, the POMS and the STAI
were filled out. Initial t-tests on all dependent variables were used to rule out any
pre-intervention differences. Separate mixed (Group x Time) ANOVAs for each de-
pendent variable (7) were made. Alpha was set at .007 to reduce for type-I errors,
due to multiple testing (Bonferroni correction).
Results and discussion
Pre-scores on all dependent variables showed no differences between groups. No

gender differences were found in a comparison of pre-scores on the STAI and the
POMS. Taken together, the two groups displayed reduced state anxiety (STAI),
Tension, Depression, Fatigue, Confusion, and enhanced Vigor (POMS). Comparing
the two groups, STAI, Depression, Anger, and Fatigue were reduced significantly
55

more in the Qigong group (Tension, Confusion and Vigor changed more in the
Qigong group, but not significantly).
The results of the study are discussed comparing different magnitudes of anxiety
reduction with another Qigong study, and the influence of having regular exercisers
in the study. Given that the control condition was attending a lecture by Qigong
master Fan Xiulan, an important person to the individuals in the study, possible
limitations and suggestions for future optimal control conditions are discussed. Thus
it seems equally beneficial for the Qigong exercisers to listen to a lecture by the
Qigong master on Tension, Confusion, and Vigor. In particular, the non-significant
difference on the Confusion subscale (POMS) between the Qigong and control
groups may be explained by the cognitive characteristics of the lecture. Possible ac-
tive mechanisms for the effects on mood and anxiety are suggested by way of in-
creased parasympathetic tone (focus on internal body, repetitive tasks and breath-
ing; Recordati, 2003), elicitation of the relaxation response (Benson et al., 1975),
Oxytocin secretion by way of self-massage (Uvnäs-Moberg et al., 2005), and by cul-
tivation of positive emotions (the Broaden-and-Build Model; Fredrickson, 2000).
Study II
Johansson, J., & Hassmén, P. (2008). Acute psychological responses to qigong exer-
cise of varying durations. The American Journal of Chinese Medicine, 36, 449-458.
Introduction
Previous Qigong studies investigating acute anxiety responses show different magni-
tudes of reduction. Although not involving the same Qigong styles, a 60-minute bout
of qigong exercise (Lee et al., 2000; 24% reduction) displayed a greater reduction in
anxiety compared to a 30-minute bout (Johansson, Hassmén, & Jouper, 2008; 12%
reduction). On the contrary, studies of physical exercise do not display greater affec-
tive effects after longer sessions of exercise compared to shorter ones (e.g. Daley &
56

Welch, 2004; Hansen, Stevens, & Coast, 2001). The aim of this study was therefore
to compare a 30-minute Qigong session with a 60-minute Qigong session.
Method
A matched (age, instructor versus exerciser, and gender) randomization was per-
formed with regular Qigong exercisers at a Qigong summer camp who were willing
to participate in the study (N = 41). Participants (35 women and 6 men; 56.7 years
of age, SD = 12.4) were allocated to a repeated measures cross-sectional design. On
the first day, one group began with 30 minutes of exercise and the other with 60
minutes of exercise. On the following day conditions were reversed, resulting in all
participants taking part in both conditions and a controlling for order effects. Meas-
ures of mood (POMS; McNair et al., 1992), state anxiety (STAI; Spielberger et al.,
1983), and Affect (self constructed one-item scales, end points representing Highest
possible and Lowest possible, measuring Activation and Valence). See Study I for
psychometric properties of the POMS and the STAI. Separate 2 x 2 within-subject
ANOVAs were carried out for each dependent variable (9). Type-I error was pro-
tected by Bonferroni correction, setting alpha-level at .006. Given that the depression
subscale of the POMS has been used as a screening instrument for depression (Grif-
fith, Szaflarski, Kent, Schefft, Howe, & Privitera, 2005), participants with scores of
more than 1 SD above the norm of healthy females (McNair et al., 1991) were ex-
cluded from subsequent analysis (five individuals).
All measures (except Activation) displayed significant beneficial changes. No signifi-

cant differences (p < .006) on the six subscales of the POMS, the STAI, and the self-
made measures of Affect, in the magnitude of changes, were found when the two
conditions were compared. Both conditions, 30 and 60 minutes, displayed significant
beneficial psychological changes (except on Activation). A longer Qigong session
therefore does not induce greater psychological responses than a shorter session
57

does. Many people report having limited time to engage in an exercise regimen; it is
therefore positive that a short session (30 minutes) is enough to induce positive psy-
chological responses of the same magnitude as a longer one (60 minutes).
The Relaxation Response (Benson et al., 1975) has been suggested as a possible
active mechanism for the beneficial effects on affective states, associated with
Qigong and mind-body therapies. The results of this study are discussed in light of
the fact that regular Qigong exercisers may be more skilled and thus require less
time to elicit the Relaxation Response, and therefore similar affective benefits in
both the 30 and 60-minute conditions. Further, the equivocal results of Vigor but
not Activation being significant are proposed to be due to the POMS being a vali-
dated instrument while the wording of the Activation measure may have an influ-
ence. A point is also made in Study II regarding the narrowness of the present per-
spective. The focus is on acute affective changes. Qigong exercise is not focused
solely on improving affective states, but rather on the continuous daily work of im-
proving health for the whole individual: physiologically, psychologically, spiritually,
and energetically. Jichu Gong is the first Qigong maneuver the beginner learns, and
Dong Gong is the second. These two different maneuvers have different aims, ac-
cording to Fan (2000), and cannot really be compared. The success of Dong Gong
practice is dependent on some experience of Jichu Gong; it is actually recommended
that the student practice Jichu Gong daily for three months before learning Dong
Gong (Fan, 2000). In the 30-minute condition Jichu Gong was performed, and in
the 60-minute condition Jichu Gong and Dong Gong were performed. However,
from a perspective of affective regulation, a single session of 30 minutes of Qigong
exercise may give the exerciser a boost in positive mood. In future studies, one
should observe even shorter bouts of Qigong exercise to see if they also provide af-
fective benefits. The focus of Study II is on people reporting not having time to exer-
cise, and therefore studies shorter bouts to determine whether they are as beneficial
as longer ones.
58

Study III
Johansson, M., Hassmén, P., & Hertting, A. (manuscript) Affective responses to
qigong exercise. A Pilot study. Submitted for publication.
Introduction
In this study we wanted to extend and develop ways of studying acute affective re-
sponses to Qigong exercise, which have not previously been done, and adopted re-
cent recommendations from exercise psychology. Hence, we chose to study affective
responses by way of a dimensional perspective on the level of affect, employing as-
sessments before, twice during (10 and 20 minutes), and after exercise. In addition to
studying average mean scores, we presented individual scores to show the individual
variation in affective changes. This perspective has been proposed by a number of
researchers (Backhouse, Ekkekakis, Biddle, Foskett, & Williams, 2007; Van Landuyt
et al., 2000) and may more realistically display the variations in affective responses
during and following physical activity. This is a new and more realistic perspective
on the classical idea that exercise makes you feel better, which has been criticized for
being too simplistic and may have been detrimental in making people become more
physically active. Given that placebo or positive expectations have been associated
with Tai Chi (Jin, 1992), we chose to study a possible relationship with the actual
affective outcomes. Finally, open-ended questions were employed to allow the par-
ticipants to describe affective experiences associated with Qigong.
Method
Forty-six women chose to participate in the study, out of 88 attending participants
(men and women) at a Biyun Qigong summer training camp. Mean age was 59
years (SD 9.2). We chose to study affect from a dimensional perspective using a
modified version of the short Swedish Core Affect Scale (SCAS; Västfjäll et al.,
2002; Västfjäll & Gärling, 2007). We thus measured affect in four dimensions: Un-
pleasantness-Pleasantness, Deactivation-Activation, Unpleasant Deactivation-
59

Pleasant Activation, and Unpleasant Activation-Pleasant Deactivation (See Figure 2).
The SCAS was validated and determined to be a reliable measure of the dimensions
of the affect circumplex (Västfjäll et al., 2002). As affect is assessed on only two di-
mensions in the short version (Västfjäll & Gärling, 2007), we included the extra two
(rotated in italics) that are included in the original version (Västfjäll et al., 2002),
while keeping the rating format of the short version (for multiple assessments). As
such, respondents rated their present affective state in a bipolar rating format (1-9).
Thus, affective responses could be assessed on four dimensions (as recommended by
Larsen & Diener, 1992).
In addition to tracking affective responses as mean averages, we studied inter-
individual responses on the Unpleasantness-Pleasantness dimension on the SCAS.
This was done from Pre- to In-task 1, and to In-task 2, categorizing responses ac-
cording to Positive, Negative, Fluctuations, and No change (Rose & Parfitt, 2007);
see Table 1. Inter-individual responses were also measured in a similar manner be-
tween each assessment (including post-measurement).
A Swedish version of the Beliefs Concerning Mood Improvements Associated
With Running Scale (O’Halloran, Murphy, & Webster, 2002) was administered to
measure beliefs regarding positive expectations related to Qigong exercise, and corre-
lations (Pearson) with actual outcomes were calculated. The scale consists of five
items measuring expected mood changes during exercise, and two items assessing
expected mood changes after the bout. Scores on the two subscales were calculated
using mean scores of the items belonging to each subscale (possible scoring on each
subscale 1-5). Examples of statements include “I experience feelings of improved
mood during a session of Qigong”. The authors report satisfactory internal consis-
tency (Cronbach alphas = .77 and .86 respectively).
To measure perceived exertion, the Borg scale (6-20) of perceived exertion (RPE)
was used in Study III. The scale ranges from No exertion at all (6) to Maximal exer-
tion. Psychometric information can be found in Borg (1998).
60

The participants were also told to describe the experience and how they generally
feel during and after a Qigong session. Adjectives describing how they feel were
grouped into the eight end points of the circumplex structure of affect, by way of
quantitative content analysis (Berg, 2001).
61

Four separate repeated measures ANOVAs were carried out for each affective
scale on the short modified SCAS. Post hoc tests (t-test) were employed when
ANOVAs were significant. The Bonferroni correction was employed to correct for
the risk of type-I error, setting alpha at .01. When violations of sphericity were de-
tected, Greenhouse-Geisser corrections were used.
Significant increases of affect (on repeated ANOVAs) between each assessment (Pre-
In-task 1, -In-task 2, and Post) were found (p < .01). Significant changes were found
(p < .01) between each assessment and every dimension (Bonferroni corrected t-tests)
on the SCAS, resulting in a shift toward increased Pleasant Activated and Deacti-
vated affect. However, the Unpleasantness-Pleasantness dimension did not display
significant affective benefits between Pre- and In-task 1. A recommendation is there-
fore that for affective benefits to be significant, the duration should not be shorter
than 20 minutes.
In a comparison of individual scores before and during, the majority of responses
indicated positive affective change, followed by no change. Further, studying changes
between single assessments, a majority of participants first show (Pre- to In-task 1)
no affective changes; some individuals report positive affective changes and some re-
port negative changes. In the two following comparisons (In-task 1 to In-task 2 and
In-task 2 to Post), individuals showing increased positive affect increase and domi-
nate, while participants showing no changes decrease. Responses in the direction of
more negative affect decrease to a minimum. When comparing Pre with Post, 87%
report increased Pleasantness and no individual reports increased Unpleasantness.
Thus, inter-individual affective patterns of change during Qigong exercise display
favorable affective changes for most individuals, particularly at the end of the bout.
Positive expectations with actual affective outcomes were only significant for one
dimension of the four scales of the SCAS. The Unpleasant Activation-Pleasant Deac-
tivation dimension was significantly correlated with expected mood outcomes at
post-measures (.31).
62

The results of the open-ended questions display a uniform positive affective ex-
perience, yet this may vary. Most individuals report affective experiences associated
with Pleasant Deactivation, followed by Pleasantness. The most common combina-
tion is Pleasantness and Pleasant Deactivation. Individuals also report beneficial
changes associated with cognition, bodily experiences, altered states of conscious-
ness, and increased well-being. The simultaneous increased activating and deactivat-
ing pleasant state, visible in the modified short SCAS, could not be seen here. During
Qigong, perceived exertion was rated at a mean average of 10.1, which can be found
between very light and light on the Borg scale.
These results were found despite the fact that the participants were interrupted
twice during the Qigong session. Qigong is advocated to be carried out without in-
terruption, and some participants displayed irritation at having to assess their affec-
tive state during the bout. It is possible that without the stops the affective responses
would have been even more positive. Some limitations of the study are mentioned,
including the absence of a control group in addition to self-selected participants at a
Qigong camp. Possible practical benefits are discussed and the pleasant affective
state reported by the qigong exercisers may have important value for adherence, sub-
jective well-being and fostering personal resources and positive affect in the future.
63

64

GENERAL DISCUSSION
Main findings
The aim of present thesis was to study Qigong-related acute affective responses in a
group of regular Qigong exercisers. In the three studies this has been done on differ-
ent levels of the affective hierarchy: basic affect, mood and emotion. Affective re-
sponses show uniform benefits on all levels (however not significantly more benefi-
cial than listening to a lecture on all mood states of the POMS; Study I). Benefits are
independent of training session length (30 and 60 minutes; Study II). Affect is sig-
nificantly improved during the bout, beginning with small changes, and greater at
the end (Study III). In line with the Dual-Mode Model (Ekkekakis, 2004) Qigong’s
low intensity characteristics create beneficial affective responses in the majority of
individuals (Study III). When responding to open-ended questions of what respon-
dents usually feel and experience during and after a Qigong session, reports are
mostly of Pleasantness and Pleasant Deactivation in nature, somewhat in contrast to
those measured by the modified short SCAS, in which a simultaneous pleasant acti-
vating and deactivating state were reported.
Complementing the few studies of acute affective responses to Qigong exercise
(Lee et al., 2004; Kjos & Etnier, 2006), the present thesis strengthens the scientific
knowledge in this area. Acknowledging some important limitations, more evidence
has now been gathered for the effectiveness of Qigong exercise, as a means for im-
proving affective states.
Research questions
Are the affective responses associated with Qigong exercise significantly dif-
ferent from a control condition?
Study I showed that State Anxiety, Depression, Anger, and Fatigue were significantly
better compared to the control group, whereas Tension, Confusion, and Vigor were
not (although pre-post comparisons were greater in the Qigong group). Studies of
65

physical activity display significantly better acute affective benefits compared to a
control group (e.g. Ekkekakis et al., 2007). State anxiety showed a significantly bet-
ter reduction from Qigong compared to sham Qigong (Qigong without the mindful
focus; Lee et al., 2004), and this superiority of mind-body therapies compared to
controls is also shown elsewhere (Berger et al., 1988; Berger & Owen, 1992; Netz &
Lidor, 2003). There are also examples of the opposite: Morgan and Bahrke (1979)
found the anxiolytic effects of Relaxation Response meditation similarly beneficial to
silently sitting in a chair. Thus, the answer to this question is partly positive; yet,
probably due to the choice of control group (a better choice would have been silent
sitting), it cannot be concluded that Qigong exercise is more effective in decreasing
Tension and Confusion, and increasing Vigor, and further studies are needed with
more appropriate control groups.
Are the affective responses associated with Qigong exercise dependent on

length of session?
Comparing affective responses to the two different durations (30 minutes of Jichu
Gong, and 60 minutes of Jichu Gong and Dong Gong) in Study II, results of the
STAI (state anxiety), the six POMS subscales, and the self-constructed measures of
Hedonic tone (valence) and Activation, all showed non-significant results. Thus, for
the sample in this study, the results imply that acute affective benefits of Qigong are
independent of duration. Yet, as Fan Xiulan reasons (Personal communication,
2009-01-21), Jichu Gong and Dong Gong are different forms and have different
aims, and it is therefore likely that experiences from the two would be different.
Hence, according to the results based on the scope of instruments of the present
study, similar effects were found, but it is possible that with different instruments or
with a qualitative approach, differences between the 30 and 60-minute bouts would
have been found (perhaps even more so if Jichu Gong had been compared with Dong
Gong). To my knowledge, affective benefits of mind-body therapies of different du-
rations have not been studied, but the result of the present thesis is in line with re-
sults from comparisons of physical activity of durations from 10 to 30 minutes
66

(Daley & Welch, 2004; Hansen et al., 2001; Petruzzello & Landers, 1994). From an
acute affective perspective, practical benefits entail allowing those with little time to
engage in activities (often a reason for not exercising; King et al., 2000) to be sure of
benefitting to a similar extent from a shorter session compared to a longer one.
Is there a relationship between affective responses and expectations of affec-

tive benefits?
Given the characteristics of Qigong exercise, suggesting extra strong placebo effects,
an association between expectations and actual outcomes was expected. However,
on the four scales of the modified short SCAS that were compared to expectations of
affective benefits during and after the actual Qigong bout, it was only in the Un-
pleasant Activation-Pleasant Deactivation dimension where a significant correlation
with expected mood outcomes at post-measures was found. The reason for this may
be partly due to different affective measure and activity (P. D. O’Halloran, personal
communication, February 25, 2008) than previously reported correlations between
mood and expected mood outcomes in the literature (O’Halloran, Murphy, & Web-
ster, 2002; O’Halloran, Murphy, & Webster, 2005). A ceiling effect, with the major-
ity of individuals showing positive expectations regarding possible Qigong-related
affective benefits, may also be responsible for the absence of significant correlations.
In addition, O’Halloran et al. (2002) used young runners to validate the scale, in
contrast to the older sample of the present thesis. On the contrary, the significant as-
sociation with increased Pleasant Deactivation may be how the relationship between
positive expectations and Qigong-related affective outcomes is displayed.
Thus, from the results of Study III, one could conclude that a significant relation-
ship between positive expectations and affective outcomes was only found in one
(increased Pleasant Deactivation at post-assessments) of eight comparisons. It seems
reasonable that there should be more significant relationships based on theoretical
suggestions (Lund, 1987), empirical findings of somatic focus (Geers et al., 2006) in
addition to Tai Chi (Jin, 1992), and jogging (O’Halloran et al., 2002). Apparently,
67

this issue cannot be resolved at this time, and clearly needs more research in which
choice of participants, self-reports, and research design are of great importance.
How do affective responses display themselves and change, from pre-, to dur-
ing, to post-exercise, using mean averages and individual scores?
Based on the results of Study III, all the dimensions of the modified short SCAS first
show small positive changes, which later increase as the session proceeds (one of the
dimensions does not display significant changes comparing Pre and In-task 1).
However, Unpleasant Activation-Pleasant Deactivation instead shows the greatest
change at the beginning, reasonably due to the relaxation phase at the beginning of
the Qigong session. The pattern is thereby more closely related to that of the Main-
tenance Model (characteristic of low-intensity exercise) than the Rebound Model
(characteristic of higher intensity exercise; Bixby, Spalding, & Hatfield, 2001). Ac-
cording to the maintenance model, affective benefits are proposed to level out into a
plateau. This does not happen, however; instead, affective benefits increase until the
last measurement. Extra post-measurements could have shown the lingering effects
of the affective responses.
Individual responses on the Unpleasantness-Pleasantness dimension from Pre to
In-task 1 and to In-task 2 show 61% of individuals categorized as Positive, 7% as
Negative, 7% as Fluctuations, and 26% as No change. The few individuals reporting
increase in negative affect (7%) are in stark contrast to the 26% presented for self-
chosen moderate intensities of jogging (Rose & Parfitt, 2007), which is also pre-
dicted for low-intensity exercise (in comparison with moderate intensities) in the
Dual-Mode Model (Ekkekakis, 2004). Comparing each measurement, the majority
first display No changes, followed by Positive, and a few Negative. As the session
proceeds this changes, and in the end the majority display Positive responses fol-
lowed by No change and a minimum of Negative responses. Comparisons between
Pre and Post displayed 87% of the individuals reporting increased Pleasantness and
non-increased Unpleasantness. Despite the select group of study (regular Qigong ex-
68

ercisers), it is interesting to see the dominating positive affective responses, which
was very different from a study of regular joggers (Rose & Parfitt, 2007).
How do the exercisers describe the experience associated with Qigong exer-
cise, during and after the session?
This enquiry was addressed in Study III through open-ended questions. Affective de-
scriptions and adjectives were analyzed by way of categorization into the eight poles
of the affect circumplex (See Figure 2). Although there may be some limitations to
the conclusions that can be drawn from two open-ended questions, all participants
report that they associate Qigong exercise with a more beneficial affective state. Re-
ports were similar in response to open-ended questions during and after Qigong. The
most common categorizations are Pleasant Deactivation and Pleasantness. These are
also the most common dimensional combinations (same individual describing in
both dimensions). Some, albeit just a few, report simultaneously experiencing being
activated and deactivated (as the results of the modified short SCAS suggest). In ad-
dition, people also report experiences that are not directly transferrable to the cir-
cumplex structure of affect, such as clearer thoughts (cognitions), feeling warm and
soft in the body (somatic experiences) and being one with everything (altered states
of consciousness), as well as feeling love, harmony and healing, and feeling light and
free. These statements are in concordance with qualitative studies of Qigong, report-
ing mental strength, relaxation, reduced mental tension, and feeling refreshed and
energized (Wenneberg, Gunnarsson, & Ahlström, 2004), and feeling at ease with
themselves, calm, centered, and refreshed for the day (Brinker, 1998).
69

Methodological issues
Participants
Studies I, II, and III took place at the annual Biyun Qigong summer camps, during
2003, 2006, and 2007. Given that many individuals return every year to the camp it
is likely that at least some individuals took part in all the studies of the present the-
sis. Thus, a specific select group participated in this thesis.
In Studies I and II there was a majority of women (9-14% men) and in Study III
only women were included. There is a dominating majority of women in the Green
Dragon (1348 women and 100 men in 2007; G. Jacobson, personal communica-
tion). An American survey (Wolsko et al., 2004) displayed a slight majority of
women reporting mind-body therapy usage, but in a study of Swedish individuals
engaged in different kinds of New Age groups (meditation, personal and spiritual
development, Yoga, etc.) there is a large majority (83%) of women (Frisk, 1998).
There are suggestions as to why especially women are highly attracted to these envi-
ronments. One refers to women actively seeking out non-patriarchal environments
that are more pro-women. Another refers to the focus on feelings, intuition, com-
munication, and relationships (more than intellect and dogma) that is found in these
alternative therapies and communities. These characteristics are considered feminine
in our society, and women may therefore feel more attracted than men (Frisk,
1998). Gender differences were initially compared on all dependent variables at pre-
measures (Studies I and II). While no statistical differences were found, means were
collapsed for gender in subsequent analyses. Gender differences were not studied
any further.
In most studies of physical activity and mental health, volunteers are employed,
and this creates some problems (Morgan, 1997). For example, studies of acute affec-
tive responses to Tai Chi (Jin, 1989), Qigong (Kjos & Etnier, 2006), and other
forms of mindful exercise (Netz & Lidor, 2003; Szabo et al., 1998) employed self-
selected volunteers from existing exercise classes. The samples of the three studies of
the present thesis were drawn from regular Qigong exercisers attending a Qigong
70

camp. It is possible that when beginning Qigong exercise, those who found the ac-
tivity affectively positive adhered, and that those who did not, quit. Thus, the ex-
perienced sample of the present thesis may possess certain qualities that predispose
them especially to the beneficial effects of Qigong exercise. Further, those who
choose to attend a Qigong summer camp have the economic means and the social
possibility of attending (leaving family and children at home), in addition to proba-
bly being positive about Qigong. This may limit external validity, or the possibility
to generalize the results to other groups of people. However, it seems important to
emphasize that, despite the fact that the sample consisted of regular Qigong exercis-
ers (with a number of years’ experience) attending a Qigong summer camp (and
meeting friends), the results still show significant beneficial affective responses in all
three studies. One could perhaps imagine that the sample was already in a pleasant
affective state and that room for improvement was thereby limited.
Design
The benefits of conducting a study at a Qigong camp include encountering a large
number of Qigong exercisers at the same time and place. However, this quasi-
experimental setting also created some restrictions, including a loss of control over
the experimental setting, and having to somewhat adjust my research to the context
of the camp.
In Study I, the Qigong intervention was compared to a control group; in Study II,
the participants served as their own controls; and in Study III no control group was
used as the focus was on affective responses during the Qigong bout (See Table 1).
Given that a control group should be as similar to the experimental condition as
possible but without the treatment (Whitley, 2002), the choice of control condition
in Study I presents some limitations. A more suitable control condition would have
been silent sitting, a non-mindful exercise or relaxation. Also, due to the probable
affection that the Qigong exercisers may possess for the master of the Qigong
method, it is possible that Qigong exercisers lacking this affection or those simply
71

listening to an unknown lecturer about Qigong would have displayed different ef-
fects. As Study I was carried out at the Qigong summer camp, and to avoid disrupt-
ing the camp schedule too much, a different control condition was not possible. At
some times the experimental designs (as recommended in exercise psychology for
physical activity; Ekkekakis & Petruzzello, 1999) interfered with the way Qigong is
normally advocated to be performed, as in Study III when participants were inter-
rupted during Qigong to rate their affective state (although it did significantly in-
crease affective benefits). Perhaps not optimal according to Qigong philosophy, it did
provide some important new results. In future Qigong studies, care should be taken
to recruit a relevant control condition.
Procedure
A number of biases can be associated with intervention studies (Morgan, 1997). The
issue of self-selected participants was discussed above. This may increase the possi-
bility of demand characteristics (the participants figure out the purpose of the study
and try to respond accordingly). Precautions were taken to minimize demand charac-
teristics by describing the purpose of the studies as “examining Qigong-associated
psychological responses”. In Studies I and II, some reduction of the Hawthorne effect
(Morgan, 1997) was possible as both groups/conditions received the same amount of
attention. These possible biases need to be taken into consideration when evaluating
the results of the present thesis.
Biyun Qigong consists of a number of specific forms of Qigong. Jichu Gong, the
basic form, was used in all three studies. However, in Study II, the shorter condition
(30 min) consisted of Jichu Gong and the longer condition (60 min) consisted of
Jichu Gong and Dong Gong performed together. Dong Gong is the second Qigong
form taught to students of the Biyun School. Qigong is practiced to improve health
on psychological, physiological, spiritual, and energetical levels. Founded in the
principles of Traditional Chinese Medicine and Qigong philosophy, certain training
requirements are advocated for safe and optimal Qigong training. Examples are op-
timal training dose and regularity. Fan Xiulan of the Biyun School emphasizes build-
72

ing from the ground up (2000). This means starting with softening the joints of the
entire body, a prerequisite for a healthy flow of qi. When one has become more ac-
customed to and has opened up for the qi flow, other more advanced forms of
Qigong techniques may be performed, such as moving qi through the body. How-
ever, this is based on the joints of the body being opened. As all forms consist to a
certain degree of similar characteristics (e.g., relaxation and meditation) affective
responses ought to be similar, whichever form one chooses to study. Yet there may
also be variations. Hence, it is important to know that the results of this thesis are
based on the most basic Qigong forms of the Biyun School.
Measures
The present studies employed self-report measures to investigate affective states as-
sociated with Qigong exercise. The procedure of rating one’s affective state implies
that the individual is consciously aware of her own emotional state, which may not
always be the case (Swinkels & Guiliano, 1995). Further, by directing attention to
an unconscious mood state the procedure may influence what it intends to study.
This may also lead to an urge to regulate one’s mood state (Parkinson et al., 1996).
Some other important possible biases associated with self-report scales (Watson,
2000) are: Social desirability may influence individuals to report more positively
than what they actually experience, as they do not want to admit to having a nega-
tive mood or experiencing anxiety. Individuals may want to cooperate and therefore
report in a way that they expect the experimenter wants them to. In addition, many
of the individuals in the present thesis have years of experience of the benefits of
Qigong, and consequently may want the results to be positive as well as make them
more prone to the benefits of Qigong. This may cause individuals to expect benefits
from the activity studied. At all times, I have urged the participants to respond as
truthfully as possible. Another bias in self-report measures concerns how respon-
dents interpret the anchoring points of scales. They may not be comparable between
individuals, but they are analyzed as comparable (nomothetic approach).
73

Despite the mentioned disadvantages of self-report measures, they have been the
main source of data gathering in the three studies of this thesis. Given that the focus
of the thesis is on the conscious, subjective experience, self-report measures are the
most sensitive and discriminating way of data gathering (Larsen & Fredrickson,
1993; Parkinson et al., 1996; Thayer, 1989).
In the three studies, affective states have been assessed from a level of emotion
(the State and Trait Anxiety Inventory; Studies I and II), from a level of mood (cate-
gorical perspective) using the Profile of Mood States (Studies I and II), and from an
affect level using a self-made affect scale (Study II) and a modified version of the
short Swedish Core Affect Scale (Study III). More specifically, in Study I, the STAI
was used to compare with a study by Lee and colleagues (2000) that used the same
measure. Interesting results (different magnitude of state anxiety reductions between
the two studies) led to the use of the STAI in Study II also. The state form of the
STAI measures anxiety.
The STAI has been criticized in the context of measuring affective changes after
bouts of physical activity (Rejeski, Hardy, & Shaw, 1991; Ekkekakis, Hall, & Ek-
kekakis, 1999), because an increase in activation is assumed to be related to or in-
duced by anxiety. The measure may therefore yield some confusion in the assessment
of changes in the context of vigorous exercise, as activation is increased in response
to increased metabolism (and is not related to, e.g., increased fear). However, as
Qigong exercise is a low-intensity activity (10.1 on the Borg scale), the risk of con-
fusing anxiety with activation seems less pertinent (note that activation does increase
by way of the Vigor subscale of the POMS, Study II, and on the modified short
SCAS, Study III). Further, some argue that even though the state version of the STAI
assesses emotion anxiety, due to the time it takes to fill out the measure it may actu-
ally measure a mood state.
The POMS was used in Studies I and II. Although it has been criticized for floor
and ceiling effects (Gauvin & Brawley, 1993), too much focus on negative states
(Gauvin & Spence, 1998), and not covering the entire affective experience (Back-
house et al., 2007), it is also the single most used mood measure in sport and exer-
74

cise psychology (LeUnes & Burger, 1998). The POMS is therefore worthwhile in
comparing the results with changes in other physical activities.
Finally, the SCAS (Västfjäll et al., 2002) provides a valuable complement as it is
based on the dimensional view of affect and thereby covers the entire affective spec-
trum (the STAI measures a specific discrete emotion, while the POMS measures six
discrete mood states). With the SCAS, the basic affective responses from a dimen-
sional perspective can be assessed (note that the PANAS was used in a Qigong study
by Kjos and Etnier, 2006, but the measure is limited to the high activated poles of
the circumplex). The SCAS also measures affect, the most basic level of the affective
hierarchy. See Figure 3 for the affective space covered by the POMS and the STAI in
the circumplex structure.
Figure 3. The STAI1 and subscales of the POMS2, set in a circumplex structure. Adapted
from Backhouse et al., 2007. The subscale Confusion of the POMS is left out.
75

Other affective measures could also have been used, such as the Activation Deactiva-
tion Adjective Check List (AD ACL; Thayer, 1978), or a Swedish version (Knez &
Hygge, 2001), both based on the circumplex model of affect and covering the entire
affective space. Assessments could also have been made with the Feeling Scale
(Hardy & Rejeski, 1989) together with the Felt Arousal Scale of the Telic State
Measure (Svebak & Murgatroyd, 1985), for multiple assessments during the bout
(one-item measures).
In Study II, two self-made one-item scales were created to assess affect according
to the circumplex structure (Russell, 1980). Thus, one scale set out to measure acti-
vation (from lowest possible to highest possible), and one scale to assess hedonic
tone/valence (from lowest possible pleasure to highest possible pleasure). Taken in
perspective, the “lowest possible…” and “highest possible…” wording may be a bit
unfortunate as these extreme end points may make respondents reluctant to assess
near the extremes, given the rather extreme phrase. For example, the Feeling Scale
(FS; Hardy & Rejeski, 1989) uses “I feel very good” and “I feel very bad” as its ex-
tremes. Another example is the Swedish Core Affect Scale (SCAS; Västfjäll et al.,
2002; used in Study III), in which extreme end points are only symbolized by highest
and lowest numbers. It is possible that the non-significant change in Activation may
be partly explained by the wording, as Vigor increased significantly, and Activation
and Pleasant Activation (of the modified short SCAS) also increased significantly in
Study III. Thus, some caution may be warranted in interpreting the results of the two
self-made scales of affect in Study II.
In accordance with recent recommendations (Backhouse et al., 2007; Rose & Par-
fitt, 2007; Van Landuyt et al., 2000) in which the use of mean scores is comple-
mented with that of individual scores, Study III displays single individuals’ affective
responses associated with Qigong exercise. Specifically, a methodology presented by
Rose and Parfitt (2007) was used. Thus, the Pleasantness-Unpleasantness scale on
the SCAS was used to study individual scores. I believe that complementing with in-
dividual assessments gives extra strength to Study III and the present thesis by show-
ing the variability between individuals and showing how affective patterns change
during the Qigong session. This may be particularly essential in the context of
76

Qigong exercise, as many variables influence the experience and make it very indi-
vidualistic.
Statistical analysis
Mixed (between-within, Study I), two-way repeated (Study II) ANOVAs, and re-
peated measures ANOVAs and t-test, Study III) were carried out in the studies. Non-
parametric equivalents could have been used (e.g., Friedman) in Study II, however no
non-parametric equivalent to mixed ANOVA exists. Parametric statistics were cho-
sen because of their greater power to detect actual differences (Hassmén & Hassmén,
1996). However, sometimes abnormally distributed, sample sizes of the studies (N =
57, 41, and 46) assures robustness of violations (N > 30; Pallant, 2007). When mul-
tiple testing, Bonferroni corrections were employed to protect for violations of type-I
error. If violations of sphericity were detected, Greenhouse-Geisser corrections were
applied (Study III). Correlations (Pearson) were calculated in Study III. Samples were
first screened and extreme outliers were deleted.
Ethical considerations
The three studies were designed and administered in accordance with recommenda-
tions by Forskningsetiska principer inom humanistisk-samhällsvetenskaplig
forskning [Research Ethics Principles in Humanistic-Social Scientific Research]
(Vetenskapsrådet, 2002). These demands were complied with by way of informing
the participants that the purpose of the studies was to study psychological responses
to Qigong exercise for research only, participants signing an informed consent form
about participating voluntarily and having the possibility to quit the study at any
time, keeping data locked up, and coding participants.
Study II was judged for ethical soundness by the Ethical Review Board of the
Uppsala region. Given that Study II was judged to not be in need of ethical evalua-
tion, Study III, of similar design, was not sent for evaluation. Before January 2004,
77

non-sensitive behavioral research was not deemed to require ethical review; thus
Study I was not ethically reviewed by any board.
78

Concluding discussions
Affective changes associated with Qigong exercise

Based on the present thesis, a greater understanding of the affective responses asso-
ciated with Qigong exercise is now emerging, contributing greatly to the field, in
which, at the time the work on the present thesis commenced, Qigong had been
found to only decrease anxiety (Lee et al., 2004). The understanding that is now
emerging, however, shows greater clarity and depth concerning acute affective
Qigong-related responses. Study III perhaps provides the greatest understanding of
these affective changes, given that a dimensional perspective of affective states was
used, thereby covering the entire affective spectrum. Following recommendations
(Larsen & Diener, 1992) on assessing affective responses on both rotated and unro-
tated dimensions of the circumplex (See Figure 2), the perceived affective responses
of the group of regular qigong exercisers display changes in the direction of greater
Activation, Pleasant Activation, Pleasantness, and Pleasant Deactivation. This is
perhaps an odd finding. Can one feel more enthusiastic and relaxed at the same
time? This may be due to the assessment of all the eight end points of the circum-
plex of the modified short SCAS. This simultaneous activated yet deactivated pleas-
ant state has been reported by individuals engaging in Transcendental Meditation
(Wallace, 1970), in which reduced physiological activation was found to coexist
with increased mental alertness, restful alertness. In Thayer’s mood model this is re-
ferred to as calm energy, and is associated with the use of Yoga and meditation
(Thayer, 2001). A balance between activation and deactivation, fang song gong
(characterized by awareness and tranquility, effortlessness, sensitivity, warmth, and
rootedness) is also advocated in Qigong exercise. This is also closely related to the
Taoist term Tai Chi – the balance point between yin and yang (Cohen, 1997), and
descriptions of experiences associated with Qigong and other mind-body therapies
(Dorcas & Yung, 2003). Could it be that a relaxed state of full alertness and height-
ened sense of awareness, in the context of Qigong, is related to a positive affective
state? Descriptions of the Qigong state (Cohen, 1997; Dorcas & Yung, 2003; Fan,
79

2000), associated scientific theories (e.g. the Hypofrontality Hypothesis, Dietrich,
2003; Optimal Experience, Nakamura & Csikszentmihalyi, 2002; the Relaxation
Response, Benson et al., 1975), and empirical findings in the present thesis, does
suggest this. This may also correspond to a balance of the parasympathetic and
sympathetic nervous systems, given the simultaneous activating and deactivating
characteristics of Qigong exercise – being alert, yet experiencing an alleviation of the
negative effects of physiological arousal.
Another advantage of using a dimensional perspective in Study III concerns the
proposition of Yeung (1996) that mind-body methods may decrease negative affect
but may not provide changes in the direction of greater positive affect as physical
exercise may do (note the contrasting finding in the 2006 Kjos and Etnier Qigong
study, in which Positive Affect increased but Negative Affect did not). Judging from
the results of Study III, Qigong exercise is associated with greater affective benefits
(of the present sample) in many directions, including increased Pleasant Activation
and Pleasant Deactivation.
Further, Study III shows that Qigong exercise is related to greater Pleasantness
not only post-exercise, which was found in Studies I and II, but also during the ses-
sion. According to the Dual-Mode Model (Ekkekakis, 2004) low-intensity activities
are proposed to provide greater pleasantness both during and after the session. The
Dual-Mode Model also suggests that low-intensity activities show uniform changes
in the direction of increased pleasantness for the majority of individuals, which was
found in the inter-individual responses. Although, the Dual-Mode Model may pro-
vide for a greater understanding of low-intensity activities, including Qigong, there
are also aspects of Qigong that are different from mere physical activity. The Dual-
Mode Model proposes that in the context of low-intensity exercise, cognitive factors
exert limited influence on affective outcomes. In the context of Qigong, on the con-
trary, it seems likely that cognitive factors (e.g., ability to direct ones attention) are
essential for affective outcomes.
Other characteristics of the experience of Qigong-related affective changes entail
a slow increase in positive affectivity. This change is evident after 10-20 minutes.
This is related to that which is proposed for low-intensity activities according to the
80

Maintenance Model (Bixby et al., 2001). However, a plateau, which was expected
some time into the bout as suggested by the Maintenance Model, was not found.
In Studies I and II, affective responses were assessed on a higher level in the affec-
tive hierarchy (except those of the self-made measures of valence and activation of
Study II); on the levels of emotion (anxiety, the STAI) and mood states (the POMS).
In both Studies I and II anxiety (STAI), Tension, Depression, Anger, Vigor, Fatigue,
and Confusion (POMS) had significantly increased as measured before and after the
bout. The contribution of using these measures also shows that the positive affective
changes are uniform across different levels of the affective hierarchy.
When the affective Qigong experience is described in words (in the open-ended
questions of Study III), the simultaneous activating and deactivating characteristics
are not visible. Instead, most individuals describe it as Pleasant Deactivation and
Pleasantness (actually, all individuals describe it as a positive experience). However,
adjectives not directly fitting the eight end points of the circumplex structure of af-
fect are also reported, like harmony, healing, stability, love, clearness of thought,
increased sense of somatic focus, and feeling free and light. Thus, to allow for an
understanding of the experience of Qigong, the basic affect level may describe it to
some degree but not completely. To more fully understand the whole Qigong ex-
perience in relation to affective states, one may need to broaden the range of focus,
and also include other areas related to beneficial states. This includes cognitive
(thinking, appraising, and perceiving), conscious (the experience of awareness and
altered states of consciousness), and somatic changes (bodily changes).
So how can the affective experience of Qigong be expressed? Based on a number
of self-reports of mean scores and individual responses, and open-ended statements,
a picture emerges. However, this picture is dependent on how the researcher chooses
to assess affective responses. For example, in Study III the use of the SCAS shaped
an affective picture in which the Qigong state was characterized by a simultaneous
pleasant activating and deactivating experience. This would not have emerged if a
different measurement had been used, for instance one scale assessing pleasantness
and one measuring activation (solely the unrotated dimensions on the circumplex;
see Figure 2), which is common in today’s exercise psychology studies (e.g. Back-
81

house et al., 2007). This was done in Study II, and resulted in increased activation
(however not significant) and pleasantness. In contrast to this are the results of the
open-ended questions, in which when the Qigong participants could freely describe
their affective experience, most reported it as a pleasant deactivated state (e.g., re-
laxed and tranquil). Individuals may experience different feelings on a moment-to-
moment basis; however, it is not likely that they would simultaneously experience
both strong positive and negative feelings (Berkowitz, 2000). Such is not the case
here; even though it is both activating and deactivating, the experience is pleasant.
Given that Qigong exercise includes energizing (e.g., stretching one’s arms over the
head) and relaxing features (e.g., relaxation practice and slow movements), the
somewhat diversified affective reports seem logical. Another explanation has to do
with that the SCAS assesses affective responses on the specific session at hand, while
the open ended questions ask for how the exercisers generally feel when performing
Qigong (sessions may vary). A final possible explanation for the differences between
results of the SCAS and those of the open-ended questions, in addition to open
(questions) and closed (SCAS) response formats, have to do with that the exercisers
rate their affective state based on different time spans. The SCAS uses a “right now”
format, while the open ended questions were answered after the Qigong bout and
focuses on the exercisers affective experience during the entire session. In addition,
Qigong was associated with more beneficial mood states (Depression, Tension, An-
ger, Fatigue, Vigor, and Confusion; the POMS) and reduced anxiety (the STAI).
Thus, to answer the question of how the affective experience of Qigong is character-
ized in the present sample of regular exercisers: It is pleasant. But this pleasant affec-
tive state varies somewhat depending on the individual and how it is measured.
A proposed model of mechanisms of affective benefits
In an earlier section, possible active mechanisms responsible for acute affective bene-
fits associated with traditional physical activity and mind-body therapies were de-
scribed. Now a model for suggested active mechanisms for acute affective responses
will be presented (See Figure 4). It is important to note that this conceptual model
82

83

was not tested empirically. Instead, relevant theories of possible active mechanism
are discussed. Given that Qigong exercise includes a number of characteristics (at-
tentional regulation, relaxation, imagery, breathing, self-massage, and slow move-
ments) it seems reasonable that a number of different active mechanisms also work
simultaneously (and probably in interaction) to provide for the beneficial affective
states found in the three studies. Other models also exist. Tsang and Fung (2008)
present a model of neurobiological pathways of anti-depressive effects associated
with Qigong exercise. Anti-depressive effects may be influenced by increased brain
serotonin synthesis, by reducing negative cognitive/affective signals to the brain (and
reducing HPA activity), and by the down-regulation of cortisol (and promotion of
neurogenesis in the hippocampus). See also Chow and Tsang for a similar model fo-
cused on anxiety reduction (2007). The present model presents some possible
mechanisms that are not included in the Chow and Tsang model. The regulation of
attention in the context of Qigong exercise refers to focusing on different parts of
the body. This narrowing of attention may create a state in which the exerciser is
absorbed by what he/she is doing at the moment (Davidson & Schwartz, 1976).
Other suggestions concerning this state are presented as Optimal Experience (Na-
kamura & Csikszentmihalyi, 2002), deep concentration, an Alternative State of
Consciousness (Vaitl et al., 2005), and the elicitation of the Relaxation Response
(Benson et al., 1975). By way of the Hypofrontality Hypothesis (in which the pre-
frontal cortex, which segregates, differentiates, and analyzes our experience is
down-regulated; Dietrich, 2003), a state of no thoughts and a unity with oneself and
life is experienced, which may create a time-out from worries (Barhrke & Morgan,
1978). Another route is based on the effects of imagery (e.g. Astin et al., 2003), re-
laxed breathing (e.g. Philippot et al., 2002, relaxation (e.g. Scheufele, 2000), self-
massage (oxytocin secretion; Uvnäs-Moberg, 2005) and the cultivation of positive
emotions (Broaden-and-Build Model of positive emotion; Fredrickson, 2000). All
these activities are related to increased parasympathetic nervous system activity (Re-
cordati, 2003) and may create a more optimal state in the nervous system, absent
from the effects of stress (Gunnarsson, 2004). As suggested by the Anthropological
Hypothesis (Martinsen, 2002) and the Dual-Mode Model (Ekkekakis, 2005), low-
84

intensity activities are beneficial from an evolutionary perspective and may create
positive affective experiences. Further, from a TCM perspective, Qigong may be a
way to release suppressed emotions (Chen, 2008), and also includes an accepting
attitude toward the contents of consciousness: mindfulness (Carrington, 2008). This
may create a relaxed perspective on oneself and one’s life. It seems logical that pla-
cebo (Catanzaro & Mearns, 1999) and positive expectations (Lund, 1987) may also
be responsible for Qigong-related affective outcomes, even though few significant
correlations were found in Study III. The characteristics of Qigong suggest that ex-
pectations should play a role (Lund, 1987), as should memories of earlier positive
affective responses to Qigong exercise, and may connect Qigong exercise with a
positive affective state (mood congruency; Bower, 1981). In performing the some-
times difficult mental and physical maneuvers of Qigong, one may feel proud of the
accomplishment by way of increased mastery (Sonstroem & Morgan, 1989) and
self-efficacy (the ability to regulate arousal, affective states, complex bodily maneu-
vers; Bandura, 1982), and the act of regularly spending time on promoting one’s
health may create increased self-love. A final suggestion is that of social interaction
(Cox, Martin Ginis, & Petruzzello, 2006). Given that the designs of Studies I, II,
and III were carried out in a group setting, it cannot be ruled out that social factors
may have affected the participants; however, as most individuals belonging to the
Green Dragon do perform Qigong regularly in their homes by themselves and re-
ceive affective benefits (Jouper et al., 2006), the social interaction hypothesis proba-
bly plays a minor role.
All the active mechanisms suggested above may, in interaction, provide for the af-
fective benefits found in the three studies. A final factor also entails individual char-
acteristics. To be able to adhere to Qigong exercise and receive affective benefits, it
is probably important that an individual enjoys performing Qigong (Motl, Berger,
& Leuschen, 2000), perhaps that the philosophy and lifestyle of Qigong seems at-
tractive (Jin, 1992), and that the individual has the ability to relax (although this
may be learned), and does not suffer from too much relaxation-induced anxiety
(Heide & Borkovec, 1984) or any other severe psychiatric disorder (Ng, 1996). Fi-
nally, scoring high on the trait absorption may make it easier to enter the Qigong
85

state and thus obtain affective benefits (Weinstein & Smith, 1992), as may the abil-
ity to concentrate (Fan, 2000).
Causality in the Qigong-affect relationship
Acute affective benefits have been displayed in the three studies of the present thesis.
Although it is not possible to infer a cause-effect relationship, whether Qigong per
se is responsible for the positive affective responses, I will speculate on this issue. A
taxonomy of eight characteristics of inferring causality from mere association has
been suggested by Hill (1965). Below these will be presented and discussed in the
light of the present thesis:
Strength of association. Based on a power analysis comparing effect sizes (eta
squared) for interacting effects between the Qigong group and the control
group of Study I, large effect sizes are found on significant measures and sub-
scales: STAI, Depression, Fatigue, and Anger. Non-significant subscales
(Vigor, Tension, & Confusion; Study I) and the self-constructed Activation
scale in Study II showed too-low power (.30 - .60) for finding a difference
(power > .80), and are thereby not valid for drawing any realistic conclu-
sions. Effect sizes of the repeated measures differences (pre-post) of Studies II
and III were all in the range of large to very large.
Consistency (effect appearing in different individuals, places, and circum-
stances). Limited consistency is found in the present studies as a homogene-
ous sample (regular exercisers) is used and in similar settings (Qigong camp).
Specificity (the influence of alternative explanations). Other variables may in-
clude social influence (not studied), certain individuals not being attracted to
Qigong (not studied), and positive expectations/placebo (Study III found one
out of eight possible significant correlations).
Temporality (order of cause-effect between independent and dependent vari-
ables). Causality is supported by the increase in affective benefits occurring
after the manipulation (Qigong). But given that the participants are self-
86

selected, it may be that they are an exclusive group that may react extra
beneficially to the effects of Qigong exercise.
Plausibility (whether causation is biologically plausible) and Coherence
(cause-effect interpretation conflicting with generally known facts based on
science). A number of theories based on the modalities used in Qigong exer-
cise (e.g. parasympathetic associated behaviors, mimicking positive emotions,
and narrowing of attention) support the biological plausibility of causality.
Biological gradient (dose-response relationship). According to Study II,
longer sessions of Qigong are not associated with stronger affective re-
sponses.
Experiment. In Study I, Qigong exercise was compared with a control condi-
tion. However, the limited nature of the control group (attending a lecture by
the Qigong master) restricts the benefits of the experimental design. That the
attendance of a lecture by Fan Xiulan yields positive effects may not be sur-
prising, given the importance of the Qigong master to the camp participants.
Other forms of control conditions may have been better suited. This may en-
tail sitting quietly and reading, meditating, or walking.
Analogy (similar kinds of activities associated with effects). Walking (Ek-
kekakis et al., 1999), other Qigong (Lee et al., 2004; Kjos & Etnier, 2006),
Tai Chi (Jin, 1989), Yoga (Berger & Owen, 1992), and relaxation (Saklofske
et al., 1992) have shown beneficial affective responses.
To some extent, the taxonomy of Hill (1965) supports a cause-effect relationship.

To more fully understand the cause-effect relationship between Qigong and acute
affect, a randomized controlled trial should be employed that can strengthen scien-
tific rigor in all parts of the design. In this vein, some limitations of the present the-
sis (self-selected regular Qigong exercisers at a Qigong camp and a somewhat lim-
ited control condition) may be bridged.
87

Is Qigong beneficial for everybody?
In a positivistic paradigm of research, the researcher wants to generalize the findings

from the sample to include the entire (Qigong) population; this is also true here.
However, some apparent limitations, self-selected participants at a Qigong camp
being the most important, restrict the possibility to generalize the findings of the
present thesis to other potential Qigong exercisers. The findings of this thesis should
be seen mainly in the light of focusing on Qigong-related affective responses of a se-
lect, specific group of individuals who engage in Qigong exercise and probably find
it enjoyable. This group is made up mainly of middle-aged women (The reason
Qigong attracts women was discussed earlier). The present thesis may not resolve
the question of whether men and women react differently to Qigong exercise, as one
may suppose from comparing the study of Lee and colleagues (Lee et al., 2004) and
the Kjos and Etnier (2006) study. Qigong and Tai Chi may be extra suited for
health issues related to the needs of middle-aged and older individuals (Jouper,
2009; Tsang, Cheung, & Lak, 2002). Qigong is gentle, has flowing movements and
fits individuals looking for a low-intensity activity and those unable to perform
more vigorous activities (Kemp, 2004).
What about Qigong beginners? Would they benefit to the same extent that the
regulars in the present thesis do? Given that Qigong exercise requires some time to
learn the demands of visualization and bodily maneuvers, for beginning exercisers
this may require so much effort that they may not be able to relax and benefit to the
same extent as those who are more experienced. However, Fan Xiulan states that it
is also possible for beginners to experience similar affective benefits as more experi-
enced individuals do, if they are able to concentrate to the same extent during
Qigong as those who are experienced (Personal communication, 2009-01-21).
With the limitations having been mentioned, a great effort has also been taken to
study and understand which theories and suggestions have been proposed for how
an activity like Qigong (and other similar) may provide for acute affective benefits
for the exerciser. Similarly, a great effort has also been made to study the empirical
support for acute affective benefits found in activities similar to Qigong exercise
88

(e.g. walking, relaxation, Yoga and Tai Chi). Although they sometimes do not use
proper scientific rigor (as in mind-body therapies; Ospina et al., 2007), many studies
are promising (particularly in their support of physical exercise). From the perspec-
tive of the three empirical studies in the present thesis, generalizing the findings to
other groups is somewhat limited. However, based on the other empirical studies,
suggestions and theories of active mechanisms, it seems likely that other groups
might also benefit from engaging in Qigong exercise.
Qigong – affective regulation and alleviation of physiological arousal?
Based on the proposed model of affective responses to Qigong exercise (Figure 3), a
number of simultaneous processes may provide for affective benefits. On a daily ba-
sis, Qigong may function (for the participants in the present thesis) as an affect-
regulating strategy and as a means for alleviating physiological arousal (e.g., induced
by stressful events).
Qigong exercise can be associated with subjective well-being, which includes hap-
piness or affective well-being, and how people view their world and themselves (Die-
ner, Suh, Lucas, & Smith, 1999). Qigong may have a beneficial influence on both
these factors. In the three studies, Qigong has been associated with positive affect.
Being in a positive state of mind has numerous beneficial effects. By way of mood
congruency (Parkinson et al., 1996), Qigong exercisers may view the world and
themselves more positively and remember more pleasant memories (Forgas, Bower,
& Krantz, 1984), thus experiencing more frequent positive moods as well as antici-
pating them occurring in the future. It has been found that the practice of meditation
was able to produce future increased amounts of positive emotions and life satisfac-
tion (Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008). Further, frequent small inci-
dences of positive affect have been shown to be more beneficial for subjective well-
being than few strong emotional incidences (Diener, Larsen, Levine, & Emmons,
1985). Having a sense of meaning and purpose in life (Myers, 1992) is also impor-
tant for subjective well-being. This can be provided by engaging in an activity
(Qigong) that is also way of life and has spiritual connotations as well. Emmons ar-
89

gues that this entails enabling a person to create a new identity based on a life narra-
tive focused around connections to a larger, transcendent purpose (Emmons, 1999).
Thus, Qigong may provide for a potent means for affective regulation, in line with
other methods like exercise and relaxation (Thayer, Newman, & McCain, 1994),
thereby promoting a more pleasant affective state, possibly preventing psychiatric
disorders (Gross, 1999), and improving subjective well-being.
Positive affect may influence other psychological variables. But does it also influ-
ence our physical health? Reviews point to the benefits of positive affect on physical
health as well (Pressman & Cohen, 2005; Steptoe & Wardle, 2005). Qigong and Tai
Chi have been found to stabilize the cardiovascular and autonomic nervous systems
(Lee et al., 2000; Lee et al., 2002; Lu & Kuo, 2006), and Qigong may improve self-
efficacy by way of arousal regulation (Bandura, 1982). Humans who were exposed
to stressors were significantly more likely to experience hypothalamic-pituitary-
adrenal (HPA) activation if the stressors were uncontrollable (Kemeny, 2005).
Through the experiencing of positive affective states, the lingering harmful effects of
physiological arousal (e.g., high blood pressure) have been found to alleviate at a
faster pace (the Undoing Hypothesis; Fredrickson & Levenson, 1998). Thus, Qigong
exercise may reduce physiological arousal, thereby removing the numerous harmful
effects of stress on the body (Gunnarsson, 2004).
Long-term benefits of regular Qigong exercise
In their review of Tai Chi, Sandlund & Norlander (2000) conclude that it may not
result in aerobic fitness but it may enhance flexibility and psychological well-being. I
believe this is also a reasonable conclusion for Qigong exercise. Perhaps only aero-
bically enhancing for the old or physically impaired (very light or light on the Borg
scale), the coordinated slow movements may increase balance and flexibility, and to
some extent strength. Chen (2007) reports that common effects of the regular prac-
tice of Qigong are associated with a harmonious and relaxed state of mind and
body, reduction in prior ailments, stress, increased resistance to illness, a heightened
sensitivity to the body’s internal organs and an increased ability to regulate one’s
90

own health and vitality. Granqvist & Hjelm (1997) suggest that the regular per-
formance of Qigong exercise may create greater self-awareness. When someone
looks inward daily, the borders between conscious and unconsciousness processes
may become less pronounced. Letting thoughts, emotions and memories pass
through awareness may create an understanding of our own inner processes. This
may lead to greater wisdom and insight into our lives and how they should be lived.
The difference between tense and relaxed muscles becomes more visible. The slow,
delicate (sometimes complex) movements can lead to a greater sensitivity of subtle
bodily movements. Heightened awareness of healthy and detrimental postures,
movements, and breathing patterns, and in general greater physical sensations from
the body, may create a greater range of possibilities of how to take care of ourselves.
Other long-term effects (studies on meditation, which can also be compared to
Qigong) include decreased sympathetic nervous system reactivity (by way of the Re-
laxation Response), thereby alleviating effects of stress (Hoffman et al., 1981), a
more sensitive and varied emotional experience and an increased ability to discrimi-
nate between different emotional states (Nielsen & Kaszniak, 2006), and fewer nega-
tive reactions to stress as well as increased brain patterns associated with positive af-
fect (Brefzcynski-Lewis et al., 2007).
Future studies
When a new area or research is delved into, insights are reached that continuously
improve the personal understanding of the area of research. To more fully under-
stand acute affective responses associated with Qigong exercise, qualitative research
designs would provide an important complement to the quantitative results found in
the present three studies. Only a few published studies (e.g. Wenneberg et al., 2005)
and master theses (Brinker, 1998; Murakawa, 2002) have investigated the experi-
ence of Qigong exercise through qualitative inquiries. For example, there were some
equivocal results in Study III, in which self-report measures displayed simultaneous
perceived activating and deactivating responses, however through the use of open-
ended questions, most individuals described Qigong as relaxing (Pleasant Deactiva-
91

tion), and only a few described it as simultaneously activating. Further studies com-
paring/complementing qualitative with quantitative designs are needed to fully un-
derstand the qigong experience. One such study of experiences associated with
Qigong exercise is in progress by the author. Another new line of enquiry not stud-
ied in the present thesis entails the duration of lingering effects of the affective im-
provements associated with Qigong exercise. According to the Maintenance Model
of affective change that is associated with low-intensity exercise, improvements of
affective responses are proposed to level out some time into the bout. Affective re-
sponses to Qigong exercise (Study III) increased continuously through the last as-
sessment upon cessation of the bout. Kjos and Etnier (2006) found increased Posi-
tive affect (PANAS) at post-exercise, but mean average decreased to below pre-
measures already after 15 minutes of post-exercise rest. This opens up for new ven-
ues of research to study the lingering effects of Qigong – perhaps several hours post-
exercise up to the whole day?
A randomized controlled study, in which beginners would learn the Qigong form
and be randomized to a Qigong or control condition (e.g., silent reading) would
provide for a greater understanding of causality as well as the ability to generalize.
Given that Qigong is intended to be performed daily, a longer intervention study
would also be of interest as it could show its chronic effects in relation to subjective
well-being, for example.
Two issues worthy of further study relate to the moderating effects of positive
expectations and depth of concentration, and their influence on acute affective out-
comes. Theories (e.g. Lund, 1987), and empirical support (Geers et al., 2006; Jin,
1992; Jouper et al., 2006; O’Halloran et al., 2002) point in the direction of the
probability of Qigong having placebo/expectation influences. Practical and personal
empirical suggestions from the founder of Biyun Qigong (Fan, 2000), theoretical
suggestions (Nakamura & Csikszentmihalyi, 2002, Smith, 1990), and empirical
evidence (Jouper et al., 2006) suggest that the level of concentration or the ability to
be absorbed by the focus of interest is important for the possibility of a beneficial
affective outcome. Finally, it seems worthwhile to continue the methodology that
was followed in Study III, including inter-individual assessments (in addition to
92

mean averages), as this may show the variation in experience between individual
Qigong exercisers.
93

CONCLUSIONS
In the three studies of the present thesis, acute affective responses associated with
Qigong have been studied. The thesis makes some important contributions to the
further understanding of and support for Qigong-related affective health benefits. It
can be concluded that the affective benefits of Qigong are partially superior to a
control condition, independent of length of session, and that there are few associa-
tions between affective outcomes and expectations of positive mood outcomes. Af-
fective responses have been studied through mean scores, individual responses and
open-ended questions, in addition to different levels of the affective hierarchy.
Qigong exercise is associated with a simultaneously activated and deactivated pleas-
ant affective state, reduced anxiety, and positive mood states. However, there is
some variation depending on the individual and how he/she chooses to measure af-
fective responses (open-ended questions showed the majority of experiences related
to Pleasant Deactivation). Positive affective responses begin to increase 10-20 min-
utes into the bout and continue to rise until cessation of exercise. A model for theo-
ries of possible active mechanisms associated with acute affective Qigong responses
is presented. It can be concluded that Qigong is associated with more beneficial af-
fective (acute) states for the sample studied. Other research, theories and suggestions
also support an association with increased pleasant affect.
94

REFERENCES
Ames, R. T. (1993). The meaning of body in classical Chinese philosophy. In T. P.
Kasulis, R. T. Ames, & W. Dissanayake (Eds.), Self as body in Asian theory and
practice (pp. 157-174). Albany, NY: State University of New York Press.
Antonovsky, A. (1991). Hälsans mysterium [Unraveling the mystery of health: How
people manage stress and stay well]. Stockholm: Natur och Kultur.
Astin, J. A., Berman, B. M., Bausell, B., Lee, W-L., Hochberg, M., & Forys, K. L.
(2003). The efficacy of mindfulness meditation plus qigong movement therapy in
the treatment of fibromyalgia: A randomized controlled trial. The Journal of
Rheumatology, 30, 2257-2262.
Astin, J. A., Shapiro, S., Eisenberg, D. M., Forys, K. (2003). Mind-body medicine:
State of the science, implications for practice. Journal of the American Board of
Family Practice, 16, 131-147.
Backhouse, S. H., Ekkekakis, P., Biddle, S. J. H., Foskett, A., & Williams, C. (2007).
Exercise makes people feel better but people are inactive: Paradox or artifact?
Journal of Sport and Exercise Psychology, 29, 498-517.
Bandura. A. (1982). The self and mechanism of agency. In J. Suls (Ed.), Psychologi-
cal perspectives on the self. (Vol. 1). (pp. 3-37). Hillsdale, NJ: Lawrence Erlbaum.
Bahrke, M. S., & Morgan, W. P. (1978). Anxiety reduction following exercise and
meditation. Cognitive Therapy and Research, 2, 323-333.
Barrows, K. A., & Jacobs, B. P. (2002). Mind-body medicine. An introduction and
review of the literature. The Medical Clinics of North America, 86, 11-31.
Batson, C. S., Shaw, L. L., & Oleson, K. C. (1992). Differentiating affect, mood, and
emotion: toward functionally based conceptual distinctions. In M. S. Clark (Ed.),
Review of personality and social psychology (Vol. 13) (pp. 294-326). Newbury
Park, CA: Sage.
Benson, H. (1983). The relaxation response: its subjective and objective historical
precedents and physiology. TINS, 6, 281-284.
95

Benson, H., Greenwood, M. M., & Klemchuk, M. M. (1975). The relaxation re-
sponse: Psychophysiologic aspects and clinical applications. International Journal
of Psychiatry in Medicine, 6, 87-98.
Berg, B. L. (2001). Qualitative research methods for the social sciences. Needham
Heights, MA: Pearson.
Bergdahl, J., & Bergdahl, M. (2002). Perceived stress in adults: Prevalence and asso-
ciation of depression, anxiety and medication in Swedish populations. Stress and
Health, 18, 235-241.
Berger, B. G., Friedmann, E., & Eaton, M. (1988). Comparison of jogging, the re-
laxation response, and group interaction for stress reduction. Journal of Sport &
Exercise Psychology, 10, 431-447.
Berger, B. G., & Motl, R. (2001). Physical activity and quality of life. In R. Singer,
H. A. Hausenblas, & C. Janelle (Eds.), Handbook of sport psychology (pp. 636-
671). New York & Chichester: Wiley.
Berger, B. G., & Owen, D. R. (1992). Mood alterations with yoga and swimming:
Aerobic exercise may not be necessary. Perceptual and Motor Skills, 75, 1331-
1343.
Berger, B. G., Owen, D. R., Motl, R. W., & Parks, L. (1998). Relationship between
expectancy of psychological benefits and mood alterations in joggers. Interna-
tional Journal of Sport Psychology, 29, 1-16.
Berger, B. G., & Tobar, D. A. (2006). Physical activity and quality of life. Key con-
siderations. In G. Tenenbaum, & R. C. Eklund (Eds.), Handbook of Sport Psy-
chology (3rd ed.) (pp. 598-620). Hoboken, NJ: John Wiley & Sons.
Berkowitz, L. (2000). Causes and Consequences of Feeling. West Nyack, New York:
Cambridge University Press.
Bernardi, L., Porta, C., Spicuzza, L., Bellwon, J., Spadacini, G., Frey, A. W., et al.
(2002). Slow breathing increases arterial baroreflex sensitivity in patients with
chronic heart failure. Circulation, 105, 143-145.
96

Biddle, S. J. H. (2000). Emotion, mood and physical activity. In S. J. H. Biddle, K. R.
Fox, & S. H. Boutcher (Eds.). Physical Activity and Psychological Well-Being (pp.
63-87). London: Routledge.
Biddle, S. J. H., & Ekkekakis, P. (2005). Physically active lifestyles and well-being. In
F. A. Huppert, N. Baylis, B. Keverne, B. (Eds.), The Science of Well-being (pp.
141-168). New York: Oxford University Press.
Biddle, S. J. H., & Mutrie, N. (2001). Psychology of Physical Activity. Determi-
nants, Well-being and Interventions. London: Routledge.
Bixby, W. R., Spalding, T. W., & Hatfield, B. D. (2001). Temporal dynamics and
dimensional specificity of the affective responses to exercise of varying intensity:
Differing pathways to a common outcome. Journal of Sport & Exercise Psychol-
ogy, 23, 171-190.
Blanchard, C. M., Rodgers, W. M., & Gauvin, L. (2004). The influence of exercise
duration and cognitions during running on feeling states in an indoor running
track environment. Psychology of Sport and Exercise. 5, 119-133.
Blomberg, M. (2004). Träning i ökad kroppskänndedom och avspänning hjälp för
att hantera stress. [Body awareness training and relaxation: help to manage
stress]. Läkartidningen, 101, 1398-1400.
Bogart, G. (1991). The use of meditation in psychotherapy: A review of the litera-
ture. American Journal of Psychotherapy, 45, 383-412.
Borg, G. (1998). Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human
Kinetics.
Bouchard, C., Blair, S. N., & Haskell, W. L. (2007). Why study physical activity and
health? In C. Bouchard, S. N. Blair, & W. L. Haskell (Eds.). Physical Activity and
Health (pp. 3-19). Champaign, Ill: Human Kinetics.
Bower, G. H. (1981). Mood and memory. American Psychologist, 36, 129-148.
Brefczynski-Lewi, J. A., Lutz, A., Schaefer, H. S., Levinson, D. B., & Davidson, R. J.
(2007). Neural correlates of attentional expertise in long term-meditation practi-
tioners. PNAS Proceedings of the National Academy of Sciences of the United
States of America, 27, 11483-11488.
97

Brinker, L. (1998). The experience of qigong in healing and self-care. Unpublished
Master Thesis.
Brown, R. P., & Gerbarg, P. L. (2005). Sudarshan kriya yogic breathing in the
treatment of stress, anxiety, and depression: Part I – Neurophysiological model.
The Journal of Alternative and Complementary Medicine, 11, 189-201.
Carrington, P. (2007). Modern forms of mantra meditation. In P. M. Lehrer, R. L.
Woolfolk, W. E. Sime (Eds.) Principles and practice of stress management (pp.
363-392). New York: Guilford Press.
Caspersen, C. J., Powel, K. E., & Christenson, G. M. (1985). Physical activity, exer-
cise, and physical fitness: Definitions and distinctions for health-related research.
Public Health Reports, 2, 126-131.
Catanzaro, S. J., & Mearns, J. (1999). Mood-related expectancy, emotional experi-
ence, and coping behavior. In I. Kirsch (Ed.), How Experiences Shape Experi-
ence. (pp. 67-91). Washington, D. C.: American Psychological Association.
Chaouloff, F. (1997). Effects of acute physical exercise on central serotonergic sys-
tems. Medicine & Science in Sports & Exercise, 29, 58-62.
Chen, K. (2007). Qigong therapy for stress management. In P. M. Lehrer, R. L.
Woolfolk, W. E. Sime (Eds.), Principles and practice of stress management (pp.
428-448). New York: Guilford Press.
Chow, Y. W. Y., & Tsang, H. W. H. (2007). Biopsychological effects of qigong as a
mindful exercise for people with anxiety disorders: A speculative review. Journal
of Alternative and Complementary Medicine, 13, 831-840.
Clore, G. L., Wyer, R. S. (Jr.), Dienes, B., Gasper, K., Gohm, C., & Isbell, L. (2001).
Affective feelings as feedback: Some cognitive consequences. In L. L., Martin &
G. L., Clore (Eds.), Theories of Mood and Cognition. A User’s Handbook (pp.
27-62). Mahwah, New Jersey: Lawrence Erlbaum Associates.
Cohen, K. S. (1997). The way of qigong. The art and science of Chinese energy heal-
ing. London, Bantam Books.
Conrad, A., Müller, A., Doberenz, S., Kim, S., Meuret, A. E., & Wollberg, E., et al.
(2007). Psychophysiological effects of breathing instructions for stress manage-
ment. Applied Psychophysiological & Biofeedback, 32, 89-98.
98

Cox, C. L., Martin Ginis, K. A., & Petruzzello, S. J. (2006). The psychology of exer-
cise: integrating theory and practice. Scottsdale, AZ: Holcomb Hathaway.
Davidson, R. J. (1994). On emotion, mood, and related affective constructs. In P.
Ekman, & R. J. Davidson (Eds.), The nature of emotion: fundamental questions
(pp. 51-55). New York: Oxford University Press.
Davidson, R. J., Goleman, D. J., & Schwartz, G. E. (1976). Attentional and affec-
tive concomitants of meditation: A cross-sectional study. Journal of Abnormal
Psychology, 85, 235-238.
Deikman, A. (1982). The observing self. Boston: Beacon Press.
Diener, E., Larsen, R. J., Levine, S., & Emmons, R. A. (1985). Intensity and fre-
quency: Dimensions underlying positive and negative affect. Journal of Personal-
ity and Social Psychology, 48, 1253-1265.
Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. (1999). Subjective well-being:
Three decades of progress. Psychological Bulletin, 125, 276-302.
Dienstbier, R. A. (1989). Arousal and physiological toughness: Implications for
mental and physical health. Psychological Review, 96, 84-100.
Dishman, R. K. (1997). The norepinephrine hypothesis. In W. P. Morgan, (Ed.),
Physical Activity and Mental Health. (pp. 199-212). Philadelphia: Taylor &
Francis.
Dietrich, A. (2003). Functional neuroanatomy of altered states of consciousness:
The transient hypofrontality hypothesis. Consciousness and Cognition, 12, 231-
256.
Dorcas, A., & Yung, P. (2003). Qigong: Harmonising the breath, the body and the
mind. Complementary Therapies in Nursing & Midwifery, 9, 198-202.
Eich, E., & Macaulay, D. (2006). Cognitive and clinical perspectives on mood-
dependent memory. In J. P. Forgas (Ed.), Affect in social thinking and behavior
(pp. 105-121). New York: Psychology Press.
Ekkekakis, P. (2003). Pleasure and displeasure from the body: Perspectives from ex-
ercise. Cognition & Emotion, 2, 213-239.
Ekkekakis, P. (2004). Exercise and affect – the study of affective responses to acute
exercise: The dual mode model. In R. Stelter, & K. K. Roessler (Eds.). New Ap-
99

proaches to Sport and Exercise Psychology (pp.119-146). Aachen: Meyer &
Meyer Sport.
Ekkekakis, P., Backhouse, S. H., Gray, C., & Lind, E. (2008). Walking is popular
among adults but is it pleasant? A framework for clarifying the link between
walking and affect as illustrated in two studies. Psychology of Sport and Exercise,
9, 246-264.
Ekkekakis, P., Hall, E. E., Van Landuyt, L. M., & Petruzzello, S. J. (2000). Walking
in (affective) circles: Can short walks enhance affect? Journal of Behavioral Medi-
cine, 23, 245-275.
Ekkekakis, P., & Petruzzello, S. J. (1999). Acute aerobic exercise and affect: Current
status, problems, and prospects regarding dose-response. Sports Medicine, 28,
337–374.
Ekkekakis, P., & Petruzzello, S. J. (2000). Analysis of the affect measurement co-
nundrum in exercise psychology: I. Fundamental issues. Psychology of Sport and
Exercise, 1, 71-88.
Ekkekakis, P., & Petruzzello, S. J. (2002). Analysis of the affect measurement co-
nundrum in exercise psychology: IV. A conceptual case for the affect circumplex.
Psychology of Sport and Exercise, 3, 35-63.
Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6,
169–200.
Emmons, R. A. (1999). The psychology of ultimate concerns: Motivation and spiri-
tuality in personality. New York: Guilford Press.
Emmons, R. A., & Diener, E. (1986). A goal-affect analysis of everyday situational
choices. Journal of Research in Personality, 20, 309-326.
Esch, T., Fricchione, G. L., & Stefano, G. (2003). The therapeutic use of the relaxa-
tion response in stress-related diseases. Medical Science Monitor, 9, RA23-34.
Everly, G. S., & Lating, J. M. (2003). A clinical guide to the treatment of the human
stress response. New York: Kluwer Academic.
Fan, X. (2000). Qigong enligt Biyun. Låt livskraften återvända [Biyun qigong. Allow
the life force to return]. Stockholm, Sweden: Svenska Förlaget.
100

Fan, X. (2001). Biyun, den hälsobevarande metoden. Jichu gong. [CD]. Örbyhus:
Biyunskolan.
Fan, X. (2004). Biyun, den hälsobevarande metoden. Dong gong. [CD]. Örbyhus:
Biyunskolan.
Farné, M. A., & Gnugnoli, D. (2000). Effects of autogenic training on emotional
distress symptoms. Stress Medicine, 16, 259-261.
Feldman Barrett, L., & Russell, J. A. (1999). Independence and bipolarity in the
structure of current affect. Journal of Personality and Social Psychology, 74, 967-
984.
Feldman Barrett, L., and Russell, J. A. (1999). The structure of current affect: con-
troversies and emerging consensus. Current Directions in Psychological Science,
8, 10-14.
Forgas, J. P. (2008). Affect and cognition. Perspectives on Psychological Science, 2,
94-101.
Fredrickson, B. L. (1998). What good are positive emotions? Review of general psy-
chology, 2, 300-319.
Fredrickson, B. L. (2000). Cultivating positive emotions to optimize health and well-
being. Prevention & Treatment, 3. Article 0001a. Retrieved March 24, 2009,
from http://www.unc.edu/peplab/publications/cultivating.pdf
Fredrickson, B. L., & Levenson, R. W. (1998). Positive emotions speed recovery
from the cardiovascular sequelae of negative emotions. Cognition & Emotion,
12, 191-220.
Fredrickson, B. L., Cohn, M. A., Coffey, K. A., & Finkel, S. M. (2008). Open hearts
build lives: Positive emotions, induced through loving-kindness meditation, build
consequential personal resources. Journal of Personality and Social Psychology,
5, 1045-1062.
Frijda, N. H. (1993). Moods, emotion episodes, and emotions. In M. Lewis, & J.
M. Haviland (Eds.), Handbook of emotions (pp. 381-403). New York: Guilford.
Frijda, N. H. (1994). Varieties of affect: emotions and episodes, moods and senti-
ments. In P. Ekman, & R. J. Davidson (Eds.), The nature of emotion: fundamen-
tal questions (pp. 59-67). New York: Oxford University Press.
101

Frisk, L. (1998). New age, paramedicin och helande. [New age, Para medicine, and
Healing]. In O. Wikström (Ed). Att se det dolda. Om new age och ockultism inför
millenniumskiftet. [Seeing what is hidden. New age and the occult at the turn of
the millennium]. Stockholm: Natur och Kultur.
Fontaine, K. L. (2005). Complementary & alternative therapies for nursing practice.
Upper Saddle River, NJ: Pearson Prentice Hall.
Forgas, J.P., Bower, G. H., & Krantz, S. E. (1984). The influence of mood on per-
ceptions of social interactions. Journal of Experimental Psychology, 6, 497-513.
Fruzzetti, A.E., Shenk, C., Mosco, E., & Lowry, K. (2003). Emotion regulation. In
W.T. O´Donohue, J.E. Fisher, & S.C. Hayes (Eds.), Cognitive behavior therapy:
Applying empirically supported techniques in your practice (pp. 152-159). New
York: Wiley.
FYSS. (2008). Fysisk aktivitet i sjukdomsprevention och sjukdomsrehabilitering
[Physical activity in the prevention and treatment of disease]. Ödeshög, Sweden:
AB Danagårds Grafiska.
Gauvin, L., & Brawley, L. R. (1993). Alternative Psychological Models and Meth-
odologies for the Study of Exercise and Affect. In P. Seraganian (Ed.), Exercise
Psychology: The Influence of Exercise on Psychological Processes, pp. 146–71.
New York: Wiley.
Gauvin, L., & Rejeski, W. J. (1993). The exercise-induced feeling inventory: devel-
opment and initial validation. Journal of Sport & Exercise Psychology, 15, 403-
423.
Gauvin, L., & Spence, J. C. (1998). In J. L. Duda (Ed.) Advances in sport and exer-
cise psychology measurement (pp. 325-336). Morgantown, WV: Fitness Informa-
tion Technology.
Geers, A. L., Helfer, S. G., Weiland, P. E., & Kosbab, K. (2006). Expectations and
placebo response: A laboratory investigation into the role of somatic focus. Jour-
nal of Behavioral Medicine, 29, 171-178.
Gill, S., Kolt, G. S., & Keating, J. (2004). Examining the multi-process theory: an
investigation of the effects of two relaxation techniques on state anxiety. Journal
of Bodywork and Movement Therapies, 8, 288-296.
102

Girdano, D. A., Everly, G. S. Jr., & Dusek, D. E. (2001). Controlling Stress and
Tension. (6th ed.). Boston: Allyn and Bacon.
Goldstein, M. S. (2000). The culture of fitness and the growth of CAM. In M. Kel-
ner, B. Wellman, B. Pescosolido, & M. Saks (Eds.), Complementary and alterna-
tive medicine: Challenge and change (pp. 27-38). Amsterdam: Harwood Aca-
demic Publishers.
Granath, J., Ingvarsson, S., von Thiele, U., & Lundberg, U. (2006). Stress manage-
ment: A randomized study of cognitive behavioural therapy and yoga. Cognitive
Behaviour Therapy, 35, 3-10.
Granqvist, H., & Hjelm, N. (1997). Qigong i teori och praktik. [Qigong: theory and
practice]. Stockholm: Svenska Förlaget.
Greenberg, L. S., & Paivio, S. (1997). Working with emotions in psychotherapy.
New York: The Guildford Press.
Griffith, N. M., Szaflarski, J. P., Szaflarski, M., Kent, G. P., Schefft B. K., Howe, S.,
et al. (2005). Measuring depressive symptoms among treatment-resistant seizure
disorder patients: POMS Depression scale as an alternative to the BDI-II. Epilepsy
and Behavior, 7, 266-272.
Gross, J. J. (1999). Emotion regulation: past, present, future. Cognition and Emo-
tion, 13, 551–573.
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: conceptual founda-
tions. In J. J. Gross, (Ed.), Handbook of emotion regulation (pp. 3-24). New
York: Guilford Press.
Gruzelier, J. H. (2002). A review of the impact of hypnosis, relaxation, guided im-
agery and individual differences on aspects of immunity and health. Stress, 5,
147-163.
Gunnarsson, L-G. (2004). Skolmedicinsk forskningmetodik – vad kan beforskas? In
M. Eklöf, (Ed.), Perspektiv på komplementär medicin. [Perspectives on comple-
mentary medicine]. (pp. 165-175). Lund, Sweden: Studenlitteratur.
Han, J. N., Stegen, K., De Valck, C., Clément, J., & Van De Woestijne, K. P.
(1996). Influence of breathing therapy on complaints, anxiety and breathing pat-
103

tern in patients with hyperventilation syndrome and anxiety disorders. Journal of
Psychosomatic Research, 41, 481-493.
Hansen, C. J., Stevens, L. C., & Coast, J. R. (2001). Exercise duration and mood
state: How much is enough to feel better? Health Psychology, 20, 267-275.
Hardy C. J., & Rejeski, W. J. (1989). Not what, but how one feels: The measure-
ment of affect during exercise. Journal of Sport and Exercise Psychology, 11, 304-
317.
Hassmén, P., & Hassmén, N. (1996). Variansanalys. [Analyses of variance]. Lund,
Sweden: Studenlitteratur.
Heide, F. J., & Borkovec, T. D. (1984). Relaxation-induced anxiety: Mechanisms
and theoretical implications. Behaviour Research and Therapy, 1, 1-12.
Hernendez-Reif, M., Field, T., & Hart, S. (1999). Smoking cravings are reduced by
self-massage. Preventive Medicine, 28, 28-32.
Hill, A. B. (1965). The environment and disease: association or causation. Proceed-
ings of the Royal Society of Medicine, 58, 295-300.
Hoffmann P. (1997). The endorphin hypothesis. In W. P. Morgan (Ed.), Physical
Activity and Mental Health (pp. 163-177). Washington: Taylor & Francis.
Hoffman, J. W., Benson, H., Arns, P. A., Stainbrook, G. L., Landsberg, L., Young, J.
B., & Gill, A. (1981). Reduced sympathetic nervous system responsitivity associ-
ated with the relaxation response. Science, 215, 190-192.
Izard, C. E. (1993). Four systems for emotion activation: cognitive and noncognitive
processes. Psychological Review, 100, 68–90.
Jin, P. (1989). Changes in heart rate, noradrenalin, cortisol and mood during tai chi. Jour-
nal of Psychosomatic Research, 33, 197-206.
Jin, P. (1992). Efficacy of tai chi, brisk walking, meditation, and reading in reducing men-
tal, and emotional stress. Journal of Psychosomatic Research, 36, 361-370.
Joseph, M. (1998). The effect of strong religious beliefs on coping with stress. Stress
Medicine, 14, 219-224.
Jouper, J. (2009). Qigong in daily life – motivation and intention to mindful exer-
cise. Unpublished doctoral dissertation, University of Örebro, Sweden.
104

Jouper, J., Hassmén, P., & Johansson, M. (2006). Qigong exercise with concentra-
tion predicts increased health. The American Journal of Chinese Medicine, 34,
949-957.
Kaptchuk, T. J. (2000). The web that has no weaver. Understanding Chinese medi-
cine. Chicago: Contemporary.
Kelner, M., & Wellman, B. (2000). Introduction. In M. Kelner, B. Wellman, B.
Pescosolido, & M. Saks, Complementary and alternative medicine: Challenge
and change (pp. 1-38). Amsterdam: Harwood Academic Publishers.
Keltner, D., & Gross, J. J. (1999). Functional accounts of emotions. Cognition and
Emotion, 13, 467–480.
Kemeny, M. E. (2005). The psychobiology of stress. In G. Miller & E. Chen (Eds.),
Current directions in health psychology (pp. 124-129). Upper Saddle River, NJ:
Pearson Education.
Kemp, C. A. (2004). Qigong as a therapeutic intervention with older adults. Journal
of Holistic Nursing, 22, 351-373.
King, A. C., Castro, C., Wilcox, S., Eyler, A. A., Sallis, J. F., & Brownson, R. C.
(2000). Personal and environmental factors associated with physical inactivity
among different racial-ethnic groups of U.S. middle-aged and older-aged women.
Health Psychology. 19, 354-364.
Kirkcaldy, B. C., & Shephard, R. J. (1990). Therapeutic implications of exercise. In-
ternational Journal of Sport Psychology, 21, 165-184.
Kjos, V., & Etnier, J. L. (2006). Pilot study comparing physical and psychological
responses in medical qigong and walking. Journal of Aging and Physical Activity,
14, 241-253.
Knez, I., & Hygge, S. (2001). The circumplex structure of affect: A Swedish version.
Scandinavian Journal of Psychology, 42, 389-398.
Krantz, G., & Lundberg, U. (2006). Workload, work stress, and sickness absence in
Swedish male and female white-collar employees. Scandinavian Journal of Public
Health, 34, 238-246.
Krisanaprakornkit, T., Krisanaprakornkit, W., Piyavhatkul, N., & Laopaiboon, M.
(2006). Meditation therapy for anxiety disorders. Cochrane Database of System-
105

atic Reviews. Issue 1. Art. No: CD004998. DOI: 10.1002/14651858.
CD004998.pub2.
Landers, D. M., & Arent, S. M. (2006). Physical activity and mental health. In G.
Tenenbaum, & R. C. Eklund (Eds.), Handbook of Sport Psychology (3rd ed.) (pp.
469-491). Hoboken, NJ: John Wiley & Sons.
Lane, A. M., Jackson, A., & Terry, P. C. (2005). Preferred modality influences on
exercise-induced mood changes. Journal of Sports Science and Medicine, 4, 195-
200.
Landstingsförbundet (2001). Den komplementära medicinens utbredning och till-
lämpning inom landets landsting. En kartläggning på uppdrag av Landstingsför-
bundet. Komplementära Hälsostudier 2. Örebro universitet.
Larkey, L., Jahnke, R., Etnier, J., & Gonzales, J. (In press). Meditative movements
as a category of exercise: Implications for research. Journal of Physical Activity
& Health.
Larsen, R. J., & Diener, E. (1992). Promises and problems with the circumplex
model of emotion. In M. S. Clark (Ed.), Review of personality and social psychol-
ogy: Vol. 13. (pp. 25-59). Newbury Park, CA: Sage.
Larsen, R. J., & Fredrickson, B. L. (1999). Measurement issues in emotion research.
In D. Kahneman, E. Diener, & N. Schwarz (Eds.), Well-being: Foundations of
Hedonic Psychology (pp. 40-60). New York: Russell Sage Foundation.
Larsen, R. J., & Prizmic, Z. (2004). Affect regulation. In R. F. Baumeister, & K. D.
Vohs (Eds.), Handbook of Self-Regulation. Research, Theory, and Applications
(pp. 40-61). New York: The Guilford Press.
LeUnes, A., & Burger, J. (1998). Bibliography on the Profile of Mood States in sport
and exercise psychology research, 1971-1998. Journal of Sport Behavior, 21, 53-
70.
Lazarus, R. (1994). The stable and the unstable in emotions. In P. Ekman, & R. J.
Davidson, The nature of emotion: fundamental questions (pp. 79-85). New York:
Oxford University Press.
106

Lee, S. L., Kang, C-W., Lim, H-J., & Lee, M-S. (2004). Effects of Qi-training on
anxiety and plasma concentrations of cortisol, ACTH, and aldosterone: A ran-
domized placebo-controlled pilot study. Stress and Health, 20, 243-248.
Lee, M-S., Kang, C-W., & Ryu, H. (2005). Acute effect of qi-training on natural kil-
ler cell subsets and cytotoxic activity. International Journal of Neuroscience, 115,
285-297.
Lee, M. S., Kang, C-W., Ryu, H., & Moon, S-R. (2004). Endocrine and immune ef-
fects of qi-training. The International Journal of Neuroscience, 114, 529-537.
Lee, M. S., Kim, B. G., Huh, H. J., Ryu, H., Lee, H-S., & Chung, H-T. (2000). Ef-
fect of qi-training on blood pressure, heart rate and respiration. Clinical Physiol-
ogy, 20, 173-176.
Lee, M-S., Kim, M-K., & Rye, H. (2005). Qi-training (qigong) enhanced immune
functions: What is the underlying mechanism? International Journal of Neurosci-
ence, 115, 1099-1104.
Lee, M-S., Lee, M-S., & Kim, H-J. (2003). Qigong reduced blood pressure and cate-
cholamine levels of patients with essential hypertension. International Journal of
Neuroscience, 113, 1691-1701.
Lee, M-S., Lee, M-S., & Kim, H-J. (2004). Effects of qigong on blood pressure, high
density lipoprotein cholesterol and other lipid levels in essential hypertension pa-
tients. International Journal of Neuroscience, 114, 777-786.
Lee, M-S., Lee, M-S., Kim, H-J., & Moon, S-R. (2003). Qigong reduced blood pres-
sure and catecholamine levels of patients with essential hypertension. Interna-
tional Journal of Neuroscience, 113, 1691-1701.
Lee, M-S., Lim, H-J., & Lee, M-S. (2004). Impact of qigong exercise on self-efficacy
and other cognitive perceptual variables in patients with essential hypertension.
The Journal of Alternative and Complementary Medicine, 4, 675-680.
Lee, S. L., Ryu, H., & Chung, H-T. (2000). Stress management by psychosomatic
training: effects of Chundosunbup qi-training on symptoms of stress: a cross-
sectional study. Stress Medicine, 16, 161-166.
107

Lee, T-I., Chen, H-H., & Yeh, M-L. (2006). Effects of chan-chuang qigong on im-
proving symptom and psychological distress in chemotherapy patients. The
American Journal of Chinese Medicine, 34, 37-46.
Leung, Y. & Singhal, A. (2004). An examination of the relationship between qigong
meditation and personality. Social Psychology and Personality, 4, 313-320.
Levander, V. L., Benson, H., Wheeler, R. C., & Wallace, R. K. (1972). Increased
Forearm Blood Flow During a Wakeful Hypometabolic State. Federation Pro-
ceedings, 31, 405.
Leventhal, H., & Scherer, K. (1987). The relationship of emotion to cognition: a
functional approach to a semantic controversy. Cognition and Emotion, 1, 3–28.
Lichstein, K. L. (2000). Relaxation training. In A. E. Kazdin (Ed.), Encyclopedia of
Psychology (pp. 28-30). Washington, D.C.: American psychological Association;
Oxford: Oxford University Press.
Lindfors, P., Berntsson, L., & Lundberg, U. (2006). Factor structure of Ryff’s psy-
chological well-being scales in Swedish female and male white-collar workers.
Personality and Individual Differences, 6, 1213-1222.
Lox, C. L., Jackson, S., Tuholski, S., Wasley, D., & Treasure, D. C. (2000). Revisit-
ing the measurement of exercise-induced feeling states: The Physical Affect Scale
(PAAS). Measurement in Physical Education and Exercise Science, 4, 79-95.
Lu, W-A., & Kuo, C-D. (2003). The effect of tai chi chuan on the autonomic nerv-
ous system modulation in older persons. Medicine and Science in Sports & Exer-
cise, 35, 1972-1976.
Lund, L-G. (1987). Placebo, belief, and health. A cognitive – emotional model. Scan-
dinavian Journal of Psychology, 28, 128-143.
Luskin, F. M., Newell, K. A., Griffith, M., Holmes, M., Telles, S., Marvasti, F. F., et
al. (1998). A review of mind-body therapies in the treatment of cardiovascular
disease. Part 1: implications for the elderly. Alternative Therapies in Health and
Medicine, 4, 46-61.
Lox, C. L., Martin Ginis, K. A., & Petruzzello, S. J. (2006). The psychology of exer-
cise: integrating theory and practice. Scottsdale: Holcomb Hathaway.
108

Mannerkorpi, K., & Arndorw, M. (2004). Efficacy and feasibility of a combination
of body awareness therapy and qigong in patients with fibromyalgia: a pilot
study. Journal of Rehabilitation Medicine, 36, 279-281.
Martinsen, E. W. (2002). The role of exercise in the management of depression. In
D. L. Mostofsky, & L. D. Zaichowsky (Eds.), Medical and psychological aspects
of sport and exercise (pp. 205-214). Morgantown, WV: Fitness Information
Technology.
Mayer, M. (1999). Qigong and research: A critique of research. The Journal of Al-
ternative and Complementary Medicine, 5, 371-382.
McCauley, E., & Corneya, K. S. (1994). The Subjective Exercise Experience Scale
(SEES): Development and preliminary validation. Journal of Sport and Exercise
McNair, D. M., Lorr, M., & Droppleman, L. F. (1992). EdITS manual for the pro-
file of mood states. San Diego: EdITS.
Mills, N., Allen, J., & Morgan, C. (2000). Does tai chi/qi gong help patients with
multiple sclerosis? Journal of Bodywork and Movement Therapies, 4, 39-48.
Morgan, W. P. (1997). Methodological considerations. In W. P. Morgan (Ed.),
Physical activity and mental health (pp. 3-32). Philadelphia: Taylor & Francis.
Morris, N. (1999). The mood system. In D. Kahneman, E. Diener, & E. Schwarz
(Eds.), Well-being: the foundation of hedonic psychology (pp. 169-189). New
York: Russell Sage foundation.
Motl, R. W., Berger, B. G., & Leuschen, P. S. (2000). The role of enjoyment in the
exercise-mood relationship. International Journal of Sport Psychology, 3, 347-
363.
Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A meta-analysis of massage
therapy research. Psychological Bulletin, 130, 3-18.
Murakawa, H. (2002). Phenomenology of the experience of qigong: A preliminary
research design for the intentional bodily practice. Doctoral Dissertation. Cali-
fornia Institute of Integral Studies.
109

Mutrie (2000). The relationship between physical activity and clinically defined de-
pression. In S. J. H. Biddle, K. Fox & S. H. Boutcher (Eds.), Physical Activity and
Psychological Well-being (pp. 46–62). London: Routledge.
Mutrie, N., & Biddle, S. J. H. (1995). The effects of exercise on mental health in
nonclinical populations. In S. J. H. Biddle (Ed.). European perspectives on exer-
cise and sport psychology (pp. 50-70). Champaign, IL: Human Kinetics.
Mutrie, N., & Faulkner, G. (2004). Physical activity: Positive psychology in motion.
In P. A. Linley & S. Joseph (Eds.), Positive psychology in practice. Hoboken, NJ:
John Wiley & Sons.
Myers, D. G. (1992). The pursuit of happiness. New York: Avon Books.
Nakamura, J., & Csikszentmihalyi, M. (2002). The concept of flow. In C. R. Sny-
der, & Lopez, S. J. (Eds.), Handbook of positive psychology (pp. 89-105). New
York. Oxford University Press.
NCCAM (2007). Mind-body medicine: An overview. National Center For Com-
plementary and Alternatives Medicine, 16, National Institutes of Health, U.S.
Department of Health and Human Services. [http://nccam.nih.gov/health/whati-
scam/ mind-body/mindbody.htm]
Naruse, K., & Hirai, T. (2000). Effects of slow tempo exercise on respiration, heart
rate and mood state. Perceptual and Motor Skills, 3, 729-740.
Netz, Y., & Lidor, R. (2003). Mood alterations in mindful versus aerobic exercise
modes. The Journal of Psychology, 137, 405-419.
Ng, B-Y. (1999). Qigong-induced mental disorders: a review. Australian and New
Zealand Journal of Psychiatry, 33, 197-206.
Nielsen, L., & Kaszniak, A. W. (2006). Awareness of subtle emotional feelings: A
comparison of long-term meditators and nonmeditators. Emotion, 3, 392-405.
Nyenhuis, D. L., Luchetta, T., Yamamoto, Terrien, A., & Parmentier, A. (1999).
Adult and geriatric normative data for the profile of mood states. Journal of
Clinical Psychology, 55, 79-86.
O’Connor, B. B. (2000). Conceptions of the body in complementary and alternative
medicine. In M. Kelner, B. Wellman, B. Pescosolido, & M. Saks (Eds.), Comple-
110

mentary and alternative medicine. Challenge and Change (p. 39-57). Amsterdam:
Harwood Academic publishers.
O’Halloran, P. D., Murphy, G. C., & Webster, K. E. (2002). Measure of beliefs
about improvements in mood associated with exercise. Psychological Reports, 90,
834-840.
O’Halloran, P. D., Murphy, G. C., & Webster, K. E. (2005). Moderators of mood during 60
minute treadmill run. International Journal of Sport Psychology, 36, 241-250.
Olson, J. M., Roese, N. J., & Zanna, M. P. (1996). Expectancies. In E. T. Higgins &
A. W. Kruglanski (Eds.), Social Psychology. Handbook of Basic Principles (pp.
211-238). New York: Guildford Press.
Orne, M. T., & Whitehouse, W. G. (2000). Relaxation techniques. In G. Fink (Ed.),
Encyclopedia of Stress (pp. 341-348). San Diego: Academic Press.
Ospina, M. B., Bond, T. K., Karkhaneh, M., Tjosvold, L., Vandermeer, B., & Liang,
Y., (2007). Meditation Practices for Health: State of the Research. Evidence Re-
port /Technology Assessment No. 155. AHRQ Publication No. 07-E010. Rock-
ville, MD: Agency for Healthcare Research and Quality.
Pallant, J. (2007). SPSS Survival Manual. A step by step guide to data analysis using
SPSS for windows (3rd ed.). Maidenhead: Open University Press & McGraw-Hill.
Paluska, S. A., & Schwenk, T. L. (2000). Physical activity and mental health. Cur-
rent concepts. Sports Medicine, 29, 167-180.
Panksepp, J. (2003). At the interface of the affective, behavioral, and cognitive neu-
rosciences: decoding the emotional feelings of the brain. Brain and Cognition, 52,
4-14.
Parkinson, B., Totterdell, P., Briner, R. B., & Reynolds, S. (1996). Changing Moods.
The Psychology of Mood and Mood Regulation. Harlow: Addison Wesley Long-
man.
Parfitt, G. and Gledhill, C. (2004) The effect of choice of exercise mode on psycho-
logical responses. Psychology of Sport and Exercise 2, 111-117.
Parfitt, G., Rose, E. A., & Markland, D. (2000). The effects of prescribed and pre-
ferred intensity exercise on psychological affect and the influence of baseline
measures of affect. Journal of Health Psychology, 5, 231-240.
111

Petruzzello, S. J., & Landers, D. M. (1994). Varying the duration of acute exercise:
implications for changes in affect. Anxiety, Stress & Coping: An International
Journal, 6, 301-310.
Petruzzello, S. J., Landers, D. M., Hatfield, B. D., Kubitz, K. A., & Salazar, W.
(1991). A meta-analysis on the anxiety-reducing effects of acute and chronic exer-
cise. Outcomes and mechanisms. Sports Medicine, 11, 143-182.
Petruzzello, S. J., Landers, D. M., & Salazar, W. (1993). Exercise and anxiety reduc-
tion: Examination of temperature as an explanation for affective change. Journal
of Sport & Exercise Psychology, 15, 63-76.
Peveler, R. C., & Johnston, D. W. (1986). Behaviour Research and Therapy, 24,
413-419.
Philippot, P., Chapelle, G., & Blairy, S. (2002). Respiratory feedback in the genera-
tion of emotion. Cognition and Emotion, 16, 605-627.
Poppen, R. (1998). Behavioral Relaxation Training and Assessment. 2nd ed. Thou-
sand Oaks: Sage.
Porcari, J. P., Ward, A., Morgan, W., Mance, M., Ebbeling, C., Kline, G., et al.
(1998). Effect of walking on state anxiety and blood pressure. Medicine and Sci-
ence in Sports and Exercise, 20, S85.
Pressman, S. D., & Cohen, S. (2005). Does positive affect influence health? Psychological
Bulletin, 131, 925-971.
Reed, J., & Ones, D. S. (2006). The effect of acute aerobic exercise on positive activated
affect: A meta-analysis. Psychology of Sport and Exercise, 7, 477-514.
Recordati, G. (2003). A thermodynamic model of the sympathetic and parasympa-
thetic nervous system. Autonomic Neuroscience: Basic & Clinical, 103, 1-12.
Reed, J., & Ones, D. S. (2006). The effect of acute aerobic exercise on positive acti-
vated affect: A meta-analysis. Psychology of Sport and Exercise, 7, 477-514.
Rejeski, W.J., Brawley, L.R., & Shumaker, S.A. (1996). Physical Activity and Health
related Quality of Life. Exercise and Sport Sciences Reviews, 24, 71-108.
Rejeski, W. J., Hardy, C. J., & Shaw, J. (1991). Psychometric confounds of assessing
state anxiety in conjunction with acute bouts of vigorous exercise. Journal of
Sport and Exercise Psychology, 13, 65-74.
112

Rose, E. A., & Parfitt, G. (2007). A quantitative analysis and qualitative explanation
of the individual differences in affective responses to prescribed and self-selected
exercise intensities. Journal of Sport & Exercise Psychology, 29, 281-309.
Rosenberg, E. L. (1998). Levels of analysis and the organization of affect. Review of
General Psychology, 3, 247-270.
Russell, J. A. (1980). A circumplex model of affect. Journal of Personality and Social
Psychology, 39, 1161–1178.
Russell, J. A., & Feldman-Barrett, L. (1999). Core affect, prototypical emotional
episodes, and other things called emotion: dissecting the elephant. Journal of Per-
sonality and Social Psychology, 76, 805–819.
Russell, J. J., Lewicka, M., & Niit, T. (1989). A cross-cultural study of a circumplex
model of affect. Journal of Personality and Social Psychology, 57, 848-856.
Russell, J. A., Weiss, A., & Mendelsohn, G. A. (1989). Affect grid: A single-item
scale of pleasure and arousal. Journal of Personality and Social Psychology, 57,
493-502.
Ryff, C., & Keyes, C. L. M. (1995). The structure of psychological well-being revis-
ited. Journal of Personality and Social Psychology, 4, 719-727.
Ryu, H., Mo, Y. H., Mo, G. D., Choi, B. M., Chang, D. J., Seo, C. M., et al. (1995).
Delayed cutaneous hypersensitivity reactions in qigong (chundosunbup) trainees
by multitest cell mediated immunity. American Journal of Chinese Medicine, 23,
139-144.
Ryu, H., Lee, M-S., Jeong, S-M., Lee, J-H., Kang, C-W., Lee, D-Y., et al. (2000).
Modulation of neuroendocrinological function by psychosomatic training: acute
effect of chundosunbup qi-training on growth hormone, insulin-like growth fac-
tor (IGF)-1, and insulin-like growth factor binding protein (IGFBP)-3 in men,
Psychoneuroendocrinology, 25, 439-451.
Sadigh, M. R. (2001). Autogenic Training: A Mind-Body Approach to the Treat-
ment of Fibromyalgia and Chronic Pain Syndrome. New York: Haworth Press.
Saklofske, D. H., Blomme, G. C., & Kelly, I. W. (1992). The effects of exercise and
relaxation on energetic and tense arousal. Personality and Individual Differences,
13, 623-625.
113

Sandlund, E. S., & Norlander, T. (2000). The effects of tai chi chuan and exercise on
stress responses and well-being: An overview of research. International Journal of
Stress Management, 7, 139-149.
Sarang, P., & Tellas, S. (2006). Effects of two yoga based relaxation techniques on
heart rate variability (HRV). International Journal of Stress Management, 13,
460-475.
Scherer, K. R. (1984). On the nature and function of emotion: A component process
approach. In K. R. Scherer & P. Ekman (Eds.), Approaches to emotion (pp. 293-
317). Hillsdale, NJ: Lawrence Erlbaum.
Scheufele, P. M. (2000). Effects of progressive relaxation and classical music on
measurements of attention, relaxation, and stress responses. Journal of Behav-
ioral Medicine, 23, 207-228.
Schwarz, N., & Clore, G. L. (1983). Mood, misattribution, and judgments of well-
being: Informative and directive function of affective states. Journal of Personal-
ity and Social Psychology, 45, 513-523.
Scully, D., Remer, J., Meade, M. M., Graham, R., & Dudgeon, K. (1998). Physical
exercise and psychological well being: a critical review. British Journal of Sports
Medicine, 32, 111-120.
Shapiro, S., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based
stress reduction on medical and premedical students. Journal of Behavioral Medi-
cine, 21, 581-599.
Shapiro, S. L., & Schwartz, G. E. R., & Santerre, C. (2002). Meditation and posi-
tive psychology. In C. R. Snyder, & J. Shane (Eds.), Handbook of Positive Psy-
chology (pp. 632-645). New York: Oxford University Press.
Shapiro, S. L., Schwartz, G. E. R., & Santerre, C. (2002). Meditation and positive
psychology. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychol-
ogy (pp. 632-645). New York: Oxford University Press.
Singer, J. L. (2006). Imagery in Psychotherapy. Washington, D.C.: American Psy-
chological Association.
Sjöberg, L., Svensson, E., & Persson, L-O. (1979). Scandinavian Journal of Psychol-
ogy, 20, 1-18.
114

Skoglund, L., & Jansson, E. (2007). Qigong reduces stress in computer operators.
Complementary Therapies in Clinical Practice, 13, 78-84.
Smith, J. C. (1990). Cognitive-behavioral relaxation training: A new system of
strategies for treatment and assessment. New York: Springer Publishing Com-
pany.
Sonstroem, R. J., & Morgan, W. P. (1989). Exercise and self-esteem: Rationale and
model. Medicine & Science in Sports & Exercise, 21, 329-337.
Solomon, R. L., & Corbit, J. D. (1974). An opponent-process theory of motivation:
I, temporal dynamics of affect. Psychological Review, 81, 119-145.
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A.
(1983). Manual for the state-trait anxiety inventory. Palo Alto, Ca: Consulting
Psychologists Press.
Steptoe, A., & Wardle, J. (2005). Positive affect and biological function in everyday
life. Neurobiology of Aging, 26, (suppl1), S108-S112.
Svebak, S., & Murgatroyd, S. (1985). Metamotivational dominance: A multimethod
validation of reversal theory constructs. Journal of Personality and Social Psy-
chology, 48, 107-116.
Swinkels, A., & Giuliano, T. A. (1995). The measurement and conceptualization of
mood awareness: Monitoring and labeling one's mood states. Personality and So-
cial Psychology Bulletin, 21, 934-949.
Szabo, A. (2003). Acute psychological benefits of exercise performed at self-selected
workloads: implications for theory and practice. Journal of Sports Science and
Medicine, 2, 77-87.
Szabo, A., Meskó, A., Caputo, A., & Gill, É. T. (1998). Examination of exercise-
induced feeling states in four modes of exercise. International Journal of Sport
Taylor, A. H. (2000). Physical activity, anxiety, and stress. In S. J. H. Biddle, K. R.
Fox, & S. H. Boutcher. Physical Activity and Psychological Well-Being (pp. 10-
45). London: Routledge.
Thayer, R. E. (1978). Toward a psychological theory of multidimensional activation
(arousal). Motivation and Emotion, 2, 1-34.
115

Thayer, R. E. (1987). Energy, tiredness, and tension effects of a sugar snack versus
moderate exercise. Journal of Personality and Social Psychology, 52, 119-125.
Thayer, R. E. (1989). The Biopsychology of Mood and Arousal. New York: Oxford
University Press
Thayer, R. E. (2001). Calm energy. How people regulate mood with food and exer-
cise. Oxford: Oxford University Press.
Thayer, R. E., Newman, R., & McClain, T. M. (1994). Self-regulation of mood:
Strategies for changing a bad mood, raising energy, and reducing tension. Journal
of Personality and Social Psychology, 67, 910-925.
Thayer, R. E., Peters, D. P., Takahashi, P. J., & Birkhead-Flight, A. M. (1993).
Mood and behavior (smoking and sugar snacking) following moderate exercise: A
partial test of self-regulation theory. Personality and Individual Differences, 14,
97-104.
Tsang, H. W. H., Fung, K. M. T. (2008). A review on neurobiological and psycho-
logical mechanisms underlying the anti-depressive effect of qigong exercise. Jour-
nal of Health Psychology, 13, 857-863.
Tsang, H. W. H., Fung, K. M. T., Chan, A. S. M., Lee, G., & Chan, F. (2006). Ef-
fect of qigong exercise programme on elderly with depression. International
Journal of Geriatric Psychiatry, 21, 890-897.
Tsang, H. W. H., Mok, C. K., Au Yeung, Y. T., & Chan, S. Y. C. (2003). The effect
of qigong on general and psychosocial health of elderly with chronic physical ill-
nesses: a randomized clinical trial. International Journal of Geriatric Psychiatry,
18, 441-449.
Tse, M. (1998). Qigong: så finner du din inre energi. [Qigong: Finding your inner
energy]. Västerås: ICA bokförlag.
Ursin, H. (2000). Psychosomatic medicine: State of the art. Annals of Medicine, 32,
323-328.
U.S. Department of Health and Human Services. (1996). Physical activity and
health: A report of the Surgeon General. Atlanta, GA: US Department of Health
and Human Services, Centers for Disease Control and Prevention, National Cen-
ter for Chronic Disease Prevention and Health Promotion.
116

Uvnäs-Moberg, K. (2000). Lugn och beröring: oxytocinets läkande verkan i krop-
pen. [The Oxytocin factor: tapping the hormone of calm, love, and healing] Stockholm:
Natur och Kultur.
Uvnäs-Moberg, K., Arn, I., & Magnusson, D. (2005). The psychobiology of emo-
tion: The role of the oxytocinergic system. International Journal of Behavioral
Medicine, 2, 59-65.
Vaitl, D., Birbaumer, N., Gruzelier, J., Jamieson, G. A., Kotchoubey, B., Kübler, A.,
et al. (2005). Psychobiology of altered states of consciousness. Psychological Bul-
letin, 131, 98–127.
Van Landuyt, L. M., Ekkekakis, P., Hall, E. E., & Petruzzello, S. J. (2000). Throw-
ing the mountains into the lakes: On the perils of nomothetic conceptions of the
exercise-affect relationship. Journal of Sport and Exercise Psychology, 22, 208-
234.
Västfjäll, D., Friman, M., Gärling, T., & Kleiner, M. (2002). The measurement of
core affect: A Swedish self-report measure derived from the affect circumplex.
Scandinavian Journal of Psychology, 43, 19-31.
Västfjäll, D., & Gärling, T. (2007). Validation of a Swedish short self-report meas-
ure of core affect. Scandinavian Journal of Psychology, 48, 233-238.
Vetenskapsrådet. (2002). Riktlinjer för humanistisk och samhällsvetenskaplig forsk-
ning. [Research Ethics Principles in Humanistic-Social Scientific Research.] Stock-
holm: Vetenskapsrådet.
Wallace, R. K. (1970). Physiological effects of transcendental meditation. Science,
167, 1751-1754.
Wallace, A. B., & Shapiro, S. L. (2006). Mental balance and well-being: Building
bridges between Buddhism and Western psychology. American Psychologist, 61,
690-701.
Walsh, R., & Shapiro, S. L. (2006). The meeting of meditative disciplines and west-
ern psychology: A mutually enriching dialogue. American Psychologist, 3, 227-
239.
117

Warburton, D. E. R., Nicol, C. W., & Bredin, S. S. D. (2006). Health benefits of
physical activity: the evidence. Canadian Medical Association Journal, 6, 801-
810.
Watson, D. (1988). Development and validation of brief measures of positive and
negative affect: The PANAS scales. Journal of Personality and Social Psychology,
6, 1063-1070.
Watson, D. (2000). Mood and Temperament. New York: The Guilford Press:
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of
brief measures of positive and negative affect: The PANAS scales. Journal of Per-
sonality and Social Psychology, 54, 1063–1070.
Watson, D., & Tellegen, A. (1985). Toward a consensual structure of mood. Psy-
chological Bulletin, 98, 219–235.
Weinstein, M., & Smith, J. C. (1992). Isometric squeeze relaxation (progressive re-
laxation) vs meditation: absorption and focusing as predictors of state effects.
Perceptual and Motor Skills, 75, 1263-1271.
Welch, A. S., Hulley, A., Ferguson, C., & Beauchamp, M. R. (2007). Psychological
responses of inactive women to a maximal incremental exercise test: A test of the
Dual Mode Model. Psychology of Sport and Exercise, 8, 401-423
Wenneberg, S., Gunnarsson, L-G., & Ahlström, G. (2004a). Using a novel exercise
programme for patients with muscular dystrophy. Part I: a qualitative study. Dis-
ability and Rehabilitation, 26, 586-594.
Wenneberg, S., Gunnarsson, L-G., & Ahlström, G. (2004b). Using a novel exercise
programme for patients with muscular dystrophy. Part II: a quantitative study.
Disability and Rehabilitation, 26, 595-602.
Wilhelm, F. H., Alpers, G. W., Meuret, A. E., & Roth, W. T. (2001). Respiratory
pathophysiology of clinical anxiety outside the laboratory: Assessment of end-
tidal pCO-sub-2, respiratory pattern variability, and transfer function RSA. In J.
Fahrenberg, & M. Myrtek (Eds.), Progress in ambulatory assessment. Computer-
assisted psychological and psychophysiological methods in monitoring and field
studies (pp. 313-343). Ashland, OH: Hogrefe & Huber.
118

Wilhelm, F. H., Gevirtz, R., & Roth, W. T. (2001). Respiratory dysregulation in
anxiety, functional cardiac, and pain disorders. Assessment, phenomenology, and
treatment. Behavior Modification, 25, 513-545.
Whitley, B. E. (2002). Principles of research in behavioral science. New York:
McGraw-Hill.
Wolsko, P. M., Eisenberg, D. E., Davis, R. B., & Phillips, R. S. (2004). Use of mind-
body medical therapies. Results of a national survey. The Journal of General In-
ternal Medicine, 19, 43-50.
Wood, C. (1998). Mood change and perceptions of vitality: a comparison of the ef-
fects of relaxation, visualization and yoga. Journal of the Royal Society of Medi-
cine, 86, 254-258.
Yeung, R. R. (1996). The acute effects of exercise on mood state. Journal of Psycho-
somatic Research, 40, 123-141.
Yik, M. S. M., Russell, J. A., & Feldman Barrett, L. (1999). Structure of self-
reported current affect: integration and beyond. Journal of Personality and Social
Åsberg, M., Wahlberg, K., Sköld, C., & Nygren, Å. (2006). Mindfulnessmeditation
– nygammal metod för att lindra stress. [Mindfulness meditation – ancient new
method of stress reduction]. Läkartidningen, 103, 3174-3177.
119

Qigong: Acute Affective Responses

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Qigong: Acute Affective Responses

Uploaded by

Copyright:

Available Formats

Qigong: Acute affective responses

“Qigong and emotion/mood”.

Qigong: Acute affective responses

Title: Qigong: Acute affective responses

Printer: Intellecta Infolog, V Frölunda 04 /2009

Key words: Qigong, affective responses, mind-body therapy, low-intensive physical

Re-produced with permission by The American Psychological Association

Re-produced with permission by World Scientific Publishing Company.

Qigong: Acute affective responses ✍ mattias johansson I 15

16 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 17

Qigong: Acute affective responses ✍ mattias johansson I 19

20 I mattias johansson ✍ Qigong: Acute affective responses

Chinese philosophy and medicine

Qigong is an integrated part of Traditional Chinese Medicine (TCM). In order to

Qigong: Acute affective responses ✍ mattias johansson I 21

22 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 23

Different styles of Qigong

24 I mattias johansson ✍ Qigong: Acute affective responses

Research on Qigong exercise

Qigong: Acute affective responses ✍ mattias johansson I 25

26 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 27

28 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 29

30 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 31

Attentional regulation (meditation)

32 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 33

Breath training is a part of many cognitive-behavioral, somatic, and mind-body

34 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 35

Differentiating between affect, mood and emotion

36 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 37

38 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 39

40 I mattias johansson ✍ Qigong: Acute affective responses

Regulating affective states

Affect regulation is defined as “any process directed at modifying or maintaining

Qigong: Acute affective responses ✍ mattias johansson I 41

Antecedents and dynamics of affective states

42 I mattias johansson ✍ Qigong: Acute affective responses

Measuring affective responses

Qigong: Acute affective responses ✍ mattias johansson I 43

A framework for the study of affective responses

44 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 45

Suggested mechanisms for acute affective benefits

Given that Qigong exercise constitutes a number of different characteristics, includ-

46 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 47

48 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 49

50 I mattias johansson ✍ Qigong: Acute affective responses

Acute affective responses to physical activity

Qigong: Acute affective responses ✍ mattias johansson I 51

Acute affective responses to mind-body therapies

Investigations of specific mind-body therapies show affective benefits in a number of

52 I mattias johansson ✍ Qigong: Acute affective responses

Qigong: Acute affective responses ✍ mattias johansson I 53