The development and evaluation of a group-based Mahāyāna Buddhist intervention : awareness training program (ATP)

Abstract

Over the past decades, mindfulness-based interventions have demonstrated effective in reducing stress-related problems. However, there is growing concern that some of these interventions have been developed in an “out of context” manner. In response to this growing concern and the immense needs of non-clinical adults experiencing stress in Hong Kong, the Awareness Training Program (ATP), a novel group-based Mahāyāna Buddhist intervention, has been developed and evaluated. Three studies were undertaken. Study 1 was a systematic review of existing group-based Mahāyāna Buddhist interventions for stress management in non-clinical adults. Five articles were identified for review from the databases ProQuest, Web of Science, ScienceDirect, Academic Search Premier, and Google Scholar. The findings revealed the need to develop a new intervention that uses a doctrinally aligned approach with a specific text as its core reference and also the need to investigate the effectiveness of such an approach in the East. Therefore, the ATP, which is doctrinally aligned with the Saṃdhinirmocana Sūtra so that its theory and praxis are coherent, was formulated. The ATP aims to enhance a person’s ability to deal with suffering by developing one’s compassion and the wisdom of nonattachment. Study 2 was a feasibility study that examined the acceptability and feasibility of the ATP. Twenty-three non-clinical Hong Kong adults participated in a single-group pretest-posttest trial with 3-month follow-up. The satisfactory participants’ quantitative ratings and qualitative feedback together with the satisfactory recruitment rate, high retention rate, smooth administration procedures, and sufficient research team competence, show that the ATP is an acceptable and feasible intervention. Study 3 was a randomized waiting-list controlled trial that investigated the ATP’s effectiveness. Middle-aged working adults (N = 122) in Hong Kong participated in this study. Self-reported psychological questionnaires were used to assess the participants’ level of stress (PSS), sense of coherence (SOC), psychological well-being (GHQ), and nonattachment (NAS) at pretest, posttest, and three months later. The data showed significant improvements in the intervention group relative to the controls for all outcome measures at the posttest and three months later (post and post-3 PSS: ηp 2 = .15 and .16; post and post-3 SOC: ηp 2 = .05 and .10; post and post-3 GHQ: ηp 2 = .16 and .13; post and post-3 NAS: ηp 2 = .17 and .14). A mediation analysis demonstrated that nonattachment mediated both the treatment and the maintenance effects for all outcome variables (post and post-3 PSS: indirect effect ab = −1.50 and −1.70; post and post-3 SOC: ab = 2.48 and 3.61; post and post-3 GHQ: ab = −1.65 and −1.56; bootstrapped 95% confidence interval; confidence interval does not include zero). It revealed that the ATP may effectively reduce stress and improve individuals’ sense of coherence and psychological well-being by enhancing their wisdom of nonattachment. To conclude, this study provides promising evidence that the ATP could be an effective intervention for middle-aged working adults in Hong Kong. This evidence lays a solid foundation for further development of the ATP.