MindBody Medicine and the Art of

Self-Care: Teaching Mindfulness to

Counseling Students Through Yoga,
Meditation, and Qigong
Marc B. Schure, John Christopher, and Suzanne Christopher
A 4-year qualitative study examined the influence of teaching hatha yoga, meditation, and qigong to counseling graduate
students. Participants in the 15-week, 3-credit mindfulness-based stress reduction course reported positive physical,
emotional, mental, spiritual, and interpersonal changes and substantial effects on their counseling skills and therapeutic
relationships. Students expressed different preferences for and experiences with the 3 mindfulness practices. Most
students reported intentions of integrating mindfulness practices into their future profession.

Unmanaged chronic stress can have deleterious effects on the

physical and psychological health of individuals. Stress may lead
to or worsen disorders and diseases such as heart disease, anxiety,
depression, hypertension, substance abuse, and gastrointestinal
disorders (Astin, 1997; Brennan & Moos, 1990; Levy, Cain,
Jarrett, & Heitkemper, 1997; D. Shapiro & Goldstein, 1982;
Treiber et al., 1993; Whitehead, 1992). Stress is also a contributing factor for lifestyle behaviors that increase vulnerability to
diseases such as lung cancer, cardiovascular disease, and obesity
(Brennan & Moos, 1990; Roth & Robbins, 2004; Treiber et al.,
1993; D. R. Williams, 1999). Stress has an impact on absenteeism rates and job performance, effectiveness, and satisfaction
(Burnard, Edwards, Fothergill, Hannigan, & Coyle, 2000). Given
the prevalence of these stress-related health conditions in the
United States, their costs to the nations health care system, and
the loss of quality of life for individuals, it is no surprise that
public health professionals are increasingly concerned over the
effects of stress. For instance, the U.S. Department of Health and
Human Services (2000) lists stress reduction as an objective in
its publication Healthy People 2010.
Health care workers are particularly vulnerable to stress overload because of high demands and unique challenges (Harris,
2001; Sharkey & Sharples, 2003; Wall et al., 1997). Burnout,
defined as exhaustion of physical or emotional strength, is the
most often-noted consequence of chronic stress in the workplace (Harris, 2001; Sharkey & Sharples, 2003). Moore and
Cooper (1996) found that mental health professionals experience emotional exhaustion alongside the usual organizational
sources of stress, and Baker (2003) described the potential for
compassion fatigue and vicarious traumatization (p. xi).
These stressors may have harmful effects on counseling students effectiveness and success by reducing their capacity for
attention, concentration, and decision-making skills (S. Shapiro,
Shapiro, & Schwartz, 2000). Educators have recognized the
importance of providing counselors with tools for self-care

early in their careers and even while they are being trained
(Baker, 2003; Brems, 2001; Kuyken, Peters, Power, & Lavender,
2003; Weiss, 2004). In an extensive review of research on stress
management in the education of health care professionals, S.
Shapiro et al. (2000) stated that although many interventions
demonstrated promising results, such as lower levels of anxiety
and depression, greater capacity for empathy, and improved
immunologic functioning, more research is needed.
One of the most well-researched stress management programs is mindfulness-based stress reduction (MBSR). MBSR
teaches mindfulness, which is the ability to attend to thoughts
and emotions as they arise and to be fully conscious of the
present-moment experience. Taught to more than 5,000 medical
patients since its inception more than 20 years ago (Kabat-Zinn,
1990), MBSR is typically run as an 8-week course instructing
mindfulness through the practice of meditation, body scan (a
type of guided awareness), and hatha yoga. One of the strengths
of MBSR, in contrast to most stress-reduction programs, is that
it offers participants different mindfulness practices from which
to choose. Research indicates that participants often find one
of the three practices more beneficial or preferred for personal
reasons; consequently, having options can improve compliance
(Kabat-Zinn, Chapman, & Salmon, 1997). This may help to
explain why MBSR has been found to have high compliance
rates, even after 3 years (Kabat-Zinn & Chapman-Waldrop,
1988; Miller, Fletcher, & Kabat-Zinn, 1995).
MBSR studies with varied populations have found significant
decreases in anxiety/depression, mood disturbance, somatic
symptoms of stress, and present-moment pain (Kabat-Zinn, Lipworth, & Burney, 1985; Kabat-Zinn et al., 1992; Kabat-Zinn et al.,
1998; Kaplan, Goldenberg, & Galvin-Nadeau, 1993; Kristeller &
Hallett, 1999; Reibel, Greeson, Brainard, & Rosenzweig, 2001;
Roth, 1997; Speca, Carlson, Goodey, & Angen, 2000; Teasdale
et al., 2000). Other mindfulness-based studies have demonstrated
improvements in quality of life, health-related quality of life,

Marc B. Schure, John Christopher, and Suzanne Christopher, Department of Health & Human Development, Montana State
University. Marc B. Schure is also now at Gallatin City-County Health Department, Bozeman, Montana. Correspondence concerning
this article should be addressed to John Christopher, 220 Herrick Hall, Department of Health & Human Development, Montana State
University, Bozeman, MT 59717 (e-mail: [email protected]).
2008 by the American Counseling Association. All rights reserved.

Journal of Counseling & Development Winter 2008 Volume 86

47

Schure, Christopher, & Christopher

general health, sleep quality, and immune function and decreases
in psychological distress and physical symptoms and conditions
(Carlson, Speca, Patel, & Goodey, 2004; Davidson et al., 2003;
Lawson & Horneffer, 2002; Roth & Robbins, 2004; K. Williams,
Kolar, Reger, & Pearson, 2001). Findings from a 3-year followup evaluation revealed maintenance of reduced levels of anxiety
and depression, thus demonstrating the long-term effects of this
program (Miller et al., 1995).
Although MBSR was developed to introduce healthy-coping
mechanisms for those experiencing ill health, increasing attention
has been given to its proposed ability to help prevent stress-related
illnesses and diseases. Researchers have evaluated MBSR as a
tool for helping college students cope with stress. A controlled
study of undergraduate students showed that MBSR participants
had statistically significant decreases in levels of depression and
anxiety and a greater sense of control and more adaptability skills
compared with a control group (Astin, 1997). S. Shapiro, Schwartz,
and Bonners (1998) study with medical and premedical students
revealed similar reductions in anxiety and depression as well as
increased empathy levels. Another controlled study of medical
students showed a significant decrease in total mood disturbance
among participants as compared with the control group (Rosenzweig, Reibel, Greeson, Brainard, & Hojat, 2003). Using both qualitative and quantitative methods, a study of nursing students found
a significant drop in psychological symptoms and higher levels of
life quality after participating in an MBSR program (Bruce,Young,
Turner, Vander Wal, & Linden, 2002). Although his study was not
a controlled study, Holland (2004) reported that college students,
including those with disabilities and chronic illness, found MBSR
to help them cope with daily stressors.
Despite limitations noted by S. Shapiro et al. (2000) and Bishop
(2002), evidence continues to point to a notable positive effect of
MBSR-based programs on many clinical and student cohorts.
However, one shortcoming of quantitative research, which relies
on preselected measures and scales, is that respondents are not able
to freely express outcomes experienced because of the programs.
Narratives (i.e., oral accounts and journals) offer a unique avenue
of inquiry with the aim of qualifying an individuals or a groups
experience (Giorgi, 1985; Patton, 1999; Van Manen, 1990). Consequently, existing research on MBSR needs to be supplemented by
qualitative methods that can explore in a more open-ended manner
the range of possible effects of an MBSR program on the different
domains of participants lives. In addition, more nuanced research
is needed to detail the specific practices that have a positive effect
on participants. Bruce et al. (2002) provided the only identifiable
study that used qualitative techniques (focus groups) to collect
process, impact, and outcome data on an MBSR program.
No study has been conducted examining the influence of mindfulness practices on counseling students. The current study seeks
to address this by using qualitative methods to explore counseling
students perceptions of the influence of mindfulness practices on
their lives (broadly defined) and their work with clients. In addition, this study examined which of three mindfulness practices
the students found most influential and how students envision
integrating mindfulness practices into their future career.
48

Method
Participants
Participants in this study were 1st- and 2nd-year masters-level
graduate students in mental health counseling, school counseling, and marriage and family counseling who were enrolled in
an elective graduate course titled Mind/Body Medicine & the
Art of Self-Care. Data were collected from 33 participants over
a span of 4 years. The age of the participants ranged from early
20s to mid-50s. There were 27 female and 6 male students; 30
were White, 2 were Japanese, and 1 was Native American. A total
of 35 students were enrolled in the class over the 4-year period;
2 students were excluded from this study because they were not
in a counseling program.
Course Description
The 15-week, three-credit elective course had a twofold purpose
of (a) familiarizing students with mindfulness and contemplative
practices and their relevance for the fields of counseling, psychotherapy, and behavioral medicine and (b) providing students with
practical tools for self-care. This course was loosely based on the
MBSR program. The course was taught by a core faculty member
of a counseling graduate program accredited by the Council for
Accreditation of Counseling and Related Educational Programs.
The instructor (second author) was a licensed counselor and psychologist who had been practicing yoga and meditation for more
than 20 years. The instructor had been a licensed yoga teacher for
20 years and began teaching MBSR in a community hospital 2
years prior to developing and teaching the counseling class.
The course included twice-weekly, in-class, 75-minute mindfulness practice using hatha yoga, sitting meditation, qigong (ancient
Chinese method combining gentle physical movement with
meditation), and conscious relaxation techniques. On the basis of
the instructors previous experience teaching MBSR programs,
qigong exercises were adopted instead of the body scan exercise.
Participants were required to practice outside of class for at least
45 minutes, four times a week. The course also included readings
from disciplines such as psychological and medical anthropology,
behavioral medicine, religious studies, cross-cultural psychology,
and psychiatry. Participants were assigned relevant readings,
conducted research on related empirical studies, and completed a
continual journal-writing exercise for reporting and reflecting on
readings, practice, and related personal experiences. Class time
was also spent discussing and sharing thoughts and feelings about
readings and practice. Students were graded on attendance and
participation, journal writing, and research presentations.
Procedure
As a final journal assignment, students were given four questions to respond to and submit in writing:
1. How has your life changed over the course of this
semester in ways that may be related to the class?
2. Of all the practices learned in class, which one are you
drawn to the most and why? How has it affected you?

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MindBody Medicine and the Art of Self-Care

3. How, if at all, has this course affected your work with
clients, both in terms of being in the room and thinking
about the treatment?
4. How do you see yourself integrating, if at all, any of the practices from class into your clinical practice (or career plans)?
Students received no direction on how long their answers
should be, and they were informed that completing the assignment would result in a passing grade for that portion of their
journal (i.e., they received no letter grade for this assignment).
Students had the option of not having their responses included
in the study. No students chose to withhold their data.
Analysis
Students turned in their responses either as hard copy documents or
as word processing files. The course instructor removed identifying
information from the documents and word processing files and
forwarded them to the first author. Student responses were stored
anonymously and were entered verbatim into word processing software and analyzed using NVivo (Software in Qualitative Research
NVivo Version 1.2) qualitative data analysis software. Responses
to the four questions were analyzed by the first author through the
use of qualitative methods described by Guba and Lincoln (1992),
Strauss and Corbin (1994), and Patton (1987, 2002). Cross-case
analysis was conducted in which responses from each question were
analyzed across the case or individual (Huberman & Miles, 1994).
Analysis was focused on the participants answers to the four open-

ended questions. The first author read through all transcripts, first, to
become familiar with the data and get a general understanding of the
text. Next, he conducted content analysis by reading the transcripts
again and deciding on labels for the phenomena identified. Data were
analyzed inductively, meaning that themes emerged from the data
instead of being decided a priori (Patton, 1987). Emerging themes
were examined, compared, and revised by the first author as new
text was analyzed. The third author independently coded a random
10% of the coded text for validity and congruence. The two authors
convened to discuss the results of their separate coding. To eliminate
bias and protect anonymity and confidentiality, the course instructor
did not code the data. When analyzing themes across course years,
the first and third authors did not find any notable differences in
participant responses. Both coders had extensive training and experience coding qualitative data.

Results
Questions and themes are shown in Table 1. Five general
themes emerged in response to the question of how the course
had affected students after 15 weeks: (a) physical changes,
(b) emotional changes, (c) attitudinal or mental changes, (d)
spiritual awareness, and (e) interpersonal changes.
Question 1: Short-Term Effects of Course
Physical changes. Many students noticed changes in their
bodies as a result of class practice. Positive changes included

Table 1
Questions and Related Themes and Subthemes Associated With Student Participation in MindBody Medicine
Question

Theme and Subtheme

How has your life changed over the course of this semester in ways
that may be related to the class?

Physical changes
Emotional changes
Attitudinal or mental changes
Spiritual awareness
Interpersonal changes

Of all the practices learned in class, which one are you drawn to the
most and why? How has it affected you?

Yoga
Increased awareness of body
Increased flexibility and energy
Increased mental clarity and concentration
Meditation
Increased awareness and acceptance of emotions and personal
issues
Increased mental clarity and organization
Increased tolerance of physical and emotional pain
Increased sense of relaxation
Qigong
Increased feelings of centeredness
Increased energy
Increased sense of mindbodyemotion connection
Increased sense of fluidity

How, if at all, has this course affected your work with clients, both in
terms of being in the room and thinking about the treatment?

Increased comfort with silence

More attentive to therapy process
Change in how therapy is viewed

How do you see yourself integrating, if at all, any of the practices from Integration of class ideas
class into your clinical practice (or career plans)?
Recommending specific practices
Incorporating practices into therapy
Continuing personal practice

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Schure, Christopher, & Christopher

increased strength, flexibility, and balance and the ability to
trust their bodies. One student expressed the following:
I also think my body is changing. I notice more balance, leg
strength, overall flexibility and a slight weight loss. I have more
aerobic capacity, which I have particularly noticed with biking
or hiking. My ability to balance on my left leg, which had the
nerve damage, is continuing to improve a bit at a time.

Some students shared that their bodies initially reacted negatively to practice but that ultimately they saw positive outcomes
as a result of committing themselves to their practice.
At first when I started the practice, my body ached and my
shoulders became even stiffer. I felt uncomfortable and wanted
to quit the practice. However, as I kept practicing, I noticed that
my shoulders are getting better. My body became more flexible.
I did not catch a cold at all in the last winter regardless that I
usually get a cold at least a couple of times in winter. I feel that
my body is more energized even in the morning. These are many
positive physical changes that I am grateful for.

Several students mentioned how their increased bodily

awareness, and its connectedness with the mind, has enabled
them to take better care of themselves.
As far as physical ailments, I feel as if I know my body a lot
better and I am able to recognize when I am starting to feel
ill and then I slow down and take care of myself.

Participants experienced a variety of physical effects: (a)

improvements in balance, strength, and flexibility; (b) other
health benefits that they associated with practice; and (c)
increased bodily awareness and sensitivity.
Emotional changes. Students commonly mentioned having
to deal with multiple stressors in their lives and the resulting
consequences of stress overload (e.g., anxiety, depression,
fears). The majority of students reported that, as a result of
the course, they developed an increased ability to deal with
strong and threatening emotions.
This course has given me the time, space and urging to increase
awareness, slow down and be more present, and to continue to
let go of fears, anxiety, self-criticism, and doubt, . . . allowing
me to just be in the moment, feel, accept, and trust.

In addition to giving students the time and space needed to turn

inward and experience their emotional reactions, students indicated that the mindfulness practices also offered techniques for
being less defensive and reactive and for being less attached to
their emotional responses, as the following person explained:
I was surprised at how emotional the class was on many levels.
My experience with slowing down and letting go was something
I have not done for years. . . . Class gave me a tool to work with
in terms of letting go of things. I feel as though now I process
and reflect on things until I have some sort of peace with them.
I have a lot of room to grow, but it is nice to have a start.

50

Students indicated that the course offered new ways of responding to fears, anxieties, doubts, and other strong negative
emotions. Furthermore, the ability to experience but also let
go of these feelings allowed room for more positive feelings
of trust and peace in their lives.
Attitudinal or mental changes. Students often expressed
changes in their thinking and attitudes as an effect of being more
open and conscious of themselves and their surroundings. For
example, one student stated simply, I am opening myself up to see
beyond the grind toward alternative ways of living and thinking.
Another expressed the correspondingly positive outcomes: Personal benefits include a greater ability to observe and process.
Related to self-understanding, acceptance was a common term
used by students to express their thought and attitude changes.
Through exploring the required readings, I have become more aware
of what it means to be whole and have begun to see the importance
of integrating the aspects of myself that I had previously abandoned.
Although the process of reintegration is a long and arduous process,
I have begun to explore this abandonment and what it would mean to
reintegrate aspects I consider to be difficult and painful and through
this, beginning to accept my flawed self.

Students indicated an increased capacity to make meaningful reflections regarding themselves. These mental changes
were often discussed in terms of changes in attitude and
perception. For others, these changes resulted in a better
understanding of themselves and incorporating aspects that
made them feel more whole as an individual.
Spiritual awareness. The course content and subsequent
discussions seemed to affect students by challenging their
beliefs and/or causing them to reflect on deeper aspects of their
lives. The resulting personal dialogues also covered ideas of
direction or purpose in ones life, as one student illustrated:
Regarding spirituality, my connection with a higher power seems
to have been strengthened, in a sense, renewed throughout the
semester. I came to believe more that I am here for some purpose,
to fulfill something meaningful in my life and in this world.

The class also led some to evaluate their own beliefs and values.
This class has also led me to explore my own belief system
and has expanded my knowledge about differing views of the
world, life and spirituality. I can honestly say that this class
has caused me to think about the kind of person that I am, and
also the kind of person that I want to be. This class has been
an important reminder of the things that matter in life in the
middle of the craziness of school.

Consequently, students frequently discussed an increased

trust of themselves and a greater self-confidence. As one student
explained, I feel more grounded and Im trusting my own perceptions more. . . . I feel more confidence in my decision making.
Another student stated,

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MindBody Medicine and the Art of Self-Care

This class has definitely aided in my self-exploration. I feel like I have
finally regained some of the confidence that I was lacking. I now
know that life is a journey, and I am the leader of this expedition.

The course seemed to have a profound effect on some students

lives, giving them purpose and direction. It caused students
to reflect on and evaluate their own belief system and values.
In addition, this exploration of self subsequently instilled a
greater sense of confidence and trust in some individuals.
Interpersonal changes. Students often reported changes in
relationships and their ability to handle social situations that
they normally might react to negatively.
I am learning to take responsibility for my own feelings, and
at the same time, not to take things personally. Disagreements
with my partner appear no longer threatening. I am able to
express my feelings more straightforwardly to him recently,
because I believe that my thoughts and feelings matter. Also, if
he does not like what I say to him, I know that it does not mean
he rejects who I am. Finally, I believe that I can work on my
own issues and improve my relationship with myself as well
as with my partner. This class truly changed my life. Every
relationship I have seems to be improving dramaticallymy
parents, clients, peers, partner, coworkers and friends.

An increased capacity for empathy toward others was mentioned frequently.

I have been noticing my capacity for empathy has increased as I
have been engaged in this class. I have a notion this is the result of
becoming aware when I am being judgmental of others or myself.
I have increased my compassion, which in turn, has given me an
increased capacity to have more genuine compassion for others.

Many students perceived positive effects on their relationships

and stated an increased capacity for empathy and compassion.
Question 2: Preferred Practices for Self-Care
The main practices in this course included yoga, meditation, and
qigong. Students were asked which practice(s) they were most drawn
to and why. Results are presented under each practice type.
Yoga. As a mindbody exercise, hatha yoga seems to have
offered multiple benefits to students of this course. Through
its gentle, yet demanding physical postures, yoga offers opportunities for participants to become more aware of their
bodies. One student summarized it this way:

What I like the most about yoga is not only how good it feels,
but the sense of satisfaction I get when I get into a particularly
difficult pose and am able to hold it. When we release the pose
I feel so loose and free. It just works for me and the emotions
are difficult for me to describe, but I guess I can equate it to
energy being able to flow more freely.

Another student stated multiple benefits of yoga that included

increased mental clarity and concentration.
I have said before that Yoga is an amazing high yield investment. The investment of an hour a day makes an immeasurable difference in the rest of my day. For a little investment,
I receive high yields. This includes high energy, fluidity and
mental clarity. This baseline allows me to relate better to other
people and especially relate to my clients.

Yoga offered different and sometimes multiple benefits across

individuals. Perceived benefits ranged from consciousness of
ones body and its capabilities, satisfaction from challenging
oneself physically, and increased energy and mental clarity
and concentration.
Meditation. Because mindfulness meditation practice
is concerned with paying attention to arising thoughts and
emotions, it is not surprising to find that many students discussed their meditation experiences as being emotionally and
mentally involving. For example, one student described her
practice in terms of being powerful:
Meditation has given me the most powerful experiences emotionally. I have found myself face to face with my inner issues
while meditating, which has been powerful. I have felt not only
the struggle with them, but more of an acceptance of them.

Meditation seemed to allow a space for dealing with difficult

emotions that arise or, as this student described, creating a
therapy room:
Meditation especially helps. Sitting quietly and concentrating on
self are useful in order to clear and organize my mind. When I
meditate, what I am really concerned would come up toward my
mind, then all feelings along with it would show up. I can look at
my feelings that I do not want to notice. I am able to observe them
more objectively during meditation. I feel safe because nobody
can read my mind. Meditation creates my own therapy room.

Finally, a student illustrated how meditation affected his own

self-concept, ability to practice patience, and ability to tolerate
physical discomfort:

I like Yoga because I feel as if I am learning more about my

body. I am learning about its capabilities, limits, cycles, and
changes. I feel as if I am finally connecting with my body and
learning how to use it. . . . It is great to learn that I am capable
of more than I thought, and not just on certain days.

I believe that my effort at practicing meditation has led to some

important insights about myself. I think it has helped in my ability
to consciously slow my thoughts and to an extent note and let go
of arising emotions. It has been effective at relaxing and calming
myself in the evening. I think it has taught me greater patience and
given me more resilience to physical pain and discomfort.

For many students, the challenge of yoga had benefits in terms

of increased flexibility and energy.

Like yoga, meditation appeared to have different benefits to

each individual. Meditation offered a tool for dealing with

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Schure, Christopher, & Christopher

powerful emotions. For certain students, this led to selfacceptance and insights about themselves and increased
awareness for their own capacity of pain.
Qigong. The gentle fluid movements of qigong had a
positive impact on several students. For example, this student
compared its qualities with dancelike movements:

More attentive to therapy process. Many students responded that they had an increased ability to be more attentive
and responsive to their clients during the therapy process. For
example, one student expressed the following:

I think innately I am most drawn to qigong. I love the fluidity

and feel of doing it, the sensuous movement, almost as though
my body remembers. I particularly love how quickly it changes
memy breath, mood, energy, and awareness. I love the feel
of the energy moving through my body, like a dance. Its a
practice I can do in a short amount of time, ten minutes before
a meeting or out of doors. It centers me.

I think that this course has helped me to feel less anxious in

the room with clients. I think that this results in me being able
to be more present, and being able to have more empathy for
experiences they share with me. I think before this class my
anxiety would override other feelings at times, and it was
harder to be in touch with these. And even beyond the affective
realm, I think that being mindful and more centered allows
me to look outside of myself more, and observe my clients
and my relationship with them more.

Another student emphasized the mindbody connection she

felt and how it affected her emotions:

Similarly, another student described how the class positively

influenced counseling relationships:

On the most conscious level, I have practiced qigong the most

(on my own). It is here that I feel the most organic flow of energy,
and the aesthetics of dance in the movements. It is here that I feel
the conscious connection of my mind, body, and emotions, and
that emotional component is of great importance to me.

I am more in-tune with myself, my body, and my reactions and

pulls to clients which I may choose to act on or simply take
note of. Also in being more in-tune as well as trusting, I am
taking more risks, being more vulnerable. I believe this directly
impacts the sense of trust and connection with clients and serves
as a model to them. It also seems that I am in a better position to
help clients be in touch with their feelings, their needs, moments
of truth, their defenses and coping mechanisms and triggers for
all if I am better at this process myself and in the position to
see what is happening for them in the room.

Compared with the other practices, qigong seemed to evoke

a sense of fluidity from which positive feelings and energy
flowed. For certain individuals, the movements positively affected mood, emotion, and consciousness.
Question 3: Influence on Counseling Practice
All students taking this course were seeing clients in a supervised clinical setting. The course affected students therapy practice in several ways. It allowed many to be increasingly more
comfortable with silence during sessions. Students also were
able to focus more on their clients and the therapeutic process.
Finally, some students expressed how ideas from the course
changed their views about therapy and the healing process.
Increased comfort with silence. A number of students described an increased ability to be with clients in moments of
silence or discomfort and not feel a need to control the situation because of their own anxiety. One student wrote,
As a result of my work in this class, I feel as if I am less reactive to my clients. . . . I also find that I am more comfortable
with confronting clients now than I ever have been. . . . I am
finding that it is much easier to sit with a client when they are
having a difficult time, or not wanting to talk.

Another student explained how an increased comfort with

silence allowed her to be more present and aware of what was
happening with a client:
I feel less pressure to fix or talk so much in session. I am
more comfortable with listening, sitting in silence, and just
being present. Mindfulness is after all about being present and
aware. In other words the course has helped me focus more
on the client, instead of believing I have to do something
to change the client, or relieve their pain.

52

Change in how therapy is viewed. Finally, the course seemed to

significantly affect many students attitudes and ideas about counseling. For example, the following student recognized the roles of
both physical and spiritual dimensions in the nature of well-being:
I think that I have been aware for quite a while that sometimes
doing something physical can bring on therapeutic issues, and
this class definitely reinforced this for memainly by watching
some of my classmates who had emotional responses to different practices. I find this very encouraging, as this has seemed
to provide another example of a mode of treatment that may be
therapeutic for some people. I also think that my view of counseling has changed somewhat in that this class seemed to emphasize
the importance and power of having a spiritual orientation and
practice on my well-being. This seems to highlight the importance
to at least explore with people about their spirituality.

The course seemed to have positively affected students in

three distinct ways. First, many felt more comfortable sitting
with silence in the room with clients. Second, it allowed some
to feel more centered and capable of staying tuned with the
therapeutic process with clients. Third, it changed the scope
of how some view therapy and its components.
Question 4: Plans for Integrating Mindfulness Into
Future Practice
Most students indicated that they would make positive use out of
ideas and practices learned in class and apply them to their own
profession. One response category that emerged was the idea of

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MindBody Medicine and the Art of Self-Care

integrating specific practices into therapy sessions. For example,
one student explained how certain practices could help clients
through the therapeutic process:
I would definitely like to use relaxation and meditation techniques during sessions with a large variety of clients: those
who are anxious, depressed, in chronic pain, and so on. I can
see these techniques being especially useful for people who are
working through intense emotional stuff so that clients have a
supportive way to endure the pain. In cases where clients are
feeling very stuck in therapy, relaxation, yoga, and meditation
could be useful in opening these clients up to themselves.

Other responses seemed to indicate the incorporation of ideas

and concepts from class into therapy.
The way I see myself using meditative practices with my clients
is mainly indirectly. I foresee that this practice will make me
more likely to incorporate opportunities for silent reflection
and internal processing within groups. It may encourage me
to push clients to just sit with things and see what arises, rather
than always doing something and avoiding space.

Some students were more comfortable with suggesting certain

practices to clients as a means of empowering them to cope
with the personal struggles.
With more practice and hopefully more training I see myself
recommending alternative practice to assist with their treatment. I believe it has been tremendously helpful in my life and
I would like to help my clients find a way that they can gain
more freedom in how they deal with their struggles.

Finally, many students expressed the importance of continuing

their personal practice because it translated into being a more
effective professional.
Students suggested a variety of ways they plan to integrate
practices into their clinical practice or career. For some,
simply continuing personal practice contributes to being an
effective professional. Integrating ideas from class into their
field offered another possibility to several students. Still others indicated recommending specific practices to clients or
incorporating them into their practice.

Discussion
The purpose of using a qualitative design in this study was to
gain insight into the influence of an MBSR-based course on
counseling graduate students. We wanted to allow the students to
share their information in an open-ended format in order to gain a
deep understanding of their experiences. This course had the dual
purpose of introducing students to the concept of mindfulness and
contemplative practices as well as providing them with practical
methods for self-care. The instructor asked students at the end of
the semester to answer questions about the effects of the course

on their lives (see Table 1). No notable differences in participant

responses were noticed when analyzing themes across years of
course attendance. The data were particularly meaningful given
the consistency of positive outcomes over time and with multiple
groups of participants for which this course was offered. We note
that not all students experienced each of the 15 themes.
Student responses to short-term physical changes of the course
revealed meaningful effects on physical, emotional, mental, spiritual, and interpersonal aspects of their lives. In the first theme
of physical effects, many responses supported the idea that yoga
promotes flexibility, strength, and balance. Several participants
expressed an additional benefit of getting sick less frequently
than normal while taking the course. This statement appears to
suggest that mindfulness practices may improve immune systems,
which is similar to what was reported by Davidson et al. (2003).
Students also expressed an increased awareness and sensitivity
to their bodies. Such findings are congruent with those in Bruce
et al.s (2002) study with nursing students. It is encouraging to
see these results given that these practices encouraged mindful
attention and sensitivity to bodily movements and states.
Emotional changesthe increased ability and capacity to deal
with so-called negative emotionscomposed a second theme of
short-term effects. Through this course, students were given the
time, space, and tools to address fears, anxieties, and doubts that
contributed to their stress. Students indicated making progress
in both accepting and letting go of these negative emotions and
thought patterns. For some students, this process was a challenging and sometimes frustrating task. Yet almost all students
indicated that the process ended in an overall positive outcome.
Findings from this study are congruent with controlled MBSR
studies that found lower anxiety and depression levels (Astin,
1997; S. Shapiro et al., 1998; Speca et al., 2000; Teasdale et al.,
2000) and increased quality of life because of program participation (Carlson et al., 2004; Roth & Robbins, 2004).
Increased clarity of thought and capacity for reflection were
often mentioned as beneficial mental effects of practice. Many
students experienced changes in attitudes and perceptions. By
engaging in course-taught practices and exploring ideas from
readings, students tapped into previously unexplored modes of
awareness and experienced new ways of relating to themselves
and their worlds. Such effects may be a direct result of the
process of slowing down the mind and its constant thought
patternsan often-stated occurrence of meditative practices
(e.g., Goleman, 2003; Kabat-Zinn, 1990; Welwood, 2000).
Students also reported effects on their belief and value systems. Given that course content included readings from different
cultural traditions, it is understandable that students would feel
challenged to reevaluate their own beliefs about themselves and
their world. Yet this effect seemed to strike deeper among some
participants by instilling a greater sense of reported trust and
confidence about themselves. Several individuals also reported
an increased sense of purpose and direction in their lives. Similar responses were reported in Bruce et al.s (2002) study. These
statements are supported by the concept of feeling grounded,
a frequently mentioned concept among participants.

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Schure, Christopher, & Christopher

The last theme of effects, interpersonal changes, is illustrated by students reports of a greater capacity for empathy and
compassion. This increased capacity is related to previously
mentioned changes in perception and attitude, mental clarity, and
enhanced listening abilities. In counseling sessions, this translated
into feeling more comfortable sitting in silence with clients and
being able to stay focused on the therapeutic process at hand.
Clearly, participants came away with positive outcomes
from participating in the course and stated potential implications for continuing practice and integrating the course concepts into their profession. Although many believed that they
could incorporate practices or ideas into their work either with
future clients or work associates, others were more comfortable in simply recommending ideas and resources related to
course practices. Finally, some students simply believed that
their professional lives would greatly benefit by continuing
with their own personal practice. We also believe that given
the recent popularity of mindfulness practices, particularly
yoga, it is beneficial for counselors to have firsthand experience with the kind of self-care techniques that their clients
may already be using. This is particularly significant given
the potential of these practices to facilitate personal growth
or be used defensively to avoid confronting personal issues or
psychopathology (Rubin, 1996; Welwood, 2000).
It would be beneficial to conduct a longitudinal study of students
who took this class to explore (a) the use of and obstacles to mindfulness practices as a form of self-care; (b) the perceived influence
of mindfulness practices on their counseling skills, practice, and
theory; (c) the influence of mindfulness practices on stress and
burnout; and (d) the use of mindfulness practices with clients. In
addition, given our preliminary findings and the lack of empirical
research, there would be merit in undertaking additional studies
with counseling students that include larger sample sizes, control
groups, and the use of quantitative measures. One advantage of
qualitative studies is that they enable the identification of themes
that may be used in future quantitative studies. We recommend
future quantitative studies to verify if the themes identified in this
study are found with other groups in other settings, which would
offer evidence of the reliability of these study findings.
In addition, it would be important to assess the effect of mindfulness training with counseling students with measures used in
other MBSR studies, including (a) measures of physical health
such as salivary cortisol, blood pressure, and pulse and (b) measures of psychological health including subjective well-being (the
Satisfaction With Life Scale [Diener, Emmons, Larsen, & Griffin,
1985] and the Positive Affect Negative Affect Scale [Watson,
Clark, & Tellegen, 1988]) and the Ryff Scales of Psychological
Well-Being (Ryff, 1989). We also believe that it would be useful
to include the Social Interest Scale (Crandall, 1975), the Life Attitude Profile (Reker & Peacock, 1981), the Revised Ego-Identity
Status Scale (Adams, Shea, & Fitch, 1979), the Therapeutic Reactance Scale (Dowd, Milne, & Wise, 1991), the Differentiation
of Self Scale (Bowen, 1978), the State-Trait Anxiety Inventory
(Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983), the
Empathy Construct Rating Scale (La Monica, 1981), the Mul54

tidimensional Measure of Religiousness/Spirituality (Ables et

al., 1999), and the Index of Core Spiritual Experiences (Kass,
Friedman, Leserman, Zuttermeister, & Benson, 1991). Finally,
in-depth individual interviewing might provide more depth of
understanding regarding participants perceived results.
This study has two main strengths. First, qualitative studies
such as this one can provide an open-ended exploration of the influence of mindfulness practices across all domains of a persons
life and are an important first step in identifying areas for future
research. Second, this study was based on data collected over a
4-year period, and results were consistent across class cohorts.
A limitation of the study is reliance on self-reported information. In addition, students had to respond to these questions as a
part of their course requirement. Students may have felt pressure
to provide positive answers to the questions, knowing that their
responses would be viewed by the course instructor. However,
students did not receive a letter grade for the assignment and
were informed that their responses would be stored and analyzed
anonymously at some point in the future. Because this was an
elective course, students who took this course may have had a
preexisting interest in the subject, which may have affected their
responses. It is also possible that personal characteristics may
have influenced the results. We did not gather personal information, other than gender and ethnicity, and did not compare data
across these categories. However, we did not note any substantive
differences across years of data collection or across participants.
Finally, although students reported that the changes they experienced were because of the course, we did not have a control
group in the study for comparison and thus verification.
This study has demonstrated that counseling students enrolled in
this MBSR-based self-care class experienced positive influences in
their personal and professional lives. This supports findings that students in other health care professions, such as medicine and nursing,
also benefit from MBSR (Bruce et al., 2002; S. Shapiro et al., 1998).
Counseling training programs often emphasize health promotion,
self-transformation, and spiritual balance, but the demands of the
curricula and clinical training often leave little room for self-care.
Our experience teaching MBSR and the reported responses from
the student participants suggest that training programs can benefit
from incorporating mindfulness practices as specific tools for selfcare. Mindfulness practice has the potential to transform counseling
trainees in a number of ways, including helping them to become less
reactive to stress-related or anxiety-provoking events such as when
clients are in crisis or are discussing painful emotions. Counseling
students can also conceivably gain new ways of relating to their emotional life that include awareness and tolerance. Instead of responding
with defensiveness and reactivity, mindfulness disciplines can assist
counselors to become more present and connect more intimately
with themselves, their clients, and their supervisors (Epstein, 1995;
Magid, 2002; Rubin, 1996; Safran, 2003). To conclude, we can do
no better than turn to the words of one student:
I suppose it is this experience of connectedness that has affected
my thoughts and questions about healing most significantly.
Whether its moving forward or back, I ask more frequently and,

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MindBody Medicine and the Art of Self-Care

I think, more deeply what is therapy, anyway? How do we heal
ourselves and what can we provide for one another that can help?
From the first tears of a client to my DSM diagnosis [i.e., diagnosis found in the Diagnostic and Statistical Manual of Mental
Disorders, 4th ed., text rev.; American Psychiatric Association,
2000] to the last handshake or hug, contemplation, which I think
of as a spiritual awareness, is at the center of my relationship to
them; I hope that it will remain at the center of my work.

References
Ables, R., Ellison, C., George, L., Idler, E., Krause, N., Levin, J., et al.
(1999). Multidimensional measurement of religiousness/spirituality for
use in health research. Kalamazoo, MI: Fetzer Institute/ National
Institute on Aging Working Group.
Adams, G. R., Shea, J., & Fitch, S. A. (1979). Toward the development
of an objective assessment of ego identity status. Journal of Youth
and Adolescence, 8, 223237.
American Psychiatric Association. (2000). Diagnostic and statistical manual
of mental disorders (4th ed., text rev.). Washington, DC: Author.
Astin, J. (1997). Stress reduction through mindfulness meditation.
Psychotherapy & Psychosomatics, 66, 97106.
Baker, E. K. (2003). Caring for ourselves: A therapists guide to
personal and professional well-being. Washington, DC: American
Psychological Association.
Bishop, S. (2002). What do we really know about mindfulness-based
stress reduction? Psychosomatic Medicine, 64, 7184.
Bowen, M. (1978). On the differentiation of self. In M. Bowen
(Ed.), Family therapy in clinical practice (pp. 467528). New
York: Aronson.
Brems, C. (2001). Basic skills in psychotherapy and counseling.
Belmont, CA: Wadsworth/Thomson Learning.
Brennan, P. L., & Moos, R. H. (1990). Life stressors, social resources,
and late-life problem drinking. Psychological Aging, 5, 491501.
Bruce, A., Young, L., Turner, L., Vander Wal, R., & Linden, W. (2002).
Meditation-based stress reduction: Holistic practice in nursing
education. In L. E. Young & V. E. Hayes (Eds.), Transforming
health promotion practice: Concepts, issues, and applications (pp.
241252). Victoria, British Columbia, Canada: Davis.
Burnard, P., Edwards, D., Fothergill, A., Hannigan, B., & Coyle, D.
(2000). Community mental health nurses in Wales: Self-reported
stressors and coping strategies. Journal of Psychiatric and Mental
Health Nursing, 7, 523528.
Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2004).
Mindfulness-based stress reduction in relation to quality of life,
mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostrate
cancer outpatients. Psychoneuroendocrinology, 29, 448474.
Crandall, J. E. (1975). A scale for social interest. Journal of Individual
Psychology, 31, 187195.
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M.,
Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain
and immune function produced by mindfulness meditation.
Psychosomatic Medicine, 65, 564570.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life scale. Journal of Personality Assessment, 49, 7175.

Dowd, E. T., Milne, C. R., & Wise, S. L. (1991). The Therapeutic

Reactance Scale: A measure of psychological reactance. Journal
of Counseling & Development, 69, 541545.
Epstein, M. (1995). Thoughts without a thinker. New York: Basic
Books.
Giorgi, A. (1985). Phenomenology and psychological research.
Pittsburgh, PA: Duquesne University Press.
Goleman, D. (2003). Destructive emotions. New York: Bantam Books.
Guba, E. G., & Lincoln, Y. S. (1992). Effective evaluation: Improving the usefulness of evaluation results through responsive and
naturalistic approaches. San Francisco: Jossey-Bass.
Harris, N. (2001). Management of work-related stress in nursing.
Nursing Standard, 16, 4752.
Holland, D. (2004). Integrating mindfulness meditation and somatic
awareness into a public education setting. Journal of Humanistic
Psychology, 44, 468484.
Huberman, A. M., & Miles, M. B. (1994). Data management and
analysis methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (3rd ed., pp. 428444). Thousand
Oaks, CA: Sage.
Kabat-Zinn, J. (1990). Full catastrophe living. New York: Delta.
Kabat-Zinn, J., Chapman, A., & Salmon, N. (1997). Relationship of
cognitive and somatic components of anxiety to patient preference for
different relaxation techniques. Mind/Body Medicine, 2, 101109.
Kabat-Zinn, J., & Chapman-Waldrop, A. (1988). Compliance with an
outpatient stress reduction program: Rates and predictors of program completion. Journal of Behavioral Medicine, 11, 333352.
Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use
of mindfulness meditation for the self-regulation of chronic pain.
Journal of Behavioral Medicine, 8, 163190.
Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher,
K. E., Pbert, L., et al. (1992). Effectiveness of a meditation-based
stress reduction program in the treatment of anxiety disorders.
American Journal of Psychiatry, 149, 936943.
Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M. J., Cropley,
T. G., et al. (1998). Influence of a mindfulness meditation-based stress
reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine, 60, 625632.
Kaplan, K., Goldenberg, D., & Galvin-Nadeau, M. (1993). The
impact of a meditation-based stress reduction program on fibromyalgia. General Hospital Psychiatry, 15, 284289.
Kass, J. D., Friedman, R., Leserman, J., Zuttermeister, P. C., & Benson,
H. (1991). Health outcomes and a new index of spiritual experience.
Journal of the Scientific Study of Religion, 30, 203211.
Kristeller, J., & Hallett, C. (1999). An exploratory study of a meditationbased intervention for binge eating disorder. Journal of Health
Psychology, 4, 357363.
Kuyken, W., Peters, E., Power, M. J., & Lavender, T. (2003). Trainee clinical
psychologists adaptation and professional functioning: A longitudinal
study. Clinical Psychology & Psychotherapy, 10, 4154.
La Monica, E. L. (1981). Construct validity of an empathy instrument.
Research in Nursing and Health, 4, 389400.
Lawson, K., & Horneffer, K. (2002). Roots and wings: A pilot of a mindbody-spirit program. Journal of Holistic Nursing, 20, 250263.

Journal of Counseling & Development Winter 2008 Volume 86

55

Schure, Christopher, & Christopher

Levy, R. L., Cain, K. C., Jarrett, M., & Heitkemper, M. M. (1997).
The relationship between daily life stress and gastrointestinal
symptoms in women with irritable bowel syndrome. Journal of
Behavioral Medicine, 20, 177193.
Magid, B. (2002). Ordinary mind: Exploring the common ground of
Zen and psychotherapy. Somerville, MA: Wisdom.
Miller, J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up
and clinical implications of a mindfulness-based stress reduction
intervention in the treatment of anxiety disorders. General Hospital
Psychiatry, 17(3).
Moore, K., & Cooper, C. (1996). Stress in mental health professionals: A theoretical overview. International Journal of Social
Psychiatry, 42, 8289.
Patton, M. Q. (1987). How to use qualitative methods in evaluation.
Newbury Park, CA: Sage.
Patton, M. Q. (1999). Myths as normative frames for qualitative
interpretation of life stories. Qualitative Inquiry, 5, 338352.
Patton, M. Q. (2002). Qualitative research & evaluation methods
(3rd ed.). Thousand Oaks, CA: Sage.
Reibel, D., Greeson, J., Brainard, G., & Rosenzweig, S. (2001). Mindfulnessbased stress reduction and health-related quality of life in a heterogeneous
patient population. General Hospital Psychiatry, 23, 183192.
Reker, G. T., & Peacock, E. J. (1981). The Life Attitude Profile (LAP):
A multidimensional instrument for assessing attitudes toward life.
Canadian Journal of Behavioural Science, 13, 264273.
Rosenzweig, S., Reibel, D. K., Greeson, J. M., Brainard, G. C., &
Hojat, M. (2003). Mindfulness-based stress reduction lowers
psychological distress in medical students. Teaching and Learning in Medicine, 15, 8892.
Roth, B. (1997). Mindfulness-based stress reduction in the inner
city. Advances, 13, 5058.
Roth, B., & Robbins, D. (2004). Mindfulness-based stress reduction
and health-related quality of life: Findings from a bilingual innercity patient population. Psychosomatic Medicine, 66, 113123.
Rubin, J. B. (1996). Psychotherapy and Buddhism: Toward an integration. New York: Plenum Press.
Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on
the meaning of psychological well-being. Journal of Personality
and Social Psychology, 57, 10691081.
Safran, J. D. (Ed.). (2003). Psychoanalysis and Buddhism: An unfolding dialogue. Sommerville, MA: Wisdom.
Shapiro, D., & Goldstein, I. B. (1982). Biobehavioral perspectives on hypertension. Journal of Consulting and Clinical Psychology, 50, 841858.
Shapiro, S., Schwartz, G., & Bonner, G. (1998). Effects of mindfulnessbased stress reduction on medical and premedical students.
Journal of Behavioral Medicine, 21, 581599.
Shapiro, S., Shapiro, D., & Schwartz, G. (2000). Stress management in medical education: A review of the literature. Academic
Medicine, 75, 748759.

56

Sharkey, S., & Sharples, A. (2003). The impact of work-related stress of

mental health teams following team-based learning on clinical risk
management. Journal of Psychiatric and Mental Health Nursing,
10, 7381.
Speca, M., Carlson, L., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: The effect of a mindfulness
meditation-based stress reduction program on mood and symptoms of
stress in cancer outpatients. Psychosomatic Medicine, 62, 613622.
Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, P. R., & Jacobs,
G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto,
CA: Consulting Psychologists Press.
Strauss, A., & Corbin, J. (1994). Grounded theory methodology: An
overview. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of
qualitative research (pp. 273285). Thousand Oaks, CA: Sage.
Teasdale, J., Segal, Z., Williams, J., Ridgeway, V., Soulsby, J., & Lau,
M. (2000). Prevention of relapse/recurrence in major depression
by mindfulness-based cognitive therapy. Journal of Consulting
and Clinical Psychology, 68, 615623.
Treiber, F. A., Davis, H., Musante, L., Raunikar, R. A., Strong, W. B.,
McCaffrey, F., et al. (1993). Ethnicity, gender, family history of
myocardial infarction, and hemodynamic responses to laboratory
stressors in children. Health Psychology, 12, 615.
U.S. Department of Health and Human Services. (2000). Healthy
people 2010 (Vol. 2). Washington, DC: Author.
Van Manen, M. (1990). Researching lived experience: Human science for an action sensitive pedagogy. New York: State University
of New York Press.
Wall, T., Bolden, R., Borrill, C., Carter, A., Golya, D., Hardy, G., et al.
(1997). Minor psychiatric disorder in NHS trust staff: Occupational and
gender differences. British Journal of Psychiatry, 171, 519523.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and
validation of brief measures of positive and negative affect: The
PANAS scales. Journal of Personality and Social Psychology, 54,
10631070.
Weiss, L. (2004). Therapists guide to self-care. New York: BrunnerRoutledge.
Welwood, J. (2000). Toward a psychology of awakening: Buddhism,
psychotherapy, and the path of personal and spiritual transformation. Boston: Shambhala.
Whitehead, W. E. (1992). Behavioral medicine approaches to gastrointestinal disorders. Journal of Consulting and Clinical Psychology,
60, 605612.
Williams, D. R. (1999). Race, socioeconomic status, and health: The
added effects of racism and discrimination. Annals of the New
York Academy of Sciences, 896, 173188.
Williams, K., Kolar, M., Reger, B., & Pearson, J. (2001). Evaluation
of a wellness-based mindfulness stress reduction intervention:
A controlled trial. American Journal of Health Promotion, 15,
422432.

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