 ABSTRAC T. Objectives: To assess the effects of Vipassana meditation on the physical and psychological health in a multi-ethnic popu- lation in the city of Muscat. Method: The subjects were participants of a Vipassana meditation course taught in a ten-day residential retreat. Self-assessments of health-related parameters and physical and psychological symptomatology were collected from them before and immediately after the course. A control group was tested for a similar time interval. Results: Immediately after their -day training, the Vipassana participants assessed themselves significantly higher compared to their levels prior to the course, suggesting that the  days’ practice had significantly improved their physical and psychological well-being. The control group did not exhibit such changes. Con- clusion: The present preliminary findings, juxtaposed with the results of studies from other parts of the world, suggest that the practice of Vipassana meditation may help mitigate psychological and psychosomatic distress. Key words: Vipassana, meditation, stress, physiological, psychological, Oman. 1Department of Behavioural Medicine, College of Medicine, Sultan Qaboos University, P.O. Box: , Al-Khod , Muscat, Sultanate of Oman. 2Department of Mathematics and Statistics, College of Science, Sultan Qaboos University, P.O.Box: , Al-Khod , Muscat, Sultanate of Oman. 3Vipassana Research Institute, Igatpuri- , Dist. Nashik, Maharashtra, India. *To whom correspondence should be addressed. E-mail: adawi@squ.edu.om V,        really are, is an ancient technique to improve concen-tration and self-awareness through meditation. e theory and philosophy of Vipassana have been extensively reviewed elsewhere.1–3 Vipassana seeks self transforma- tion through self observation, where the meditator pays disciplined attention to the physical sensations that con- tinuously interact with and condition the mind.3,4 Being an ancient technique, many schools of Vipassana—both sectarian and non-sectarian—have evolved. Prominent among the non-sectarian approaches is the one adopted by S. N. Goenka and Assistant Teachers in their ten-day residential courses conducted in many countries includ- ing UAE and Oman.3–6 One of their courses conducted in Oman provided data for this study. Vipassana’s observation-based journey to the common root of mind and body is expected to reduce the tendency of the mind to dwell on the past (thereby reducing regrets), or to delve into the future (thus lowering expectations and anxieties), helping the participant to remain in the ‘here and now’ and achieve relative mental tranquillity.1,3,4,7,8 Both traditional and clinical literature suggest that Vipassana practice increases awareness, promotes integra- tion of subjective experience and facilitates acceptance and tolerance to sufficiently reduce physical and psychological distress.2,3 With the advent of invasive measurement tools, there is also evidence that changes reported from non- invasive assessment measures are accompanied by altered physiological parameters.9 If a technique has universal application, then it ought Vipassana meditation: A naturalistic, preliminary observation in Muscat Ala’Aldin Al-Hussaini1, Atsu S.S. Dor vlo2, Sajjeev X. Antony1 Dhananjay Chavan3, Jitu Dave3, Vimal Purecha3, Samia Al-Rahbi1, *Samir Al-Adawi1     :   , : , : , – ©     to transcend cultural barriers and show its efficacy in all populations. Studies in the West on meditative techniques akin to Vipassana have demonstrated enhancement in functional status, and physical and mental well-being in practitioners.10 Studies in Asia have also reported simi- larly.2,6,7 Among the most intriguing of these cross-cultural studies have been the ones conducted among prisoners where Vipassana meditation reportedly improved the inmates’ mood and behaviour. 2, 6, 11 ere is a need for the quantification of the relevance of these health-promoting techniques in other regions of the world, especially in the Middle East.12 Lack of reports from the Arab world prompted the need for testing the effect of Vipassana meditation on the health-related quality of life and physical and psychological symptomatology in the residents of this region. e present study was therefore designed to test the hypothesis that Vipassana training could improve the health-related quality and impact on physical and psychological symptomatology in a multieth- nic population like that in Oman. M E T H O D     e study constituted a naturalistic experiment with  Vipassana participants who were voluntarily attending a ten-day residential meditation course in Muscat, Oman, during July . e participants were tested twice, once at the beginning of the -day course and thereaer upon completion of the course. e control group consisted of  students of Sultan Qaboos University. ese students did not take part in the meditation sessions but were given the same assessment instruments both at the beginning and at the end of the -day period. Being a naturalistic experi- ment, the groups were not initially matched for specific factors that could arise by chance. Vipassana meditation course requires the novice to maintain strict silence for  days except to clear doubts with the teacher or to solve material problems with volun- teers. e meditators are permitted to break their silence on the morning of the th day, to facilitate their transition back to the outside world. e course ends the th day morning. Prior to start of the course, a brief explanation of the study was given to the participants and they were assured that the data and results would be treated confidentially. eir oral consent was then taken. e control group stu- dents were also similarly assured and their oral consent obtained. Both the groups were assessed twice. e first assessment () was administered just before the start of the - day meditation training session. e second assessment () was done immediately aer the conclusion of the training. Even though the group of students did not take part in the training, their assessment was done at the same time as that of the training group. Both the groups were asked during the assessment not to discuss the question- naire between themselves so as to avoid peer pressure.             All the participants were assessed with non-invasive meas- ures, via self-report questionnaires. In this study, it was not viable to collect biochemical markers or conduct clinical interviews to verify self-report data. Since the participants could elect not to fill the questionnaire, there was no obvi- ous reason for them to give inaccurate information. e subjective functioning data using Likert type self-report are described in the result. Conventional assessment measures were also used and included GHQ-, a -item scaled version of the original �������������������������������������������������������������� ���������������������������������������������������� � � ���� ��� ������ �� ���������� ��� �� ��� �������� ��� �� ��� � ������ ������ ��� ��� ��� ������ � � � � ���������������������������������������������������������������� ��������������������������������� � � ���� ��� ������ �� ���������� ��� �� ��� �������� ��� �� ��� � ������ ������ ��� �� ��� ������ � � � � ������������������������������������������������������������ ������������������ � � ����������� ������������� � �� ���������� �� �� ��� �������� �� ��� ��� � ������ ������ ��� ��� ��� ������ �   -               General Health Questionnaire (GHQ), with four subscales derived by factor analysis.13 ese include somatic symp- toms, anxiety and insomnia, social dysfunction, and severe depression. e validity of the subscales is discussed in Goldberg & Williams.14 e four subscales in GHQ- represent dimensions of symptomatology; thus more symptoms result in a higher score but high scores do not necessarily correspond to any psychiatric diagnosis. e present anal- ysis was derived from the composite score of GHQ-. e other conventional assessment measure used, the Hospital Anxiety and Depression Scale (HADS),15 is a -item ques- tionnaire with two -item sub-scales, one for depression and the other for anxiety. Symptoms are listed and subjects rate the frequency or severity of these during the preceding week on a -point scale (–), making a maximum possible score of  on each sub-scale. e original validation study for the HADS suggested that on either sub-scale, non-cases scored  or less, doubtful cases –, and definite cases  or more. Separate indices of anxiety and depression were recorded for the present analysis.            e statistical soware SPSS Version  for Windows was used to analyse the data. e summary statistics were computed for some of the demographic variables by group. Independent-sample t-test and paired t-test were used to compare group means. Cross-tabulation was used on the categorical variables and the chi-square (χ2) statistic and corresponding p-values computed were applicable. For × tables, Fisher-exact p-values were computed. R E S U L T S (i) Demographic information Fourteen subjects ( male and  female; mean age .±. years) participated in the Vipassana training session. irty-one subjects ( male and  female; mean age .±.) formed the control group. e two groups differed significantly in age (p<.). Being a naturalistic experiment, it was logistically not possible to balance ages between the groups. In terms of marital status, in Vipassana group,  were married and  were single. Among the con- trols, only  were married and the rest were single. (ii)  : Subjective functioning on Health-Related Quality of Life e subjective functioning pertaining to health param- eters are summarized below. Most participants believed in their own abilities to overcome difficult situations [Table ], with no significant difference between the two groups (p=.). Over  (/) of the participants agreed that faith or spiritual values helped them cope with pressures of life [Table ]. ere was no significant differences between the two groups, p=.. e control group perceived they had insufficient or poor financial resources [Table ], as is typical of students. e perceived fitness levels of the two groups were simi- lar [Table ]. irteen percent felt they were in excellent physical condition while  felt the opposite. (iii) Performance across  and  e subjective functioning of the participants is summa- rized in Table . In the first assessment, the majority (/ ) felt undecided whether they were happy or unhappy. However, the majority of the Vipassana group (/) felt happy about life in the first assessment itself. At the second assessment, four more participants from the Vipassana group indicated that they felt happy about life. All Vipassana meditators showed a pronounced improvement in Hospital Anxiety and Depression Scale and Modified General Health Questionnaire. Scores for  and  are presented in Table . Affective functioning e summary statistics of the Hospital Anxiety and Depression Scale are provided in Table . All the partici- pants of Vipassana showed a pronounced improvement in anxiety and depression. e drop in the anxiety level in this group was particularly significant: an average drop from  to . (p=.). On the other hand, the average                 � ������� ��� ���� ������� ��� ���������� ��������� ��� �������� ���� ���������� � � � � � � � �� �� �������������������� ����� ������������������ ����� ������������� ��������������� ��������������������� ����� �� �� �� ��� ��� �� �� �� �� � ������ ������   anxiety level of the control group increased marginally. e Vipassana group also showed a marked drop on the Depression score (p=.). Before meditation, they scored , but aer the course the score dropped signifi- cantly to .. General health ere were significant changes (p<.) between the  and  assessment using the Modified General Health Questionnaire (GHQ-). As can be seen from Table  and Figure , the control group’s total score remained relatively stable. In contrast, the Vipassana group showed steep reduction in the indices of psychiatric symptomatology, suggesting the retreat was effective in ameliorating their psychiatric symptomatology. D I S C U S S I O N In this age when many people seek alternative therapeutic methods, there is a dearth of research of the efficacy on such interventions in the population in the Middle East, and particularly in Oman. is pilot study has attempted to address this lack by examining the effects of Vipassana training on health-related quality of life and physical and psychological symptomatology in a heterogeneous group of subjects from among the resident population of Muscat. Studies from elsewhere provide evidence that such an undertaking can enhance one’s functional status and well- being as well as reduce physical symptoms and psychologi- cal distress.4,16,17 In the present study, prior to Vipassana training, the performance of those subjects who voluntarily elected to enrol in the -day course of Vipassana meditation had not differed from that of the control group. Specifically, on subjective functioning (apart from the issue pertaining to income and whether they were happy or not) the two groups did not differ. ese results support the observa- tion by Gillani18 and Smith19 that prospective meditators do not differ from the general population in their level of stress or distress. When tested immediately aer the -day training, their performance on several parameters changed, suggesting alleviation of physical symptoms and decreased psychological distress. In contrast, such fluc- tuations were not seen in the control subjects who were tested at the same interval. is finding is compatible with emerging evidence suggesting that meditative techniques can have a great effect on physical and psychological functioning.2,19,20 � ��������������������������������������������������������������� ���������� � � ���������� ����� ����� ������ �� ���������� �� �� �� ��� �������� �� ��� ��� ��� ������ ������ �� ��� ��� ��� ������ � � � � ������������������������������������������������������������� ������������������� � � � ������ ���������� �������� �� ���������� �� �� �� ������ �������� �� ��� �� ������� ���������� ��� �� �� ������ �������� �� ��� �� ������� � � � � ��������������������������������������������������� � � � ������ ������ � � ����� ���� ����� ���� �� ���������� ������ ����� � ����� ����� �������� �������� ����� ����� � ������ ����� ������ ���������� ����� ����� � ����� ����� ����������� �������� ������ ����� � ������ ����� ������ �� � � � ������������������������������� � � ������ ������ � ����� ���� ����� ���� �� ���������� ������ ������ ������ ������ �������� ������ ������ ������ ������ ������ � �   -             � ������������������������������ � � � �� �� �� �� �� �� �� ��������������� ������������� �� �� �� ��� ��� �� �� �� �� � ������ ������   e present study is, however, not conclusive and had several possible limitations. e scope of generalizing its findings could be limited due to various factors. First, the sample size was small. Second, the Vipassana subjects were a self-selective group of different ages and it was not clear how many participants had previous experience with med- itation. ird, being naturalistic, the study relied entirely on subjective reports. To overcome these limitations, it would be necessary to replicate the study in different and larger populations and to use stronger experimental methodology with random allocation between conditions. Future studies could also employ objective physiological measures to confirm the subjects’ perceived improve- ment. In the emerging functional in-vivo neuro-imagining techniques, misreporting by subjects can be independently verified.21,22 Fourth, it was not clear how long the observed improvement would persist, since the post assessment was conducted right at the end of the retreat. On the other hand, some studies have reported that one-year follow-up revealed maintenance of initial improvements on several outcome parameters.2 Data collection by questionnaire is also not without problems.23 Although some structured questionnaires are easy to apply, studies have found that different cultures attach different meanings to life and thus conceive reality differently.24Although all the items of the screening instrument have been validated in cross-cul- tural settings,,25–26 its usefulness could still be hampered by subtle linguistic and conceptual misunderstandings. erefore, specificity and sensitivity of these assessment tools need to be examined. A factor that could have enhanced the positive sub- jective states of the Vipassana participants is the retreat environment itself rather than the exercise per se: the subjects were residing in a tension-free, cloistered envi- ronment for  days. ey were completely sheltered from outside happenings, since TV, newspapers, telephones and visitors were forbidden. e simple food served could also have had a positive effect. Breakfast was served at : am, lunch at : am, and tea and fruit at  pm, aer which no food was served. e meditators went to sleep at : pm to awake the next day at : am. No physical exertion apart from walking in a confined area was permitted. Ten days of such an uncomplicated routine could have contrib- uted positively to the mood and behaviour of the novice. Again, since the meditators spent ten valuable days on this process, they might have liked to think that their efforts were successful.18 is might have caused them to rate themselves higher in the second assessment. Similarly, the researcher’s expectations could have influenced the results. However, the authors are of the view that these limitations do not obscure the fact that Vipassana meditation, with its simple technique and tightly controlled variables, offers a fertile field for future studies, which should comprise pre- cise invasive and non-invasive methods. e evidence from this study, however partial, com- bined with those from other studies around the world, sug- gests that Vipassana meditation may have the potential to enhance the health-related quality of life and physical and psychological symptomatology, irrespective of ethnic or cultural backgrounds. In Oman, the population has been growing since the late s at an annual rate of .,27 one of the fastest in the world, which would increase competition for social and occupational roles, and leave many failed individuals behind.28 Such a demographic trend would place more and more individuals at risk for developing various adjustment problems.29 e trend so far has been to embrace ‘hi-tech’ therapeutic methods including psychotropic medications which are expensive and oen have side effects.30-32 With the rising cost of running health care systems33 and in an age where many physical and psychological disorders arise because of what people do to themselves rather than solely from external sources,34 a non-sectarian technique such as Vipassana may help in prevention and therapy. e next challenge to the healthcare planners in developing countries like Oman would be how to respond to the rising tide of the ‘diseases of affluence.’ 23,35 Serious contemplation of these considera- tions should make clear the need to develop and allocate low-cost therapeutic interventions such as meditation that have potential to alleviate suffering and improve people’s functionality. C O N C L U S I O N e results from this pilot study on participants of Vipassana meditation in Muscat, Oman, when juxtaposed with the results of studies in other parts of the world, sug- gest that this meditation technique may help mitigate psychological and psychosomatic distress. e study also implies that Vipassana meditation, with its simple method and controllable variables, offers a fertile field for future research, which should comprise invasive and non-inva- sive methods. R E F E R E N C E S . Kahn M. Vipassana meditation and the psychobiology of Reich, Wilhelm. J Humanist Psychol , , –. . Chandiramani K, Verma SK, Dhar PL. Psychological Effects of Vipassana on Tihar Jail Inmates. Maharashtra, Vipassana Research Institute, . . Fleischman PR. e Experience of Impermanence. Maharashtra: Vipassana Research Institute, .                   . Srinivasan S. Understanding the process of Vipassana medita- tion. 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